DITHM EXAM - WEEK 9 - Injury types and management

Question 1

Over what time span does each phase of healing typically occur?

Answer 1

Inflammatory phase:
- 0 - 6 days
Repair phase:
- Days 4 - 24
Remodeling phase:
- days 21 - 2 years +

Question 2

What are some of the key cells in each phase of healing?

Answer 2

Phase 1: Inflammatory Phase
Key cells: Platelets, Neutrophils, Macrophages, Mast Cells

Phase 2: Repair Phase
Key cells: Fibroblasts and Endothelial cells

Question 3

Describe the elements of the LOVE principle and briefly describe each?

Answer 3

L for Load
Let pain guide your gradual return to normal activities. Your body will tell you when it’s safe to increase load.

O for optimism
Condition your brain for optimal recovery by being confident and positive.

V for Vascularisation
Choose pain-free cardiovascular activities to increase blood flow to repairing tissues.

E for Exercise
Restore mobility, strength and proprioception by adopting an active approach to recovery.

Question 4

What are the histological features of each grade of muscle strain (tear)?

Answer 4

Minor partial tear:
Tear with a maximum diameter less that a muscle fascicle.

Moderate partial tear:
Tear with a diameter greater then a muscle fascicle.

Full thickness tear:
Tear involving the complete muscle diameter injury involving the enthesis.

Question 5

Describe the types of fractures and briefly describe them?

Answer 5

1. Transverse Fracture
   Breaks that are in a straight line across the bone.
2. Spiral Fracture
   A fractre that spirals around the bone. Usually in the femur, tibia, or fibula in the legs.
3. Greenstick Fracture
   Bone bends and breaks but does not seperate into two seperate pieces.
4. Stress Fracture
   Stress fractures are also called hairline fractures. This type of fracture looks like a crack. Caused by repetitave stress.
5. Compression Fracture
   Occurs when a bone is crushed. The broken bone will be wider and flatter than it was before the injury.
6. Oblique Fracture:
   When the break is diagonal across the bone.
7. Impacted fracture:
   When the broken ends of teh bone are driven together.
8. Segmental fracture:
   The same bone is fractured in two different places, leaving floating segments.
9. Comminuted Fracture:
   A comminuted fracture is one in which the bone is broken into 3 or more pieces.
10. Avulsion fracture:
    When a fragment is pulled off the bone by a tendon or ligament.
11. Pathological Fracture:
    Fracture secondary to a pre-exisiting underlying disease.

Question 6

List factors that may contribute to delays in healing?

Answer 6

Local Factors:
Infection:
Bacteria or other pathogens can disrupt the healing process and prolong inflammation.

Poor Blood Supply:
Adequate blood flow is essential for delivering oxygen and nutrients to the healing tissues. Conditions like peripheral vascular disease or diabetes can impair blood flow.

Movement or Re-injury:
Excessive movement or re-injury at the healing site can disrupt tissue repair and delay healing.

Foreign Bodies:
Presence of foreign objects (e.g., splinters, debris) can interfere with healing and increase the risk of infection.

Poor Wound Care:
Inadequate wound care or improper dressing can impede healing and promote infection.

Stress and Psychological Factors:
High stress levels can affect the immune system and contribute to delayed healing.

Systemic Factors
Age:
Healing tends to be slower in older individuals due to decreased cell turnover and reduced immune function.

Nutrition:
Poor nutrition, especially deficiencies in protein, vitamin C, and zinc, can impair collagen synthesis and other vital healing processes.

Chronic Diseases:
Conditions such as diabetes, cardiovascular disease, and autoimmune diseases can negatively impact the immune system and blood flow, hindering healing.

Medications:
Certain medications, like corticosteroids and chemotherapy drugs, can suppress the immune system and delay healing.

Smoking:
Smoking constricts blood vessels and reduces oxygen delivery to tissues, impairing healing.

Question 7

What are some of the processes that occur in each phase of healing?

Answer 7

Phases 1: Inflammatory Phase
Hematoma Formation: Blood vessels rupture, leading to bleeding and the formation of a blood clot (hematoma) at the injury site. This hematoma acts as a scaffold for future repair.

Inflammation: Damaged cells release chemical signals, triggering an inflammatory response. This involves increased blood flow, swelling, redness, and pain, all aimed at protecting the injured area and initiating the healing process.

Cellular Activity: White blood cells (leukocytes) migrate to the area to remove damaged tissue and debris. Platelets release growth factors to stimulate the repair process.

Phases 2: Repair
Fibroblast Migration & Proliferation:
Fibroblasts, cells responsible for producing collagen, migrate to the injury site and start producing new collagen fibers.

Angiogenesis:
New blood vessels form to supply oxygen and nutrients to the healing tissue.

Granulation Tissue Formation:
The combination of new blood vessels, fibroblasts, and collagen forms granulation tissue, a temporary, reddish, and fragile tissue that fills the injury gap.

Scar Tissue Formation:
As collagen production continues, the granulation tissue is gradually replaced with scar tissue, which is stronger but less flexible than the original tissue.

Phases 3: Remodelling

Scar Maturation: The scar tissue continues to remodel and reorganize. Collagen fibers become more aligned and stronger.

Tissue Strengthening: With appropriate loading and exercise, the repaired tissue gains strength and function.