Lecture 3 Flashcards
What is soft tissue healing?
- Local reaction to tissue injury (the body defence & repair mechanism)
- ITIS = inflammation
What is the repair mechanism of soft tissue healing?
- After trauma when soft tissue swells, it bleeds
- In the blood, there are cells which will develop into replacement of the damaged tissue
What are 3 factors that cause inflammation?
- physical trauma
- chemicals
- bacterial or viral influences
What are 5 types of physical trauma that cause inflammation?
- foreign body (i.e., splinter or dirt)
- blunt trauma to the tissue
- overuse (i.e., tendinitis)
- burns (chemical or electrical)
- sunburns/frostbite
What are 3 types of bacterial or viral influences that can cause inflammation?
- stapylococci
- streptococci
- meningococcal
What is stapylococci?
- types of germs commonly found on the skin or in the nose
- Most of the time, these bacteria cause no problems or cause relatively minor skin infections
What is streptococci?
- type of bacteria that causes strep throat
What is meningococcal?
- a rare but serious bacterial infection that can cause meningitis and bloodstream infections
- can be found in the back of the nose & throat
What are 5 signs & symptoms of inflammation?
- Swelling
- Redness
- Rise in Temperature: can occur b/f redness
- Pain: Swelling causes stretching of tissue with increased firing of pain sensory nerves
- Loss of Movement
What is ischemia?
- means decreased blood flow
What are 3 types of inflammation?
- acute
- sub acute
- chronic
What is acute inflammation?
- Comes on quickly within first 48-72 hours
- Usually short duration, swelling from bleeding resolves in 7-10 days
What is sub acute inflammation?
- Characterized by fibrous tissue formation over 6-10 days post injury
- Early treatment intervention is critical in order to decrease/prevent chronicity
What is chronic inflammation?
- Occurs as a result of repeated micro traumas over weeks/months
- Can last for months
What are 3 goals of the inflammation process?
- Isolate, destroy or inactivate the tissue irritants or destroyers
- Remove dead cells or destructive by-products
- Prepare the area for subsequent healing & tissue restoration
What are 3 processes of soft tissue healing?
- vascular events
- cellular events
- chemical events
What are vascular events in soft tissue healing?
- the initial changes that occur in blood vessels at the site of an injury
- i.e., increased blood flow, increased fluid leakage from vessels, & the formation of new blood vessels
- minor trauma it can last 15-30 mins
- major trauma delay response may occur
What is margination?
- Leukocytes (white blood cells) in the blood vessels adhere to the endothelial wall of the venules
- increased permeability of the vessel wall where leukocytes now move out of the vessel & chemo taxis move to the injury site
What are cellular events in the soft tissue healing process?
- platelets form a clot to stop bleeding (hemostasis), followed by an inflammatory response with neutrophils & macrophages cleaning debris
- fibroblasts migrate in to lay down new collagen, then remodeling of the collagen to strengthen the tissue
What are 3 major leukocytes (white blood cells)?
- Basophils - anticoagulants
- Monocytes - ingest large cells, Begin working about 5 hours after injury
- Neutrophils - Ingest small bacteria, dead cells, or debris & attract more leukocytes to the area
What is histamine?
- given off by blood platelets, basophils, mast cells
- Function: Vasodilation (increase in blood flow, reducing blood pressure) of arteries, venule & capillary permeability (generally decreases)
What is serotonin?
- found in platelets & mast cells
- Function: vasoconstrictor (the narrowing of blood vessels by small muscles in their walls)
What is bradykinin?
- plasma protease
- Function: increases cell permeability, also increase pain due to chemical irritation of sensory nerves
What is heparin?
- found in mast cells & basophils
- Function: temporarily helps to prevent coagulation
What is prostaglandins?
- a group of hormone-like substances that regulate many bodily processes
- Function: Can raise or lower tissue permeability depending on conditions at injury site
What is leukotrienes?
- fatty chemicals that are part of the immune system’s response to inflammation and allergic reactions
- Function: alter capillary permeability (generally increases)
- Also a major pain producer
What are the 4 stages of soft tissue healing?
- Haemostasis
- hyperaemia
- granulation (repair)
- cicatrization (remodelling)
What is Haemostasis?
- Termination of blood flow through mechanical or chemical means or coagulation
- this is the first stage towards healing
- This process must occur in a selective fashion such that blood flow continues throughout the body but stops at the injury site
What are the 3 processes of Haemostasis?
- blood vessel spasm
- platelet plug through aggregation
- blood coagulation
What is the blood vessel spams process of Haemostasis?
- Once injury happens, blood vessels constrict & platelet plug forms
What is the platelet plug process of Haemostasis?
- Platelets will stick to the endothelial wall (exposed collagen)
- Platelets secretes ADP to increase stickiness of platelet wall
- Positive feedback loop creating increased aggregation
- Platelets release epinephrine, serotonin & prostaglandins which further constricts the blood vessel
What is the blood coagulation process of Haemostasis?
- the process by which blood changes from a liquid to a semi-solid clot
- has a intrinsic & extrinsic mechanism
What is the intrinsic method of the blood coagulation stage of soft tissue healing?
- Is part of the process of forming the platelet plug
- As the platelets stick together they release four platelet clotting factors
- This helps to seal the vessels & reduce overall tissue damage
What is the extrinsic method of the blood coagulation stage of soft tissue healing?
- Damaged tissue activates the vessel spasm & platelet plug formation & the damaged tissue releases a lipoprotein called thromboplastin
- This allows for clotting to occur outside the vessels as well as into the surrounding tissue
What’s is thromboplastin?
- a lipoprotein formed from tissues or platelet disintegration
- function: catalyses thrombin formation
What is hyperaemia?
- increased blood flow to the injured area
- it delivers necessary cells and nutrients to facilitate repair & regeneration of the tissue
What is granulation in soft tissue healing?
- involves a 3 step process:
- Resolution: very little tissue damage normal restoration
- Granulation: large vascular mass full of immature connective & endothelial cells, A dense fibrous scar may form
- Regeneration: Involves substantial tissue loss, increased infiltration of fibroblastic cells to form collagen
What is cicatrization?
- the process of a wound healing & forming scar tissue, synthesis & lysis of tissue
- Early - seen as pink to red scar, Late - capillaries get cut off, scar becomes white
- can take from 3 weeks to 1 year to complete
What are some factors that interfere with soft tissue healing ?
- severity of injury, lack of O2, decreased blood flow, infection, poor nutrition, medical conditions, poor protection
What are 4 ways you can manage inflammation?
- Cryotherapy & Thermotherapy: Use of ice within 24-48 hours & apply heat after that
- Drugs: NSAIDS & Corticosteroids
- Electrical & Acoustical Modalities
- Exercise & Rehabilitation
What are the 5 stages of fracture healing?
- stage of haematoma
- stage of granulation
- stage of callus
- stage of consolidation
- stage of remodelling
What is the hematoma stage of fracture healing?
- a collection of blood that pools outside of a blood vessel caused by an injury
- Begins immediately upon fracture, occurs over 6-8 hours & lasts 1-2 weeks
- Blood from damage escapes into the fracture site where coagulation occurs, forming a hematoma
Why does necrosis occur during the hematoma stage of fracture healing?
- the tissue adjacent to the fracture site dies because of ischemia (lack of blood) & the inflammatory response
What is the granulation stage of fracture healing?
- Begins approximately 48 hours post-fracture & lasts about 2 weeks
- Osteoblasts migrate into the haematoma where they lay down a collagen matrix
- The collagen tissue meets & blends with the fractured bone fragments
What is the stage of callus in fracture healing?
- Calcium is deposited within the collagen matrix allowing long bone to form but is very immature
- can take up to 8-12 weeks
- Dangerous stage - bone is not healed & partial weight bearing continues
What is the consolodation stage of fracture healing?
- the bone is maturing (i.e., more & more calcium) is deposited into the collagen matrix
- Takes 4-5 months from time of fracture
What is the remodelling stage of fracture healing?
- the bone is constantly being remodelled to the demands placed upon it
- the bone becomes strengthened along lines of stress (weight bearing). WOLFE’S LAW
- Osteoblasts & osteoclasts play a role in remodelling
- The medullary canal is re-established in this stage. The end result is a healed fracture within the bone
What are 5 factors that influence fracture healing?
- age
- type of fracture
- blood supply
- patient health
- bone disease or infection
What are 7 complications in fracture healing?
- non union
- delayed union
- mal union
- associated injury
- fat embolism
- secondary joint dysfunction
- premature osteoarthritis
What is a non union complication in fracture healing?
- condition where a broken bone fails to heal permanently
- they will not come back together
What is a delayed union complication in fracture healing?
- a fracture that takes longer than expected to heal, but is expected to heal without surgery
What is a mal union complication in fracture healing?
- two ends of the broken bone are not lined up properly & heal with a deformity
- occurs when a large space between the displaced ends of the bone have been filled in by new bone
What is a fat embolism complication in fracture healing?
- a condition where particles of fat get into your bloodstream & block blood flow
- quite rare & unserious, however, if severe can be lethal
What is the secondary joint dysfunction complication in fracture healing?
- can occur when an injury or other condition damages a joint, causing it to become less mobile
- This can lead to pain, stiffness, and limited range of motion
What is premature osteoarthritis complication in fracture healing?
- caused by wear & tear on joints, injuries, or genetics
- Symptoms include pain, stiffness, swelling, & a reduced range of motion in the joint
What is casting?
- a rigid material (plaster, fibreglass) around the affected area to immobilize an injured limb, typically a broken bone
- it provides support & protection to promote proper healing & reduce pain while the bone sets back into place
What are rigid splints?
- to immobilize & support injured body parts, such as bones, joints, ligaments, or tendons
- usually made of wood, plastic, or metal
What are internal fixations ?
- a surgical procedure that uses metal implants to stabilize & reconnect broken bones (i.e., plates, nails, screws, wires)
- The implants prevent the bones from healing abnormally
What are bone grafts?
- a surgical procedure that replaces damaged bone with new bone or bone substitutes
