Lecture 5: Healing and repair 2 Flashcards
1
Q
Bone healing- inflammatory stage
A
- ~5 days
- Disruption to structure and bleeding = swelling and haematoma
- Bone fragment edges die
- Cytokines released – healing process initiated
- Osteoclasts remove dead bone
- Fibroblasts lay down granulation tissue to provide a scaffold between fragments
2
Q
Soft callus formation
A
- 4 days to 3 weeks
- Fibroblasts form cartilage and fibrocartilage- spongy material filling gap
- Weak to external stress from 2-6 weeks +
3
Q
Soft callus stability
A
- Enables angiogenesis
- Osteoblasts at periosteum lay down woven bone
- Woven bone is soft and disorganised bone acting as first contact between fragments
4
Q
Hard callus formation
A
- 2-6 weeks UL
- 6-12 weeks LL
- Release of calcium and phosphate into cartilage enables hard callus to form
- Bridge of hard callus= fracture union
- Formation facilitated by controlled load exercises
- Bone responds to repeated, controlled load by laying down more bone tissue
5
Q
Bone remodelling
A
- Osteoblasts/clasts continue to react to stresses/load
- Progressive weight bearing/load = increased bone strength
- Woven bone replaced with lamellar bone (highly organised and stronger)
- At least as strong as before
6
Q
Bone healing problems
A
- Compartment syndrome
- Neurovascular injury
- Infection
- Post-traumatic arthritis
- Growth abnormalities
- Delayed, mal- or non-union
7
Q
Nerve injury and repair- therapy
A
- Education- protection and care of area
- Joint range
- Neuroplasticity
- Results impacted by type of wound/nerve, injury location, systemic factors
8
Q
Muscle/tendon grading
A
- Minor fibre disruption, micro-tears
- Partial tears, larger fibre nos. involved
- Severe/full tear, rupture or avulsion- may require surgery
9
Q
Muscle regeneration
A
involves fusion of satellite cells to form new myotubes and muscle fibres
10
Q
Muscle scar tissue
A
- Collagenous scar provides scaffold
* Never more than 80% strength
11
Q
Muscle remodelling phase
A
- Maturation of regenerating myofibers
* Remodelling of scar tissue along lines of load
12
Q
Tendon healing
A
similar to other soft tissue although limited self-healing is present due to less metabolic activity
13
Q
Therapy muscle/tendon regen phase
A
- Gradually mobilise muscle
- Elongate scar tissue
- Progressively increase tissue strength
- Specific functional exercises
14
Q
Therapy in healing and repair
A
- Control swelling, pain and protect tissue
- Restore ROM, strength, endurance
- Restore vol contractions and reflex responses
- Restore complex functional movements and activities
15
Q
Inflammatory mediators
A
- Histamine- immune response, increased bleeding
- Bradykinin(s)- vasodilators
- Prostaglandins/prostanoids- strong vasodilators, fever
- NSAIDs- anti-inflam, analgesic, temp reduction
