Pathoph Tiss Healing
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| What are the phases of tissue healing? | show 🗑
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| show | Reactive Reparative Remodelling
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| show | Impaction Induction Inflammatory
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| Name the subphases of reparative phase of bone healing | show 🗑
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| What happens during impaction? | show 🗑
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| 2 phases of reactive phase | show 🗑
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| show | Osteoblastic/osteoclastic activity is stimulated at site of blood supply disruption Hemotoma develops
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| show | Resorption of necrotic bone Creation of early fibrous or cartilaginous callus Loss of fracture line visualization Fracture site gapping Peak at 4-6 weeks
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| show | (unknown time frame or when it starts) activated by oxygen gradients, forces, bone morphogenic, proteins or noncollagenous proteins
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| show | 1. increase vascularity (form hemtoma) scaffold for bone 2. invaded by neutrophils, macrophages and phogocytes 3. elim necrotic tissue 4. fracture line more visible
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| describe reparative phase | show 🗑
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| show | Initially the soft callus is composed mainly of fibrous tissue and cartilage with a very small amount of bone
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| show | 5012 weeks osteoblasts destroy soft callus, make hard one of woven bone, increase stability Immature and wk Bridging of the fx complete when stable clinical and radiological healing
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| show | 4 weeks to months Osteoblastic and osteoclastic activity Immature bone replaced by mature bone Stability increases
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| wolf's law | show 🗑
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| show | Occurs with direct or intimate contact between the fracture fragments Bone grows across compressed bone ends slow proc. Fixation devices: compression screws and plates
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| Secondary bone healing | show 🗑
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| Factors that affect healing | show 🗑
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| How to assess fx for healing? | show 🗑
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| radiographic evidenced of fx healing assessment | show 🗑
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| time lines for bone healing | show 🗑
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| show | Keep in mind that the process from fracture to full bone resorption takes weeks to months
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| factors that influence bone healing | show 🗑
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| How does location of tear affect healing? | show 🗑
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| show | Depends on the makeup of the tendon: proportion of collagen to elastin; Degree of tear & amount of loading applied(small/partial verse total)
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| What is the healing time for tendons? | show 🗑
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| What must you consider for rehab in relation to the tensile strength of the repaired tendon? | show 🗑
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| show | Vascularity is poor Heal by scarring location: fingers 3 weeks, knee 3 mos, ankle moths to >1yr Degree of tear
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| show | poor vascularity, other factors immobilization, degree of tear 3-5 weeks
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| show | when sudden, heavy compressive force (direct blow to muscle)
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| show | excessive tensile force leads to overstraining of the myofibers; more likely to occur during eccentric contractions (higher tensile stress) and on muscles that cross 2 joints
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| show | 90% contusions and straings
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| show | Myotendinous junction: end of muscle fiber and tendon
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| Where does skeletal muscle usually occur? | show 🗑
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| show | repair with scar regeneration requires intact basement membrane
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| What could affect the basement membrane? | show 🗑
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| show | Limited healing ability: no lymph, no blood, no nerves Articular cartilage only versus with subchondral bone involvement
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| show | don’t form clot, no recruitment macrophages or neutrophils
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| What happens if bone is involved wth articular cartilage injury? | show 🗑
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| show | less likely to heal
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| Zone 1 of articular cartilage | show 🗑
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| ZOne II and III of articular cartilage | show 🗑
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| show | Calcified cartilage layer
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| show | Lavage and debridement 40-66% good results after 3 years Marrow Stimulation 50-60% satisfactory improvement 3-5 years Autologous Perichondral Grafts Good: 1-2 year f/u Poor to fair > 8 years
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| show | Osteochondral Autographs Good 2 year f/u Autologous Chondrocytes Implantation Good to excellent results at 39 months (Brittenberg et al) Good to excellent results at 4 years (Petersen et al) Cartilage similar to surrounding cartilage
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| Factors influencing healing | show 🗑
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| show | Vasc sply: nutrition, O2, inflammatory response requires this. w/o it increased risk of infection infection,increase lysis n decrease collagen production n get excessive granulation tiss
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| show | Physical agents: thermal, electromagnetic, mechanical forces, cryotherapy, thermotherapy, US, radiation, light, electrical currents mechanical pressure
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| how does movement affect healing? | show 🗑
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| show | Age: sun exposure, decrease density and cross-linking ability of collagen (reduced tensile strength), decreased mast cells and fibroblasts, lower rate of epithelialization, poor organization of cutaneous vessels
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| show | DM: impaires collagen synthesis, increases risk infection, dampened immuned response, decreased phagocytosis, decreased blood flow (PVD), increased risk for injury due to neuropathy
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| show | Immunosuppressed/immunocompromised: infection due to inadequate inflammatory response (person with transplant, HIV)
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| show | CV: decreased oxygen from poor supply diabetes- decreased phgocytosis, decreased collagen production, increase risk of neuropathy
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| show | block inflammatory cascade via inhibition of inflammatory molecules cytokines, enzymes, receptors, adhesion molecules) cortisone or hydrocortisone
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| corticosteroids | show 🗑
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| NSAIDs | show 🗑
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| show | Vit A retard epithelialization, rate of collagen synthesis, cross-linking Thiamine (B1) decreases collagen formation B5 decreases tensile strength, reduces fibroblasts Vit C impairs collagen synthesis, capillary rupture , risk of infection
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| ZInc Mg Copper | show 🗑
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| Intervetion considerations (stages of healing) | show 🗑
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