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2) Patho 2 > 1) ST & Bone Healing > Flashcards

1) ST & Bone Healing Flashcards

(63 cards)

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1
Q

What are the 5 phases of healing?

A

1) Injury
2) Hemostasis & Degeneration
3) Inflammation
4) Proliferation & Migration
5) Remodeling & Maturation

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2
Q

What happens during the hemostasis & degeneration phases of healing?

A

HEMOSTASIS: Blood vessels seal
Clots form to build fibrin lattice–>These platelets release GF’s to call inflammatory cells to the tissue

DEGENERATION: Hematoma, Necrosis, Inflammatory response

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3
Q

In the hemostatic phase of healing, what do platelets do (besides form the fibrin lattice)?

A

Release GF’s

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4
Q

What is the purpose of the fibrin lattice?

A

Source of tensile strength to the healing wound

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5
Q

What type of responses occur during the inflammation phase of healing?

A

Cellular, Vascular, Humoral, Neurological

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6
Q

What occurs with the vascular response of the inflammation phase?

A

Vasodilation (mediated by histamine, bradykinin, hageman factor, & prostoglandins)

Incr hemoconcentration to incr blood viscosity to slow blood flow from damaged vessels

Edema

Accumulation & adherence of WBC’s to damaged vessels

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7
Q

What occurs with the humoral response of the inflammation phase?

A

Activation of the complement system which stims leukocytes
Incr vascular permeability
Phagocytosis

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8
Q

What occurs with the neurologic response of the inflammation phase?

A

Glucocorticoids are released to regulate WBC fxn

SNS stims hypothalamus to regulate vascular response

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9
Q

What occurs with the cellular response of the inflammation phase?

A

Pathogen is killed & removed
T-cells activate inflammatory mediators
B-cells make antibodies
Macrophages eat

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10
Q

What occurs during the proliferation phase of healing?

A

Neovascularization
Epithelialization
Collagenization

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11
Q

What is the purpose of epithelialization?

A

Provides a barrier to the wound to prevent fluid & electrolyte loss & decr infection risk

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12
Q

What occurs during neovascularization in proliferation?

A

Macrophages stim the release of GF’s
Angiogenesis
Fibroblasts move into unhealthy tissue & proliferate

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13
Q

What is the timeline of collagen during healing?

A

Type 3 collagen is layed down initially

Day 7: There’s a significant amount of collagen, which incr the tensile strength of the wound

Day 12: Type 1 collagen replaces type 3

Day 21: Max collagen production; Strength is 20% of normal

6th wk: Strength is 80% of normal

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14
Q

What occurs during the maturation phase of healing?

A

Collagen Synthesis
Collagen Fiber Orientation
Injury is healed

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15
Q

What day of healing does the maturation phase start on?

A

Day 9

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16
Q

What is the longest phase of healing?

A

Maturation phase

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17
Q

How long does collagen synthesis last for?

A

1-2yrs

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18
Q

What will happen if the basement membrane of the lung is not intact?

A

Fibrosis so decr gas exchange & restrictive lung disease

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19
Q

What direction do gut cells reproduce?

A

Proximal to distal

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20
Q

True or false: Neurons & axons in the CNS & PNS regenerate similarly?

A

True

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21
Q

What occurs as a result of damage to neurons & axons?

A

Glial cells are stimulated to form a fibrous glial scar

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22
Q

In the PNS, where does wallerian degeneration occur in relation to the injury?

A

Distally

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23
Q

Is glial scarring in the PNS an issue?

A

No

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24
Q

Which CN’s have limited to capacity for regeneration?

A

1,2,6, & 9-12

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25
Which CN's can make a slow, full recovery?
2-5, 7
26
Which CN rarely regenerates?
8
27
If the endomysium of a muscle is not intact or the muscle has chronic inflammation, what will happen?
Necrosis/Fibrosis
28
What is the purpose of remobilization for muscle strains?
Incr fiber regeneration Improved fiber orientation Decr scarring
29
After a tendon injury, how long does the maturation phase take?
2-16wks
30
After a tendon injury, how long does it take for full tensile strength to be regained?
Up to 50wks
31
What is the rehab protocol for a sutured tendon?
Rest for inital 3-5days Gentle PROM on days 4-28 GE AAROM 4th-8th wks After 8th wk, gradually incr forces
32
What other part of the body do grade 1 sprains heal similarly to?
Tendons
33
What limits the healing of grade 2 & 3 sprains & why?
Synovium tears bc it limits hematoma formation & GF localization
34
How much weaker is a well-healed ligament?
30-50%
35
What enzyme limits ACL healing?
Matrix metalloproteinase
36
What is NSAID-use associated w/following injury?
Ligament failure
37
How is microfx surgery done & what are the effects
Cleans out calcifications & creates tiny fx's in the subchondral bone Blood & bone marrow seep out, which creates a clot that releases cartilage-building cells
38
How does healing of the meniscus occur?
Via chondrocyte migration
39
What part of the intervertebral disc has minimal healing capacity & why?
Sections that are not in direct contact w/vertebral body bc its basically avascular
40
How does synovium heal?
Hemmorhage, hypertrophy, & hyperplasia
41
What are the ways fx's can be classified?
Trauma/Stress Pathological Displaced/Non-displaced Open/Closed
42
Types of Fx's
``` Transverse Oblique Spiral Comminuted Segmental Avulsed Impacted Torus Greenstick ```
43
Transverse Fx
Fx is at a right angle (perpendicular) to the long axis of the bone Caused by shear forces
44
Oblique & Spiral Fx's
Fx is at an angle Result of extreme twisting forces
45
Comminuted Fx
Bone breaks into multiple fragments
46
Segmental Fx
2 fx lines
47
Avulsed Fx
Small piece of bone gets broken off due to an extreme force from tendon/ligament
48
Impacted Fx
Bone fragments get driven into each other
49
Torus Fx
Bone buckles into itself from axial loading
50
Greenstick Fx
Bone gets bent
51
3 Stages of Fx Healing
1) Inflammation 2) Repair 3) Remodeling
52
What happens during the inflammation phase of bone healing?
Bleeding-->Delivers fibroblasts, platelets, osteoprogenitor cells, cytokines & GF's Clotting eventually occurs-->Forms fibrous matrix
53
What happens during the reparative phase of bone healing?
Soft callus formation that eventually turns into a hard callus * Osteoclasts clear necrotic bone * Osteoblasts produce hyaline cartilage * Primary bony spicules are formed
54
What GF's are involved w/the reparative phase of bone healing?
``` Fibroblast GF Insulin-like GF Platelet-derived GF Transforming GF-8 Vascular Endothelial GF ```
55
How long does the reparative phase of bone healing last?
Wks 2-6/12
56
What happens during the remodeling phase of bone healing?
* Immature bone becomes hard lamellar bone * Hard callus gets absorbed by osteoclasts * Osteocytes remodel in response to WB
57
How long does the remodeling phase of bone healing last?
Until bone is normal strength, so months-years
58
Purpose of bone stimulators
Stim Ca2+ uptake & gene expression to incr mineralization
59
Some complications of fx's
Malunion Delayed Union Nonunion
60
Malunion
Bone doesn't align properly
61
Delayed Union
Fx takes extra long to heal
62
Nonunion
Bone doesn't heal
63
Some risks of fx's
``` ST Injury Infection-->Esp w/open fx Skin Ulceration Growth Disturbances from effected growth plates Post-traumatic arthritis Adhesions Arthrodesis Myositis Ossificans Osteomyelitis Re-fx Neuro complications Vascular compromise ```

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