M1-INTRO

PATHOLOGY CATEGORIES

Description, Etiology, Radiographic Appearance, Treatment, Complications

CONGENITAL/HERIDITARY DESCRIPTION

Conditions present at birth resulting from genetic or environmental factors

INFLAMMATORY DESCRIPTION

Results from the body’s response to a nonspecific agent that causes an injury

DEGENERATIVE DESCRIPTION

Deterioration of the body resulting from age or a previous injury or disease process

METABOLIC DESCRIPTION

Results from physical and chemical processes in the body

TRAUMATIC DESCRIPTION

Results from a mechanical force to the body or external forces on the body such as ionizing radiation, and extreme hot and cold

NEOPLASTIC DESCRIPTION

New and abnormal tissue growth

ETIOLOGY

Cause of pathology

SIGN-ETIOLOGY

an objective description of the effects of the pathology that can be visualized or measured by a physician.

SYMPTOM-ETIOLOGY

can be referred to a patient’s perception of the disease and is truly subjective as only the patient can describe what they are feeling.

RADIOGRAPHIC APPEARANCE

A demonstration of the pathology on diagnostic images such as x-ray, ultrasound, CT scan or MRI

TREATMENT

Cures and options to reduce symptoms and improve healing.

COMPLICATIONS

Immediate or chronic symptoms which result from poor healing of a fracture.

WOUND

Defined as any injury that causes a break in the skin or other body membranes. This injury can be internal or external.

ABRASION

Involve tearing away of the epidermal cells by friction (ROAD RASH)

LACERATION

Is one type of torn tissue, resulting in jagged edges around the site of injury

INCISION

Tissue is torn with a sharp cutting instrument such as a knife or scissors. The edges of the wound are straight and smooth.

CONTUSION

Result of damage to the walls of the blood vessels which causes rupture and interstitial bleeding. Swelling results from blood accumulation

PENETRATION (PUNCTURE)

An object such as a knife, bullet or nail, penetrates some distance into the tissues leaving a small surface opening.

FRACTURE

Break or crack in the bone

TISSUE HEALING

Occurs when dead and damaged tissue is replaced with new, healthy cells. Cells that continually replace themselves have an increased chance of repair

REGENERATION

Also known as first intention healing, as an exact copy of the former cell is made. This type of healing occurs at sites with simple cell function such as the skin, mucous membranes, bone marrow and interstitial lining (success is dependent on degree of damage to the tissue, complex structures dont regen but heal with scar

FIBEROUS CONNECTIVE TISSUE REPAIR

Also referred to as second intention healing, Tissue repair of this nature can occur in any cell/tissue. It results in a collagen deposit that fills in the gap between normal tissue edges. This is otherwise known as the development of scar tissue

STAGE 1-FCTR

A small cut involving the epidermis and dermis occurs affecting the connective tissue.

STAGE 2-FCTR

Exudate fills the gap. Capillaries and fibroblasts appear.

STAGE 3-FCTR

The epidermis regenerates and gaps fill with granulation tissue

STAGE 4-FCTR

The epidermis returns to normal and fibroblasts produce collagen to form a permanent scar

EXTENT OF INJURY-CAH

If the injury is severe, there will be a decreased overall healing rate and quality of healing. This factor can greatly affect the rate of healing. The more severe the injury, the slower the rate of healing will be

AGE-CAH

Cell regeneration, metabolism, and circulation all affect the healing process. Children heal more quickly than adults and experience a better quality of healing due to increased cell regeneration, metabolism and circulation while the elderly experience a decreased rate of healing due to decreased cell regeneration, metabolism, and circulation

NUTRITION-CAH

Malnutrition at any age will result in decreased ability to heal. For example, decreased levels of vitamin C results in poor cell health. Healing is also affected by conditions that change your metabolism such as diabetes, alcoholism and the abuse of corticosteroids.

BLOOD SUPPLY-CAH

Increased ischemia will lead to decreased healing. For example, individuals with diabetes may develop gangrene

DRAINAGE-CAH

Normal drainage of the injury site includes a decreased collection of exudates (pus), decreased swelling and increased healing rate

IMMOBILIZATION-CAH

Proper immobilization of the affected part promotes healing by preventing disturbance of the healing process. If undisturbed, the wound edges are allowed to heal and close the site

DISLOCATION

A dislocation is described according to the position of the distal fragment relative to the main or proximal bone.

FULL DISLOCATION

A dislocation can have a complete loss of articular contact. It is also described in relation to the bony structure surrounding it by describing the apposition or distance between the structures

PARTIAL DISLOCATION

A partial dislocation can be referred to as a subluxation, which is a widening of the joint space with good apposition. Joint subluxation is common in the spine, AC joints, and ankles.

ASSOCIATED FRACTURES

Sometimes there is a fracture associated with a dislocation. These pathologies are collectively called fracture dislocations.I

IDENTIFYING FRACTURES

Locate fracture, identify type of fracture, describe fracture according to spatial relationships, determine whether there’s soft tissue involvement, determine stability of fracture

DETERMINE TYPE OF FRACTURE

Is skin penetrated, how many fragments is the fracture comprised of, is fracture line complete or incomplete

SPATIAL RELATIONSHIP-ALIGNMENT

Refers to the specific direction of the distal bone fragment (or dislocated bone) relative to the proximal portion of the bone.

The direction of the distal bone or bone fragment is always discussed in reference to its normal anatomic position.

APPOSITION

Refers to the distance between the fragments

GOOD APPOSITION

Means there is almost complete contact between the fragments.

PARTIAL APPOSITION

Refers to a gap being present between the fragments

DISTRACTION APPOSITION

Is used to describe fragments which have a considerable amount of space between them.

STAGES OF FRACTURE HEALING

Hematoma formation, inflammatory process, callus formation, consolidation and remodeling

HEMATOMA FORMATION-SFH STAGE 1

When a fracture occurs, there is a rupture of the periosteum and endosteum, causing bleeding into the marrow and soft tissue

INFLAMMATORY PROCESS-SFH STAGE 2

This stage starts within 48 hours of injury. This process can also be referred to as the granulation process. During this stage, the fibroblasts and capillaries increase in the area and begin to repair the cellular damage

CALLUS FORMATION-SFH STAGE 3

This usually occurs 5 - 10 days post-trauma. There is periosteal repair by the formation of a bony (callus) collar around the fracture.

CONSOLIDATION-SFH STAGE 4

This is usually seen 4 weeks post-trauma. During the consolidation stage, the osteoblasts change the primary callus (bony collar) into mature bone. The periosteum and endosteum are also strengthened

REMODELING-SFH STAGE 5

Usually occurs 8 to 12 weeks post-trauma. In the remodeling stage, the secondary bone formation is almost normal. The periosteum and endosteum appear more normal. There is a residual scar in the tissue

ARTERIAL INJURIES-IMMEDIATE COMPLICATIONS

Arterial injuries can be life-threatening and may accompany a fracture, as the displaced bone fragments can affect arterial flow

COMPARTMENT SYNDROME-IMMEDIATE COMPLICATIONS

In the case of a fracture, there is uncontrolled edema and hemorrhage.  As the tissues release fluid/blood into the compartment, the pressure within the compartment increases and the blood vessels are compressed

GANGRENE-IMMEDIATE COMPLICATIONS

Gangrene results in the loss of blood supply due to an infection process by Clostridium bacteria.  This is seen within one to three days post injury or surgery

FAT EMBOLISMS-IMMEDIATE COMPLICATIONS

In the event of a major bone fracture, fatty particles escape from the bone marrow into the injured venous system and find their way into the pulmonary system.  Sudden chest pain and respiratory distress occurring 24 to 72 hours post-trauma and/or surgery

THROMBOEMBOLISM-IMMEDIATE COMPLICATIONS

A blood clot which can impede blood flow. The inactivity imposed by the lengthy immobilization and bed rest required post injury or surgery can cause blood clots to grow.

OSTEOMYELITIS-INTERMEDIATE COMPLICATIONS

Infection of the bone caused by the Staphylococcus aureus (staph) organism

HARDWARE FAILURE-INTERMEDIATE COMPLICATIONS

Occurs in patients who are not following their immobilization regime and start mobilizing too soon

COMPLEX REGIONAL PAIN SYNDROME (CRPS)-INTERMEDIATE COMPLICATIONS

Abnormal localized pain at the site of trauma which is disproportionate to the injury.

POST TRAUMATIC OSTEOLYSIS-INTERMEDIATE COMPLICATIONS

Bone begins to break down at the trauma site causing impaired bone healing usually due to an inflammatory response to polyethylene debris from hardware component insertion.

REFRACTURE-INTERMEDIATE COMPLICATIONS

Indicates that there is disruption of the healing fracture site. The possible causes are inadequate immobilization, non-compliant patient, underlying tumor or infection, weakened bone e.g. osteoporosis

SYNOSTOSIS-INTERMEDIATE COMPLICATIONS

Indicates that there is an abnormal fusion between adjacent bones after a trauma. This is due to the proximity of the bones

DELAYED UNION-INTERMEDIATE COMPLICATIONS

Refers to a fracture site that fails to reunite within the normal time span.

INFECTION PROCESS-INTERMEDIATE COMPLICATIONS

Infection causes continuous tissue destruction, which delays or prevents healing

OSTEONECROSIS-DELAYED COMPLICATIONS

An interrupted or lack of blood supply to a tissue site, causes avascular necrosis or death of the bone occurs. 

DEGENERATIVE JOINT DISEASE-DELAYED COMPLICATIONS

An intra-articular fracture results in articular cartilage damage which contributes to premature wear and tear of cartilage surface causing degeneration of the joint.

OSTEOPOROSIS-DELAYED COMPLICATIONS

Inactivity post-trauma can contribute to a weakened bone matrix because of the loss of bone mass.

NON-UNION-DELAYED COMPLICATIONS

Sometimes the bone repair stops and there is a failure of the fracture to heal.  There is an absence of callus bone production which is seen by smooth fragment edges as bone edges are starting to atrophy. 

MAL-UNION-DELAYED COMPLICATIONS

When a fracture heals and there is rotational or angulation deformities of the bone.

REDUCTION-FRACTURE TREATMENTS

Manual reduction: manually applies traction to reposition the fragments so they realign

Mechanical reduction: sometimes gravity with or without weights is used to reduce a fracture or dislocation

Closed Joint reduction: fracture is reduced or manipulated externally with the skin still intact

FIXATION-FRACTURE TREATMENT

Surgical devices which are used to hold fracture fragments in place to prevent further displacement and disruption of healing

CLOSED REDUCTION WITH EXT FIXATION-FRACTURE TREATMENTS

Provide instant fixation of the fracture fragments. Pins are inserted into the bone through the skin and then attached to an external bar

SURGICAL INTERVENTION-FRACTURE TREATMENTS

Performed in extreme traumas where there is an extensive injury