CLASSIFICATION+AND+MECHANISMS+OF+INJURIES

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CLASSIFICATION+AND+MECHANISMS+OF+INJURIES

  1. 1. CLASSIFICATION AND MECHANISMS OF INJURIES
  2. 2. OBJECTIVES <ul><li>MECHANISMS OF INJURY </li></ul><ul><li>TISSUE-BASED CLASSIFICATION </li></ul><ul><li>GENERAL PATHOLOGY OF THE REPAIR PROCESS </li></ul><ul><li>BASIC BIOMECHANICS OF TISSUE INJURY </li></ul>
  3. 3. OBJECTIVES <ul><li>LIGAMENTS AND TENDONS </li></ul><ul><li>BONE </li></ul><ul><li>FIBROCARTILAGE MENISCI OF THE KNEE </li></ul><ul><li>MUSCLE </li></ul>
  4. 4. MECHANISMS OF INJURY <ul><li>PRIMARY INJURY: </li></ul><ul><li>1) DIRECT OR EXTRINSIC INJURY </li></ul><ul><li>2) INDIRECT OR INTRINSIC INJURY </li></ul><ul><li>3) OVERUSE INJURY: </li></ul><ul><li>A) ACUTE REPETITIVE FRICTION </li></ul><ul><li>B) CHRONIC REPETITIVE MICROFATIGUE </li></ul>
  5. 5. MECHANISMS OF INJURY <ul><li>SECONDARY INJURY: </li></ul><ul><li>1) SHORT TERM – PRIMARY INJURY MISMANAGED </li></ul><ul><li>2) LONG TERM – DEGENERATIVE PROBLEMS ( ACL ) </li></ul>
  6. 6. TISSUE-BASED CLASSIFICATION <ul><li>SOFT TISSUE INJURIES: </li></ul><ul><li>1) SKIN AND DEEP FASCIA </li></ul><ul><li>2) MUSCLE-TENDON UNIT AND TENDOPERIOSTEAL ATTACHMENTS </li></ul><ul><li>3) MUSCLE COMPARTMENTS </li></ul><ul><li>4) JOINTS AND THEIR ASSOCIATED STRUCTURES </li></ul><ul><li>5) INTEVERTEBRAL DISC </li></ul>
  7. 7. TISSUE BASED CLASSIFICATION <ul><li>HARD TISSUE INJURIES: </li></ul><ul><li>1) BONE FRACTURES, OSTEOCHONDRAL FRACTURES AND AVULSIONS </li></ul><ul><li>2) PERIOSTITIS </li></ul><ul><li>3) STRESS FRACTURES </li></ul><ul><li>4) HYALINE ARTICULAR AND EPIPHYSEAL CARTILAGE INJURIES </li></ul>
  8. 8. TISSUE BASED CLASSIFICATIONS <ul><li>SPECIAL TISSUE OR ORGAN INJURIES: </li></ul><ul><li>1) BRAIN AND PERIPHERAL NERVES </li></ul><ul><li>2) EYE, NOSE, SINUSES, LARYNX, TEETH </li></ul><ul><li>3) THORACIC, ABDOMINAL AND PELVIC ORGANS </li></ul>
  9. 9. GENERAL PATHOLOGY OF THE REPAIR PROCESS <ul><li>THREE PHASES: ( ALVAREZ ET AL 1987 ) </li></ul><ul><li>1) THE ACUTE INFLAMMATORY RESPONSE ( APPROX.0-72H AFTER INJURY ) </li></ul><ul><li>2) THE MATRIX AND CELLULAR PROLIFERATION PHASE (72H-6/52 ) </li></ul><ul><li>3) REMODELING AND MATURATION OF HEALING ( 6/52 – 7/12 ) </li></ul>
  10. 10. BASIC BIOMECHANICS OF TISSUE INJURY <ul><li>MUSCLE-TENDON-BONE INJURY: </li></ul><ul><li>1) “ TWO-JOINT MUSCLES” – RECTUS FEMORIS AND HAMSTRINGS </li></ul><ul><li>2) ECCENTRIC AND LESS CONCENTRIC LOADING – JUMPERS KNEE </li></ul>
  11. 11. BASIC BIOMECHANICS OF TISSUE INJURY <ul><li>MUSCLE-TENDON JUNCTION: </li></ul><ul><li>- THE TERMINAL MUSCLE SARCOMERE INFOLDING </li></ul><ul><li>TENDON INJURY: </li></ul><ul><li>SPONTANEOUS TENDON RUPTURE: </li></ul>
  12. 12. LIGAMENTS AND TENDONS <ul><li>1) STRUCTURE AND BIOMECHANICS OF LIGAMENTS AND TENDONS </li></ul><ul><li>2) CORRELATION OF COLLAGEN FIBRIL SIZE WITH MECHANICAL PROPERTIES OF TISSUE </li></ul><ul><li>3) THE EFFECTS OF IMMOBILIZATION OF LIGAMENTS </li></ul>
  13. 13. BONE <ul><li>1) ACUTE FRACTURES </li></ul><ul><li>2) AVULSION FRACTURES </li></ul><ul><li>3) STRESS FRACTURES: THRESHOLD LEVEL VS CYCLIC LOADING </li></ul><ul><li>MEASURE OF PLASMA HYDROXYPROLINE (BONE RESORPTION ) </li></ul>
  14. 14. FIBROCARTILAGE MENISCI <ul><li>LOCATION OF THE TEAR DICTATES THE RESPONSE TO THE INJURY </li></ul>
  15. 15. MUSCLE <ul><li>TWO COMPETING PROCESSES DURING MUSCLE HEALING: </li></ul><ul><li>1) REGENERATION OF THE DISRUPTED MUSCLE FIBRES </li></ul><ul><li>2) THE PRODUCTION OF CONNECTIVE TISSUE COLLAGEN </li></ul>
  16. 16. MUSCLE <ul><li>- IMMOBILIZATION ( LESS POSSIBLE ) WILL REDUCE CONNECTIVE TISSUE AND ASSIST PENETRATION OF REGENERATED FIBRES </li></ul><ul><li>- STRETCHED MUSCLES WILL INCREASE NUMBER OF TERMINAL SARCOMERES, REDUCE INTRAMUSCULAR CONNECTIVE TISSUE </li></ul>

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