Basics of Tissue Injury

Injury Types

Soft Tissue• Affects Skin, muscle,

ligaments, and tendons, and nerves

• When soft tissue is injured it may:• Bleed• Become inflamed• Produce extra fluid

Bone Injuries• Affects Skeletal system

• Fractures• Dislocations

Types of Soft Tissue Injuries

Sprains• Bleed internally• Injury to ligaments

Strains• Bleed Internally• Injury to muscle or tendon

Sprains and strains are categorized in order of severity.• First Degree – No loss of motion in the injured area, stability intact• Second Degree – Some loss of motion, some signs of instability• Third Degree – Cannot move affected body part, and major instability

IncisionOpen wound made by a cutting instrument.

Very straight and clean cut

Not seen often in athletics

AbrasionScraping off a layer of skin

May or not bleed, depending on the amount of skin removed.

Contusion•Closed wound

•Also known as a “Bruise”

•Causes bleeding under the skin, causing swelling and discoloration

LacerationJagged, Irregular open wound

Caused by something irregular

Avulsion•Partial tearing away of a body part

•Can be opened or closed

Amputation•Open wound in which a part is completely cut away from the body.

•Traumatic or Surgical

Puncture•Injury occurs when a pointed object enters the body.

•Do not bleed much

•More likely to become infected

Contrecoup•Occurs on opposite side of initial injury.

•Usually occurs in the brain when the head hits an unyielding object

•The impact forces the brain against the opposite side

Stages of soft tissue healing

• Stage I: Acute inflammation– Increased flow of blood to the injured area bring cells and

chemicals to begin healing.• Phagocytes – specialize in eating up the dead cells• Leukocytes – infection fighting WBC’s• Platelets – carry blood clotting material

– This stage lasts for approx. 2-3 days.

Stages of soft tissue healing

• Stage II: Repair– Injured area is filled with blood, cells, and chemicals to

aid in repairing damaged tissue.• Fibroblasts begin building fibers across the area of injury

– Form the scar which can take from 6 weeks to as long as 3 months

Stages of soft tissue healing

• Stage III: Remodeling– Body’s way of building tissue strength in tendons,

muscles, and ligaments to withstand stress.– Can take up to a year or more

Healing Time

• Depends on several factors.– Severity of injury– Location and blood supply– Age– Nutrition – Illnesses (ie. Diabetes)– Medications – Infections

Complications

• Scar Tissue– Necessary component– Excessive scar tissue can delay healing– Not as pliable as normal tissue– May develop inside of joint, requiring surgical removal

• Too early of a return to activity– Causing further cellular damage

BONE INJURIESTypes of

Dislocation•Occurs when a force displaces bone so that the two bone ends in the same joint no longer line up.

•Cause deformity and pain

•Not easily moved

•Subluxation: is a slight dislocation that might return back to previous position without tx.

•A temporary Dislocation

Avulsion FractureA ligament or tendon pulls so hard at its attachment that a portion of the bony is torn away.

Common with Sprains, strains, and dislocations

Stress Fracture•Also known as Fatigue Fracture

•Occurs where there is a repetitive stress.

•Microscopic and may not be picked up on a x-ray

•Incomplete fracture

Spiral Fracture•Torsional force along the length of a bone.

•Ex: foot moves to the right while the rest of your body goes to the left.

Longitudinal FractureA Fx that runs the length of the bone.

Usually caused by impact.

Ex: Basketball hits tip of finger

Compression FractureOpposing forces are applied from both ends at the same time.

Commonly occur in the spine, due to landing on feet from a height.(Impact from ground is one force, body weight is the other)

Oblique FractureDiagonal fracture from one side to the other.

ComminutedCrushing injury, breaking bone into smaller pieces.

Greenstick FractureBones bend and fracture only partway through.

Children’s bones have cartilage like qualities.

Transverse Fracture

• Fracture that travels across a bone, perpendicular.

•Ex. Falling on a stick

Depressed Fracture•Direct impact to the skull, which indents.

•This indent is called a depression

Blowout FractureOccurs when the eye is pushed hard backwards and down into the eye socket.

Small bones under the eye are crushed and embedded into the muslces of the eye.

Pathological Fracture•Disease process weakens the bone

•Tumor

Epiphyseal FractureFracture that occurs where bone growth occurs, the Epiphysis.

Once growth plates are closed bone is uniformly strong.

Stages of Healing

Bone Fracture Healing

Bone Fracture Healing

• Stage I: Acute– Bone breaks, and bleeding occurs.– Osteogenesis – Process of laying down new bone

• Oseoclasts begin to remove the debris and resorb it into body.• Osteoblasts add new layers to the outside of the bone.

– Continues for approx. 4 days

Bone Fracture Healing

• Stage II: Repair– Osteoblasts and Osteoclasts continue to regenerate

bone.– Bony splint, called a fibrous Callus, holds the bone ends

together.– Process of turning callus into bone begins about week 3 and continues for 3 months.– Usually able to return to activity around 6-8 weeks.

Bone Fracture Healing

• Stage III: Remodeling– Callus is reabsorbed and replaced with a fibrous cord of

bone– Can take several years to complete.

– If bone never heals, it is referred to as a Nonunion FX.• Most common in the Scaphoid bone in the wrist.• Leads to arthritis and loss of function