general overview of trauma-2

Musculoskeletal healing following acute traumatic injury will results in the following:

• restoration of original tissue
• scar
• Excessive repair
• failure of healing

There are four variables that influnce healing and extend of injury

• The injury itself

1. type
2. intensity
3. duration

• patient factor

1. age
2. metabolic state
3. disease and its modification

• tissue types

1. bone
2. cartilage
3. muscle
4. skin

• Treatment

1. apposition
2. stabilization
3. loading and motion

Where as in nervous tissue the results is not as good.
It can be divided into either injury in peripheral nerve or in central nervous system
in peripheral nerves
it depens either cut or crush injury.There will mild degenerative changes of the neuron and the distal ends will undergoes wallerian degeneration. Within 48 hrs the axon disintegrates and myelin becomes fatty droplets.The Schwann cells survives and engulf the degenerative tissue =autophagosomes.
The Schwann cells proliferate to established continuity with sprouting axons elongates along the tract of degenerated tissue by 20mm/week=1mm/d.
Within 6 months to one year and good apposition good restoration of function is expected.Otherwise there will be formation of traumatic neuroma and the distal nerve remnants dissapear and muscles become severely atrophied.

In CNS
the affected cells undergo chromatolysis and necrosis with proliferating neuroglia cells to become dense glial scar.Oligodendroglia will take the place of schwan cells.
After initial swelling with inflammation which later subsides there will gradual improvement and that depends on the improved utilization of the residual undamaged pathway with some limited new fibres maybe formed and it take places in nine to 12 months