Metabolic response phases

The metabolic response is characterized by four phases 1. The injury phase. This lasts 5 to 7 days. During the first 2 days, there are large hormonal changes with an increase in catecholamine and corticosteroid levels, and an initial decrease in the level of insulin. These hormonal changes are thought to be stimulated by the release of numerous cytokines such as interleukin. The result is muscle, fat, and glycogen store catabolism, liberating substrates such as glucose, lactose, proteins and...

Polytrauma Metabolic Response

The metabolic response to injury is a physiological 'systemic inflammatory' reaction to tissue damage. It is a hormone-mediated defence response that establishes the optimum environment for wound control, debridement and subsequent repair. In some circumstances it may become prolonged or exaggerated. If control is lost, this may lead to a pathological systemic inflammatory response known 'host defence failure disease' or 'multi-organ failure'. This accounts for the third peak of the ATLS...

Rockwood Classification

Tossy Classification

Tossy classified injury of the ACJ into three types. This has been increased to six by Rockwood Figure 1 . Of these six types, 98 are type I, II or III Table 1 . Controversies regarding operative or non-operative management centre around type III which make up 40 of all ACJ injuries. Conjoined tendon of Biceps and Coracobrachial Figure 1. Rockwood's classification of acromioclavicular joint injuries. Reprinted from Rockwood C.A., Williams G.R., Young D.C. Injuries to the acromioclavicular...

Peripheral Nerve Injuries And Repair

Each peripheral nerve contains many nerve fascicles. The fascicles and intervening connective tissue are bound by a sheath of epineurium. Fascicles contain many individual nerve fibres surrounded by perineurium. A nerve fibre consists of an axon with a Schwann cell covering, bound by endoneurium. Nerve fibres may be myelinated A and B or unmyelinated C . The myelin sheath is produced by the Schwann cell. Sequential' Schwann cells surround myelinated fibres, separated at the nodes of Ranvier....