A boy is brought in with a fractured right cubital and comminuated /compound fracture on his right brachial caused by falling forward. We learn that he is lactose intolerant and only eats junk food.
Periosteum is a fiborous tissure that lines the outside of the bone
four types of bone cells
osteoblasts
osteocytes
osteogenic cells
osteoclasts
background
endosteum is a decicate membrane that lines the medulary cavity
the long shaft part of the bone is called the diaphysis. It is made of compact bone with a tunnel in the middle called the medulary cavity. Inside is yellow marrow in adults and red marrow in children
the ends of the bone are called the epiphysis. They are made of spongy bone. This is where the red marrow lives
anatomy of long bone
in compact bone there are ostions. The lamella are rings inside with collagen lining in opposite directions to provide stregnth
formation and remodeling
*in early embryonic stages, a "model" is formed made of hyaline cartilage
During intramembranous ossification, compact and spongy bone develops directly from sheets of mesenchymal connective tissue
early osteoblasts appear in a cluster called an ossification center. The osteoblasts secrete osteoid, uncalcified matrix, which calcifies
some osteoblasts get trapped in their own ostiod. Once entrapped, the osteoblasts become osteocytes
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in remodeling, osteoclasts will shave off the bone it needs to (it can be because of damage or growth). the osteoblasts lay down new bone
stages of bone remodeling
- callus
compact bone replaces spongy bone
- hemotoma
The epiphyseal plate is the area of growth in a long bone. It is a layer of hyaline cartilage where ossification occurs in immature bones. When the plate grows, the bone will not grow in length anymore
materials needed for bone growth
Calcium:Needed to make calcium phosphate and calcium carbonate, which form the hydroxyapatite crystals that give bone its hardness
Vitamin D:Needed for calcium absorption
Vitamin K:Supports bone mineralization; may have synergistic effect with vitamin D
Magnesium:Structural component of bone
Fluoride:Structural component of bone
Omega-3 fatty acids Reduces inflammation that may interfere with osteoblast function
types of fractures
Greenstick - Incomplete fracture. The broken bone is not completely separated.
Transverse - The break is in a straight line across the bone.
Spiral - The break spirals around the bone; common in a twisting injury.
Oblique - Diagonal break across the bone.
Compression - The bone is crushed, causing the broken bone to be wider or flatter in appearance.
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Comminuted - The break is in three or more pieces and fragments are present at the fracture site.
Segmental - The same bone is fractured in two places, so there is a "floating" segment of bone
upstream
direct cause
indirect cause
the boy fell with his weight on his arm
the child doesn't have enough calcium or other nutrients in his diet needed to make bones strong
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downstream
the fractures include a comminuated and compound fracture on his right brachial region. visible fracture on his right cubital
the child will need to make sure he changes his diet to get the right nutrients discribed in this map to ensure his bones will remodel correctly.
children's bones repair faster than adults so if he is getting the right nutrients, he should heal well in about 4-6 weeks