Pt to ED with open FX to R arm after forward fall (Anatomy of Long Bones (…
Pt to ED with open FX to R arm after forward fall
Pt had forward fall braced for impact with R arm. Obvious open FX to distal humerus/proximal radius or ulna
HX of lactose intolerance & dietary deficits
Possible vitamin/mineral deficiency
Pt appears to have at least a Displaced, comminuted, open fracture of the R arm at the elbow.
Cleaning of wound
Splints or casts to hold the bone in place, even if surgery is not needed
Surgery to pin, screw, or wire pieces of bone into place
RX for Antibiotics to prevent infection due to break on skin
RX for nutritional supplements to compensate in deficiencies due to dietary restrictions
Calcium to aid in bone health
Vit D to aid in Calcium absorption
Exercises or physical therapy (after the injury heals)
Due to age 3-6 weeks in cast/splint
With proper supplements and monitoring should regain full use.
Anatomy of Long Bones
Diaphysis: tubular shaft that runs between the proximal and distal ends of the bone, diaphysis is composed of dense and hard compact bone.
Epiphysis: wider section at each end of the bone
medullary cavity, which is filled with yellow marrow
epiphyseal plate (growth plate) at the ends of long bones (metaphysics), a layer of hyaline (transparent) cartilage in a growing bone.
Endosteum membranous lining; where bone growth, repair, and remodeling occur
Periosteum covered with a fibrous membrane; contains blood vessels, nerves, and lymphatic vessels that nourish compact bone
epiphyses are covered with articular cartilage(hyaline), reduces friction and acts as a shock absorber
osteogenic cell: deep layers of the periosteum and the marrow, develop into osteocytes
osteoblast: found in the growing portions of bone, periosteum and endosteum synthesize and secrete the collagen matrix and calcium salts once trapped becomes osteocyte
osteocyte: located in a space called a lacuna, maintain the mineral concentration, maintain the mineral concentration canaliculi channels within the bone matrix
osteoclast: bone resorption/breakdown, found on bone surface, multinucleated
osteon structural unit of compact bone
lamellae: concentric rings of calcified matrix
central canal/Haversian canal: enter of each osteon, contains blood vessels, nerves, and lymphatic vessels
1.Formation of bone model by chondroblasts.
Blood vessels penetrate model, chondroblasts expand and die.
Osteoblasts invade and convert cartilage to bone.
Formation of ossification centers.
During childhood there is cartilage at epiphyseal plate and at articular ends.
Adults only have cartilage at articular ends.
The cartilage in the region of the epiphyseal plate next to the epiphysis continues to grow by mitosis
The chondrocytes, in the region next to the diaphysis, age and degenerate.
Osteoblasts move in and ossify the matrix to form bone.
Osteoblasts in the periosteum form compact bone around the external bone surface
At the same time, osteoclasts in the endosteum break down bone on the internal bone surface, around the medullary cavity.
Microfractures or stress activate the process
Osteoclasts breakdown and polish the old bone to be resorbed when done they self-destruct
Osteoblast creates new replacement bone substance
Osteocyte monitors bone again
1) Hematoma formation.
2) Fibrocartilage formation.
3) Callus formation.
5) Consolidation and remodeling
Materials needed for bone growth and repair
Amino Acids: to produce collagen
Glucose to breakdown ATP
Calcium and phosphate
Types of Fractures
Simple FX: Closed, complete break within skin
Compound FX: Open, bone pierces through the skin
Oblique FX: diagonal to bone axis
Transverse FX: perpendicular to bone axis
Spiral FX: fracture line twists around the bone
Comminuted FX: bone broken into several fragments
Liner FX: parallel to long axis of the bone
Greenstick FX: more common in children, partial FX to one side of the bone
Impacted FX: extreme pressure, bone splits, fragments jam into each other
Complete/incomplete FX: complete fx bone fragments vs. only partial for incomplete
Compression FX: occurs when at least two bones are forced against each other (spine)
Avulsion FX: occurs when muscle forcefully contracts breaking bone
Stress FX (hairline): overuse injury, common in athletes
Displaced FX: occurs when bone breaks into two separate parts, loses alignment
Nondisplaced FX: bone in two pieces remain aligned.
Pathological FX: underlying health issue creates weaker bones causing fx.