Pt to ED with open FX to R arm after forward fall

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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

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DX

Pt appears to have at least a Displaced, comminuted, open fracture of the R arm at the elbow.

Tx

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

Pain control

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)

PROGNOSIS

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

Bone Formation

1.Formation of bone model by chondroblasts.

  1. Blood vessels penetrate model, chondroblasts expand and die.
  1. Osteoblasts invade and convert cartilage to bone.
  1. Formation of ossification centers.
  1. During childhood there is cartilage at epiphyseal plate and at articular ends.
  1. Adults only have cartilage at articular ends.

Bone growth

Bone Growth

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.

Appositional growth

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.

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Bone Remodeling

Osteocyte monitors

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

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Bone Healing

1) Hematoma formation.

2) Fibrocartilage formation.

3) Callus formation.

4) Ossification.

5) Consolidation and remodeling

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Materials needed for bone growth and repair

Amino Acids: to produce collagen

Glucose to breakdown ATP

Calcium and phosphate

Hydroxyapatites

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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.