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Chief Complaint: -Right elbow broken -Right upper arm protruding from…
Chief Complaint:
-Right elbow broken
-Right upper arm protruding from skin
Possible Direct Upstream Cause:
-Broken Bones
-Protruding from Skin
Possible Indirect Upstream Cause
-Lactose Intolerance
-Poor Diet
Background Information Needed
Anatomy of Long Bone
Compact Bone:
-Dense outer layer, smooth & solid
Spongy Bone
-Honeycomb , needle-like pieces of bone called "trabeculae"
Structure of Flat, Irregular, and Short Bones:
-Thin plates of spongy bone covered by compact bone
-Bone marrow scattered throughout spongy bone
Periosteum:
covers outside of compact bone
-2 layers
Endosteum
covers inside of compact bone
-delicate connective tissue
Epiphysis:
Ends of bone
Diaphysis:
Shaft of the bone
Epiphyseal Line
between diaphysis and epiphysis
Eppihyseal plate
where bone growth ocurs
Red Bone Marrow
-blood forming
-children have
-yellow marrow can convert to red if anemic
Bone Markings ( 3 categories)
-projection sites for muscle/ligament attachment
-Joint surfaces
-Depressions/openings
Osteogenic Cells
active stem cells in periostium and endosteum
Osteoblasts
secretes osteoid
Osteocytes
mature cells in lacunae, no longer divide, maintain bone matrix
Osteoclasts
multinucleate cells that aid in bone resorption
Components of Compact Bone
-osteon
-Canals and caniliculi
-interstitial and circumferential lamellae
Osteon
structural unit of compact bone
elongated cylinder, runs parallel to bone
-rings are "lamellae"
-lamellae have collagen fibers running in diff. directions , "twister resister"
Canals & Caniliculi
Central canal
runs through core of osteon
-has blood vessels and fibers
Perforating Canals
lie @ right angle w/ central canal
Lacunae
small sites, house osteocytes
Caniliculi
hairlike canals, connect lacunae to each other and central canal
Interstitial Lamellae
NOT part of osteon
-some fill gaps between forming osteons
Circumferential Lamellae
deep to periosteum, superficial to endosteum
help long bones resist twisting
Chemical Composition of Bone
Organic Components
allow it to resist tension (stretch)
Osteoid
organic part of matrix , secreted by osteoclasts
-contributes to high tensile strength and flexibility
Inorganic Composition
allow bone to resist compression
Hydroxyapatites
- (mineral salts)
-65% bone mass
-responsible for hardness and resistance to compression
Bone Development
Ossification (osteogenesis)
formation of bone tissue
-skeleton begins forming in month 2 of development
-postnatal bone growth until early adulthood
Formation of Bony Skeleton
Endochondral Ossification
-Bones form by replacing hyaline cartilage
-form most of skeleton
Intramembranous Ossification
-bones develop from fibrous membrane
-form cranial and clavicle bones
Steps in Intramambraous Ossification
Ossification centers form when mesenchymal cells cluster and become osteoblasts
Osteoid secreted, then calcified
Woven bone formed when osteoid is laid around blood vessels , forming trabeculae
Compact and Spongy bone form, red marrow appears
Steps in Endochondral Ossification
Bone collar forms around diaphysis of cartilage
Central cartilage calcifies and dies, develops cavities
Periosteal bud invades cavities, forming spongy bone
Diahysis elongates, medullary cavity forms
Epiphyses ossify
Bone Growth
Interstitial Growth
lengthwise
Appositional Growth
thickness
Interstitial Growth
-Requires presence of epiphyseal cartilage
-Epihyseal plates maintain constant thickness
Epiphyseal plate becomes epiphyseal line , when epiphysis and diaphysis fuse
Appositional Growth
-Occur throughout life, not dependent on cartilage
-Thicken due to stress from activity/added weight
-Osteoblasts beneath periosoteum secrete bone matrix on external bone
-Osteoclasts remove bone on endosteal surface
-more building up than breaking down, leads to growth
Hormonal Regulation
Growth Hormone
most important in stimulation of epiphyseal plate
Thyroid Hormone
modulates activity of growth hormone, ensuring proper proportions
Sex Hormones
promote growth spurts
Hypersecretion of Growth Hormone
-Acromelagy (in adults)
-overgrwoth( hands, feet and face),after growth plates close
Gigantism (in children)
-before growth plates close
Hyposecretion of Growth Hormone
-Can cause pituitary dwarfism in children
-synthetic growth hormone therapy available
Bone Remodeling
-consists of both bone deposit and resorption
-Occurs @ periosteum & endosteum
Bone Deposit
-Function of osteoblasts
-Vitamin D enhances calcium absorption
-Vitamin C needed for collagen formation
-Calcium and phosphate for calcification
Control of Remodeling
Parathyroid Hormone
produced by parathyroid gland, in response to low calcium levels
Responses to Mechanical Stress
-When weight is put on bones or muscles pull on them, they stress
-Diaphysis thickest where bone stresses the most
Classification of Fractures
Nondisplaced:
ends retain normal position
Displaced
ends out of normal alignment
Complete Break
Broken all the way through
Incomplete
not broken all the way through
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Treatment
Reduction
realignment of broken bones
Closed Reduction
Physician manipulates to correct position
Open Reduction
Surigcal pins/wires secure ends
Bone Repair ( 4 steps)
Hematoma forms
Fibrocartilaginous callus forms
3.Bony callus formation
4.Bone remodeling
Normal Physiology & Homeostatic Set Points
Red Bone Marrow
-Makes blood
Blood flows to the blood vessels
Blood then enters the circulatory system
Circulatory system transports blood to the body
Bone Repair
Bone breaks
Pain and swelling occurs
Hematoma forms
Fibrcartilaginous callus forms
Bony callus forms
Bone remodeling occurs
Good nutrition is crucial for overall health
Certain nutrients and dairy are especially great for bones
Dairy contains calcium, phosphate and phosphorus which are all crucial for bone growth
Relevant Intracellular Energy/ Nutrition/Metabolism Pathways
Bones give protection and support to body
Provide movement throughout the entire body
Produce blood in red bone marrow
Blood is transported to the cardiovascular system
Oxygen is transported throughout the body
Proper Nutrition nourishes bones
Bones become stronger
being lactose intolerance makes bone growth a bit difficult
Lactose intolerant people can develop osteoporosis
Osteoporosis creates porous bones/ lose bone mass
Poor nutrition doesn't deliver the adequate amount of nutrients to the rest of the body
1 more item...
Specific Problem #1
Broken Bones
Possible Direct Downstream Effects
Pain
Swelling
Bruising
Possible Indirect Downstream Effects
-Longer healing time
-Immobility during healing process
Specific Problem #2
Protruding Bone through Skin
Possible Direct Downstream Effects
Infection
Possible Indirect Downstream Effect
-Can cause osteonecrosis
-Can delay healing process
-Can impede blood circulation
Specific Problem # 3
protruding bones and several fragments
Possible Direct Downstream Effects
Longer healing process
Possible Indirect Downstream Effect
-Could become more difficult to heal due to protruding bone
-
Specific Problem #4
Boy is lactose intolerant
Possible Direct Downstream Effect
Weak Bones will be created
Possible Indirect Downstream Effect
-Osteoporosis can occur
Specific Problem #5
Boy has a poor diet
Possible Direct Downstream Effect
Bones don't get the adequate amount of nutrients
Possible Indirect Downstream Effect
-Can contribute to osteoporosis as well
-Weak bones can form
-If overweight, can stress out bones and cause them to be weaker