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Case Study: A young boy appears to have broken several bones in multiple…

- - - - Occurred in a boy, the age of 12
        
        He ran & fell forward
        
        Landing on right arm
        
        Broken bones & their locations
        
        Part of the humerus is protruding through the skin
        
        Fragment of bone in the wound
        
        Breaking elbow (olecranon)
  - - - Young kids bones don't break that easily
        
        Factors that led to this
        
        Diet
        
        Lactose intolerance
        
        No consumption of dairy
        
        Needs Ca for bone remodeling
        
        1 more item...
        
        Junk food mainly consumed
        
        Needs more nutrients
        
        Possibly not getting enough amino acids for osteoid production
        
        1 more item...
      - Bones are still going through growth stages
- - - - Right elbow (olecranon) broken
        
        Classification of fracture
        
        Closed simple fracture
        
        Other possible types of breaks
        
        Greenstick fracture
        
        Displaced fracture
        
        Incomplete fracture
    - - Part of humerus is protruding through the skin
        
        Fragment of bone in the wound
        
        Classification of fracture
        
        Open compound fracture
        
        Other possible types of breaks
        
        epiphyseal break
        
        Greenstick break
        
        Incomplete fracture
  - - - Location of break
        
        Humerus break
        
        If an epiphyseal break
        
        A method for growth continuation should be addressed
        
        In order to maintain bone symmetry on all side of body
        
        He would possibly require steroids or growth hormone
        
        1 more item...
        
        Olecranon break
        
        If a greenstick fracture
        
        The bones need to be re-brocken
        
        & Placed in the proper position
      - Boys diet
        
        Diet would benefit from change
        
        Mico & macro nutrients are important for the healing process
        
        By adding more minerals so they are properly stored
        
        So the body can use it for bone remodeling
      - Age of boy
        
        The epiphyseal plate is still active in males until about 21 yrs
        
        So its important to look at factors possible for affecting growth
- - - - A cast or traction could be placed around bone
        
        So proper repair can take place
- - - - Anatomy of bones classified by shape
        
        Short bones
        
        Special type of short bone
        
        Sesamoid bones
        
        Form in a tendon
        
        Vary in size & # in individuals
        
        Ex: Patella
        
        Shape
        
        Cubed
        
        Ex: Bones of wrist & ankle
        
        Flat bones
        
        Shape
        
        Flat
        
        A bit curved
        
        Thin
        
        Example
        
        scapulae
        
        Ribs
        
        Sternum
        
        Most cranial bones
        
        Irregular bones
        
        Shape
        
        They have complicated shapes
        
        Examples
        
        Vertebrae
        
        Hip bones
        
        Long bones
        
        Shape
        
        Consists of a shaft & 2 ends
        
        Ex: All limbs except patella, wrist, & ankle bones
        
        Other ex: the 3 bones in the fingers (phalanges)
        
        Known for elongated shape, not overall size
        
        Longer than they are wide
        
        Anatomy
        
        All contain 3 general structures
        
        Bone ends
        
        AKA -> Epiphyses
        
        2 more items...
        
        Membranes
        
        Periosteum
        
        1 more item...
        
        Endosteum
        
        1 more item...
        
        Shaft
        
        AKA -> Diaphysis
        
        2 more items...
        
        Other structural components
        
        Well vascularized
        
        Main vessels in diaphysis
        
        2 more items...
        
        Hematopoietic tissue
        
        Blood forming tissue
        
        1 more item...
      - Divided into 2 groups
        
        Axial skeleton
        
        Includes
        
        Vertebral column
        
        Rib cage
        
        Skull
        
        Appendicular
        
        Includes
        
        Bones of upper & lower limbs
        
        Girdles (shoulder & hip bones)
    - - Hormone production
        
        Bone produce osteocalcin (hormone)
        
        Which regulate
        
        Glucose homeostasis
        
        Energy expenditure
        
        Insulin secretion
      - Blood cell formation
        
        Hematopoiesis ( blood cell formation) occurs in red marrow of certain bones
      - Mineral & growth factor storage
        
        Ex: bone stores Ca & P, along w/growth hormone
        
        Which is then released into the bloodstream as the body needs it
      - Triglyceride storage
        
        Fat can be stored in bone as yellow marrow
        
        For an energy source
      - Anchorage
        
        Skeletal muscles use bones as levers to move body
      - Support
        
        The skeleton provides a framework for the body to be used by muscles
      - Protection
        
        Only in certain areas
        
        Such as
        
        Vertebrae surround the spinal cord
        
        Rib cage protects vital organs
        
        Fused bones of skull protect brain
        
        The femur for example does not protect anything
    - - They are organs
      - Structure
        
        Contain
        
        Epithelial in blood vessels in the bone
        
        Dense connective tissue covering their external surface
        
        Cartilage in their articular cartilages
        
        Nervous tissue in their nerves
        
        Smooth muscle around blood vessels
        
        Sometimes muscle fibers
        
        3 bone structural levels
        
        Gross anatomy
        
        Spongy bone
        
        Internal layer - AKA -> trabecular bone
        
        The honeycomb of small flat pieces -> trabeculae
        
        1 more item...
        
        Thin plates of spongy bone -> Diploe
        
        Importance: Adult's way of making blood in bones
        
        Compact bone
        
        External dense outer layer of bone
        
        Microscopic anatomy
        
        5 major cell types in bone tissue
        
        Osteoblast
        
        Function: Bone forming cells
        
        1 more item...
        
        Also actively mitotic
        
        Shape
        
        2 more items...
        
        Osteocytes
        
        Shape
        
        1 more item...
        
        Mature bone cells
        
        Function
        
        4 more items...
        
        Osteoprogenitor cells
        
        Mitotically active stem cells
        
        Location
        
        2 more items...
        
        Function: When stimulated, some of these become
        
        1 more item...
        
        Shape
        
        1 more item...
        
        Bone lining cells
        
        Shape
        
        1 more item...
        
        Location: Bone surfaces where bone remodeling occurs
        
        Function: Thought to help maintain matrix
        
        Osteoclasts
        
        Shape
        
        1 more item...
        
        Location: At sites for bone resorption (breaking down bone)
        
        Function: Break down bone
        
        Chemical composition of bone (Made of 2 different things in matrix)
        
        Soft organic components
        
        Includes
        
        Osteoid
        
        4 more items...
        
        Cells
        
        Osteoprogenitor cells
        
        Osteoblasts
        
        Osteocytes
        
        Bone lining cells
        
        Osteoclasts
        
        Hard inorganic components
        
        Includes
        
        Mineral salts AKA hydroxyapatites
        
        1 more item...
    - - Endochondral ossification
        
        Process
        
        1) Hyaline cartilage is surrounded by perichondrium initially
        
        Mesenchymal cells become osteoblasts
        
        Perichondrium becomes periosteum
        
        A collar bone forms when the osteoblasts secrete osteoid against the hyaline cartilage diaphysis
        
        1 more item...
        
        2) Cartilage calcifies in center of diaphysis & develops into cavities -> Area of deteriorating cartilage matrix
        
        3) Periosteal bud invades cavities -> Spongy bone replaces cartilage
        
        Month 3 of development
        
        4) Diaphysis elongates & medullary cavity forms
        
        Secondary ossification centers appear in epiphyses
        
        Week 9 until birth
        
        5) The epiphyses ossify
        
        Then ossification is complete, hyaline cartilage remains only in epiphyseal plates & articular cartilages
        
        Characteristics
        
        Begins in 2nd month of development
        
        Bones formed
        
        Mainly long bones w/some others
      - Intramembranous ossification
        
        Bones formed
        
        Flat bones
        
        Such as
        
        Cranial bones
        
        Clavicles
        
        Characteristics
        
        Begins at week 8 of development
        
        Process
        
        1) Ossification begins w / a membrane of fibrous connective tissue
        
        Mesenchymal cells cluster & differentiate into osteoblasts
        
        2) Osteoid, secreted by osteoblasts, begins to calcify in days time
        
        Trapped osteoblasts become osteocytes
        
        3) Immature spongy bone & periosteum form
        
        Osteoblasts on outside make compact bone on surfaces
        
        4) Red marrow develops
        
        Whats left over from the connective tissue is what forms the periosteum
    - - 2 Ways bones grow
        
        Appositional growth
        
        All bones that grow in thickness
        
        Occurs on the outside of bone by means of addition of it
        
        Process
        
        1) Osteoblasts in periosteum add more matrix layers on the external surface of bone
        
        2) At the same time that step one is occurring, in the endosteal surface of the diaphysis, osteoclast remove bone
        
        Goal: The outside gains more layers & the inside loses layers to widen bone w/out making it too heavy
        
        Interstitial growth AKA longitudinal growth
        
        Long bones lengthen by
        
        Growth of the epiphyseal plate cartilage & its replacement by bone
        
        Occurs within the tissue
        
        Process
        
        4) Ossification zone
        
        Osteoclasts partly erode the cartilage spicules created from the calcification process
        
        Then osteoblasts cover them with new bone
        
        1 more item...
        
        3) Calcification zone
        
        Adding Ca in order that the matrix becomes calcified
        
        Chondrocytes die
        
        1 more item...
        
        Goal
        
        Push the epiphysis up & add bone to diaphysis
        
        Which pushes the the epiphyses further apart
        
        2) Hypertrophic zone
        
        The older condrocytes closer to diaphysis enlarge
        
        Their lucunae erode & enlarge
        
        1 more item...
        
        1) Proliferation zone
        
        Cartilage cells (condroblasts) undergo mitosis
        
        Pushing the epiphysis away from diaphysis
        
        1 more item...
      - Hormones responsible in bone growth
        
        Thyroid hormones
        
        Modulate the activity of growth hormone
        
        Estrogens & testosterone
        
        Masculinization or feminization of parts of skeleton depend on theses levels
        
        Growth hormone
        
        Released by anterior pituitary gland
    - - Hormones responsible in bone remodeling
        
        Calcitonin
        
        Produced by thyroid to help slow down osteoclast activity
        
        PTH
        
        Stimulate osteoclast to break down bone matrix
        
        Goal of both of these
        
        To regulate BLOOD-Ca LEVELS
        
        Maintain Ca homeostasis
        
        Keeping bone strong
      - Process
        
        2 main steps involved
        
        Bone resorption
        
        Increase blood-Ca levels
        
        PTH is released
        
        Osteoclasts remove the minerals & proteins
        
        In adults, both of these work at the same rate
        
        Bone deposition
        
        Osteoblasts deposit Ca & proteins throughout osteoid
        
        Creating calcified bone matrix
      - Characteristics
        
        Remodeling replaces 5-10% of our skeleton every yr
        
        Our entire skeleton is replaced about every 10 yrs
        
        Spongy - Every 3-4 yrs
        
        Compact - Every 10 yrs
        
        Includes removal of old matrix w/replacement of new
        
        Occurs: From embryo -> death
    - - Position of bone ends
        
        Displaced
        
        Bone ends are not lined in position
        
        Nondisplaced fractures
        
        Bone ends are lined in position
      - Completeness of break
        
        The bone is broken all the way through
      - Whether the bone ends penetrate the skin
        
        The bone is an open (compound) fracture
      - Common types of fractures
        
        Epiphyseal break
        
        Epiphysis separates from diaphysis along the plate
        
        Is a serious injury b/c it could effect growth
        
        Growth hormone & steroids are possibles -> mitosis
        
        Spiral
        
        Twisted break
        
        Ex: Machinery accidents or abused child
        
        Compression
        
        Bone is crushed
        
        Ex: Calcaneous shatters if you land on your heels too hard
        
        Greenstick
        
        Bone breaks incompletely (only one side breaks)
        
        Common in kids w/ more organic matrix
        
        Comminuted
        
        Bones shatter in many pieces
        
        Ex: In elderly
        
        Depressed
        
        Broken bone is pressed inward
        
        Ex: skull fracture
    - - Treatment
        
        Begins w/ reduction
        
        Realignment of broken bones
        
        Closed external reduction
        
        Physician's hand put bone ends into position
        
        Open internal reduction
        
        Bone ends are secured together surgically w/screws & plates
        
        After reduced
        
        Immobilized by
        
        2 more items...
        
        Time it takes adults to heal (small - medium )
        
        6-8 wks
      - Stages of bone healing in a simple fracture
        
        2) Fibrocartilaginous callus forms
        
        Blood vessels grow into new clot
        
        Fibroblast & condroblasts invade the fracture site
        
        Fibrocartilaginous callus spans the break & connects the broken bone ends
        
        3) Spongy bone forms -> Bony callus forms
        
        Osteoblasts form spongy bone
        
        1) Lots of blood pulling -> Hematoma forms
        
        When a bone breaks, blood vessels in bone are torn
        
        The hemorroraged blood clots forming hematoma
        
        Tissue becomes swollen
        
        4) Bone remodeling occurs
        
        Bony callus is removed
        
        Compact bone is laid down