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12 year-old boy with a bone fracture injury (injury (fracture (comminuted,…

- - - - steps
        
        Fibrocartilagenous: Internal and external callus forms
        
        From chondrocytes in endosteum and periosteum,
        
        secrete a fibrocartilaginous matrix between the two pieces
        
        creates hyaline cartilage and the surrounding bone breaks off ( now stabile)
        
        48 hrs
        
        Fracture hematoma ( from clotted blood )
        
        6-8 hrs
        
        Cartilage replaced by trabecular bone ( spongy)
        
        Osteoclasts resorb dead bone
        
        Osteogenic cells become active and divide to make osteoblasts,
        
        Osteoblasts adjacent to callus makes trabeculae (spongy) via endochondral ossification,
        
        remodeling
        
        several weeks
        
        Compact bone replaces spongy bone,
        
        side note: on remodeling
        
        Resorption of old bones
        
        5-10% of skeleton replaced yearly,
        
        Influenced by hormones and mechanical stress (exercise ( helps bone become stronger))
    - - flat bones
        
        Intramembranous Ossification
        
        Osteoblasts group into clusters, and ossification centers form,
        
        Osteoblast secrets osteoid which traps osteoblasts which turns them into osteocytes,
        
        Trabecular matrix and periosteum form,
        
        Compact bone develops above trabeculae which crowds blood vessels and it condenses into red marrow,
      - long bones
        
        endochondral ossification
        
        Mesenchymal cells differentiate into chondrocytes,
        
        The cartilage model and the perichondrium forms,
        
        Capillaries penetrate cartilage. Perichondrium transforms into periosteum. (Periosteal collar develops) Primary ossification center develops,
        
        Cartilage and chondrocytes continue to grow at ends of the bone,
        
        Secondary ossification centers develop( at the ends of the bone )
        
        Cartilage remains at epiphyseal (growth) plate and at joint surface as articular cartilage,
        
        side note on epiphyseal plate
        
        found in the middle of the Epiphysis and Diaphysis
        
        On epiphyseal side the cartilage grows,
        
        On diaphyseal side, bone grows ( bone grows in length),
        
        called Interstitial growth
        
        1 more item...
        
        area of hyaline cartilage in immature bone where ossification occurs
        
        once all the cartilage is replaced with bone it becomes the epiphyseal disc
    - - helps in bone remodeling, growth, healing
        
        Calcium,
        
        helps bone be built and rebuilt
        
        makes the bone have tensile strength
        
        Vitamin K,
        
        in conjuction with vitamin d stimulates the transformation of fracture site stem cells to bone building osteoblast
        
        helps bind calcium to bone ( helps bone mineralization )
        
        Vitamin D,
        
        regulator of calcium intake
        
        in conjuction with vitamin k stimulates the transformation of fracture site stem cells to bone building osteoblast
        
        Magnesium,
        
        in structure of bones
        
        aid in absorption and metabolism of calcium
        
        Flouride,
        
        in bones' structure. Strengthens bone and enamel of teeth
        
        Omega 3 fatty acid,
        
        decrease inflammation that may interfere with osteoblast function.
  - - - long bones
        
        greater in length than width
        
        Elongated, cylindrical shaft ( diaphysis)
        
        Most common bone shape,( all finger bones)
        
        used for leverage
        
        Regions
        
        diaphysis
        
        Elongated, usually cylindrical shaft (middle ),
        
        Provides leverage and weight support,
        
        Compact bone,
        
        Medullary cavity (hallow)
        
        within the diaphysis,
        
        Contains red bone marrow in children,
        
        Contains yellow bone marrow in adults,
        
        (Epiphysis) each end of long bone
        
        Proximal epiphysis (closest to body trunk),
        
        Distal epiphysis (farthest from trunk),
        
        Composed of
        
        outer layer of compact bone
        
        inner layer of spongy bone
        
        Articular (hyaline)cartilage ( in the outer layer)
        
        Covers the joint surface,
        
        Reduces friction,
        
        Absorbs shock in moveable joints,
        
        epithelial disk is here
      - flat bones
        
        thin surfaces
        
        surface for muscle attachment,
        
        in top of skull, scapulae, sternum, ribs,
        
        Protects underlying soft tissues
        
        outer layer compact
        
        inner layer spongy
      - Irregular bones
        
        vertebrae, ossa coxae (hip bones), several bones in skull (ethmoid, sphenoid, temporal)
        
        doesnt fit any other category
      - Sesamoid bones
        
        patella (kneecap)
        
        bones that sometimes develop within tendons
      - Short bones
        
        Length nearly equal to width.
        
        carpal and tarsals
        
        stability and support
      - Wormian
      - main two types of bones
        
        compact bone
        
        composed of osteons
        
        components
        
        Canaliculi
        
        Tiny, interconnecting channels that
        
        travel through lamellae and connect from, lacunaes to the central canal,
        
        Allow exchange between blood vessels and osteocytes,
        
        Osteocytes
        
        Mature bone cells,
        
        Found in lacunae,
        
        Maintain bone matrix,
        
        Concentric lamellae,
        
        Concentric rings of calcified matrix,
        
        Surround central canal,
        
        Central canal,
        
        channel at center of osteon ,
        
        Blood vessels and nerves enter through this central channel ,
        
        Perforating canals( haversian canals)
        
        Blood vessels and nerves travel through ,
        
        connect osteons to osteons
        
        spongy bone
        
        Trabeculae- network of matrix spikes,
        
        Osteocytes (housed in lacuna) no concentric circles,
        
        Trabecula form along lines of stress to provide strength to bone,
        
        light so that mucles can move bone with ease
        
        usually has red bone marrow
    - - Periosteum is a tough membranous sheath that covers the outer surface of the bone, anchored to bone by collagen fibers
        
        types
        
        Inner cellular layer
        
        Inner cellular layer
        
        osteogenic cells
        
        –Stem cells from mesenchyme, will become an osteoblast
        
        only bone cells that divides (One will be a stem cell (mesenchyme)and the other will be an osteoblast)
        
        osteoblast ( bone builder)
        
        Makes and secretes goo : collagen matrix (organic) that attracts calcium salts (inorganic) to form a new bone
        
        might become trapped within the matrix, and become osteocytes
        
        1 more item...
        
        osteoclast ( polisher)
        
        big, multinuclear, phagocytic cells,
        
        Derived from fused blood stem cells,
        
        Involved in bone resorption ( sanding off wood),
        
        Outer fibrous layer of dense irregular CT
        
        Protects bone from surrounding structures,
        
        contains blood,lymph vessels,nerves that nourish compact bone,
        
        Attachment site for ligaments and tendons,
      - Endosteum covers the internals of the bone within the medullary cavity
        
        contains osteogenic cells
        
        osteoblasts
        
        Covers all internal surfaces of bone within medullary cavity,
        
        osteoclasts
    - - Simple-closed,
      - Compound-open (through skin),
      - transverse fracture- straight across,
      - Spiral fracture- spiral often from a twisting action,
      - Comminuted fracture- more than 2 pieces,
      - impacted fracture-one fragment driven into another,
      - greenstick fracture- incomplete break with splintering,
      - incomplete – not all the way through,
      - complete- all the way through,
      - fissured fracture- Incomplete horizontal ( a crack),
- - - - calcium
      - Vitamin K,
      - Fluoride,
      - Omega 3 fatty acids,
      - Magnesium
  - - - little calcium intake (or vitamin D)
- - - - upper arm
        
        needs antiobiotics
        
        needed to put the bone back in place and close the wound to stop infections and antibodies from further entering the body
        
        need fixation of the fracture fragments with plates, screws or pins.
        
        needs to clean out wound (remove the small fragments )
      - elbow
        
        need fixation of the fracture fragments with plates, screws or pins
    - - is going to need pain reliever
      - since it the humerus,to keep it place he is going to need an arm cast
        
        going to need rehablitaion to:
        
        joint motion
        
        flexibiity
        
        restore muscle strength
        
        well include excercising
      - Do to horrible diet he has a low income of calcium,magnesium,flouride,omega 3 fatty acid, vitamin D. and vitamin K his healing will be slower than most children
        
        would need to change diet to more leafy greens, and certain fish such as salmon to bring his required nutrients/vitamins up ( additional examples include nuts and beans for magnesium, some OJ for vitamin D etc)
      - although he has a horrible diet he is still a child and the bones are smaller and has a dense periosteum
        
        means his bones will heal faster ( thicker periosteum = more chondrocytes ) ( with a proper nutritional diet his chondrocytes can attract calcium and other nutrients and form "new" bone