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12 year old boy fractures his right arm from a simple fall. (Upstream…
12 year old boy fractures his right arm from a simple fall.
Upstream
Direct
The boy was running and he fell forward on his arm.
Indirect
The lack of proper nutrition due to the boy being lactose intolerant and not being able to get enough vitamin D to absorb calcium to make his bones stronger.
Lack of inorganic bone material
Downstream
Clinical fracture description
Fracture
Open
Comminuted
Treatment of the Fracture
Age
The boy is young so, the fracture will heal quickly
however by him being young and active her will need several plates, screws and cast to keep all of the bone alive and in place so, it heals propperly
Location
Broken at a joint
Articular joint damaged
Will not heal well
Needs to keep arm still with no setbacks for best healing efforts
Will result in arthritis as he ages
Articular cartilage is not vascular and it is amitotic
Broken at the end of a long bone
end of humerous shattered
Epiphyseal line shattered
Growth in right arm disrupted
Right arm will ultimately be shorter than the left
Diet
Lactose intolerant
Lacking in Calcium
Need to take calcium supplements
There is not enough organic materials in the bone
So, it is brittle
Needs to eat more leafy greens
Background
Physiology
How bone forms, grows, and remodels
Formation
Intramembranous ossification
Step 1
Osteoblast cluster together and make ossification center
Step 2
Osteoblast make osteoid that traps some of them so they become osteocytes.
Step 4
Compact bone forms around the trabecula and protects it.
Red blood vessels get squished and make red bone marrow
Step 3
If/when osteoid is secreted around capillaries they become condensed and it creates the trabecula (spongy bone)
Outside mesenchyme cells become the periostenum
Endochondral Ossification
Step 1
Mesenchyme turns into chondocytes
Step 2
A cartilage model
, and perichondrium forms
Step 3
Capillaries penetrate the perichondrium and it transforms into the periosteum.
perosteal collar develops and
primary ossification center develops
Step 4
Cartilage and chondrocytes continue to grow
Secondary ossification center forms
Step 5
Cartilage remains at epiphyseal plate and at joint surface as articular cartilage.
Growth
Intersitial growth
Longitudinal growth of the bone
Facilitated by the epiphyseal plate
Has 5 zones
Resting
Proliferation Zone
Cartilage is undergoing mitosis
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Hypertrophic zone
Older chondrocytes get bigger
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Calcification zone
Chondrocytes die because of calcified matrix
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Ossification Zone
Osteoblast make bone tissue in the rest of the calcified cartilage
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(
role of epiphyseal plate
)
Controlled by hormones
Apositional Growth
Growth in bone width
Happens under the periosteum
Osteoclast shave away bone in the endosteum
Osteoblast lay down bone on the inside of the periosteum
This is also called
modeling
Remodeling
happens throughout adulthood
whole new skeleton every 5-7 years
Reabsorption of old bone by osteoclast
Creation of new bone by osteoblast
Influenced by hormone and mechanical stress
Stages of bone healing
Stage 1
Hemotoma form within 6-8 Hours
Stage 2
External callous forms within 48 hours
Chondrocytes form a fibrocartilage bridge btwn the two points to stablize the bone
Hyaline cartilage and bone shell form around the fibrocartilage
Stage 3
Cartilage replaces the broken trabecular bone on the inside
Osteoblast eats the broken bone
Osteoclast builds new good bone
Endochondrial Ossification
Stage 4
Compact bone replace spongy bone on surface of the bone
Bump of extra bone will be remodel away over several weeks
Anatomy
Anatomy of Long Bones
Cells
Osteblast
Builds the bone
Makes gooey collagen matrix (organic)
And calcium salts (inorganic)
Osteoclast
Bone resorption
Multinucleatied
Phagocytic cells
From fused blood stem cells
Osteogenic
Stem cell
One daughter cell stay and one become osteoblast
Loct. in the periosteum and bone marrow
Osteocytes
Maintain mineral concentration in the bone
From trapped osteoblast
Organ
Bone
Regions
Diaphysis
Leverage and support
Compact on outside of the area
Spongy on the inside of the area (medullary cavity)
Medullary cavity
Hallow place in the diaphysis
Has the endostenum membrane lining the inside of the cavity
Marrow
Yellow
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Red
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Metaphysis
Epiphyseal plate (line in adults)
Region between the Epiphysis and Diaphysis
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Epiphysis
Knobby region at the end of a long bone
Proximal
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Distal
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Periosteum membrane covering the long bone
Tissue
Compact
Hard outer shell of the bone
Spongy
Inner trabeculae part of the bone
Marrow
Red
Hematopoises
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Yellow
Fat storage
Classification of Bone Fractures
Types of Fractures
Stress fracture
Thin break caused by physical activity
repetitive loads on the bone
Pathological fracture
A break in the bone due to being weakened by dieseas
Simple facture
Broken bone that does not pierce the skin
Compound fracture
Broken bone that pierces the skin and is exposed to the outside world
Ways the bone can break
Transverse
A break that is straight across
Comminuted
The bone is broken into more than 2 pieces
Impacted
Two fragments impact on one another
Spiral
The break looks like a spiral staircase down the bone
Oblique
A diagonal break in the bone
Greenstick
The bone is not broken all the way through
Splinters on one side
Raw materials needed for membrane growth and repair
Growth
Intramembranous ossification
Mesenchymal cells
They make osteoblast
Osteoblast become osteocytes
Endochondral ossification
Mesenchymal cells
Turn into chondrocytes
Osseous tissue forms
Repair
Chondrocytes
Fibrocartilage
Osteolast
Osteoblast
vitamins and minerals
Phosphate
Vitamin D
Calcium
Location of epiphyseal plate
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