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A 12 year old boy i brought in with a bone fracture injury. Part of bone…

- - - - the fact that he was able to break this bone so severily is a sign of osteoporosis
  - - - lack of calcium can cause a loss in bone density
        
        overtime the patient may develop osteoporosis
  - - - childhood fractures are common BUT not in the location of this child
        
        the type of fracture at his age is a sign of osteoporosis
- - - - regular x rays may be required to ensure no shifting
  - - - patient will wear cast or splint while bones are getting ligned up
        
        pins are usually temporary and taken out after healing
        
        splint is worn for a month after final surgery just to ensure enough healing time
- - - - 1. Collar bone is formed when the perichondrium becomes periosteum and secretes osteids against the hyaline cartlige. Its formation causes chondroctyes within the shaft to enlarge
        
        2. The chondrocytes calcify the surrounding carilag and die, causing the matrix to deteriortate This opens up cavities but the hyaline cartlige stablizes and continues growth
        
        3. The forming cavities are invaded by periosteals bud, containins osteopogenitor cells. These cells become osteoblasts creating spongy bone
        
        4. Osteoclasts break down the nwly formed spongy bone and open up the medullary cavity
        
        5. The spongy bone interior is retained and hyaline cartlige reamins on the epophyseal surface and the junction of the diaphysis and epiphysis
    - - 1. Mesnchymal cells cluster and duferentiate into osteoblasts , forming an ossification center
        
        2. Osteoblasts continue to secre the osteoid which calcifies in a few days.
        
        3. Accumulating osteoid is laid down between embryonis blood vessels, forming immature spongy bone. Vascularized mesenchyme condeses on the external face of the bone and becomes the periosteum
        
        4. Trabeculae just deep to the periosteum are remodeled and replaced with compact bone. The immature spongy bone in the center is remodeled inot mature spongy bone that is eventually filled with red marrow
  - - - 2.Hypertonic zone:older chondorcytes in the stack hypertrophy. Ther lacunae erode and enlarge, leaving large interconnecting spaces
        
        3.Calcification zone: surrounding cartlige matrix calcifies, the chondrocytes die, and the matrix begins to deteriorate, allowing blood vesels to invade, leaving spicules of calcified cartlige at the ED junctons
        
        4. Ossification zone The calcified spicules are invaded by marrow elements from the medullary cavity. Osteoclasts partly erode the cartlige spicules, then osteoblasts cover them with new bone.
  - - - 2. Deposition:osteoblasts deposit new bone matrix. Betweenthe osteoid seam and the older mineralized bone, there is an abrupt transition called the calcification front
  - - - 2.The chondroblasts secrete a cartllaginous matrix that bulges externally and later calcifies, forming a fibrocartilaginous callus that spans the break and connects the broken bone ends
        
        3.Gradually the fibrocartliaginous callus os replaced by immature bone, converting it to a bony callus. Bony callus formation continues until a fimr union forms about two months later.
        
        4. Bone Remodleing
- - - - The diaphysis is the tubular shaft that runs between the ends of the bone and is composed of compact bone
        
        The hollow region in the diaphysis is called the medullary cavity, which is filled with yellow marrow
        
        The epiphyses is the bone ends, which are filled with spongy bone, and protected by compact bone, with a thin layer of hyaline cartilage covering the joints
        
        The epiphyseal plate (growth plate) is a disc of hyaline cartilage that grows during child growth
        
        The epiphyseal line is the "growth plate" in adults
        
        The enosteum covers the interanl bone surfacesand is made of psteoprogenitor cells, osteoblasts and osetoclasts
  - - - 1. Bone collar fomrs around the diaphysis of the hyaline cartilage model
        
        2. Cartlidge calcifies in the center of the diaphysis and then develops cavitie
        
        3. The periosteal bud invades the internal cavities and spongy bone forms
        
        4.The diaphysis elongates anda medullary cavity forms. Secondary ossification centers appear in the epiphyses
        
        5.The epiphyses ossify. When ossification is complete hyaline cartilage remains only in the epiphyseal plates and articular cartliges
    - - 1. Ossifictaion centers develop in the fibrous connective tissue membrane.
        
        2. Osteoid is secreted and calcifies; trapped osteoblasts become osteocytes
        
        3. Immature spongy bone and periosteum form
        
        4. Compact bone replaces immature spongy bone, just deep to the periosteum. Red marrow develops.
  - - - 2.Fibrocartliginous callus form both internal and external of the injury within 48 hours
        
        3. Boney callus forms trabeculae span the width of the callis amd unite the two fragements of broken bone
        
        4.Bone remodeling occurs
  - - - 2. Hypertrophic zone: older cartlige cells enlarge
        
        3. Calcification zone: Matrix becomes calcified; cartlige cells die; matrix begins deteriorating
        
        4. Ossification zone: new bone is forming
  - - - 2. Deposition calcium salts are depostied on the bones surface
        
        3. Formation: osteoblast lay down new bone until the resorbed bone is completely replaced