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A 12 year-old boy with bone fracture injurys (Physiology (Functions of…
A 12 year-old boy with bone fracture injurys
Physiology
Functions of Bones
Mineral and growth factor storage
Calcium and phosphorus, and growth factors reservoir
Blood cell formation
Hematopoiesis occurs in red marrow cavities of certain bones
Movement
Levers for muscles action
Acts as the "rigid bar" portion of the lever
Triglyceride (fat) storage
Fat, used for an energy source is stored in bone cavities
Protection
Protects the brain, spinal cord, and vital organs
Thoracic cavity protects heart and lungs
Hip bones protects kidneys and reproductive organs
The skull protects brain
Hormone production
Osteocalcin secreted by bones helps to regulate insulin, secretion, glucose levels, and metabolism
Support
For body and soft organs
Bones support the body and provide shape
Serve as scaffolding for attachment of skeletal muscles
Bone Remodeling
Purpose: to regulate blood-calcium level and thicken bon
Helps maintain blood calcium levels
Accomplished by osteoblast and osteoclast
Causes: hormones and mechanical stress
Parathyroid hormone increases osteoclast activity to trigger bone resorption and increase blood calcium levels
Calcitonin promotes osteoblast activity and acts as an antagonist to parathyroid hormone
Stages of bone healing
Callus formation
Fibroblasts form in granulation tissue, form bone, form cartilage at surfaces more distal to blood supply, provisional callus develops, holds bone together but will not support weight
Ossification
Callus forms into bone, fuses together fracture defect
Cellular proliferation
Blood supply increases, cells proliferate and the ends of bone fragments, hematoma becomes granulation tissue, fibroblasts convert to osteoblasts, halisteresis (softening of bone ends) and bone cells resorbed
Consolidation and remodeling
Bone marrow cavity restored, compact bone forms according to stress patterns, remodeling occurs according to Wolff's law, fracture line always visible
Hematoma formation
Impact, bleeding from bone and tissue, clotting, granulation tissue formed, osteoblastic activity stimulated
Location and Role of Epiphyseal Plate
Location
Disc of hyaline cartilage between epiphysis line and diaphysis in a bone that is still growing
The proliferation (growth) zone
Area of cartilage on diaphysis side of epiphyseal plate that is rapidly diving
New cells formed move upward, pushing epiphysis away from diaphysis, causing lengthening
Hypertrophy zone
Resting (quiescent) zone
Area of cartilage on epiphyseal side of epiphyseal plate that is relatively inactive
Calcification zone
Ossification (osteogenic) zone
Role
Growth plate
Maintains constant thickness
Rate of cartilage growth on one side balanced by bone replacement on other
Raw material for bone growth and repair
Made up of both organic and inorganic components
Organic components
Osteogenic cells
Bone-lining cells
Osteocytes
Osteoclasts
Osteoblast
Osteoid
Makes up 1/3 of organic bone matrix; secreted by osteoblasts
Consists of ground substance and collagen fibers
Inorganic components
Hydroxyapatite (mineral salts)
Consist mainly of tiny calcium, phosphate, crystals in and around collagen fibers
Responsible for hardness and resistance to compression
Make 65% of bone by mass
Joint Classification
Structural classifications
Fibrous
Suture
Example: fibers connecting flat bones of skull
Gomphosis
Example: periodontal ligament holding teeth in mandible
Composed of dense regular connective tissue between bones
Syndesmosis
Example: interosseous membrane between bones; ligaments
Cartilaginous
Synchondrosis
Example: costal cartilage; epiphyseal plates
Symphysis
Example: pubic symphysis; intervertebral discs
Bones joined by cartilage
Synovial
Ends of bones covered with hyaline cartilage, bones separated by capsule containing synovial fluid
Example: most joints of appendicular skeleton including knee, elbow, etc.
Functional classifications
Diarthrosis
Freely movable joint
Types of freely moving joints
Biaxial movement
Saddle joint
Ex: carpometacarpal joint of thumb
Condylar joint
Ex: knuckle and wrist joints
Uniaxial movements
Pivot joint
Ex: atlantoaxial joint
Hinge joint
Ex: elbow and interphalangeal joints
Nonaxial movement
Plane joint
Ex: inter tarsal and intercarpal joints
Multiaxial movement
Ball-and-socket joint
Ex: shoulder and hip joint
Always synovial
Synarthrosis
May be fibrous or cartilaginous
Immovable joint
Amphiarthrosis
Slightly movable joint
May be fibrous or cartilaginous
Upstream
Indirect
Behavior
Poor diet
Not intaking the right minerals and proteins
Calcium
Phosphate
The height of the boy
If the boy hit his arm from a taller height he is exposed to more critical fractures
If the boy hit his arm from a height closer to the ground he is exposed to less critical fractures
Direct
Trauma
Speed
Surface
The type of surface the boy fell unto can affect how hard he hit himself
Genetic Mutation
Lactose intolerance
Downstream
Location of the break
Right elbow appears broken (the elbow is a joint)
The elbow can cause many fractures
Neck fractures
Radial head
Signs and symptoms
Bruising
Stiffness
Swelling
Pain
Treatments
Surgery
Casts are used more frequently in children
Upper arm appears to be protruding from the skin
Which means a bone is poking out/broken
Also known as an open fracture/compound fracture
Treatment
Immobilize the injured area
Apply ice packs to limit swelling
Stop any bleeding
Considered a therapeutic emergency depending on the level of energy trauma
Boy's diet
Homeostatic imbalance
Even minute changes in blood calcium levels can cause severe neuromuscular problems
Hypercalcemia
High levels of calcium causes nonresponsiveness
Sustained high blood calcium levels can lead to deposits of calcium salts in blood vessels or kidneys and formation of kidney stones
Hypocalcemia
Low levels of calcium cause hyperexcitablility
Osteomalcia
Bones are poorly mineralized
Results in soft, weak bones
Pain upon bearing weight
Osteoid is produced, but calcium salts not adequately deposited
Rickets (osteomalacia of children)
Results in bowed legs and other bone deformities because bone ends are enlarged and abnormally long
Cause: Vitamin D deficiency or insufficient dietary calcium
Age of boy
Youth vs. Elderly
Elderly
As you get older bones become weaker
There bone contain more hydroxyapatite and less of proteins
Older people can break their bones quicker
Youth
Bones are stronger
In youth bones are stronger because of the proteins and osteoid
Osteoid include collagen and youth have a lot of that
Anatomy
Classification of Bones
Axial Skeleton
Skull
Cranial Bones
Frontal
Parietal
Occipital
Temporal
Sphenoid
Ethmoid
Facial Bones
Maxilla
Palatine
Zygomatic
Lacrimal
Nasal
Vomer
Inferior Nasal Concha
Mandible
Middle Ear Bones
Malleus
Incus
Stapes
Hyoid
Thoracic Cage
Ribs
Sternum
Body
Xyphoid
Manubrium
Vertebral Column
Cervical Vertebra
Thoracic Veertebra
Lumbar Vertebra
Sacrum
Coccyx
Appendicular Skeleton
Pectoral Girdle
Scapula
Clavicle
Pelvic Girdle
Os Coxa
Ishium
Pubis
Ilium
Upper Limbs
Ulna
Carpal
Triqueetrum
Hamate
Trapezium
Capitate
Scaphoid
Psiform
Lunate
Trapezoid
Radius
Metacarpal
Humerus
Phalanx
Lower Limbs
Femur
Tibia
Fibula
Patella
Tarsal
Talus
Calcaneus
Navicular
Cuboid
Lateral Cuneeiform
Intermediate Cuneiform
Medial Cuneiform
Metatarsal
Phalanx
Anatomy of a bone
Anatomy of a long bone
Epiphyseal Line
Between the diaphysis and distal epiphysis
Epiphyseal Line
Between the proximal epiphysis and diaphysis
Diaphysis (Shaft of the bone)
A thin layer of spongy bone between the marrow and compact bone
Function
To be rigid enough to tolerate strong forces and not bend or break
Medullary (marrow) Cavity
Contains yellow marrow (fat)
Compact Bone
Found deep to periosteum
Functional unit is an osteon
Osteocytes are arranged in layers called concentric lamellae
Periosteum
A membrane that covers the diaphysis
Proximal Epiphysis
Contains compact bone
Functional unit is an osteon
Osteocytes are arranged in layers called concentric lamellae
Covers the outside of the epiphysis
Articular cartilage (at joints)
Helps reduce friction when one bone meets another bone
periosteum (elsewhere but not at the joints)
Lines the outside of the epiphysis
Spongy Bone
Made up trabeculae
Helps resist stress
Bone marrow is found
Red bone marrow
Makes blood cells
Yellow bone marrow
Stores energy as fat
Proximal Epiphysis
Contains compact bone
Functional unit is an osteon
Osteocytes are arranged in layers called concentric lamellae
Covers the outside of the epiphysis
Articular cartilage (at joints)
Helps reduce friction when one bone meets another bone
periosteum (elsewhere but not at the joints)
Lines the outside of the epiphysis
Spongy Bone
Made up trabeculae
Helps resist stress
Bone marrow is found
Red bone marrow
Makes blood cells
Yellow bone marrow
Stores energy as fat
Basic structural unite of bone
Osteons
Cylindrical, weight-bearing structures that run parallel to the bone's axis
Composed of tubes inside of tubes (Lamellae)
Creates a cross-section of an often that looks like the rings of a tree trunk
Lamellae is filled with collagen fibers
Fibers seem to run in the same direction, but they run in a different direction
Between the layers of lamellae are tiny oblong spaces called lanculae
Lanculae houses osteocytes
Osteocytes monitor and maintain bone matrix
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Osteons are central canals
Hold nerves and blood vessels
Bone formation, growth, and remodeling
Bone Formation
Endochondral ossification
Bones are called cartilage (endochondral) bones
Form most of skeleton
Bone forms by replacing hyaline cartilage
Makes long bones
Osteoclasts create the hollow medullary cavity
Cartilage beside the articulate cartilage and epiphyseal plate is replaced with bone. Growth plates finally ossification. and become the epiphyseal line
Starts in hyaline cartilage; chondrocytes that secrete cartilage matrix get trapped in the lacunae and the perichondrium is calcified which creates a bone collar
Blood and ost4eoblast are sent from the periosteum bone collar to the core of the shaft. They fill the vacated areas left behind by the chondrocytes and it becomes the first ossification center in the diaphysis
Intramembranous ossification
Bone develops from fibrous membrane
Bones are called membrane bones
Makes flat bones
Calcium enters the ossification site and the osteoid is calcified into the bone matrix
The osteoblast get tipped in the matrix and are referred to as osteocytes
Mesenchymal cells become osteoblasts that secrete osteoid at the ossification center within the thin layer of mesenchyme
Woven bone made up of spongy bone and blood vessels is formed. The surrounding mesenchyme thickens to create the periosteum
Woven bone becomes lamellae as compact bone forms laterally towards the periosteum and spongy bone forms medially
Up to 8 weeks
Fibrous membranes and hyaline cartilage of fetal skeleton are replaced with bone tissue
Bone Remodeling
About 5-7% of bone mass is recycled each week
Spongy bone replaced
Every 3-4 years
Compact bone replaced
Every 10 years
Consist of both bone deposit and bone resorption
Bone deposit
Contains osteoid seam
Band of unmineralized bone matrix that marks area of new matrix
Calcification front
abrupt transition zone between osteoid seam and older mineralized bone
New bone matrix is deposited by osteoblast
Bone resorption (for osteoclasts)
Acidity coverts calcium salts to soluble forms
Osteoclast activate PTH (parathyroid hormone) and immune T cell proteins
Secrete lysomal enzymes and protons (H+) that digest matrix
Break down matrix
Occurs at surfaces of both periosteum and Endosteum
Packets of adjacent osteoblasts and osteoclasts coordinate remodeling process
Bone Growth
Interstitial
Five zones of epiphyseal plate
Calcified cartilage; multiple layers of dying chondrocytes and minerals
Ossification; capillaries and osteoprogenitor cells are present; new bone matrix is created
Hypertrophic cartilage; chondrocytes enlarge and resorb matrix
Resting cartilage; small chondrocytes; connects to epiphysis
Proliferating cartilage; chondrocytes undergo mitosis and enlarge
Increases length of long bones until epiphyseal plat4e closes
Appositional
Osteoclast resorb old bone matrix in the medullary cavity
Osteoblast in the periosteum produce more bone matrix
Bones get thicker but not heavier
Bone Fracture Classification
Position of the bone ends after fracture
Displaced fractures
The bone ends are out of normal alignment
Non-displaced fractures
The bone ends retain their normal position
Whether the bone ends penetrate the skin
Open (compound) fracture
When the bone ends penetrate the skin
Closed (simple) fracture
When the bone ends don't penetrate the skin
Completeness of the break
Complete fractures
The bone is broken through
Incomplete fractures
The bone isn't broken through
Types of movement at joints
Angular movements
Lateral flexion
Lateral bend in vertebral column
Abduction
Movement of body part away from midline in lateral direction
Ex: raising arm laterally
Hyperextension
Extending joint past anatomical portion
Ex: extending next to look up
Adduction
Movement of body part toward midline in lateral plane
Ex: lowering arm laterally to side of body
Extension
Angle of joint increases in anterior-posterior plane
Ex: straightening elbow
Circumduction
Continuous movement that includes flexion, extension, abduction, and adduction to move distal end of appendage in a circle
Ex: making a cicular motion with the hand to wax a car
Flexion
Ex: bending elbow
Angle of joint decreases in anterior-posterior plane
Rotational movements
Supination
Rotating forearm so palm is facing anteriorly
Medial rotation
Rotating body part toward midline
Ex: rotating head from looking to the side to looking forward
Pronation
Rotating forearm so pain is facing posteriorly
Lateral rotation
Rotating body part away from midline
Ex: turning head to side
Bone pivots around longitudinal axis
Gliding movements
Ex: bones of wrist in wrist flexion
Two bones slide past each other in any direction
Special movements
Eversion
Twisting the foot to expose the sole laterally
Inversion
Twisting the foot to expose the sole medially
Plantar flexion
Ankle movement that pointes toes
Protraction
Moving a body part anteriorly from anatomical position
Ex: thrusting jaw forward
Dorsiflexion
Ankle movement that raises toes
Retraction
Moving a body part posteriorly from anatomical position
Ex: drawing jaw back from protracted position
Elevation
Moving a body part up or superiorly
Ex: raising the jaw to close mouth
Opposition
Bringing thumb to fingers for grasping
Depression
Moving a body part down or interiorly
Ex: lowering the jaw to open mouth