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12 year old boy running & fell forward on right arm. Bone fracture…
12 year old boy running & fell forward on right arm. Bone fracture injury right elbow appears broken, upper arm appears to be protruding form skin. Fragments of bone in the wound. Child is lactose intolerant, never consumes dairy products only eats burgers, hot dogs, spaghetti & junk food
Anatomy of long bone
Diaphysis: Shaft, or middle section, of a long bone
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Articular cartilage:Thin layer of hyaline cartilage located on the distal and proximal epiphysis of the bone.
Periosteum:Tough layer of fibrous connective tissue that surrounds the bone and is continuous with tendons and ligaments
Medullary Cavity:Hollow space within the diaphysis, which contains the yellow marrow.
Endosteum:Thin layer of cells lining the medullary cavities and the trabeculae of spongy bone inside the bone
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Epiphyseal plate: band of hyaline cartilage found between the diaphysis and epiphyses of long bones during childhood and adolescence; area where bone increases in length
Bones form
Remodeling
5-7% bone mass recycle each week, Spongy bone 3-4 year, Compact bones every 10 years
Bone Resorption
the dissolution or assimilation of a substance, as bone tissue, by biochemical activity.
Bone Deposition
it is the formation of bones. This is the principal role of calcitriol. It requires both calcium and phosphate.
Bone healing
Primary healing:(also known as direct healing) requires a correct anatomical reduction which is stable, without any gap formation
Contact Healing:When the gap between the bone ends is less than 0.01 mm In this case, cutting cones, which consists of osteoclasts, form across the fracture lines Osteoblasts fill up the cavities with the Haversian system.
Gap Healing: fracture is filled by osteoclasts and then by lamellar bone oriented perpendicular to the axis of the bone. The bone is weak, a secondary osteonal reconstruction is required to re-orient the lamellar bone longitudinally. Takes about 3-8 weeks
Secondary healing: (also known as indirect fracture healing) is the most common form of bone healing
Reaction: inflammation, granulation tissue formation
Repair: Cartilage callus formation, Lamellar bone deposition
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Bone growth/repair
Proliferation Zone: Cartilage cells undergo mitosis, cells divide quickly
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Calcification Zone: Cartilage cells die, matrix beings deteriorating
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Hormones: Thyroid hormones modulate the activity of growth hormone, ensuring that the skeleton has proper proportions as it grows
Puberty: sex hormones released in increasing amounts. Some circulating testosterone converts to estrogen that has critical role in bone development
Epiphyseal Plate
The epiphyseal plate (or epiphysial plate, physis, or growth plate) is a hyaline cartilage plate in the metaphysis at each end of a long bone.
Bone fractures
Types of fractures
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Compression - The bone is crushed, causing the broken bone to be wider or flatter in appearance.
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Segmental - The same bone is fractured in two places, so there is a "floating" segment of bone.
Treatment/Repair
A hematoma forms: Bone breaks then blood vessels in bone are torn. Forming blood clots, nutrition dies and tissue site becomes swollen, painful, inflammed
Bony callus forms: Spongy bone begins forming. Fibrocartilaginous replaced by immature bone to bony callus until hard
Fibrocartilaginous callus forms: Blood vessels grow into clot. fibroblast creates collagen fibers that connect broken bone ends
Bone remodeling occurs: Compact bone is laid down to reconstruct shaft wall. Repaired area resembles original unbroken bone region.
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The radius and ulna, bones of the forearm run from the elbow to the wrist. Ligaments, muscles, and tendons maintain the elbow's stability and allow joint movement.
radial head is the knobby end of the radius where it meets the elbow. It glides up and down the front of the distal humerus when you bend your arm and rotates around the ulna when you turn your wrist up or down.
olecranon is the part of the ulna that "cups" the lower end of the humerus, creating a hinge for elbow movement. The bony "point" of the olecranon can be easily felt beneath the skin because it is covered by just a thin layer of tissue.
Diet
Collagen is a protein that's an important building block for bone. Vitamin C helps your body make collagen, which helps your bone fracture heal. You can get it from many tasty, fresh fruits and veggies
Foods like cheese or yogurt may be easier to digest than milk, so try a cup ofyogurt for dessert or add a piece of cheese to your sandwich. Lactose-free milk isalso a great way to get calcium in your diet without the problems that can come withlactose.