ARIEF ZAMIR TANTI WIDYA ISHWARA

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 Fractures
Dislocations Sprains Muscle injuries (Strains, contusions, cramps)

Functions of Bones
Support of the body
Protection of soft organs

Movement due to attached skeletal muscles

Storage of minerals and fats Blood cell formation
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Bones of the Human Body

The skeleton has 206 bones
22 bones in skull 6 in middle ears 1 hyoid bone 26 in vertebral column 25 in thoracic cage

4 in pectoral girdle 60 in upper limbs 60 in lower limbs 2 in pelvic girdle

Two basic types of bone tissue

Compact bone
Homogeneous Spongy bone Small needle-like pieces of bone Many open spaces
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Figure 5.2b

Bones are classified by their shape: 1.Long- bones are longer than they are wide (arms, legs) 2.Short- usually square in shape, cube like (wrist, ankle) 3.Flat- flat , curved (skull, Sternum) 4.Irregular- odd shapes (vertebrae, pelvis)

Classification of Bones on the Basis of Shape

Figure 5.1
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Types of Bone Cells

Osteocytes
Mature bone cells

Osteoblasts
Bone-forming cells

Osteoclasts
Bone-destroying cells Break down bone matrix for remodeling and release of calcium
Bone remodeling is a process by both osteoblasts and osteoclasts
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The Skeletal System

Parts of the skeletal system
Bones (skeleton) Joints Cartilages Ligaments (bone to bone)(tendon=bone to muscle)

Divided into two divisions

Axial skeleton Appendicular skeleton

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The Axial Skeleton

Forms the longitudinal part of the body Divided into three parts Skull Vertebral Column Rib Cage

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The Appendicular Skeleton

Limbs (appendages) Pectoral girdle Pelvic girdle

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Bones of the Shoulder Girdle

Figure 5.20a, b
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Bones of the Upper Limb

The arm is formed by a single bone
Humerus

Figure 5.21a, b
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Bones of the Upper Limb

The forearm has two bones

Ulna
Radius

Figure 5.21c
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Bones of the Upper Limb

The hand
Carpals wrist

Metacarpals palm
Phalanges fingers
Figure 5.22
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Bones of the Pelvic Girdle

Hip bones Composed of three pair of fused bones
Ilium Ischium Pubic bone

Protects several organs

Reproductive organs Urinary bladder Part of the large intestine

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Slide 5.37

The Pelvis

Figure 5.23a

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Bones of the Lower Limbs

The thigh has one bone

Femur thigh bone

Figure 5.35a, b
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Bones of the Lower Limbs

The leg has two bones

Tibia Fibula

Figure 5.35c
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Bones of the Lower Limbs

The foot
Tarsus ankle

Metatarsals sole Phalanges toes

Figure 5.25
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Diaphysis Long, narrow shaft Dense, compact bone Metaphysis Head of bone Between epiphysis and diaphysis Medullary canal Contains marrow

Periosteum Outer fibrous covering Allows for increase in diameter Vascular Nerves Epiphysis Articulated, widened end Allows bone to lengthen Cancellous bone with red blood marrow Weakest point in childs bone

Anatomy of a Long Bone

Diaphysis
Shaft Composed of compact bone

Epiphysis
Ends of the bone
Composed mostly of spongy bone
Figure 5.2a
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Slide 5.6

Structures of a Long Bone

Periosteum
Outside covering of the diaphysis
Fibrous connective tissue membrane

Sharpeys fibers
Secure periosteum to underlying bone

Arteries
Supply bone cells with nutrients
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Figure 5.2c

Slide 5.7

Structures of a Long Bone

Articular cartilage
Covers the external surface of the epiphyses
Made of hyaline cartilage Decreases friction at joint surfaces

Medullary cavity
Cavity of the shaft Contains yellow marrow (mostly fat) in adults Contains red marrow (for blood cell formation) in infants
Figure 5.2a

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Slide 5.8a

Microscopic Anatomy of Bone

Figure 5.3

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Compact bone osteocytes within lacunae arranged in concentric circles called lamellae This surround a central canal; complex is called Haversian system Canaliculi connect osteocytes to central canal and to each other

Fetus: 1st 2 months

Endochondral Ossification

2o ossification center

cartilage

bone
calcified cartilage
Just before birth

epiphyse al plate
Childhood Adult

epiphyseal line

A joint, or articulation, is the place where two bones come together.

Fibrous- Immovable (synarthoses) :connect bones, no movement. (skull and pelvis). Cartilaginous- slightly movable (amphiarthoses), bones are attached by cartilage, a little movement (spine or ribs). Synovial- freely movable (diarthroses)- , much more movement than cartilaginous joints. Cavities between bones are filled with synovial fluid. This fluid helps lubricate and protect the bones.

The Synovial Joint

Figure 5.28
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Types of Synovial Joints Based on Shape

Figure 5.29ac
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Types of Synovial Joints Based on Shape

Figure 5.29df
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Break in the continuity of the bone, When force is applied that

exceeds the tensile strength or compressive strength of the bone

2 types :
Closed or simple fracture
Injury to the bone No external or open wound on the skin

Open or compound fracture

Break in the bone Open wound on the skin

Type II

Type IIIA

Type IIIB

Type IIIc

Direct Break occurs at point of impact

Indirect Force is transmitted along bone Injury occurs at some point distant to point of impact Femur, hip, pelvic fracture due to knees hitting dash

Twisting Distal limb remains fixed Proximal part rotates

Shearing, fracturing occur

Avulsion Muscle and tendon unit with attached fragment of bone ripped off bone shaft

Stress Occur in feet secondary to prolonged running or walking

Pathological Result of Fx with minimal force Cancer, osteoporosis

Complete
Complete cortical circumference involved Fragments are completely separated

Incomplete
Not fractured all the way through Only one cortex involved e.g Greenstick fracture

 greenstick oblique transverse comminuted spiral impacted

Oblique

Comminuted

Spiral

Compound

 Cuts shaft at right angle to long axis Often caused by direct injury

 Pliable bone splinters on one side without complete break Occurs in children

 Fx site coils through bone like spring Occurs with torsion

 Occurs at angle to long axis of shaft

 Bone broken into 3 or more pieces

Periosteal reaction

Callus / Osteosclerosis

Fat pad sign / Sail sign

patophysiology

Moderate to severe energy transmitted

Bone impact exceed tensile strength Fat embolus Break in the continuity of the bone Bleeding

Swelling Pain Deformity Loss of function Impaired sensation Decrease mobility

Myoglobinurea
Compartment syndrome

Hematoma formation Bone tissue dies

Stimulates inflammatory response

Decalcify fracture bone ends

Bone tissue revascularization

Osteoblast
Procallus Callus

Remodeling

New bones

Local Swelling

Loss of function or abnormal movement of affected part

Deformities such as shortening, rotation Crepitation

Pain/ local tenderness

Anesthesia and flaccidity (few minute to hours) - This is due to a temporary loss of nerve function at the

site associated vascular injury.

History of Present Injury

Where is pain felt? What occurred? What position was limb in? Were deceleration forces involved? Was there direct impact? Has there ever been previous trauma or Fx?

Palpation and Inspection

Swelling/Ecchymosis
Hemorrhage/Fluid at site of trauma

Deformity/Shortening of limb
Compare to other extremity if norm is questioned

Guarding/Disability
Presence of movement does not rule out fracture

Palpation and Inspection

Tenderness
Use two point fixation of limb with palpation with other hand. Tenderness tends to localize over injury site.

Crepitus
Grating sensation Produced by bones rubbing against each other. Do not attempt to elicit.

Palpation and Inspection

Exposed bones
Fx can be open without exposed bones

Principal danger is not to bones, but to underlying neurovascular structures around bone.

Palpation and Inspection

Distal to injury, assess:
skin color skin temperature sensation motor function

If uncertain, compare extremities When in doubt splint!

blood clot in space between edges of break Fibrocartilage callusbegins tissue repair

Hematoma -

Bony callusosteoblasts produce trabeculae (structural support) of spongy bone and replace fibrocartilage

Remodelingosteoblasts build new compact bone, osteoclasts build new medullary cavity

The callus is the first phase of healing which can be demonstrated radiographically.

Stages in the Healing of a Bone Fracture

Figure 5.5

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Slide 5.19

Hemorrhage
Possible loss within first 2 hours
Tib/Fib - 500 ml Femur - 500 ml Pelvis - 2000 ml

Interruption of Blood Supply

Compression on artery
decreased distal pulse

Decreased venous return

Disability
Diminished sensory or motor function
inadequate perfusion direct nerve injury

Specific Injuries
Dislocation Amputation/Avulsion Crush Injury (soft tissue trauma discussion)

Osteomyelitis
The open area is a rich culture medium for infection. It retards healing by destroying newly formed bone and interrupting its blood supply. S. aureus is the usual cause.

Complications
Embolism
Fat & Pulmonary Embolism
Fractures of long bones may release enough fat to travel through the veins, they attract platelets which become part of the microembolus and deplete circulating platelets

Complications
incorrect

Delayed union

Failure

Complications
Nerve Damage

Bone fragments may

rupture and compress nerves that may also be damaged by dislocation or direct trauma

Complications

Subluxation

Dislocation

if the contact bone between the opposing bone surface is partially lost.

temporary displacement of one or more bones in a joint in which the opposing bone surface loss contact entirely.

Complication
Myoglobinuria (Rrabdomyolysis)
Severe muscle trauma. An excess myoglobin (intracellular muscle protein) in the urine. Muscles damage, with disruption of sarcolemma, releases myoglobin which would lead to renal failure

Complication
COMPARTMENT SYNDROME
- Pressure build within the compartment
due to bleeding. - swelling reaches the point at which the

fascia permits no outward enlargement

- increasing pressure is directed inward and compresses components in the compartments.

Dislocation