1. Skeletal System

2. Two Parts Axial Skeleton Axial Skeleton –Skull, sternum, ribs, vertebrae Appendicular skeleton Appendicular skeleton –Upper extremities, lower extremities, shoulder girdle, pelvic girdle How many bones total?

3. Function Foundation/Framework Foundation/Framework Protection of vital organs Protection of vital organs Movement (can’t do without muscles) Movement (can’t do without muscles) Blood production Blood production –Avg of 2.6 million erythrocytes produced each second by marrow Storage of minerals Storage of minerals

4. Types of Bones Long Long Short Short Flat Flat Irregular Irregular Sesamoid Sesamoid http://www.human- anatomy.net/images/anatomy_for_exercise/C lassification_of_bones.jpg

5. Long Bone Epiphysis Epiphysis –End of bone Metaphysis Metaphysis –Trans from epiphys plate to diaphysis Diaphysis Diaphysis –Shaft of bone (growing part) Epiphyseal Plate (Physis) Epiphyseal Plate (Physis) –Growth plate  Starts as cartilage and is replaced by bone http://www.web-books.com/eLibrary/Medicine/Physiology/Skeletal/long_bone.jpg

6. Bone Image Diaphysis (shaft) Metaphysis (transition) Epiphyseal Plate (growth plate) Epiphysis (end of bone)

7. Bone and Articular Cartilage Articular=places where bones meet (articulate) Articular=places where bones meet (articulate) Smooth surface at end of bones to help with gliding during mvmnt Smooth surface at end of bones to help with gliding during mvmnt Deterioration can occur Deterioration can occur –Arthritis –Chondral defects http://www.eorthopod.com/sites/default/files/imag es/knee_cart_surg_intro01.jpg

8. Bony Injuries Contusions Contusions Infections (osteomyelitis) Infections (osteomyelitis) Apophysitis Apophysitis –Growth plates http://www.boostphysio.com/blog/ wp- content/uploads/2010/06/osgood- schlatter.gif http://www.cjthakkar.com/old/photo/osgo od.jpg

9. Bony Injuries Fractures Fractures –Simple/Closed  Displaced  Non-Displaced –Complete –Incomplete –Compound/Open Multiple Types Multiple Types http://www.waybuilder.net/sweethaven/MedTech/Surgery02/927fig0502.jpg

10. Fracture Video http://www.youtube.com/watch?v=_kTyS pdpofg&feature=related http://www.youtube.com/watch?v=_kTyS pdpofg&feature=related http://www.youtube.com/watch?v=V1RlOj XzO7o&feature=related http://www.youtube.com/watch?v=V1RlOj XzO7o&feature=related

11. Specific Fracture (Fx) Types Linear Linear –Along length –MOI: landing from high jump (force through long axis) Comminuted Comminuted –More than 2 pieces –MOI: hard blow, awkward fall –Difficult to manage http://www.chezlark.com/pictures/Fracture.jpg

12. Specific Fx Types Transverse Transverse –Directly across bone –MOI: direct blow Oblique Oblique –Angled across bone –MOI: twisting/torsion Spiral Spiral –S-shaped (usually oblique in nature) –MOI: twisting with other end fixed http://ajs.sagepub.com/content/30/6/900/F3.large.jpg

13. Specific Fx Types Depression Depression –Abnormal concavity to bone –MOI: direct blow Impacted Impacted –One end wedged into other –MOI: significant load Stress Stress –Very small, incomplete fractures (don’t usually show on x-ray) –MOI: chronic stress on bone http://www.imagingpathways.health.wa.gov.au/includes/images/osteo/radial%20fracture.jpg

14. Specific Fx Types Greenstick Greenstick –Incomplete fx –Adolescents Apophyseal Apophyseal –Portion of bone starts to pull away –MOI: strong muscle contraction at growth plate http://www.mayoclinic.com/images/image_popup/ww5rl5 5.jpg

15. Specific Fx Types Avulsion Avulsion –Portion of bone is actually pulled off –MOI: progression of apophyseal fx; ligamentous stretch (ligament stronger than bone) Physeal (SALTER-HARRIS) Physeal (SALTER-HARRIS) –Fx through growth plate –MOI: any of aforementioned http://www.consultantlive.com/image/image_gallery?img_id=1419 701&t=1244224256843 http://www.davidlnelson.md/images/Salter -Harris.jpg

16. Fracture Healing Types of bone cells Types of bone cells –Osteocytes= bone cells –Osteoblasts= bone-forming cells –Osteoclasts= cells that absorb and remove bone

17. Fracture Healing Video http://www.youtube.com/watch?v=qVougi CEgH8 http://www.youtube.com/watch?v=qVougi CEgH8 http://www.youtube.com/watch?v=qVougi CEgH8 http://www.youtube.com/watch?v=qVougi CEgH8

18. Fx Healing cont. Fracture occurs Fracture occurs –Disrupts periosteum and capillaries Bony tissue is immobilized Bony tissue is immobilized –May require realignment Osteoblasts form callus Osteoblasts form callus –Bridge between fx areas Osteoclasts reshape bone Osteoclasts reshape bone –Wolff’s law: bone adapts to the stresses that are placed upon it http://upload.wikimedia.org/wikipedia/commons/f/f5/ Communitive_midshaft_humeral_fracture_callus.jpg

19. Fx Healing (http://www.scribd.com/doc/2562740/Bone-Histology-Healing-iBooktk) DAY 1: Hematoma (collection of blood forms as capillaries are torn) DAY 1: Hematoma (collection of blood forms as capillaries are torn) DAY 1-5: Inflammatory Phase (WBC invade, clotting, healing starts) DAY 1-5: Inflammatory Phase (WBC invade, clotting, healing starts) Day 7: Soft Callus forms (bony scar tissue forms matrix) Day 7: Soft Callus forms (bony scar tissue forms matrix) Day 21-42: Hard Callus (soft callus replaced with stronger bony tissue) Day 21-42: Hard Callus (soft callus replaced with stronger bony tissue) Day 42+: Remodels callus and continues to strengthen Day 42+: Remodels callus and continues to strengthen

20. Fx Healing cont. Cast usually removed at 4 weeks Cast usually removed at 4 weeks Start to stress bone at approx 4-6 weeks to help with remodeling Start to stress bone at approx 4-6 weeks to help with remodeling Weight bearing bones, site of fracture, and bones that have more difficulty healing take longer Weight bearing bones, site of fracture, and bones that have more difficulty healing take longer

21. Callus Formation

22. Surgical Fracture Videos http://www.youtube.com/watc h?v=qKeJd0j2J4E&feature=rel ated (Plated fibula) http://www.youtube.com/watc h?v=qKeJd0j2J4E&feature=rel ated (Plated fibula) http://www.youtube.com/watc h?v=qKeJd0j2J4E&feature=rel ated http://www.youtube.com/watc h?v=qKeJd0j2J4E&feature=rel ated http://img.medscape.com/pi/emed/ckb/orthopedic_sur gery/1230552-1239870-1173.jpg

23. Surgical Fracture Videos http://www.youtube.com/watch?v=OuPec rbui3M&feature=related (IM rod of femur) http://www.youtube.com/watch?v=OuPec rbui3M&feature=related (IM rod of femur) http://www.youtube.com/watch?v=OuPec rbui3M&feature=related http://www.youtube.com/watch?v=OuPec rbui3M&feature=related http://0.tqn.com/d/orthopedics/1/G/p/1/tibialrodap. jpg

24. Factors that Affect Bone/Healing Osteopenia; Osteoporosis Osteopenia; Osteoporosis –Reduced bone mass without fx; end stage/progression with presence of deformity of fx Menstrual Irregularities Menstrual Irregularities –Change in hormone production decreases bone strength Activity Level Activity Level –Wolff’s law; menstrual issues

25. Factors that Affect Bone/Healing Smoking Smoking –Nicotine cause vasoconstriction  decreased blood flow to areas of bone that are growing/healing Age Age –Older age  slower healing time –Kids tend to heal/remodel much better than adults

26. Recognition Factors for Fractures Pop or snap Pop or snap Obvious deformity Obvious deformity Localized swelling and deformity Localized swelling and deformity Palpable tenderness to bone Palpable tenderness to bone Express significant pain Express significant pain Clinical tests Clinical tests –X-ray –Bone scan –Percussion –compression

27. Bone Markings Processes of the bone are divided into two types. Processes of the bone are divided into two types. –Those that form joints –Those that connective tissue attach to (i.e. tendons, ligaments, etc.)

28. Processes that form joints Condyle – a large rounded articular prominence Condyle – a large rounded articular prominence Head – a rounded articular projection Head – a rounded articular projection Facet – a smooth flat surface Facet – a smooth flat surface

29. Femoral Condyle and Head

30. Facet

31. Processes to which connective tissue attach Tubercle – a small rounded process Tubercle – a small rounded process Tuberosity or styloid – a large rounded usually roughened process Tuberosity or styloid – a large rounded usually roughened process Trochanter – a large blunt projection Trochanter – a large blunt projection

34. Processes to which connective tissue attach Crest – a prominent border or ridge on a bone Crest – a prominent border or ridge on a bone Line – a ridge less prominent than a crest Line – a ridge less prominent than a crest Spinous process – a sharp slender process Spinous process – a sharp slender process Epicondyle – a prominence above a condyle Epicondyle – a prominence above a condyle