1. Skeletal System

2. Question of the Day
How long does the inflammatory phase of healing last and what are the six steps?
Duration is 3-5 days directly following injury; 6 steps: vasoconstriction, release of chemical mediators, vasodilation, margination, phagocytosis, and clotting

3. Two Parts Axial Skeleton (80 total bones)
Skull, sternum, ribs, vertebrae
Appendicular skeleton (126 total bones)
Upper extremities (shoulder girdles=64), lower extremities (pelvic girdles=62)
How many bones total?
How many in an infant?

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

5. Types of Bones Long Short Flat Irregular Sesamoid

6. Long Bone Epiphysis Metaphysis Diaphysis Epiphyseal Plate (Physis)
End of bone
Metaphysis
Trans from epiphys plate to diaphysis
Diaphysis
Shaft of bone (growing part)
Epiphyseal Plate (Physis)
Growth plate
Starts as cartilage and is replaced by bone

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

8. Bone and Articular Cartilage
Articular=places where bones meet (articulate)
Smooth surface at end of bones to help with gliding during mvmnt
Deterioration can occur
Arthritis
Chondral defects

9. Bony Injuries Contusions Infections (osteomyelitis) Apophysitis
Bony Injuries
Contusions
Infections (osteomyelitis)
Apophysitis
Growth plates

10. Bony Injuries Fractures Multiple Types Simple/Closed Compound/Open
Displaced
Non-Displaced
Complete
Incomplete
Compound/Open
Multiple Types

11. Fracture Video
(joe theisman)

12. Questions of the day
What are the 5 types of bone (list an example of each)? What are the four parts of a long bone?
Answer: Long (femur), Short (carpals or tarsals), Flat (bones of skull; ribs), Irregular (vertebrae, pelvic), sesamoid (patella); Epiphysis (end), physis (growth plate), metaphysis (transition), diaphysis (shaft)

13. Specific Fracture (Fx) Types
Linear
Along length
MOI: landing from high jump (force through long axis)
Comminuted
More than 2 pieces
MOI: hard blow, awkward fall
Difficult to manage

14. Specific Fx Types Transverse Directly across bone MOI: direct blow
Oblique
Angled across bone
MOI: twisting/torsion
Spiral
S-shaped (usually oblique in nature)
MOI: twisting with other end fixed

15. Specific Fx Types Depression Abnormal concavity to bone
MOI: direct blow
Impacted
One end wedged into other
MOI: significant load
Stress
Very small, incomplete fractures (don’t usually show on x-ray)
MOI: chronic stress on bone

16. Specific Fx Types Greenstick Incomplete fx Adolescents Apophyseal
Portion of bone starts to pull away
MOI: strong msl contraction at growth plate

17. Specific Fx Types Avulsion Physeal (SALTER-HARRIS)
Specific Fx Types
Avulsion
Portion of bone is actually pulled off
MOI: progression of apophyseal fx; ligamentous stretch (ligament stronger than bone)
Physeal (SALTER-HARRIS)
Fx through growth plate
MOI: any of aforementioned

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

19. Fracture Healing Video
(1:13)

20. Fx Healing cont. Fracture occurs Bony tissue is immobilized
Disrupts periosteum and capillaries
Bony tissue is immobilized
May require realignment
Osteoblasts form callus
Bridge between fx areas
Osteoclasts reshape bone
Wolff’s law: bone adapts to the stresses that are placed upon it
Communitive_midshaft_humeral_fracture_callus.jpg

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

22. Fx Healing cont. Cast usually removed at 4 weeks
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

23. Surgical Fracture Videos
(Plated fibula) [2:27]

24. Surgical Fracture Videos
(IM rod of femur) [2:23]

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

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

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

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

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