A Classification of Fractures Fractures are clasified according to their external appearance, their location, and the nature of the crack or breakin the bone. Important types of fracture are indicated here by representative X rays. Closed, or simple, fractures are completely internal. They do rot involve a break in the skin and are usually relatively simple to ‘weat, asthe ends of the bone remain close together. Open, or compound, fractures project through the skin. They are more dangerous than closed fractures, due to the possibilty of infec: tion oF uncontrolled bleeding, Many fractures fall into more than A Pott’ fracture occurs atthe ankle and affects both bones of the le, Comminuted fractures, such as this fracture of the femur, shatter the affected area into a ‘multitude of bony fragments, A Colles fracture, ‘a break inthe distal portion of the radius, is typically the result of reaching out to ceushion a fal Tn a greenstick fracture, such as this fracture of the radius, only one side of the shaft is broken, an the other is bent. This ype of fracture penerally oceurs in children, bones have ossify fully calcific ‘Transverse fractures, such as ths fracture of the ulna, break a shaft bone across its long axis Epiphyseal feactures, such as this fracture of the femur, tend to occur ‘where the bone matrix is undergoing jon and chondrocytes ate dying, A clean transverse fracture generally heals well Unless carefully treated, fractures between the epiphysis and the epiphyseal cartilage can permanently stop growth at this site, along this bi (5 focus cone category, For example, a Colles fracture isa transverse frac ture that, depending on the injury, may also be an open or closed comminuted fracture. Commninuted fractures are characterized by a shattering of the affected bone, These fractures are common in industries in which heavy equipment is used, such as farming and construction, Representative examples of the common types of fractures are shown in Figure 6-15e, identifying the fracture in these images takes some practice. Look forthe dark line that in- terrupts the homogenous appearance of the bone of the shat. Spiral fractures such as this fracture of the tibia, are produced by twisting stresses that spread along the length of the bone, Displaced fractures produce new and abnormal bone arrangements; nondisplaced fractures retain the normal alignment of the bones or fragments. ‘Compression fractures occur in vertebrae subjected to extreme stresses such as those produced by the forces tha rise when you land on your seat in a fall FIGURE 6-15 Major Types of Fractures204 CHAPTER 6 OSSEOUS TISSUE AND SKELETAL STRUCTURE I 6-7 AGING AND THE SKELETAL SYSTEM Objective © Summarize the effects of the aging process on the skeletal system. ‘The bones of the skeleton become thinner and weaker as a nor- mal part of the aging process. Inadequate ossification is called ‘osteopenia (os-t8-0-PE-né-uhs penta, lacking), and all of us be- come slightly osteopenic as we age. This reduction in bone mass begins between the ages of 30 and 40. Over that period, 08- ‘coblast activity begins to decline, while osteoclast activity con- tinues at previous levels. Once the reduction begins, women lose roughly 8 percent oftheir skeletal mass every decade, whereas the skeletons of men deteriorate at about 3 percent per decade. Not all parts of the skeleton are equally affected. Epiphyses, vertebrae, and the jaws lose more than their share, resulting in fragile limbs, a reduction in height, and the loss of teeth, When the reduction in bone mass is sufficient to compromise normal function, the condition is known as osteaporosis (os-té- 6-por-O-sis; porosus, porous). The fragile bones that result ate likely to break when exposed to stresses that younger individeals could easity tolerate. For example, a hip fracture can occur when woman in her nineties simply tries to stand, Any fractures that do occur lead to a loss of independence and an immobility that further weakens the skeleton. The extent of the loss of spongy bone mass due to osteoporosis is shown in Figure 6-169; the re: duction in compact bone mass is equally severe Sex hormones are important in maintaining normal rates of bone deposition, Over age 45, an estimated 29 percent of women, and 18 percent of men have osteoporosis. The condition acceler- ates after menopause, owing toa decline in circulating estrogens. Because men continue to produce androgens until relatively late in lif, severe osteoporosis is less common in males below age 60 than in females in that same age group. Osteoporosis can also develop as a secondary effect of many cancers, Cancers of the bone marrow, breast, or other tissues re- lease @ chemical known as osteoclast-activating factor. This compound increases both the number and activity of osteoclasts and produces severe osteoporosis. [1 osteoporosis and Age-elated Stolett Abnormalities ¥ At which point in fracture repair would you find an external ellos? Why is osteoporosis more common in older women than in older nome start om page 21 (b) Spongy bone in osteoporosis (SEM x 21) FIGURE 6-16 The Effects of Osteoporosis. (a) Normal spongy bone from the epiphysis of a young adult. (a) Spongy bone from a person witChapter Review SELECTED CLINICAL TERMINOLOGY Terms Discussed in This Chapter acromegaly: A condition caused by excess secretion of growth hor- ‘mone after puberty. Skeletal abnormalities develop, affecting the car tilages and various small bones. (p. 198) external callus: A toughened layer of connective tissue that encir~ cles and stabilizes bone at a fracture site. (p. 200) fracture: A crack or break in a bone. (p. 198) fracture hematoma: A large blood clot that closes off the injured vessels around a fracture and leaves a fibrous meshwork in the dam- aged area of bone; the first step in fracture repair. (p. 200) ‘gigantism: A condition resulting from an overproduction of growth hormone before puberty. (p: 198) internal callus: A bridgework of bone trabeculae that unites the broken ends of a bone on the marrow side ofa fracture. (p. 200) Marfan’s syndrome: An inherited condition linked to defective production of fibril, a connective tissue glycoprotein. Extreme height ancl long, slender limbs are the most obvious physical indica tions of Marfan’ syndrome; cardiovascular problems are the most dangerousaspects of the condition. (p. 198) ‘osteoclast-activating factor: A compound, released by cancers of the bone marrow, breast, or other tissues, that produces a severe 0s leoporosis. (p. 204) STUDY OUTLINE 6-1 THE SKELETAL SYSTEM: AN INTRODUCTION p. 183 1, ‘The skeletal system includes the bones of the skeleton and the cartilages, ligaments, and other connective tissues that stabilize fr connect them. The functions of the skeletal system include support, storage of minerals and lipids, blood cell production, protection, and leverage 6-2 A CLASSIFICATION OF BONES p. 184 BONE SHAPES p. 184 1. Bones may be categorized as long bones, short bones, flat bones, irregular bons, sesamoid bones, and sutural bones (Wormian bones). Figure 6-1) BONE STRUCTURE p. 185 2. The two types of bane are compact (dense) bone and spongy (cancelious) bone. 3. A representative long bone has a diaphysis, epiphyses, retaphyses, articular cartilages, and a marrow cavity. (igure 6-2) 4 The marrow cavity and spaces within spongy bone contain ether yellow bone marrow (for lipid storage) 07 red bone marrow (fr ‘ood call formation). 6-3 BONE HISTOLOGY p. 186 1. Osseous tissue is a supporting connective tissue with a solid ma trix, The minerals are deposited in lamellae and ensheathed by a periosteum. Chapter Review [205 costeomalacta (os-té-3-ma-LA-sheS-uh): A softening of bone due to a decrease in its mineral content, (p. 199) ‘osteopenia (0s-t2-6-PE-né-uh): Inadequate ossification leading to thinner, weaker bones. (p. 204) ‘osteoporosis (9s-8-6-por-O-sis:_A reduction in bone mass to a degree that compromises normal function. (p 204) pituitary growth failure (pituitary dvarfism): A disorder caused by inaclequate production of growth hormone. (P. 198) rickets: A childhood disorder that reduces the amount of calcium salts in the skeletons typically characterized by a bovlegged appear- ance, because the lg bones bend under the body’s weight. (p. 198) scurvy: A condition involving weak, brittle bones as a result ofa vi tamin C deficiency. (p. 197) Im Additional Terms Discussed the Applications Manual achondroplasia inyperostosis tulcogenesisimperfecta ‘osteomyelitis csteopetro Paget ‘THE MATRIX OF BONE p. 186 2, Bone matrix consists largely of crystals of hydroxyapatite. CELLS IN BONE p. 185 3, Osteocytes, located in lacunae, are mature bone ells. Adjacent ‘osteocytes are interconnected by canaliculi. Osteoblasts synthe- size the bony matrix by asteogenesis. Osteoclasts dissolve the bony matrix through osteolysis. Osteoprogenitor cells differen tiate into osteoblasts, (Figure 6-3) COMPACT BONE AND SPONGY BONE p. 188 44, The basic Functional unit of compact bone is the osteon, con taining osteocytes arranged around.a central canal. Perforating canals extend perpendicularly tothe bone surface. (Figure 6-1) Spongy bone contains trabeculae, typically in an open network, (Figure 6-4) 6. Compact bone is located where stresses come trom a limited range of directions, suchas along the diaphysis of some bones. Spongy bone is located where stresses are few or come from many directions stich as atthe epiphyses of some bones. (Figure 6-5) THE PERIOSTEUM AND ENDOSTEUM p. 190 7. Abone is covered by a periosteum and lined with an ‘endosteum. (Figure 6-5) Bone markings: Anatomy CD-ROM: Skeletal System/Axial Dissections206 | CHAPTER 6 OSSEQUS TISSUE AND SKELETAL STRUCTURE 6-4 BONE DEVELOPMENT AND GROWTH p. 191 1. Ossification isthe process of converting other tissues to bone. Calcification is the process of depositing calcium salts within & tissue INTRAMEMBRANOUS OSSIFICATION. p. 191 2. Intramembranous ossification begins when osteoblasts differen tiate within connective tissue. The process produces dermal bones Such ossification begins at an ossification center, (Figure 6-7) ENDOCHONDRAL OSSIFICATION. p. 192 3, Endochondral ossification begins witha cartilage model that is sradually eplaced by bone a the metaphysis, In this way, bone length increases. (Figure 6-8) ‘The timing of closure of the epiphyseal cartilage differs among. bones and among individuals. (Figure 6-9) 5. Bone diameter increases through appestional growth, (Figure 6-10) .<£aIntramembranous and endochondal ossification: Companion Website: Chapter 6/Tutorals ‘THE BLOOD AND NERVE SUPPLIES p. 194 6. Three major sets of blood vessels provide an extensive supply of blood to bone. (Figure 6-11) 6-5 THE DYNAMIC NATURE OF BONE p. 196, 1. The organic and mineral components of bone are continuously recycled and renewed through remodeling, EFFECTS OF EXERCISE ON BONE. p. 196 2. The shapes and thicknesses of bones reflect the stresses applied to them, REVIEW QUESTIONS HORMONAL AND NUTRITIONAL EFFECTS ON BONE p. 197 3, Normal osteogenesis requires a reliable source of minerals, vita- mins, and hormones, 4. Growth hormone and thyroxine stimulate bone growth, Cakitonin and parathyroid hormone control blood calcium levels. (Table 6-1) THE SKELETON AS A CALCIUM RESERVE p. 198 alcium is the most common mineral in the human body, with oughly 99 percent of it located in the skeleton, (Figure 6-12) 6. Interactions among the bones, intestinal tract and kidneys affect the ealium ion concentration, (Figure 6-13) 7. Two hormones, calcitonin and parathyroid hormone (PTH), regulate calcium ion homeostasis, Caleitonin leads toa decline in the calcium concentration, whereas parathyroid hormone in- creases the calcium concentration. (Figure 6-13) FRACTURE REPAIR p. 199 8, A fracture isa crack ora break in a bone, The repair ofa fracture involves the formation ofa fracture hematoma, an external cal- lus, and an internal calls. (Figure 6-14) 6-6 BONE MARKINGS (SURFACE FEATURES) p. 201 1, Each bone has characteristic bone markings, including cleva- tions, projections, depressions, grooves, and tunnels. Table 6-2) 6-7 AGING AND THE SKELETAL SYSTEM p, 204 1. The eects of aging on the skeleton include osteoper osteoporosis. (Fire 6-16) and More assessment questions are available to you on the Companion Website. You wil find Matching, Multiple Choice, TrueFalse, and other ‘izes to help further your understanding of the material covered inthis chapter. To access the site, go to www. aw com/mattii LEVEL 1 Reviewing Facts and Terms 1. Hematopoiesis occurs in the bones ofthe skeleton in areas of| (a) yellow marrow (b) ted marrow (©) the matrix of bone tissue (€) the ground substance 2, Two-thirds ofthe weight of bone is accounted for by (a) crystals of calcium phosphate (b) collagen fibers (©) osteocytes (4) calcium carbonate 3. The membrane found wrapping the bones, except atthe joint cavity, isthe (a) periosteum (b) endosteum (6) perforating fibers (@) asb,and care correct 4. The basic functional units of mature compact bone are called (a) lacunae (b) osteocytes (6) osteons (@) canaliculi 5. Unlike compact bone, spongy bone contains concentric lamellae that form struts or plates called (a) canaliculi (b) canals of Volkmann (6) osteons (@) trabeculae 6. The vitamins essential for normal adult bone maintenance and repair are (a) Aand E (&) Cand D (©) Band E (@) Beomplex and K 7. The hormones that coordinate the storage, absorption, and ex- cretion of calcium ioas are {@) growth hormone and thyroxine (b) caeitonin and parathyroid hormone (6) calcitriol and choleakifrol (@) estrogens and androgens 8 The deposition of calcium salts in tissues other than bone is re- ferred tas (@) endochondial ossification (©) intramembranous ossification {@) califcation (a) osteogenesis 9. ‘The primary reason that osteoporosis accelerates after ‘menopause in women is (a) reduced levels of circulating estrogens (6) reduced levels of vitamin C (©) diminished osteoclast activity (@) increased osteoblast activity 10, A child with rckets would have (a) oversized facial bones (© weak, brite bones (b) long limbs (a) bowlegs 11, What are the five primary functions of the skeletal system?12, List the four distinctive cell populations of osseous tissue. 13, What isthe functional difference between an osteoblast and an, osteoclast? 114, What ate the primary perts of atypical long bone? 15, What is the primary difference between intramembranous ossif. cation and endochondral ossification? 16, List the organic and inorganic components of bone matrix. 17, (a) What nutritional factors are essential for normal bone growth and maintenance? {(b) What hormonal factors are necessary for normal bone growth and maintenance? 18, Which three organs or tissues interact to assist in the regulation ‘of calcium ion concentration in body ids? 19, What major effects of parathyroid hormone oppose those of calcitonin? 20, What are the major functions of the hormone calcitonin? LEVEL 2 Reviewing Concepts 21. If spongy bone has no osteons, how do nutrients reach the osteo cytes? 22, Why are stresses oF impacts to the side of the shaft ina long bone more dangerous than stress applied to the long axis ofthe shaft? 23, Why do extended periods of inactivity cause degenerative changes in the skeleton? 24, What are the functional relationships between the skeleton, on the ‘one hand, and the digestive and urinary systems, on the other? 25, During the growth ofa long bone, how is the epiphysis forced futher from the shaft? 26, Why would a physician concerned about the growth patterns of, ‘a young child request an X ray of the hand? 227, How might damage to the thyroid gland influence calcium regu- lation in the body? Study Outline [207 28, Why docs a second fracture in the same bone tend to occur ata site different from that ofthe first fracture? 29, What type of bone growth occurs as bones gain mass in response to weight training? 30, How might bone markings be useful in identifying the remains ‘of a criminal who has been shot and killed? 31. What purpose do elevations or projections serve on bones? LEVEL 3 Critical Thinking and Clinical Applications 32. While playing on hee swing set, 10-year-old Sally alls and breaks her right leg. At the emergency room, the doctor tll her parents that the proximal end of the tibia where the epiphysis meets the ddiaphysis is fractured. The fracture is propery set and eventually heals, During a routine physical when she is 18, Sally learns that her right legis 2 cm shorter than her left, probably because of her acident. What might account for this diference? 33, Sherny isa pregnant teenager, Her diet before she was pregnant consisted mostly of junk food, and that hasn't changed since she became pregnant. Approximately 8-10 weeks into her pregnancy, she falls and breaks her arm, She doesn't understand why the bone broke, because it wasn't a hard fal. Test results determine ‘hata significant amount of bone demineralization is occurring, Explain what is happening to Sherry. ‘34. Would you expect to see changes in blood levels of the hormones caleitonin and PTH as a result of vitamin D, deficiency? Explain. 135. Why might a person in kidney failure exhibit symptoms similar to those of osteoporosis? 36, In physical anthropology cultural conclusions can be drawn, froma thorough examination ofthe skeletons of ancient peo- ples, What sors of clues might bones provide as to their owner's lifestyle?CHAPTER ‘CLINICAL NOTES. = TM Syndrome 224 = Craniostenosis 228 Spina Bifida 231, Whiplash 231 = Thoracentesis 239 CLINICAL DISCUSSIONS. ® Sinus Problems and Septal Defects 226 7-1 DIVISIONS OF THE SKELETON 209 7-2 THE SKULL 210 Cranial Bones 216 Facial Bones 220 ‘The Individual Bones ofthe Skull The Foramina and Fissures of the Skull 224 The Orbital and Nasal Complexes 224 The Skulls of Infants and Children 226 7-3 THE VERTEBRAL COLUMN 228 Spinal Curvature 228 Vertebral Anatomy 230 Vertebral Regions 231 7-4 THE THORACIC CAGE 236 The Ribs 238 The Sternum 239 (CHAPTER REVIEW 239 216