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ARIEF ZAMIR TANTI WIDYA ISHWARA

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

publishing as Benjamin Cummings .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 Copyright © 2003 Pearson Education. Inc.

Inc.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 Copyright © 2003 Pearson Education.2b . publishing as Benjamin Cummings Figure 5.

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

Inc. publishing as Benjamin Cummings .1 Copyright © 2003 Pearson Education.Classification of Bones on the Basis of Shape Figure 5.

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 Copyright © 2003 Pearson Education. publishing as Benjamin Cummings . Inc.

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publishing as Benjamin Cummings . Inc.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 – Copyright © 2003 Pearson Education.

Inc. publishing as Benjamin Cummings Slide .The Axial Skeleton   Forms the longitudinal part of the body Divided into three parts  Skull  Vertebral Column  Rib Cage Copyright © 2003 Pearson Education.

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The Appendicular Skeleton  Limbs (appendages)  Pectoral girdle  Pelvic girdle Copyright © 2003 Pearson Education. Inc. publishing as Benjamin Cummings Slide .

b Copyright © 2003 Pearson Education. publishing as Benjamin Cummings Slide . Inc.Bones of the Shoulder Girdle Figure 5.20a.

Bones of the Upper Limb  The arm is formed by a single bone  Humerus Figure 5. b Copyright © 2003 Pearson Education. publishing as Benjamin Cummings Slide . Inc.21a.

publishing as Benjamin Cummings Slide . Inc.Bones of the Upper Limb • The forearm has two bones • Ulna • Radius Figure 5.21c Copyright © 2003 Pearson Education.

Inc.36 .Bones of the Upper Limb  The hand  Carpals – wrist  Metacarpals – palm  Phalanges – fingers Figure 5.22 Copyright © 2003 Pearson Education. publishing as Benjamin Cummings Slide 5.

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 Copyright © 2003 Pearson Education. publishing as Benjamin Cummings Slide 5. Inc.37 .

23a Copyright © 2003 Pearson Education. Inc.The Pelvis Figure 5. publishing as Benjamin Cummings Slide .

35a. b Copyright © 2003 Pearson Education. publishing as Benjamin Cummings Slide . Inc.Bones of the Lower Limbs  The thigh has one bone  Femur – thigh bone Figure 5.

35c Copyright © 2003 Pearson Education.Bones of the Lower Limbs  The leg has two bones  Tibia  Fibula Figure 5. publishing as Benjamin Cummings Slide . Inc.

publishing as Benjamin Cummings Slide 5.25 Copyright © 2003 Pearson Education.41 .Bones of the Lower Limbs  The foot  Tarsus – ankle  Metatarsals – sole  Phalanges – toes Figure 5. Inc.

 Diaphysis ◦ Long. widened end ◦ Allows bone to lengthen ◦ Cancellous bone with red blood marrow ◦ Weakest point in child’s bone   . 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.

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2a Copyright © 2003 Pearson Education. Inc. publishing as Benjamin Cummings Slide 5.Anatomy of a Long Bone  Diaphysis  Shaft  Composed of compact bone  Epiphysis  Ends of the bone  Composed mostly of spongy bone Figure 5.6 .

2c Slide 5.Structures of a Long Bone  Periosteum  Outside covering of the diaphysis  Fibrous connective tissue membrane  Sharpey’s fibers  Secure periosteum to underlying bone  Arteries  Supply bone cells with nutrients Copyright © 2003 Pearson Education.7 . publishing as Benjamin Cummings Figure 5. Inc.

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. publishing as Benjamin Cummings Slide 5.8a . Inc.2a Copyright © 2003 Pearson Education.

3 Copyright © 2003 Pearson Education. publishing as Benjamin Cummings Slide . Inc.Microscopic Anatomy of Bone Figure 5.

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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 .

(skull and pelvis)..Immovable (synarthoses) :connect bones. no movement.slightly movable (amphiarthoses).freely movable (diarthroses). is the place where two bones come together.   . This fluid helps lubricate and protect the bones. Cavities between bones are filled with synovial fluid.A joint. Cartilaginous.  Fibrous. bones are attached by cartilage. much more movement than cartilaginous joints. a little movement (spine or ribs). Synovial. or articulation.

Inc.51 .28 Copyright © 2003 Pearson Education. publishing as Benjamin Cummings Slide 5.The Synovial Joint Figure 5.

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publishing as Benjamin Cummings Slide . Inc.Types of Synovial Joints Based on Shape Figure 5.29a–c Copyright © 2003 Pearson Education.

publishing as Benjamin Cummings Slide .Types of Synovial Joints Based on Shape Figure 5. Inc.29d–f Copyright © 2003 Pearson Education.

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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 .

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 Direct ◦ Break occurs at point of impact  Indirect ◦ ◦ ◦ Force is transmitted along bone Injury occurs at some point distant to point of impact Femur. osteoporosis . hip. 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. pelvic fracture due to knees hitting dash  Twisting ◦ ◦ Distal limb remains fixed Proximal part rotates ◦  Shearing.

g “Greenstick fracture” . Complete ◦ Complete cortical circumference involved ◦ Fragments are completely separated  Incomplete ◦ Not fractured all the way through ◦ “Only one cortex” involved ◦ e.

◦ greenstick ◦ oblique ◦ transverse ◦ comminuted ◦ spiral ◦ impacted .

Oblique Comminuted Spiral Compound .

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◦ 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.This is due to a temporary loss of nerve function at the site associated vascular injury. rotation Crepitation   Pain/ local tenderness Anesthesia and flaccidity (few minute to hours) . .

 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.  Do not attempt to elicit. ◦ Crepitus  Grating sensation  Produced by bones rubbing against each other.  Tenderness tends to localize over injury site. .

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 Copyright © 2003 Pearson Education. publishing as Benjamin Cummings Slide 5.19 . Inc.

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 Hemorrhage ◦ Possible loss within first 2 hours  Tib/Fib .500 ml  Pelvis .500 ml  Femur .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) .

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

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

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

increasing pressure is directed inward and compresses components in the compartments.swelling reaches the point at which the fascia permits no outward enlargement .Complication COMPARTMENT SYNDROME .Pressure build within the compartment due to bleeding. . .

Dislocation .