attachment for muscles that move various parts of the head.

The bones • Describe the following cranial bones and their main features:
also provide attachment for some muscles that produce facial expression frontal, parietal, temporal, occipital, sphenoid, and ethmoid.
such as the frown of concentration you wear when studying this book.
The facial bones form the framework of the face and provide support for
Frontal Bone
FIGURE 7.3 Anterior view of the skull.
The frontal bone forms the forehead (the anterior part of the cra-
nium), the roofs of the orbits (eye sockets), and most of the anterior
The skull consists of cranial bones and facial bones.
part of the cranial floor (Figure 7.3). Soon after birth, the left and right

Lecture 3: Skeletal System Frontal bone

Compiled by: Heirich Fevrier P. Manalili,

RPh MD Frontal squama Coronal suture

Supraorbital foramen
Parietal bone
Supraorbital notch Supraorbital margin

Anatomy of the Skeletal System Squamous suture Optic foramen (canal)

Superior orbital fissure
Orbit Temporal bone

Axial skeleton Ethmoid bone

Palatine bone
Sphenoid bone
Nasal bone

• Bones of the head, neck, and trunk

Inferior orbital fissure
Lacrimal bone
Middle nasal concha
Zygomaticofacial
Appendicular skeleton foramen
Zygomatic bone
Infraorbital foramen

Maxilla

• Bones of the arms and legs Perpendicular plate

of ethmoid bone
Alveolar process
• Bones of the girdles: attach arms Inferior nasal
concha
of maxilla

and legs to trunk Vomer

Alveolar process
of mandible
Mental foramen
Classification of Bones According to Shape Mandible

Anterior view
• Long bones are longer than they are Q Which of the bones shown here are cranial bones?

wide and have clubby ends. • Maxillae

(eg.tibia) • Form upper jaw, anterior
• Short bones are cubelike. (eg.carpal portion of hard palate, part
bones) of lateral walls of nasal
• Flat bones look like they are a sheet cavity, floors of eye orbits
of clay that has been molded. (eg. • Maxillary sinus
parietal bone) • Palatine bones
• Irregular bones have many • Form posterior portion of
projections and spines. (eg. hard palate, lateral wall of
vertebrae.) nasal cavity
• Sesamoid bones grow in tendons • Zygomatic bones
where there is a lot of friction. (eg. • Cheek bones
patella.) • Also form floor and lateral
wall of each eye orbit
Axial Skeleton • Lacrimal bones
The axial skeleton contains the following • Medial surfaces of eye orbits
bones: • Nasal bones
• Cranial bones: frontal, occipital, • Form bridge of nose
temporal, parietal, ethmoid and • Vomer
sphenoid • In midline of nasal cavity
• Facial bones: nasal, lacrimal, • Forms nasal septum with the
zygomatic, inferior nasal concha, ethmoid bone
maxilla, palatine, mandible, vomer • Inferior nasal conchae
• Spinal column: 7 cervical vertebrae, • Attached to lateral walls of
12 thoracic vertebrae, 5 lumbar nasal cavity
vertebrae, sacrum, coccyx • Mandible
• Lower jawbone
• Only movable skull bone
 Maxillary sinus

Spinal Column
• Extends from skull to pelvis
• Flexible and sturdy longitudinal
support for trunk
• Formed by 24 movable vertebrae, a
sacrum, and a coccyx
• Possess intervertebral disks
o Shock absorbers

• Possess four distinct curvatures

Ethmoid Bone Vertebra

• Anterior portion of the cranium, Structure of a Vertebra
including medial surface of eye orbit • All vertebrae have common features
and the roof of the nasal cavity o Vertebral foramen
• Nasal conchae o Spinous process
Sphenoid Bone o Transverse process
• Forms part of the cranium floor, o Body
lateral portion of eye orbits, lateral
portions of the cranium anterior to
the parietal bones
• Sella turcica
Sinuses
• Some skull bones contain sinuses:
• Sphenoid sinus
• Frontal sinus
• Ethmoid sinus
 • Ribs articulate on the facets
of the transverse processes
and bodies

Sacrum and Coccyx

Cervical Vertebrae • Sacrum
• Support neck • Five fused sacral bones
• Possess unique transverse foramen • Forms posterior wall of pelvic
• Atlas girdle
• cervical vertebra 1 • Coccyx
• Articulates occipital • Tailbone
condyles of occipital • Three to five fused
bone rudimentary vertebrae
• Supports head
• Axis:
• cervical vertebra 2
• Possesses the
odontoid process
(dens)
• Serves as a pivot
point for atlas

Axial Skeleton
The axial skeleton contains the following
bones:
• Sternum: flat bone forming
the anterior rib cage
• Ribs: 12 pairs
• 7 pairs are true ribs
• 5 pairs are false ribs
• 2 pairs are floating
Thoracic (a) and Lumbar Vertebrae (b) • Hyoid bone: U-
• Larger vertebra with longer shaped bone
spinous process then cervical between the
vertebrae
 mandible and the
larynx

Ribs

• Attached to thoracic vertebrae

• True ribs (#1-7)
• Attached to sternum directly
by costal cartilages
• False ribs (#8-12)
• Attach to costal cartilage of
superior ribs
• Floating ribs (#11-12)
• Do not attach anteriorly, no
costal cartilages
Appendicular Skeleton
• composed of the bones of the limbs
and the bones of the girdles that
connect the limbs to the axial
skeleton.
• Pectoral girdle: clavicle and scapula
• Bones of the upper limb: humerus,
radius, ulna, carpal bones,
metacarpals, phalanges
• Pelvic girdle: ilium, ischium, pubis
• Bones of the lower limb: femur,
patella, tibia, fibula, tarsal bones,
metatarsals, phalanges

Pectoral girdle – 2 clavicles, 2 scapula

Hyoid Bone Clavicle – articulates sternum and scapula

• Found in anterior portion of neck,
inferior to mandible
• Does not articulate with any other
bones
• Used as attachment site for tongue
muscles
Scapula • Medial and lateral
• Located on each side of vertebral epicondyles
column • Olecranon fossa
• Held in place by muscles to allow
free shoulder movement Bones of the upper limb

• Radius
• Lateral bone in the forearm
• Bone that rotates when the
hand is rotated
• Bony markings include the
head and styloid process
• Ulna
• Medial bone in forearm
• Bone does not move with
hand rotation
• Bony markings include the
olecranon, trochlear notch,
and styloid process
Humerus

• Articulates with scapula at the

shoulder and ulna and radius at the
elbow
• Bony markings include: • Carpals
• Head • Wrist bones
• Greater and lesser tubercles • Scaphoid, lunate, triquetrum,
• Deltoid tuberosity pisiform (proximal)
• Capitulum • Trapezium, trapezoid,
• Trochlea capitate, hamate (distal)
 • Metacarpals • There are distinct differences
• Bones of the palm of the between the male and female pelvis.
hand • Female pelvis is:
• Phalanges • Wider and shallower
• Bones of the fingers • More rounded pelvic brim
• Larger pelvic inlet/opening

Bones of the Lower Limb

• Femur
• Thigh bone
• Largest and strongest bone
in the body
Pelvic Girdle • Patella
• Consists of three coxal bones (ossa • Kneecap
coxae) • Sesamoid bone in tendon
• Ilium that extends anterior to knee
• Ischium
• Pubis
• Forms a rigid, bony pelvis with
sacrum and coccyx
• Coxal bones attached to one
another at the pubic symphysis
 Chapter 6 Bones and Skeletal Tissues 199
(Sharpey’s) fibers—tufts of collagen fibers that extend from its Projections—bone markings that bulge outward from the
fibrous layer into the bone matrix—secure the periosteum to surface—include heads, trochanters, spines, and others. Each
the underlying bone (Figure 6.4). The periosteum also provides has distinguishing features and functions. In most cases, bone
anchoring points for tendons and ligaments. At these points the projections indicate the stresses created by muscles attached to
perforating fibers are exceptionally dense. and pulling on them or are modified surfaces where bones meet
• Tibia Bones
A delicate connective•tissue membrane calledof the the
endos- instep
and form joints.
• Shinbone teum (en-dos′te-um;
• Phalanges “within the bone”) covers internal bone Bone markings that are depressions and openings include
surfaces (Figure 6.4). The endosteum covers the trabeculae of fossae (singular: fossa), sinuses, foramina (singular: foramen),
• Larger of the lower leg bones spongy bone and lines the•canals thatToe bones
pass through the compact and grooves. They usually allow nerves and blood vessels to
• Bears body weight bone. Like Tarsals
• the periosteum, the endosteum contains osteogenic pass. Table 6.1, on p. 202, describes the most important types
cells that can differentiate into other bone cells. of bone markings. Familiarize yourself with these terms because
• Fibula • The tarsal and metatarsals you will meet them again as identifying marks of the individual
• Slender, lateral bone in lower Hematopoietic Tissue in Bonesform arches bones studied in the lab.
leg Hematopoietic tissue, red marrow, is typically• found Longitudinal
within arch
the trabecular cavities of spongy bone of long bones and in the Microscopic Anatomy of Bone
• Transverse arch
diploë of flat bones. For this reason, both these cavities are often
Cells of Bone Tissue
called red marrow cavities. In newborn infants, the medullary
cavity of the diaphysis and all areas of spongy bone contain red Five major cell types populate bone tissue: osteogenic cells, oste-
bone marrow. In most adult long bones, the fat-containing yel- oblasts, osteocytes, bone lining cells, and osteoclasts. All of these 6
low marrow extends well into the epiphysis, and little red mar- except for the osteoclasts originate from embryonic connective
row is present in the spongy bone cavities. For this reason, blood tissue cells. Each cell type is a specialized form of the same basic
cell production in adult long bones routinely occurs only in the cell type that has transformed to its mature or functional form
heads of the femur and humerus (the long bone of the arm). (Figure 6.5). Bone cells, like other connective tissue cells, are
The red marrow found in the diploë of flat bones (such as the surrounded by an extracellular matrix of their making.
sternum) and in some irregular bones (such as the hip bone) is Osteogenic Cells Osteogenic cells, also called osteoprogeni-
much more active in hematopoiesis. When clinicians suspect tor cells, are mitotically active stem cells found in the membra-
problems with the blood-forming tissue, they obtain red mar- nous periosteum and endosteum. In growing bones they are
row samples from these sites. However, yellow marrow in the flattened or squamous cells. When stimulated, these cells dif-
medullary cavity can revert to red marrow if a person becomes ferentiate into osteoblasts or bone lining cells (see below), while
very anemic and needs more red blood cells. others persist as osteogenic cells.
Bone Markings Osteoblasts Osteoblasts are bone-forming cells that secrete
the bone matrix. Like their close relatives, the fibroblasts and
The external surfaces of bones are rarely smooth and feature-
chondroblasts, they are actively mitotic. The unmineralized
less. Instead, they display projections, depressions, and open-
bone matrix they secrete includes collagen (90% of bone pro-
ings. These bone markings serve as sites of muscle, ligament,
tein) and calcium-binding proteins that make up the initial
and tendon attachment, as joint surfaces, or as conduits for
Histology of
blood vessels and nerves. the Skeletal System
unmineralized bone, or osteoid. As described later, osteoblasts
also play a role in matrix calcification.

(a) Osteogenic cell (b) Osteoblast (c) Osteocyte (d) Osteoclast

Stem cell Matrix-synthesizing cell Mature bone cell that monitors Bone-resorbing cell
responsible for bone growth and maintains the mineralized
bone matrix

Figure 6.5 Comparison of different types of bone cells. The bone lining cell, similar in
appearance to the osteogenic cell and similar to the osteocyte in function, is not illustrated.

• Tarsals
• Ankle bones M06_MARI6971_10_SE_CH06_193-218.indd 199 3/26/15 5:1

• Metatarsals
Types of Bone Tissue: • Hyaline cartilage
1.Compact Bone • Elastic cartilage
• Fibrocartilage
• is well organized into osteons
(Haversian systems). 1. Hyaline Cartilage matrix
• Osteons • is smooth and clear.
• Osteonic canals • Found as nasal cartilages,
• Lamellae costal cartilages, and
• Canaliculi articular cartilages covering
the ends of long bones.

2. Elastic Cartilage matrix

• has fibers going in all
directions so as to be elastic
• Found in the pinna of the ear
and the epiglottis

2.Cancellous Bone

• is loosely organized as trabeculae.

• Interior of small bones, skull bones,
and epiphyses
• Consists of trabeculae and spaces
filled with red bone marrow
• Reduces bone weight without
reducing strength
Chondrocytes
• produce a matrix composed of 3. Fibrocartilage Matrix
proteoglycans and water • has fibers going in one
Three types of Cartilage: direction to act as a shock
absorber.
 • Found in the intervertebral
disks, the menisci of the
knee, and the pubic
symphysis

Anatomy of a Long Bone

• Epiphyses
• are the clubby ends of the
bone.
• They are composed of
cancellous bone.
• The diaphysis
• is the shaft of the bone.
• It is composed of compact Main types of Joints
bone. • Fibrous Joints
• The periosteum • Cartilaginous Joints
• covers the diaphysis of the • Synovial Joints
bone.
• The endosteum Fibrous Joints
• lines the marrow • have fibrous tissue between bones.
(medullary) cavity. • Suture.
• Red bone marrow • Is formed by the
• is found in the epiphyses. membranes of
• Yellow bone marrow intramembranous
• Fills the marrow cavity in the ossification.
diaphysis • Gomphoses
• Is formed by
ligaments holding the
tooth in its socket.
• Syndesmoses.
 Chapter 8 Joints 273

• Is formed by an (a) Synchondroses

interosseous Bones united by hyaline cartilage

membrane.
272 UNIT 2 Covering, Support, and Movement of the Body

(a) Suture (b) Syndesmosis (c) Gomphosis Sternum (manubrium)

Joint held together with very short, Joint held together by a ligament. “Peg in socket” fibrous joint. Periodontal Epiphyseal
interconnecting fibers, and bone edges Fibrous tissue can vary in length, but ligament holds tooth in socket.
interlock. Found only in the skull. is longer than in sutures.
plate (temporary Joint between first rib
hyaline cartilage and sternum (immovable)
joint)

Socket of
Suture Fibula alveolar
line process
Synovial Joints
Tibia
(b) Symphyses

Bones united by fibrocartilage

Root of
tooth
are lined by a synovial membrane
•
8 and have synovial fluid in the joint
Body of vertebra
274 UNIT 2 space.
Covering, Support, and Movement of the Body

Fibrous
connective Ligament Synovial
8.4 Periodontal joints have a
tissue ligament
fluid-filled joint cavity
Figure 8.1 Fibrous joints. Cartilaginous Joints Learning Objectives
• have cartilage between Syndesmoses
the bones.
Describe the structural characteristics of synovial joints.
Compare the structures and functions of bursae and
Fibrocartilaginous
intervertebral disc
8.2 In fibrous joints, the bones are (sandwiched between
connected by fibrous tissue
• There are 2 types: tendon sheaths.
In syndesmoses (sin″des-mo′sēz), the bones are
List three natural factors that stabilize synovial joints.
connected hyaline cartilage)
Pubic symphysis
exclusively by ligaments (syndesmos = ligament), cords or Ligament
Learning Objective o Symphyses Name and describe (or perform) the common body
bands of fibrous tissue. The amount
movements. Chapterof8movement
Joints allowed 273 at
a syndesmosis depends on the length of the connecting fibers.
Describe the general structure of fibrous joints. Name and
give an example of each of the three common types of § Is formed Name andby fibers are always longer thantypes
Although the connecting provide examples
joints based on the movement(s) allowed.
of the six
thoseof synovial
Joint cavity
(contains
in sutures, they vary quite a bit in length. If the fibers are short
(a) Synchondroses Figure 8.2 Cartilaginous joints. synovial fluid)
fibrous joints.
In fibrous joints, the bones are joined by the collagen fibers
fibrocartilage
Synovial joints (si-no′ve-al; “joint eggs”)
(as in the ligament connecting the distal ends of the tibia and are those in which
the articulating bones are separated by a fluid-containing joint
of by fibula, Figure 8.1b), little or no movement is allowed, a char- Articular (hyaline)
of connective tissue. No joint cavity is present. The amount
movement allowed depends on the length of the connective
Bones united between
hyaline cartilageThis the
cavity.
acteristic best described aspubic
arrangement “give.”permits substantial
If the fibers are long freedom
(as in of move- cartilage

tissue fibers. Most fibrous joints are immovable, although a bones. ment, and interosseous
the ligament-like all synovialmembrane
joints are freely movable
connecting the radius diarthroses. synostoses.
Fibrous Another example of a synchondrosis is the immov-
few are slightly movable. The three types of fibrous joints are and Nearly
fall
possible. into
all joints
ulna, Figure
this
of252),
7.29, p.
class.
the limbs—indeed,
a large amount ofmost jointsisof8.3
movement In cartilaginous joints, the
the body—
ablelayer
joint between the costal cartilage of the first rib and the
sutures, syndesmoses, and gomphoses. o Synchondroses 8
Sternum (manubrium) bones are connected by cartilage manubrium
Synovial of the sternum (Figure 8.2a).
membrane
Articular
capsule
Sutures § IsGomphoses formed
General Structure by hyaline Learning Objective
(secretes
synovial
Sutures, literally “seams,” occur only between bonesEpiphyseal A gomphosis
Synovial joints(gom-fo′sis)
have six is distinguishing
a peg-in-socket features fibrous joint
(Figure 8.3): Symphyses
fluid)
of the skull
plate (temporary
(Figure 8.1a). The wavy articulating bone edges interlock, and
cartilage 8.1c). Thebetween
(Figure Articular only example is Joint the
the
cartilage. Glassy-smooth
articulation
between tooth Describe
rib of a cartilage
hyaline
first
the general structure of cartilaginous joints.
covers the
A joint where fibrocartilage unites the bones is a symphysis
●
hyalineofcartilage with its bony alveolar socket. The term gomphosis comes from Name and give an example of each of the two common Periosteum
joint)the peri- diaphysis
the Greek gompho,and meaningthe
the junction is completely filled by a minimal amount very opposing bone surfaces articular
asand sternum cartilage.
(immovable) These thin (1 mm
short connective tissue fibers that are continuous with “nail” or “bolt,” and refers to the types of cartilaginous joints.
or less) but spongy cushions absorb compression placed on the (sim′fih-sis; “growing together”). Since fibrocartilage is compress-
way teeth are embedded in their sockets (as if hammered in).
osteum. The result is nearly rigid splices that knit the bones
together, yet allow the skull to expand as the brain grows dur-
epiphyses joint and thereby
The fibrous connection of inbonesthis case is in
keep the bone ends from beingIncrushed.
the short periodontal cartilaginous joints (kar″tĭ-laj′ĭ-nus), the articulating bones ible and resilient, it acts as a shock absorber and permits a limited
ligament Joint (articular)
(Figure 23.12, p. cavity. A feature unique to are
888). synovial
united byjoints,
cartilage. LikeFigure joints,General
fibrous 8.3 a joint cav- of a amount
they lack structure synovial of movement
joint. at the joint. Even though fibrocartilage is
children.
●
ing youth. During middle age, the fibrous tissue ossifies and
the joint cavity is really just a potential space that contains a the main element of a symphysis, hyaline cartilage is also present
the skull bones fuse into a single unit. At this stage, the closed Check Your Understanding
small amount of synovial fluid.
ity and are not highly movable. The two types of cartilaginous
sutures are more precisely called synostoses (sin″os-to′sēz), lit-
erally, “bony junctions.” Because movement of the cranial bones 3. To what functional
Articular class do The
capsule. joint cavity
most fibrous
Knee
joints are synchondroses and symphyses.
is enclosed by a two-lay-
joints belong?
the joint is loaded (put under pressure). in the formThisof articular
process,cartilages
called on the bony surfaces. Symphy-
ses are
freeamphiarthrotic
surfaces ofjoints designed for strength with flexibility.
●
weeping lubrication, lubricates the the carti-
would damage the brain, the immovable nature of sutures is (b) a Symphyses ered articular capsule, or joint
For answers, capsule.
see Answers
fibrous layer is composed of dense irregular connective
The tough external
Appendix. • is a relatively lages and nourishes unstable jointinclude
their cells. (Remember,
Examples held
cartilage is avas- joints and the pubic symphy-
the intervertebral
protective adaptation.
tissue that is continuous with the periostea of the articulat-together
Synchondroses cular.) Synovial fluid also contains phagocytic cells that rid
Bones united by fibrocartilage by five ligaments: sis
the joint cavity of microbes and cellular debris.
of the pelvis (Figure 8.2b, and see Table 8.2 on pp. 276–277).
ing bones. It strengthens the joint so that theA bones of hyaline cartilage unites the bones at a syn-
are not
bar or plate
pulled apart. The inner layer of the joint capsule is a synovial 8
chondrosis (sin″kon-dro′sis;
●
theof cartilage”).
• strengthened
Reinforcing
“junction medial
ligaments. and
Synovial
Virtually
by a number
lateral
Check Your Understanding
joints are reinforced
of bandlike ligaments. Most often,
and
membrane composed of loose connective tissue. Besides lin-
ing the fibrous layer internally, it covers all internal all synchondroses
joint sur-are synarthrotic collateral
these(immovable).
are capsular ligaments, ligamentswhich
4. MAKINGare thickened parts
connections Evan is 25ofyears old. Would you expect to
Body of vertebra faces that are not hyaline cartilage. The synovialThe most common examples
membrane’s of synchondroses
the fibrous are thecases, theyfindremain
layer. In other distinct
synchondroses and
at the endsareof his femur? Explain. (Hint: See
epiphyseal plates in long•bones found
ofthe outsideanterior
(the 8.2a). and
capsule (as posterior
extracapsular 6.) ligaments) or
M08_MARI6971_10_SE_CH08_271-297.indd 272 3/14/15 4:03 PM
function is to make synovial fluid. children Figure Chapter
deep to it (as intracapsular ligaments). Since intracapsular
synovialplatesfluidare temporary joints and eventually become
Synovial fluid. A small amount of slippery Epiphyseal
●

Fibrocartilaginous
intervertebral disc
(sandwiched between
hyaline cartilage)
Figure 8.2 Cartilaginous joints.
occupies all free spaces within the joint capsule. This fluid cruciate
ligaments are covered ligaments
with synovial membrane, they doFornot answers, see Answers Appendix.
actually lie within the joint cavity.
is derived largely by filtration from blood flowing through
the capillaries in the synovial membrane. Synovial fluid has
• People thesaid patellar ligament
to be double-jointed amaze the rest of us by
placing both heels behind their neck. However, they have the
a viscous, egg-white consistency (ovum = egg) due to•hyalu-It also contains fibrocartilage pads
normal number of joints. It’s just that their joint capsules and
ronic acid secreted by cells in the synovial membrane, but it
ligaments are more stretchy and loose than average.
thins and becomes less viscous during joint activity.
Synovial fluid, which is also found within the articu-
called ●
menisci that act as shock
Nerves and blood vessels. Synovial joints are richly supplied
lar Pubic symphysis
cartilages, provides a slippery, weight-bearing film thatabsorbers. with sensory nerve fibers that innervate the capsule. Some of
these fibers detect pain, as anyone who has suffered joint injury
reduces friction between the cartilages. Without this lubri-
M08_MARI6971_10_SE_CH08_271-297.indd 273 3/14/15 4
cant, rubbing would wear away joint surfaces and excessive is aware, but most monitor joint position and stretch. Moni-
friction could overheat and destroy the joint tissues. The toring joint stretch is one of several ways the nervous system
synovial fluid is forced from the cartilages when a joint is senses our posture and body movements (see p. 509). Synovial
compressed; then as pressure on the joint is relieved, syno- joints are also richly supplied with blood vessels, most of which
vial fluid seeps back into the articular cartilages like water supply the synovial membrane. There, extensive capillary beds
into a sponge, ready to be squeezed out again the next time produce the blood filtrate that is the basis of synovial fluid.

synostoses. Another example of a synchondrosis is the immov-

8.3 In cartilaginous joints, the able joint between the costal cartilage of the first rib and the
bones are connected by cartilage manubrium of the sternum (Figure 8.2a).

Learning Objective M08_MARI6971_10_SE_CH08_271-297.indd 274 3/14/15 4:03 PM

 Examples: Metacarpophalangeal (knuckle) joints, wrist joints

(e) Saddle joint Biaxial movement

Medial/ Anterior/
lateral posterior
• A rounded head of one bone fits into axis axis

a concavity on another bone Articular

Metacarpal Ι surfaces
• Movement may be rotational are both
concave or in
and convex
any plane
Adduction and abduction Flexion and extension

• Example: Trapezium hip and shoulder joint

Example: Carpometacarpal joints of the thumbs

(f) Ball-and-socket joint Multiaxial movement

Chapter 8 Joints 275 Cup

(socket)
Medial/lateral
axis
Anterior/posterior Vertical axis
axis

Scapula

Table 8.1 Summary of Joint Classes Spherical

head
(ball)
STRUCTURAL CLASS STRUCTURAL CHARACTERISTICS TYPES MOBILITY Humerus
Flexion and extension Adduction and
abduction Rotation

Fibrous Adjoining bones united by collagen fibers Suture (short fibers) Immobile (synarthrosis) Examples: Shoulder joints and hip joints

283
    Syndesmosis (longer fibers) Slightly movable (d) Condylar joint Biaxial movement

(amphiarthrosis) and immobile Saddle Joins

M08_MARI6971_10_SE_CH08_271-297.indd 283 3/14/15 4:03 PM
Medial/ Anterior/
    Gomphosis (periodontal ligament) Immobile Phalanges lateral posterior
• Ends of each bone are saddle axis axis

Cartilaginous Adjoining bones united by cartilage Synchondrosis (hyaline cartilage) Immobile shaped Oval
articular
Metacarpals• Movement is side surfaces
to side and
    Symphysis (fibrocartilage) Slightly movable back and forth
Flexion and extension Adduction and abduction
• Example: joint between
Synovial Adjoining bones covered with articular Plane Condylar Freely movable (diarthrosis;
trapezium and
Examples: metacarpal
Metacarpophalangeal of
(knuckle) joints, wrist joints
cartilage, separated by a joint cavity, and movements depend on design
F O C U S Synovial Joints Hinge Saddle thumb
enclosed within an articular capsule lined
Focus Figure 8.1 Six types of synovial joint shapes determine
of joint)
with synovial membrane
the movements that can occur at a joint.
Pivot Ball-and-socket (e) Saddle joint Biaxial movement

Six Types of Synovial

(a) Plane joint Joints Nonaxial movement
Medial/ Anterior/
lateral posterior
axis axis

Hinge Joint
• Allow movement in one direction
Metacarpals Flat
Articular
articular Metacarpal Ι surfaces
surfaces
are both

Besides the basic componentsonly

just described, certain syno- Bursae and Tendon Sheaths
concave
Gliding

8
Carpals
and convex Adduction and abduction Flexion and extension
• Example: knee and elbow joints
vial joints have other structural features. Some, such as the hip
Examples: Intercarpal joints, intertarsal joints, joints between vertebral articular surfaces

and knee joints, have cushioning fatty pads between the fibrous Bursae and tendon sheaths are not strictly part of synovial joints, Trapezium
Example: Carpometacarpal joints of the thumbs

but they are often found closely associated with them (Figure 8.4).
(b) Hinge joint Uniaxial movement

layer and the synovial membrane or bone. Others have discs or

Humerus

wedges of fibrocartilage separating the articular surfaces. Where Cylinder

Essential y bags of lubricant, they act as “ball bearings” toGliding
Medial/lateral
axis reduce Joints (f) Ball-and-socket joint Multiaxial movement

present, these articular discs, or menisci (mĕ-nis′ki; “cres-

Trough
friction between adjacent structures during joint activity. Bursae• Involve sliding of bones across each Cup Medial/lateral Anterior/posterior Vertical axis

(ber′se; “purse”) are flattened fibrous sacs lined with synovial other
(socket) axis axis

cents”), extend inward from the articular capsule and partial y or

Ulna Flexion and extension

• Example: carpal and tarsal

completely divide the synovial cavity in two (see the menisci of membrane and containing a thin film of synovial fluid. They occur
Examples: Elbow joints, interphalangeal joints

bones Scapula

the knee in Figure 8.7a, b, e, and f). Articular discs improve the where ligaments, muscles, skin, tendons, or bones rub together.
Uniaxial movement Spherical
A tendon sheath is essential y an elongated bursa that wraps
(c) Pivot joint

fit between articulBall

ating boneand
ends,Socket
making the jointJoint
head

more sta- (ball)

completely around a tendon subjected to friction, like a bun

Vertical axis Humerus

ble and minimizing wear and tear on the joint surfaces. Besides Sleeve
(bone and
Flexion and extension Adduction and

around a hot dog. They are common where several tendons are
ligament) abduction Rotation

the knees, articular discs occur in the jaw and a few other joints
Ulna Axle (rounded
bone) Examples: Shoulder joints and hip joints

(see notations in the Structural Type column in Table 8.2).

Radius crowded together within narrow canals (in the wrist, for example).
Rotation
283
Examples: Proximal radioulnar joints, atlantoaxial joint
 FOCUS Synovial Joints
Focus Figure 8.1 Six types of synovial joint shapes determine
the movements that can occur at a joint.

Osteoblasts produce a chemical that

•
(a) Plane joint Nonaxial movement
allows calcium phosphate crystals to
be deposited.
• This is a positive feedback
mechanism starting with a
FOCUS Synovial Joints
Metacarpals Flat
articular
surfaces
seed crystal.
Focus Figure 8.1 Six types of synovial joint shapes determine Gliding Bone development
the movements that can occur at a joint.
Carpals

Examples: Intercarpal joints, intertarsal joints, joints between vertebral articular surfaces • Flat bones are formed through
intramembranous ossification.
Ellipsoid Joints
(a) Plane joint
(b) Hinge joint
Nonaxial movement
Uniaxial movement • Long bones are formed through
endochondral ossification.
Humerus • Allow movement fromMedial/lateral
side to side
and back and forth Cylinder
axis
Intramembranous Ossification
Metacarpals • Example:Flat between carpals
Trough

and bones
surfaces of forearm
articular
• Forms most skull bones
Ulna
Carpals
Gliding and extension
Flexion • Fontanelles present at birth
(d) Condylar joint Biaxial movement
Examples: Elbow joints, interphalangeal joints
Examples: Intercarpal joints, intertarsal joints, joints between vertebral articular surfaces • Steps involved:
• 1. Connective tissue
Medial/ Anterior/
Phalanges lateral posterior
axis axis
(c) Pivot joint
Oval
Uniaxial movement membranes form at sites of
(b) Hinge joint Uniaxial movement
future intramembranous
articular
Metacarpals surfaces
Vertical axis

Flexion and extension Adduction and abduction

bones.
Humerus Sleeve
Medial/lateral
(bone and
axis
ligament)
• 2. Some cells become
Ulna
Examples: Metacarpophalangeal
Cylinder(knuckle) joints, wrist joints
Axle (rounded osteoblasts.
Troughbone)
• 3. Osteoblasts deposit
Pivot Joints (e) Saddle joint
Radius Biaxial movement
Rotation
spongy bone beginning at
Ulna Examples: Proximal radioulnar joints, atlantoaxial joint
Flexion and extension center of bone.
Medial/ Anterior/
• Allow rotational movement lateral
posterior
axis
axis
• 4. Osteoblasts form layer of
282
Example:
• Examples: atlas on the axis
Elbow joints, interphalangeal joints
compact bone atop the
Articular
Metacarpal Ι surfaces
are both
spongy bone.
concave
M08_MARI6971_10_SE_CH08_271-297.indd 282 and convex Adduction and abduction
3/14/15 4:03 PM
(c) Pivot joint Uniaxial movement Flexion and extension
Trapezium
Example: Carpometacarpal joints of the thumbs
Vertical axis

Sleeve
(f) Ball-and-socket joint (bone and Multiaxial movement
ligament)
Cup Medial/lateral Anterior/posterior Vertical axis
Ulna Axle (rounded
(socket) axis axis
bone)

Scapula Rotation
Radius

Spherical
head
Examples:(ball)
Proximal radioulnar joints, atlantoaxial joint
Humerus
Flexion and extension Adduction and
282 abduction Rotation

Examples: Shoulder joints and hip joints

Mineral Deposition 283

M08_MARI6971_10_SE_CH08_271-297.indd 282 3/14/15 4:03 PM

M08_MARI6971_10_SE_CH08_271-297.indd 283 3/14/15 4:03 PM

 Chapter 6 Bones and Skeletal Tissues 205
3. Periosteal osteoblasts form a compact
bone collar around primary ossification
dly growing epiphyses
aline cartilage models
Mesenchymal
cell
center
f viable cartilage cells Collagen 4. Cartilage in the primary center calcifies
s” cartilage formation fiber
tilage calcifies, erodes, Chapter 6 Bones and Skeletal Tissues
Ossification 205 and chondrocytes die
pikes on the epiphyseal center
pidly growing epiphyses Mesenchymal
5. Blood vessels and nerves penetrate the
hyaline cartilage models Osteoid
have
of a bony
viable diaphysis
cartilage cells
cell
Collagen
Osteoblast
center, bring osteoblasts with them
ne,
ses”a cartilage
wideningformation
medul-
iphyses.calcifies,
artilage Shortly before
erodes, 1 Ossification centers appear in the fibrous
fiber
Ossification
connective tissue
6. Osteoblasts form spongy bone at the
nspikes
centersonappear
the epiphyseal
in one membrane. center
primary ossification center
y. Selected centrally located mesenchymal cells cluster and
gain bony tissue. (Typi-
es have a bony diaphysis
Osteoid

ondary centers inmedul-

bone, a widening both
differentiate into osteoblasts, forming an ossification center
Osteoblast
that produces the first trabeculae of spongy bone. 7. Secondary ossification center forms in
nes form only onebefore
sec-
epiphyses.
agecenters
on
Shortly
in the center
appear ofin the
one
1 Ossification centers appear in the fibrous connective tissue
membrane. the epiphyses
Osteoblast
Selected centrally located mesenchymal cells cluster and
s gain bony
pening tissue. (Typi-
up cavities
condary centers in both
that differentiate into osteoblasts, forming an ossification center 8. Osteoclasts remove the spongy bone and
trabeculae appear, just that produces the first trabeculae of spongy bone.
Osteoid
bones form only one sec-
fication
tilage center.
in the center of the
form the medullary cavity
Osteoblast
6 9. Bone continues to grow
opening
ae appear,upjust
cavities that
as they
Osteocyte
ne trabeculae appear, just Osteoid
nssification
center. center. Newly calcified
bone matrix
Osteocyte
10. At the end of the process, the
cation centerjust
ulae appear, is formed.
as they 6
ondistinct
ral center. ossification Newly calcified epiphyseal plate separates the epiphyses
bone matrix
fication center is formed.
most exactly ossification
eral distinct the events
2 Osteoid is secreted within the fibrous membrane and calcifies.
from the diaphysis
ongy bone in the inte- 2 Osteoid is secreted within the fibrous membrane and calcifies.
lmost exactly the events
yspongy
forms bone
in the epiphy-
in the inte-
plete,
ity hyaline
forms in thecartilage
epiphy- Mesenchyme
mplete, hyaline cartilage condensing
Mesenchyme
to form the
condensing
ar cartilages periosteum
to form the
ular cartilages periosteum
iphysis, where it forms
epiphysis, where it forms Trabeculae of
Trabeculae of
woven bone
woven bone

Blood
Blood vessel
vessel

hethe cranialbones
cranial bonesofofthe
the
emporal bones) and the
mporal bones) and the 3 Woven bone and periosteum form.
rocess are flat bones. At 3 Woven bone and periosteum form.
ocess are flat
on begins bones.
within At
fibrous
n begins
d within fibrous
by mesenchymal cells.
by mesenchymal
depicted in Figurecells.
6.9.
epicted in Figure 6.9.
Fibrous
periosteum
es lengthen entirely by Fibrous
Osteoblast
plate cartilage and its periosteum
owlengthen entirely
in thickness by
by appo- Plate of
Osteoblast
compact bone
ing during
late adolescence.
cartilage and its
ose
inof the nose by
thickness andappo-
lower Diploë (spongy
Plate of
tibly throughout life. bone) cavities
compact bone
ng during adolescence. contain red
marrow
e of the nose and lower Diploë (spongy
4 Lamellar bone replaces woven bone, just deep to the
bone)cavities
bly throughout life. periosteum. Red marrow appears.
contain red
bone replaces them, forming compact bone plates.marrow
tion. Diagrams 1 and
han diagrams 3 and 4 . 4 Lamellar bone replaces woven bone, just deep to the Bone Growth
periosteum. Red marrow appears.
• Long bones continue to grow longer
bone replaces them, forming compact bone plates.
on. Diagrams 1 and
an diagrams 3 and 4 .
after birth through endochondral
growth until the epiphyseal plates
Endochondral Ossification are closed.
• Forms most bones of the body • Create epiphyseal line
3/26/15 5:11 PM

• Example: long bones • Appositional growth makes bones

Steps: more massive. It occurs along lines
1.Bones are preformed in hyaline cartilage of stress.
3/26/15 5:11 PM

2. Primary ossification center forms in

center of cartilage
ns, like coins in a stack. look like stalactites hanging from the roof of a cave. These
“top” (epiphysis-facing) calcified spicules ultimately become part of the ossification
zone comprise the prolif- or osteogenic zone, and are invaded by marrow elements
divide quickly, pushing from the medullary cavity. Osteoclasts partly erode the car-
ysis and lengthening the tilage spicules, then osteoblasts quickly cover them with
new bone. Ultimately spongy bone replaces them. Even-
e older chondrocytes in tually as osteoclasts digest the spicule tips, the medullary
diaphysis (hypertrophic cavity also lengthens.
During growth, the epiphyseal plate maintains a constant
Bone Remodeling
thickness because the rate of cartilage growth on its epiphysis- • If blood levels of calcium are too
• is done by osteoclasts. They remove
facing side is balanced by its replacement with bony tissue on its
diaphysis-facing side.
high, calcitonin tells osteoblasts to
Resting zone bonegrowth
Longitudinal by producing
is accompanied hydrochloric
by almost continuous deposit bone.
remodeling of the epiphyseal ends to maintain the proportion
betweenacid, which
the diaphysis dissolves
and epiphyses. the calcium
Bone remodeling involves • If blood levels of calcium are too
both new bone formation and bone resorption (Figure 6.11).
phosphate crystals.
As adolescence ends, the chondroblasts of the epiphyseal low, PTH tells osteoclasts to
1 Proliferation
zone
plates divide less Bones
• often. actbecome
The plates as a thinner
reservoir
and thin-
ner until they are entirely replaced by bone tissue. Longitudinal
for reabsorb bone.
Cartilage cells
undergo mitosis.
bone growth ends when calcium.
the bone of the epiphysis and diaphysis
fuses. This process, called epiphyseal plate closure, happens at
about 18 years•of ageBone remodeling depends
in males. on
Gland Hormone Target Tissue Function of
in females and 21 years of age
Hormone
Once this has occurred, only the articular cartilage remains in
blood
bones. However, an adult bonecalcium levels
can still widen and the
by appositional Thyroid Gland Calcitonin Osteoblasts 1. Deposit bone,
growth if stressed by stress reducing blood
2 Hypertrophic applied
excessive muscle activityto theweight.
or body bone. calcium levels
zone
Older cartilage cells
enlarge. 2. Osteoclasts 2. Inhibits
osteoclasts from
3 Calcification Bone growth Bone remodeling
reabsorbing
zone
Matrix calcifies;
bone
cartilage cells die; Articular cartilage
matrix begins Cartilage Parathyroid Parathyroid 1. Osteoclasts 1. Reabsorb
deteriorating; blood grows here.
vessels invade
Glands Hormone (PTH) +2

Bone Epiphyseal plate

bone, inc. Ca
cavity.
replaces levels
4 Ossification cartilage Bone that was 2. Kidneys 2. Reabsorb
zone here. here has been +2
New bone forms. resorbed.
Cartilage Ca , maintain
grows here. Appositional +2
growth adds blood Ca levels
Bone replaces bone here.
cartilage here.
Bone that was 3. Small +2
ng bone occurs at
here has been Intestine 1. Absorb Ca ,
physeal plate facing the resorbed.
+2
e cells of the epiphyseal Increasing Ca
are arranged in four levels (need
Figure 6.11 Long bone growth and remodeling during
of growth 1 to the
youth. Left: endochondral ossification occurs at the articular Vitamin D)
e 4 (115×). Ovaries Estrogen Osteoblasts Tell osteoblasts
cartilages and epiphyseal plates as the bone lengthens. Right: bone
to work faster,
Nutritional Requirements
remodeling during growth maintains proper bone proportions. The
red dashes outline the area shown in the left view. serves as a lock
• Calcium sources on bone by
inhibiting
• Dairy products, green leafy osteoclasts
Testes Testosterone Osteoblasts Tell osteoblasts
vegetables, broccoli, collards, to work faster,
kale, turnip greens, 3/26/15 5:11 PM
serves as a lock
on bone by
• Phosphorus for phosphates found inhibiting
osteoclasts (less
in dairy products and meats effect than
• Vitamin D needed for calcium estrogen)

absorption
• Vitamin D is activated by the
liver and kidneys to become
calcitriol.
• Calcitriol increases
calcium absorption in
the small intestines.
Hormonal Regulation
• Bone deposition and reabsorption
are regulated by hormones on the
basis of blood calcium levels.
Functions of the Skeletal System
a. Support
• Vertebral column allows the body to
be erect.
b. Movement
• The arrangement of bones and joints
allows a range of movements.
c. Protection
• The cranial bones protect the brain.
• The sternum and rib cage protect
the lungs and heart.
d. Acid-Base Balance
• Phosphate ions can bind to excess
hydrogen ions to buffer the pH of
the blood.
e. Electrolyte Balance
• Bones serve as a reservoir for
calcium.
f. Blood Formation
• Red blood cells, white blood cells,
and platelets are produced in the
red bone marrow.
Effects of Aging
• The ratio of deposition to
reabsorption changes as we age.
Condition Age Group
Deposition>Reabsorption Birth to Age 25
Deposition=Reabsorption Ages 25 to 45
Deposition<Reabsorption Ages 45 and
over
• Each vertebra becomes thinner
• Spinal column more curved
and compressed
• Neck is tilted
• Compression fractures more
common
• Change in posture affects gait and
balance
• Elderly more prone to falls
• Long bones lose mass but not length
• Scapulae thin and become more
porous
• Joints stiffen and become less
flexible as osteoarthritis sets in.
• Minerals may deposit in joints,
especially on the shoulder
• Phalangeal joints lose cartilage, and
the bones may thicken slightly.
• Effect on the cartilage:
• Erodes (especially in
osteoarthritis)
• Intervertebral disks become
thinner due to gravity
• Good bone health:
• Proper nutrition with vitamin
D
• Exercise
Diagnostic Tests for Skeletal System
Diagnostic Test or Screening Description
The use of low-dose
DEXA (dual-energy X-ray radiation to measure bone
absorptiometry) scan density in the hip and
vertebrae
The use of electromagnetic
radiation that sends photons
X-ray through the body to create a
visual image of dense
structures such as bone
Effect
Increasing Bone Diseases:
mass and density
Maintaining Bone
mass and density Osteoporosis
Decreasing Bone
mass and density • is a severe lack of bone density.
• Affects all bone, but more common
in cancellous bone
• Risk Factors: decrease in Calcium,
vitamin D in diet, lack of exercise,
diminished estrogen, testosterone
Osteomalacia
• Softening of the bones due to
reabsorption of calcium
Rickets
• Lack of bone deposition in children
 • Exaggerated curvature of the
lumbar vertebrae
• Aging, Pregnancy

Osteogenesis Imperfecta
• Lack of collagen fibers in bone CHAPTER 26 Bones, Joints, and Soft-Tissue Tu

tion in the gene TCIRG1, which encodes a com

proton pump. A less severe autosomal recessive
from a mutation in the gene that encodes RAN
prisingly, these individuals have fewer osteoclast
In animals, osteopetrosis can also be caused by
a large number of other genes, including M-CS
OPG, which you will recall regulate osteoclast
function.21

Morphology. The morphologic changes o

trosis are explained by deficient osteocla
The bones lack a medullary canal, and t
long bones are bulbous (Erlenmeyer flask
and misshapen. The neural foramina are
compress exiting nerves. The primary
which is normally removed during grow
and fills the medullary cavity, leaving no ro
hematopoietic marrow and preventing the
of mature trabeculae (Fig. 26–8). Deposit
not remodeled and tends to be woven in a
In the end, these intrinsic abnormalities
bone to be brittle and predisposed to frac
logically, the number of osteoclasts may
increased, or decreased depending on the
genetic defect.
Abnormalities of the Spinal Column
Figure: (a) scoliosis, (b) kyphosis, (c) lordosis

BursitisFIGURE 26–6 Skeletal radiogram of a fetus with lethal type II

osteogenesis imperfecta. Note the numerous fractures of virtually
all bones, resulting in accordion-like shortening of the limbs.

• Inflammation of the bursa

abnormally brittle and fracture easily, like a piece of chalk.
Osteopetrosis is classified into variants based on both the
Gout mode of inheritance and the clinical findings. The two major
groups include autosomal recessive and dominant forms. The

• Excessive build up of uric acid

autosomal recessive type is further divided into mild and
severe variants. The autosomal recessive severe type and the
autosomal dominant mild type are the most common
crystals within the joints and soft
variants.
Pathogenesis. Most of the mutations underlying osteope-

tissues
trosis interfere with the process of acidification of the osteo-
clast resorption pit, which is required for the dissolution of
the calcium hydroxyapatite within the matrix. Examples
include autosomal recessive defects in the gene CA2, which
encodes the enzyme carbonic anhydrase II.21 Carbonic anhy-

Rheumatoid arthritis
drase II is required by osteoclasts and renal tubular cells to
generate protons from carbon dioxide and water. Absence of
CAII prevents osteoclasts from acidifying the resorption pit
and solubilizing hydroxyapatite, and also blocks the acidifica-
tion of urine by the renal tubular cells. In an autosomal reces-
• Autoimmune disease where the
sive severe form of the disease, a mutation in the chloride
channel gene CLCN7 interferes with the function of the H+-
FIGURE 26–7 Radiogram of the upper extremity
with osteopetrosis. The bones are diffusely scl
ATPase proton pump located on the osteoclast ruffled border.21
body’s own immune system attacks
distal metaphyses of the ulna and radius are

• Scoliosis Another severe autosomal recessive form is caused by a muta- (Erlenmeyer flask deformity).

• Lateral curvature of the the structures of the joint

verterbral column • Ankylosis – state when the
• Kyphosis articulating bones fuse to one
• “hunchback” another
• Exaggerated abnormal • Tends to have periods of remission
curvature of the thoracic
vertebrae
• Aging, osteoporosis
• Lordosis
• “Swayback”
 Osteomyelitis
1222 CHAPTER 26 Bones, Joints, and Soft-Tissue Tumors
• is a bone infection.
Osteoarthritis
provide a route for the bacteria to seed the epiphyses and
subchondral regions in the adult.
• Most common
Morphology. The morphologic changes of osteomy-
• “wear andontear”
elitis depend of (acute,
the stage the joint or injury
subacute, or chronic)
and location of the infection. Once in bone, the bac-
to
teriathe joint asand
proliferate the articular
induce an acutecartilage
inflammatory
wears
reaction.with age and becomes
The entrapped bone undergoesrough necrosis
within the first 48 hours, and the bacteria and inflam-
• Crepitus-
mation spread creaking
within thesound
shaft ofduring
the bonetheand may
movement of affected joints
percolate throughout the haversian systems to reach
the periosteum. In children the periosteum is loosely
attached to the cortex; sizable subperiosteal abscesses
may form that can track for long distances along the
bone surface. Lifting of the periosteum further impairs
the blood supply to the affected region, and both the
suppurative and the ischemic injury may cause seg-
mental bone necrosis; the dead piece of bone is
known as a sequestrum. Rupture of the periosteum
leads to a soft-tissue abscess and the eventual forma- FIGURE 26–18 Resected femur in a person with draining osteo-
myelitis. The drainage tract in the subperiosteal shell of viable
tion of a draining sinus. Sometimes the sequestrum new bone (involucrum) reveals the inner native necrotic cortex
crumbles and forms free foreign bodies that pass (sequestrum).
through the sinus tract.
In infants, but uncommonly in adults, epiphyseal
infection spreads through the articular surface or
along capsular and tendoligamentous insertions into
Osteosarcoma
cases, acute osteomyelitis fails to resolve and persists as chronic
a joint, producing septic or suppurative arthritis, • Malignant
infection. Chronicity maybone
developtumor
when there is delay in diag-
which can cause destruction of the articular cartilage nosis, extensive bone necrosis, inadequate antibiotic therapy
Mastoiditis
and permanent disability. An analogous process or surgical debridement, and weakened host defenses. Acute
involves the vertebrae, in which the infection destroys flare-ups may mark the clinical course of chronic infection
the hyaline cartilage end plate and intervertebral disc and are usually spontaneous, have no obvious cause, and may
• Inflammation of the vertebrae.
and spreads into adjacent mastoid process occur after years of dormancy. Other complications of chronic
caused byfiinfection
After the rst week chronic inflammatory cells osteomyelitis include pathologic fracture, secondary amyloi-
dosis, endocarditis, sepsis, development of squamous cell car-
become more numerous and their release of
cytokines stimulates osteoclastic bone resorption, cinoma in the sinus tract, and rarely sarcoma in the infected
ingrowth of fibrous tissue, and the deposition of reac- bone.
tive bone in the periphery. When the newly deposited
bone forms a sleeve of living tissue around the TUBERCULOUS OSTEOMYELITIS
segment of devitalized infected bone, it is known as
an involucrum (Fig. 26–18). Several morphologic vari- A resurgence of tuberculous osteomyelitis is occurring in
ants of osteomyelitis have eponyms: Brodie abscess developed countries, attributed to the influx of immigrants
is a small intraosseous abscess that frequently from countries where tuberculosis is endemic, and the greater
involves the cortex and is walled off by reactive bone; numbers of immunosuppressed people (Chapter 8). In devel-
sclerosing osteomyelitis of Garré typically develops oping countries the affected individuals are usually adoles-
in the jaw and is associated with extensive new bone cents or young adults, whereas in the indigenous population
formation that obscures much of the underlying of the United States they tend to be older, except for those who
osseous structure. are immunosuppressed. Approximately 1% to 3% of individu-
als with pulmonary or extrapulmonary tuberculosis have
osseous infection.
Clinical Course. Clinically, hematogenous osteomyelitis The organisms are usually blood borne and originate from
may manifest as an acute systemic illness with malaise, fever, a focus of active visceral disease during the initial stages of
chills, leukocytosis, and marked-to-intense throbbing pain primary infection. Direct extension (e.g., from a pulmonary
over the affected region. The presentation may be subtler with focus into a rib or from tracheobronchial nodes into adjacent
only unexplained fever, particularly in infants, or only local- vertebrae) or spread via draining lymphatics may also occur.
ized pain in the absence of fever in the adult. The diagnosis The bony infection is usually solitary and in some cases may
 1226 CHAPTER 26 Bones, Joints, and Soft-Tissue Tumors

a coarse, lace-like architecture but also may be depos-

ited in broad sheets or as primitive trabeculae. Other
matrices, including cartilage or fibrous tissue, may be
present in varying amounts. When malignant carti-
lage is abundant, the tumor is called chondroblastic
osteosarcoma. Vascular invasion is usually conspicu-
ous, and up to 50% to 60% of an individual tumor may
be necrotic.

Clinical Course. Osteosarcomas typically present as

painful, progressively enlarging masses. Sometimes a sudden
fractureFractures
of the bone is the first symptom. Radiograms of the
primary tumor usually show a large destructive, mixed lytic
and blastic mass with infiltrative margins (Fig. 26–24). The
tumor Closed
frequently Fracture
breaks through (formerly called
the cortex and lifts thesimple
peri-
fracture)
osteum, resulting in reactive periosteal bone formation. The
triangular shadow between the cortex and raised ends of peri-
• Does
osteum is known not cause
radiographically a break
as Codman in and
triangle theis skin.
characteristic but not diagnostic of this tumor. These aggres-
FIGURE 26–22 Osteosarcoma of the upper end of the tibia. The • A shattered bone may
sive neoplasms spread hematogenously, and at the time not break
of
tan-white tumor fills most of the medullary cavity of the metaphy-
sis and proximal diaphysis. It has infiltrated through the cortex, through the skin, but it hardly seems
diagnosis approximately 10% to 20% of affected individuals
lifted the periosteum, and formed soft-tissue masses on both have demonstrable pulmonary metastases, and it is likely that
sides of the bone. many more have appropriate
occult metastases.to In refer
those whoto die
it as simple.
of the
neoplasm, 90% have metastases to the lungs, bones, brain, and
elsewhere.
Chondrosarcoma Open Fracture
tumors frequently destroy the surrounding cortices • Formerly called a compound
and produce soft-tissue masses. They spread exten-
Malignant
CHAPTER tumor
sively in26the
Bones, of the
medullary
Joints, and cartilage
canal, infiltrating
Soft-Tissue and replac-
Tumors 1229
fracture
ing the marrow surrounding the preexisting bone • breaks through the skin.
trabeculae. Infrequently, they penetrate the epiphy-
nful, and because of seal plate or enter the joint. When joint invasion
e effusions and restrict occurs, the tumor grows into it along tendoligamen-
roduce a well-defined tous structures or through the attachment site of the
s spotty calcifications. joint capsule. The tumor cells vary in size and shape
curettage. Pulmonary and frequently have large hyperchromatic nuclei.
have undergone prior Bizarre tumor giant cells are common, as are mitoses.
ge. Apparently in these The formation of bone by the tumor cells is charac-
d into ruptured vessels, teristic (Fig. 26–23). The neoplastic bone usually has
ulation.

f cartilage tumors and

mistaken for sarcoma.
d 20s and has a male FIGURE 26–30 Chondrosarcoma with lobules of hyaline and
equently arise in the myxoid cartilage permeating throughout the medullary cavity,
n involve virtually any growing through the cortex, and forming a relatively well-circum-
scribed soft-tissue mass.

rom 3 to 8 cm in
cumscribed, solid, Cleft Palatean
demonstrate eccentric geographic lucency that is well
opically, there are delineated from the adjacent bone by a rim of sclerosis. Occa-
ine cartilage and sionally the tumor expands the overlying cortex. The treat-
ment of choice is simple curettage, and even though they may
us septae. The cel-
st cellularity are at
• theyCongenital
recur, defect
do not pose a threat resulting
for malignant in failure
transformation
the cartilaginous of the hard and/or soft palate to
or metastasis.
uated in lacunae;
e cells are stellate, fuse
Chondrosarcoma FIGURE 26–24 Distal femoral osteosarcoma with prominent
xtend through the FIGURE 26–23 Coarse, lacelike pattern of neoplastic bone pro- bone formation extending into the soft tissues. The periosteum,
pproach or contact Chondrosarcomas
duced are malignant
by anaplastic a group of tumor
tumorscells.
that span
Note athe
broad
mitotic which has been lifted, has laid down a proximal triangular shell
spectrum
gures. of clinical and pathologic findings. The feature
contrast to other
eoplastic cells in
fi
common to all of them is the production of neoplastic carti- Complete Fracture
of reactive bone known as a Codman triangle (arrow).

arying degrees of lage. Chondrosarcoma is subclassified according to site as

presence of large central (intramedullary) and peripheral ( juxtacortical and
findings include surface). Histologically, they include conventional (hyaline • The bone is in two or more pieces.
artilaginous matrix and/or myxoid), clear cell, dedifferentiated, and mesenchymal
eoclast-type giant variants. Conventional central tumors constitute about 90%
of chondrosarcomas.
Chondrosarcoma of the skeleton is about half as frequent
as osteosarcoma and is the second most common malignant
oma usually complain matrix-producing tumor of bone. Individuals with chondro-
instances, radiograms sarcoma are usually in their 40s or older. The clear cell and
especially the mesenchymal variants occur in younger patients,
in their teens or 20s. The tumor affects men twice as frequently
as women. About 15% of conventional chondrosarcomas
(usually peripheral tumors) arise from a preexisting enchon-
droma or osteochondroma.
 Crushed
vertebra

• There is a crack in the bone.

6
iral Ragged break occurs when excessive twisting forces Epiphyseal Epiphysis separates from the diaphysis along the
are applied to a bone. epiphyseal plate.
 
Common sports fracture Tends to occur where cartilage cells are dying and
calcification of the matrix is occurring

Greenstick Fracture
pressed Broken bone portion is pressed inward. Greenstick Bone breaks incompletely, much in the way a green
twig breaks. Only one side of the shaft breaks; the
Displaced
Typical Fracture
of skull fracture   • Bone breaks incompletely, much in
other side bends.
• The bone is no longer in proper the way a green twig breaks.
Common in children, whose bones have relatively
alignment. • Only
more organic oneand
matrix side
are of theflexible
more shaft than
Non-displaced Fracture breaks; the other side bends.
those of adults
• The bone is in proper alignment.

Depressed Fracture

• The bone has been dented.

• This fracture is found where there is
cancellous bone, as in skull
fractures.
06_193-218.indd 211
Hairline Fracture
3/26/15 5:11 PM

• Aka stress fracture

 Depressed Broken bone portion is pressed inward. Greenstick Bone breaks incompletely, much in the way a green
twig breaks. Only one side of the shaft breaks; the
  Typical of skull fracture  
other side bends.
• This may occur when
Common in children, whose bones have relatively
morechildren fall while
organic matrix and arekneeling
more flexible than
thoseon a chair at the table with
Ragged break occurs when excessive twisting forces211 Epiphysea
of adults
Spiral Chapter 6 Bones and Skeletal Tissues
their feet
are applied to a bone. sticking through
   
able 6.2 Common Types of Fractures Common sportsthefracture
chair’s spokes.
RACTURE FRACTURE
YPE DESCRIPTION AND COMMENTS TYPE DESCRIPTION AND COMMENTS

omminuted Bone fragments into three or more pieces. Compression Bone is crushed.
Particularly common in the aged, whose bones are   Common in porous bones (i.e., osteoporotic bones)
moreTransverse
brittle Fracture subjected to extreme trauma, as in a fall

• The bone is broken perpendicular to

its length.
Crushed
vertebra

Depressed Broken bone portion is pressed inward. Greenstick

Epiphyseal Fracture
  • Typical of skull fracture
Epiphysis separates from the  

diaphysis along the epiphyseal plate.

• Tends to occur where cartilage cells
are dying and calcification of the 6
piral Ragged break occurs when excessive twisting forces Epiphyseal Epiphysis separates from the diaphysis along the
are applied to a bone.
matrix is occurring
epiphyseal plate.
 
_10_SE_CH06_193-218.indd 211
• The break occurs at the 3/26/15 5:1
Common sports fracture Tends to occur where cartilage cells are dying and
epiphyseal
calcification of the matrix isplate in a child.
occurring

Oblique Fracture
• The break in the bone is at an angle.

epressed Broken bone portion is pressed inward. Greenstick Bone breaks incompletely, much in the way a green
Comminuted
twig breaks.Fracture
Only one side of the shaft breaks; the
Typical of skull fracture  
The
• other bone
side bends.(commonly referred to as
Spiral Fracture shattered)
Common is broken
in children, into three
whose bones or
have relatively

• The break in the bone spirals up the more

more pieces.
organic matrix and are more flexible than
those of adults
bone.
• This type of break often results from
M06_MARI6971_10_SE_CH06_193-218.indd 211

twisting the bone.

 Table 6.2 Common Types of Fractures
FRACTURE FRACTURE
TYPE DESCRIPTION AND COMMENTS TYPE DESCRIPTION AND COMMENTS

Comminuted Bone fragments into three or more pieces. Compression Bone is crushed.
  Particularly common in the aged, whose bones are   Common in porous bones (i.e., osteoporotic bones)
more brittle subjected to extreme trauma, as in a fall

Crushed
vertebra

6
Spiral Ragged break
Chapter occurs and
6 Bones whenSkeletal
excessive twisting forces211 Epiphyseal
Tissues Epiphysis separates from the diaphysis along the
  Compression Fracture
are applied to a bone.
 
epiphyseal plate.
Common sports fracture Tends to occur where cartilage cells are dying and
calcification of the matrix is occurring
FRACTURE Cancellous bone has been
•
TYPE
compressed.
DESCRIPTION AND COMMENTS

es.
• This
Compression
type of fracture may occur in
Bone is crushed.
bones are  
the vertebrae.
Common in porous bones (i.e., osteoporotic bones)
subjected to extreme trauma, as in a fall

Crushed
vertebra
Depressed Broken bone portion is pressed inward. Greenstick Bone breaks incompletely, much in the way a green
twig breaks. Only one side of the shaft breaks; the
  Typical of skull fracture  
other side bends.
Common in children, whose bones have relatively
more organic matrix and are more flexible than
those of adults
6
isting forces Fracture
Epiphyseal Healing
Epiphysis separates from the diaphysis along the
epiphyseal plate.
  1.Hematomas form due to bleeding.
Tends to occur where cartilage cells are dying and
2.Thecalcification
healing of a fracture
of the starts with
matrix is occurring
stem cells forming a soft callus in a
hematoma.
3.Osteoblasts deposit bone in the soft
callus to form a hard callus.
4.Osteoclasts finish the healing of the
fracture by remodeling the hard callus
to reestablish the marrow cavity. Herniated Disk

• The lateral bulge of an intervertebral

Greenstick Bone breaks incompletely, much in the way a green
disk
twig breaks. Only one side of the shaft breaks; the
 
other side bends.
Common in children, whose bones have relatively
more organic matrix and are more flexible than
those of adults
M06_MARI6971_10_SE_CH06_193-218.indd 211 3/26/15 5:11 PM
STUDY HARD! J