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Bones Online
Bones Online
Cannot teach you all about bones The aim of the lecture is to highlight topics you need to know Emphasise the basic principles that will help you pass your exam Test what you know
Bone:
Composition Structure Function
What are the three main components the form the bones microstructure??
Matrix, organic and inorganic Organic Type 1 collagen Non organic carbonated hydroxyapatite Matrix cells
Osteoclasts, osteocytes and osteoblasts
Cells OsteoBlasts: Broduce bones Osteocytes: Maintains bones -most numerous stuck in lacunae, stellate processes OsteoKlasts: Kills bone
Compact tissue - the harder, outer tissue of bones Cancellous tissue - the sponge-like tissue inside bones. Subchondral tissue - the smooth tissue at the ends of bones covered with cartilage.
Layer of spongy bone sandwiched between parallel layers of compact bone b. Periosteum covers compact bone c. Endosteum covers spongy bone Hematopoietic tissue: Red marrow Red marrow cavities i. Spongy bone of long bones In adults, fat containing medullary cavity extends into epiphysis i. Little red marrow
LAMELLAR Arrangement of Type I collagen parallel Osteocytes in matrix few Osteocyte morphology uniform Deposition/production slow Tensile strength strong Present in adult skeleton Normal Found in bone forming tumor rare Pathologic formation Reaction to persistent stress and slowly growing tumors
WOVEN Irregular Numerous Pleomorphic Rapid Low Abnormal Usual Reaction to rapidly growing tumor or virulent infection
Outline
"Real People Have Calcified Osses": Resting zone (reserves) Proliferation Hypertrophy Calcification Ossification
1. 2.
Bone needs to be replaced. Resorbs and reforms Osteoblasts and Osteoclasts work together PTH +Osteoblasts + Collagenase & Osteoclasts Bone reabsorbed Remodelling Osteoblasts Osteoid --> Bone formed Osteoid= collagen
PTH stimulates Osteoblasts Osteoblasts stimulates Osteoclasts and Collagenase which reabsorb bone Coupling signals stimulate Osteoblasts to form Osteoid (mineralization). Osteoblasts flatten and deactivate
Physiology
Function of Calcium Contractility of cardiac muscles depends on extracellular Ca2+ (ligand for cell membrane depolarisation) Contractility of skeletal muscles depends on intracellular Ca2+ (actual mechanism for contraction) Plasma membrane ion channel activities Transmission of nervous impulses Enzyme activities Maintenance of bones and teeth Blood clotting Calcium Regulation 99% found in bones and 1% soluble in cells and blood plasma (in dynamic equilibrium)
Osteoclasts are activated to digest bone matrix and release calcium into blood Calcitonin is released in response to high calcium in blood Calcium salts are deposited into bone
40% of eaten Ca++ is absorbed through the small intestine Through epithelial receptor called Calbindin
Sats depend on 1,25-dihydroxvitamin D
1There is a joint cavity 2.The parts of the bones in contact with each other are covered by smooth articular cartilage. 3. The joints are surrounded by a connective tissue capsule 4. The inner surface of the capsule and the non-articular surfaces of the bones are covered with synovial membrane 5. The capsule is reinforced by ligaments 6. The joint is capable of movement
Synovial joint Three joint in one (Medical tibiofemoral joint, later TFJ and patellofemoral joint) Unstable (due to weight) hence susceptible to injury Ligaments and meniscus
Meniscus:
Fibrocartilage discs Medial and lateral Shock absorbers Reduce friction
Menisci attachments in knee Each meniscus has something attached to it. The medial meniscus has the medial collateral ligament The lateral meniscus is attached to the popliteal muscle.
Cruciate ligaments: insertions PAMS APPLES: Posterior [passes] Anterior [inserts] Medially. Anterior [passes] Posteriorly [inserts] Laterally.
Small fluid filled sac that reduces friction Prepatellar bursa: Between the patella and skin Infrapatellar bursa: Between tibia and patellar ligament Suprapatellar bursa: Inf femur and quads muscle
Knee
injuries
Medial meniscus is torn more often than the lateral lateral meniscus is smaller in diameter, thicker in periphery,
Damage usu due to mechanical stresses produced from: Acceleration and deceleration Coupled with sudden change in direction and landing after a jump (eg basketball and football)
Injuries commonly occur usually when the knee is flexed and there is significant rotation between the femur and tibia
Ligaments can be damaged together or in isolation Occurs when a joint is loaded in the direction in which the ligament resists movement: MCL snaps when forcing knee into valgus LCL snaps when forcing knee into varus
Valgus outward angulation of the distal segment of a bone or joint (causing knee to point medially) Varus inward angulation of the distal segment of a bone or joint (causing knee to point laterally)
In young people with strong bones, the ligaments are usually relatively weaker and will be the first to be injured The converse is true in elderly people with weak bones
MCL damage
Fractures around the knee can be associated with injuries to other structures
Transverse fractures in the patella may occur due to quadriceps contracting suddenly against a resistance
How would you test for an Anterior cruciate ligament tear clinically?
Anterior draw test, Lachmans test
Occurs when a force exceeds the compressive or tensile strength of the bone
highest incidence is seen in young males between ages 1524 (tibia, clavicle and distal humerus) and usually the result of trauma. In the elderly, fracture of proximal femur, proximal humerus, vertebrae, distal radius, or pelvis are often associated with osteoporosis.
Stage of Haematoma Blood vessels break and leaking blood produces a haematoma Stage of Subperiosteal and Endosteal Cellular Proliferation osteoblasts and chondroblasts are activated and proliferate at periosteum and endosteum Stage of Callus Chondroblasts lay down hyaline cartilage & Osteoblasts lay down collagen fibres which then calcifies to form woven bone Stage of Consolidation Osteoblasts lays down lamellar bone at the expense of woven bone
Osteoporosis
Define osteoporosis
A bone mineral density that is 2.5 SDS or more below the mean peak bone mass (average of young, healthy adults) as measured by DEXA scan
Osteoporosis is a bony disorder characterized by progressive decrease in bone density and mass Osteon is bone and porosis is hole in Greek
Female male ratio 4:1 and higher incidence of male osteoporosis Up to 50% postmenopausal women affected One in ten older women with a previous fragility fracture has a referral for bone density assessment in her electronic medical record
History of fracture as an adult and in an immediate (first-degree) relative Low body weight Lifelong low calcium intake Current cigarette smoking Alcoholism Advanced age Early menopause Asian
Clinical picture Serological Se Calcium, Phosphorus and Alkaline Phosphatase. Other markers from blood and urine Gold standard- DXA
Two X-ray beams with differing energy levels are aimed at the patient's bones a method of estimating the strength of bones and the likelihood of bone fractures with minimal or no trauma On X-ray you will see changes only after 3040% bone loss
Clinical
Loss of bone mass sufficient to significantly increase the risk of fracture
Diagnostic
T score number of standard deviations above or below the mean for a similar healthy 30 year old
Normal BMD = Osteopenia BMD = Osteoporosis BMD = T: 0 to -1 T: -1 to -2.5 T: less than -2.5
Z score number of standard deviations above or below the mean for the patients age, sex and ethnicity
Lifestyle
Smoking Exercise
Excessive uncontrolled destruction of bone by abnormally large and active osteoclasts Concurrent inadequate attempts at haphazard new bone formation by osteoblasts Produces physically weak woven bone Very high alk phos, normal Ca2+ and Po4
Vitamin D deficiency Normal collagen production but mineralization is inadequate Leads to trabecular bone that is only partially mineralised and is therefore soft and weak Low Ca++, high PO4, Normal Alk Phos, High PTH