Reviewing: Epiphyseal Plates (younger skeletons) eventually will disappear. Bones grow lengthwise up and down from each plate, and in a circular ‘collar

like ‘fashion around the diaphysis. These plates will become thin lines and be virtually undetectable in an

adult long bone

EPIPHYSEAL PLATE IN FEMUR

Sites for bone marrow testing, removal or implantation

Biopsy needle inserted through: periosteum, compact bone into red marrow/spongy bone

below

Bone marrow from donor to recipient

Examples of fractures – text pg 30

Types of Fractures:• 1. Simple Fracture – no separation of the bone into parts,

but a crack or break is detectable; aka hairline (very faint crack) – bone is NOT exposed to air through skin – Cause?? Fall, body contact, impact

• 2. Compound Fracture – the bone breaks into 2 separate pieces; bone may be exposed through the skin in serious fractures – Cause?? Major blow (e.g.Bad slide tackle..) or bad angles into contact

• 3. Comminuted Fracture – the broken ends of the bone are shattered into many pieces - cause?? Car accident or major fall from height – need lots of speed or force into impact

Shapes of Fractures

•A word may be used to describe the shape of the fracture eg.

Transverse ‘straight across’; greenstick /oblique ‘angled’

spiral ‘S shape’/twirl;

A simple fracture of the right tibia – no broken skin, bone intact

Forearm Fracture – Simple

Comminuted Fractures - fibula is broken at both proximal/head and distal end and

tibia is badly shattered

Hairline fracture of the 3rd metatarsal – often need more than 1 x-ray [and

view] to diagnose

Comminuted of the first metacarpal (thumb!!) – also note appearance of

sesamoid bone on thumb – distal end of 1st metacarpal

A difficult bone to break – the humerus !

Compound fracture of distal end of fibula – lateral malleolus would be ‘wrong’ looking – landing from height with lots of eversion?? Or

tackle from side right against lateral leg?? Theisman?? Ski boot injury??

A compound fracture of distal humerus in a child

Proximal humerus requires immobilization

Bad, bad compound fracture of distal end of Tibia!!!

A beginning to be healed compound fracture – stapling may be used to close wound

Collisions with the leg and a planted foot can have serious implications on the tibia and fibula depending on where the contact

comes from.

Comminuted/shattered fracture of fibula – skiing injury?? Also, appears to a fracture of

distal tibia at the medial malleolus – a chipped off piece of bone is called an avulsion fracture

The femur is one of the most difficult bones to fracture – car accidents, falls from height etc..

Falls on the outstretched arm usually fracture: the radius, the scaphoid (carpal bone) or the

first metacarpal (thumb)

• Bone• Bones can be fractured following collisions, falls and impacts.

Typically, the signs of a fracture are swelling, tenderness, bruising, restriction of movement and, in some instances, obvious deformity.

• Fractures are potentially serious injuries and a considerable amount of blood can be lost either externally (if the skin is broken) or internally (when the skin is unbroken, known as a closed fracture). Loss of blood can lead to physiological shock. The surrounding soft tissues are often also damaged.

• Treatment by a suitably qualified individual involves controlling the bleeding, preventing further damage or movement (by splinting if appropriate) and transporting the person to hospital, treating for potential shock on the way. Even if a fracture is only suspected, medical assessment is still necessary. The manipulation of a displaced fracture is for the medically qualified.

Causes of fractures…

Sports with legal body contact such as tackling (rugby, football) hockey (checking)

may have upper body fractures, separations or dislocations

Separation – refers to the clavicle moving away from either the coracoid process or acromion process of the scapula

Dislocation – bone is displaced from its original location

• Most common is finger, shoulder or kneecap

• Dislocations can tear ligaments and the joint capsule

This looks painful! Shoulder or Elbow dislocation perhaps??

Treating fractures: immobilize, ensure alignment, proper nutrition during healing, prevention of

infection if compound! •

Healing: Text pg 30

- if bones are not aligned – they need to be put into alignment – this can be done with or without

pain management – nasal bone fractures

- use of plates, screws etc.. in serious cases – these usually stay in forever!

-if bone heals in a misaligned fashion it needs to be rebroken – can be very traumatic

- bone chips can be used from other parts of body to facilitate healing

- Calcium, Vitamin D, phosphorous and Vitamin A and C are all thought to aid bone healing

• Common sports injuries• Articular cartilage injuries - injuries to the surfaces of the bones where they come together

to form joints (articular cartilage, a material that allows the bone surfaces to glide smoothly across each other). Chronic wearing down of this material is called osteoarthritis. A chondral or osteochondral fracture occurs when a fracture of the bone involves both bone and cartilage.

• Children's Memorial Institute for Sports Medicine provides care for competitive athletes of all disciplines.

• Avulsion fracture - a fracture where a tendon pulls off a piece of bone, usually as a result of a violent or forceful muscle contraction. In children and adolescents, an avulsion fracture typically occurs at a growth center (an area of the bone made up of cartilage which is also the site where tendons attach to bone).

• Dislocation - when a joint comes fully out of the socket and needs to be put back in place.• Exercise-induced asthma - not the same as chronic asthma, the more proper term is exercise-

induced bronchospasm (EIB). EIB is shortness of breath and wheezing that are triggered by exercise or physical activity. The symptoms usually occur during or shortly after exercise.

• Growth plate injuries - injuries to the cartilage found at the ends of the bones in children and adolescents. Cartilage is softer than bone and therefore more vulnerable to injury. Growth plate injuries include fractures and avulsions.

• Heat illness - illness resulting from excessive exercise in high temperature or humidity.• Ligament injuries - include sprains (stretched or partially torn) and complete tears or

ruptures to the pieces of fibrous tissue that connect one bone to another -- the ligaments.• Meniscus injuries - injuries to the crescent-shaped rubbery wedge of fibrous cartilage

-- the meniscus - which is located between the shinbone (tibia) and the thigh bone (femur). The meniscus acts as a cushion for the knee joint and helps to stabilize the knee during twisting motions. Injury to the meniscus results in a tear.

• Minor fractures - a crack or break in a bone.• Stress fracture - overuse injury of a bone that results when too much stress is placed

on it, causing its cortex (outside layer) to crack.• Tendonitis - inflammation in a tendon which typically results from overuse.• Tendon injury - partial or complete tear of a tendon.• Overuse injuries - Tissue breakdown due to repetitive activity. Overuse injuries cause

pain that worsens over time.• Sports-related concussion - A traumatic head injury that is characterized by various

physical symptoms, the most common of which are headaches and dizziness, and is also associated with changes in brain function, such as memory loss, difficulties with attention, processing speed, reaction time, and concentration.

Bad, bad compound fracture of both radius and ulna!!

Looks like a compound fracture of distal end of tibia!!