Help: Bone Fracture and Bones

1. What is meant by a “complete, comminuted, intertrochanteric fracture of the right hip? a. A complete fracture is when the entire bone impacted is fractured. A comminuted fracture is when the bone breaks shatters into many pieces. Intertrochanteric refers to the top part of the femur. So, a complete, comminuted intertrochanteric fracture is the upper most part of the femur is completely shattered. A comminuted fracture is common in older people, so this fracture is normal for someone Margaret’s age.

(Marieb, Elaine N.R., Ph.D. “5/The Skeletal System.” Essentials of Human Anatomy & Physiology. San Francisco: Pearson Education, 2006/ 137. Print.) 2. Draw a picture of what you think Margaret’s fractured femur looks like b.

3. The radiologist reports signs of osteoporosis. How is osteoporotic bone different from regular bone? c. Osteoporotic bone differs from regular bone because it has a lower bone mass and a loss of bone tissue, which can lead to weak, fragile bones. Osteoporosis is known to affect elderly women more often than men.

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Since our bones stop gaining density at the age of 25, it is important to continue to build strong bones after that time. Compared to regular bones, osteoporotic bones look thinner and have bigger pores. (Shiel, William C., JR. “Osteoporosis Picture Slideshow: Are Your Bones At Risk?” Www.MedicineNet.com. MedicineNet, Inc 1996-2012. Web.)

4. Why do bones become osteoporotic in some people? (What, specifically, is happening in the bones themselves?) d. Bones become osteoporotic in some people because the bone density stops forming. At a certain age, bones stop evolving.

At that point, it is important to exercise and consume all the vital vitamins our body needs to remain strong. When bones begin to lose their density, there is a chance of osteoporosis occurring. When bones become osteoporotic, they start to thin out and the pores in the bones grow larger. This makes the bones turn weak and fragile, re-enforcing the idea that people with osteoporotic bones are more likely to suffer more serious fractures than those that do not have osteoporosis.

5. Describe the changes that a broken bone undergoes as it is healing. e. When a bone breaks or fractures, the first step of the healing process is inflammation. Lasting for a few days, the inflammation occurs because the blood channels are disturbed. This is known as hematoma – bleeding within tissue. Damaged bone tissue dies, and releases a chemical called Cytokines, which initiates the healing process. Osteoclasts then begin to remove dead bone cells. The blood from the fractured bones begins to form a blood clot, which acts as the first link between the fragment pieces. Fibroblasts then begin to lay down new tissue a few days after the fracture occurs. The Soft Callus begins a few days after the bone was broken. The Fibroblast cells that were present during the inflammation stage are responsible for making Cartilage and Fibrocartilage. Fibrocartilage is a spongy material that fills in the space between fractured pieces of the bone. The fibrocartilage will not strengthen too much, and it is weak, so it is extremely important that there is very little movement when this part of the process is taking place.

For another two – three weeks, the Soft Callus transforms into woven bone. This process is the most time consuming, taking anywhere from six – twelve weeks to fully finish. Hard Callus is aided by calcium and phosphate being released into the cartilage tissues. The next part of the healing process is the Fracture Union. Bone remodeling begins ones the fractured bone has come back together. The shape of the bone is not the same as it was originally, but over time Osteoclasts remove unnecessary parts, which Osteoblasts lay down bone where needed. (PhysioRoom. “Bone Fracture Healing Explained” www.physioroom.com. PhysioRoom.com, 2012. Web.)

6. How does weight bearing influence the bone healing process? (Be detailed!) f. According to Wolfe’s Law, bones grow and remodel in response to the mechanical stresses that are placed upon it. When different types of stresses are placed in specific directions, the bones are remodeled and become healthy once again. For people that have osteoporotic bones or fractured bones, Wolfe’s Law must be applied during physical therapy for the bone to heal properly. The formation of the trabeculae adapts to the changes occurring as a result of weight bearing. The external cortical – one of the two types of osseous tissues that form bones - portion of the bone then undergoes changes as well. (Wikipedia. “Wolfe’s Law.” www.wikipedia.com. Wikimedia Foundation Inc.,, 7 Dec. 2012. Web.) 7. In addition to the physical therapy benefits, why else might Margaret’s physician want her to avoid prolonged bed-ridden activity? (Think of Wolfe’s Law)

g. If Margaret remains on bed rest for too long, there are many negative affects that will surface as a result of this. Muscle strength will decrease daily. The lack of gravitational forces may lead to osteopenia – when bone mineral is lower than normal. Joints begin to show a loss of connective tissue after too much inactivity. Immobilization also causes ligament strength to decrease tremendously. Cardiovascular efficiency decreases, along with blood and plasma volumes. When there is less daily activity, the amount of stress the skeleton has to endure is less, which causes a loss in bone mass. (Cuccurullo S, editor. Physical Medicine and Rehabilitation Board Review. New York: Demos Medical Publishing; 2004. Effects of Extended Bed Rest- Immobilization and Inactivity. http://www.ncbi.nlm.nih.gov/books/NBK27213.)

8. What risk factors does Margaret have for osteoporosis? h. Because Margaret has such a long history of smoking, she is more likely to encounter many more problems with her bones. Smoking is known to release hormones that lead to the break down of bones. Smoking damages blood vessels, causing the circulation of blood and oxygen to be hindered. This makes the bone healing process that much harder for Margaret because her body has to fight numerous things to begin healing itself. Sedentary is a word used to describe those that sit more often than move around. Since Margaret is sedentary, she places excess stress on her skeleton, causing her bones to endure more pain. Margaret’s lifestyle suggests that she is a likely candidate for osteoporosis.

9. What bones are most vulnerable to osteoporosis and why? i. When discussing osteoporosis, the bones that automatically come to mind are the wrist, spine, and hip. Certain parts of the vertebral column are also common osteoporotic bones. In the vertebral column, the upper lumbar, lower thoracic, and cervical vertebrae are usually the bones that end up becoming osteoporotic. 10. Specifically describe how each of these medications works to treat Margaret’s condition. j. Oral Calcium Supplements are used to prevent and treat low blood calcium levels for people that do not get enough calcium. Calcium supplements are commonly used for people that suffer from Osteoporosis, like Margaret.

The calcium will help keep her bones from deteriorating more than they already have. Estrogen is a hormone that the female body uses to regulate the menstruation cycle. Postmenopausal women suffer from a lack of estrogen, which can cause the body to go haywire. Estrogen not only regulates women’s bodies after menopause, it also prevents bone loss. This would also help Margaret’s case of Osteoporosis greatly. Lastly, Alendronate Sodium (Forsamax) helps to inhibit the activity of osteoclasts. This medicine would help Margaret because the osteoclasts are bone cells that break down parts of the bone. Margaret needs the opposite of that, so Forsamax would prevent her osteoporosis from getting worse.

Mini Case Studies

1. A 12 year-old boy fell while playing basketball. The physician explained that the head (epiphysis) of the femur was separated from the shaft (diaphysis). Although the bone was properly set, by the time the boy was 16 it was apparent that the injured lower limb was shorter than the normal one. Explain why this difference occurred. a. The difference in the limbs could be a result of a lack of weight-bearing exercise. When fracturing any bone, weight-bearing exercise is vital to the repair and remodeling of said bone. If the proper physical therapy is not done, bones can heal differently than they originally were.

2. One day while shopping, Ms. Wantta Bargain picked up her 3-year-old son, Somm, by her right wrist and lifted him up into a shopping cart. She heard a clicking sound and Somm immediately began to cry and hold his elbow. Given that lifting the child caused a separation at the elbow and not a fracture, which is more likely: separation of the radius and humorous or separation of the ulna and humorous? Why? b. The crack that Ms. Wantta Bargain heard when she lifted up Somm was most likely the separation of the ulna and humorous. The joint that connects the ulna to the humorous is a synovial joint, more specifically, by articular cartilage. Articular cartilage covers the ends of the bones forming a joint. Because the ulna is significantly smaller than the radius, it is more likely that that’s the bone that was separated from the humorous.

* Marieb, Elaine N.R., Ph.D. “5/The Skeletal System.” Essentials of Human Anatomy & Physiology. San Francisco: Pearson Education, 2006/ 137. Print. * Shiel, William C., JR. “Osteoporosis Picture Slideshow: Are Your
Bones At Risk?” Www.MedicineNet.com. MedicineNet, Inc 1996-2012. Web. * PhysioRoom. “Bone Fracture Healing Explained” www.physioroom.com. PhysioRoom.com, 2012. Web. * Wikipedia. “Wolfe’s Law.” www.wikipedia.com. Wikimedia Foundation Inc.,, 7 Dec. 2012. Web. * Cuccurullo S, editor. Physical Medicine and Rehabilitation Board Review. New York: Demos Medical Publishing; 2004. Effects of Extended Bed Rest- Immobilization and Inactivity. http://www.ncbi.nlm.nih.gov/books/NBK27213.