Mareena AlvarezMr. BlakelyA&PNovember 20, 2018 Case Study: Bone Tissue While at work, a 45-year-old woman was brought into the emergency room due to a heavy box full of metal rivets falling 20ft down striking her outstretched arm. She then fell backwards hitting her head. When the paramedics arrived at the scene she was unconscious.
They noticed that she was losing a lot of blood from her left arm so the paramedics then applied a pressure bandage to minimize further hemorrhage. When Mrs.Morgan was brought to the hospital she was complaining of severe back and arm pain. Plus, Mrs.
Morgan also said she had an excruciating headache. After looking over the patient the doctor noticed she had bruising covering her left shoulder, left wrist, and lower back. When the doctor took off the blood-soaked bandages he noticed she had a gaping wound with what looked to be bone tissue sticking out. To determine the degree of Mrs.
Mogans’s injuries the doctor had her undergo several x-rays which revealed that Mrs.Morgan had an open compound fracture on her left humerus at the proximal diaphysis. The doctor also found that she had a stable compression fracture in her L-3 vertebrae. The x-ray also revealed that the patient had a depressed occipital fracture in her skull.
After looking over the x-rays and reading the paramedics discovery at the scene. The doctor determined the cause of the humerus being fractured was due to the box of metal rivets falling onto her upper arm. Furthermore, the doctor knew that the fracture was on Mrs. Morgans left humerus proximal to the diaphysis of the bone.
Meaning, the fracture was closest to the center of the patient’s bone, and the bone Mrs. Morgan broke was closest to the trunk of her body. Eventually, the doctor discovered that the wound was an open compound fracture. CITATION Elaon l 1033 (Elaine N. Marieb) Having found this crucial information the nurse first cleaned the wound to prevent any infections from damaging the bone and soft tissues. Then the nurse dressed it in sterile dressings to prevent anymore harmful bacteria from entering the wound. After the nurse cleaned the wound she placed Mrs.
Morgan’s arm in a splint until the patient could be seen in the operating room for surgery. CITATION Ort17 l 1033 (OrthoInfo) Once Mrs. Morgan was in the operating room the doctor determined he would place metal rods inside the patient’s arm to hold the bone in place, and to keep it together while the fracture heals. Afterward, the doctor put the patient in a cast to prevent from further movement or damage. CITATION Ort17 l 1033 (OrthoInfo) To better understand the humerus that Mrs. Morgan had fractured, the doctor needed to determine what classification of bone and what layers the bone is made up of. Knowing the bone’s classification and layers in the humerus would help the doctor know what kind of treatment to give and how long the humerus will heal for.
The doctor determined the humerus that Mrs. Morgan had fractured is classified as a long bone, which is made up of mostly compact bone. Compact bone is made up of layers called lamellae. The layers are named according to the compact bones shape or position. The first of the lamellae layers that make up the humerus is concentric, it makes a circular shape that forms the osteon. Second, is interstitial lamellae, that is located in between the osteons. Third is circumferential lamellae, it is located at the outer or inner surfaces of compact bone. CITATION Elaon l 1033 (Elaine N.
Marieb) Next thing the doctor should consider is the connective tissues and its anatomical structures. For example, Mrs. Morgan’s left arm.
The humerus has central canals that house arteries and veins. That is what led to her hemorrhaging when the bone broke. When the humerus broke the jagged ends of the bone pierced the blood vessels within the bone causing uncontrollable bleeding. The sharp pieces of the humerus also damaged the soft tissue such as the muscles or skin surrounding the bone resulting in further blood loss.
CITATION Elaon l 1033 (Elaine N. Marieb) Next the doctor addressed the occipital part of Mrs. Morgan’s skull. The doctor believed that Mrs. Morgan hit the back of her head when she fell backward and hit the floor.
The doctor found that Mrs. Morgan had fractured her occipital region of her skull from the x-rays. Once the doctor found this out he put her through a CT scan to see if the brain identified any skull fractures inside. The doctor checked this because the skull fragments can cut the dura mater, a tough covering over the brain. Which could cause a cerebrospinal fluid leak.
CITATION Sku18 l 1033 (Skull Fracture) The doctor took the patient into the surgery room which the doctor determined that the depression was small and no brain damage was found. So the doctor put Mrs. Morgan in a head brace and gave her some pain medication for her headache.
The doctor also told Mrs. Morgan to keep movement as minimal as possible. CITATION Sku18 l 1033 (Skull Fracture) After further investigation the doctor determined that the pain in Mrs. Morgan’s back was from her falling on it when she fell backwards. When doing x-rays on the patient, the doctor found out that Mrs. Morgan had fractured her third lumbar vertebral.
When the doctor found out the cause of the patient’s back pain the doctor then immobilized the patient and took her into the surgery room. After the doctor examined Mrs. Morgan, the doctor prescribed Mrs.
Morgan pain medication, reduced activity, and put the patient in a brace. The doctor told Mrs. Morgan not to do any heavy lifting or anything else that would put too much strain on her back while she heals. CITATION Lum03 l 1033 (Lumbar Compression Fracture) CITATION Ort15 l 1033 (Ortho Info) Mrs. Morgan then asked why her spine cracked with such a short fall? The doctor then explained to Mrs.Morgan that the older a person gets the more brittle their bones become. CITATION Elaon l 1033 (Elaine N.
Marieb) The doctor also explained compression fractures of the spine generally occur from too much pressure on the vertebral body. This usually results from a combination of bending forward and downward at the same time. So, when she fell her buttocks hit the floor before her head that caused the spine to bend forward concentrating the pressure on the front part of the spine. CITATION Lum03 l 1033 (Lumbar Compression Fracture) Thus, resulted in Mrs. Morgan fracturing her L-3 vertebral. The doctor then explained how spongy bone is made up of trabeculae, it has an wide distribution of osseous tissue.
Trabeculae helps reduce the weight of the bone. Additionally, spongy bone trabeculae lines up along stress lines to prevent any breakage. While explaining the healing process to Mrs.
Morgan and how a bone heals the doctor first told her that within days after a fracture a soft callus of fibrocartilage forms. Collagen fibers are then found in immense abundance in the fibrocartilage tissue matrix. This is due to the fibroblasts that produce collagen fibers that anchor the gaps between fracture ends. We also have chondroblasts that will form endochondral ossification.
During that process it will form chondrocytes in the growing cartilage matrix. While a fracture of a bone is being repaired, new bone is added to the injury site. This is because of bone deposition. The cell that helps with bone deposition process is called the osteoblast. The osteoblast is a bone forming cell that secretes unmineralized bone matrix called osteoid.
Osteoblasts are actively mitotic which means it is constantly making more and more of itself so it can repair. Additionally, the osteoblast also secretes both type one collagen fibers and osteoid ground substance through exocytosis. Thus, the osteoid ground substance will then become ossified with the addition of calcium and phosphorous. CITATION Elaon l 1033 (Elaine N. Marieb) During the final stages of bone repair some of the osseous tissue must be broken down and removed. This process is called bone resorption which dissolves away osseous tissue. The cell that helps in the bone resorption process is called osteoclast. Osteoclasts secrets substances by exocytosis that dissolves the bone matrix.
Meaning, osteoclasts break down the tissue in bones and release the minerals, resulting in a transfer of calcium from bone tissue to the blood. This is very important in bone healing so that bone regeneration can progress further. Osteoclasts leave more room for osteoblasts to repair the bone. CITATION Ric12 l 1033 (Richard Marsell) CITATION Elaon l 1033 (Elaine N. Marieb) The doctor also had to consider the extracellular matrix of bone. The ECM is considered to be a composite material made up of inorganic and organic matter. The inorganic matter is made up of hydroxyapatite, which is a crystalized calcium and phosphate.
The organic matter is made up of collagen fibers, glycosaminoglycans, and glycoproteins. This is important because the acid phosphates secreted by the osteoclast target the collagen fibers to eliminate them. The osteoclast has hydrogen pumps available in high numbers on the ruffled borders. The ruffled borders also help increase the surface area. It also helps to seal off the surrounding matrix. While the hydrogen ions are pumped out they combine with chloride ions forming hydrochloric acid. This results in the acid to act directly on hydroxyapatite to liberate calcium.
Additionally, hydrochloric acid increases the solubility of calcium therefore it can be brought back into the blood for other uses. CITATION Elaon l 1033 (Elaine N. Marieb)1.