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Mr. Nichols
PHHS
Paget’s Disease:
Is a chronic disorder that can result in
enlarged and misshapen bones. The
excessive breakdown and formation
of bone tissue causes affected bone
to weaken, resulting in pain,
misshapen bones, fractures, and
arthritis in the joints near the affected
bones.
Paget’s Disease:
Paget's disease may be caused by a
slow virus infection (measles
association, Canine distemper virus)
present for many years before
symptoms appear.
Paget’s Disease:
Many patients do not know they have
Paget's disease because they have a
mild case and have no symptoms,
characterized by ‘spotty bone pain.’
Paget’s Disease:
Goal of treatment is to relieve bone pain
and prevent progression of disease.
Bisphosphonates: Didronel (200400mg), Fosamax (40mg once daily)
phalangies
metatarsals
tarsals
tarsals
metatarsals
phalangies
Osteoblast
Builds new bone
Mature bone cell
Osteocyte
Osteoclast
Eats bone
Osteoporosis
29
40
84
92
Immovable Joints
(synarthrosis)
suture
pubis symphisis
Slightly Movable Joint
(ampharthrosis)
(diarthrosis)- freely moveable
pelvis
ligaments
femur
joint
capsule
pelvis
hyaline
cartilage
synovial
cavity
femur
Synovial Joint Movement
Extension
Flexion
Rotation
Adduction
Abduction
275 bones
12 weeks (6-9
inches long)
Fetus: 1st
2 months
Endochondral Ossification
2o ossification
center
bone
cartilage
calcified
cartilage
Just before
birth
epiphyseal
line
epiphyseal
plate
Childhood
Adult
Osteoblast
Builds new bone
Mature bone cell
Osteocyte
Osteoclast
Eats bone
Bone Repair:
1. Electrical stimulation of the fracture site:
• Increases speed and completeness of healing
• The e- stimulation inhibits PTH and slow osteoclasts
down from reabsorbing bone
2. Ultrasound treatment:
• Daily treatments reduce healing time of broken bones
by 25-35%
3. Free vascular fibular graft technique:
• Transplant fibula in arm
• Gives good blood supply not available in other
treatments
4. Bone substitutes:
• Crushed bone from cadaver- but risk of HIV and
hepatitis
• Sea bone- coral
• Artificial bone- ceramic
hematoma
callus
bony callus
bone
remodeling
Osteoporosis
29
40
84
92
Diseases of the Skeletal System:
Rickets- vitamin D deficiency
Osteomalacia- soft bones, inadequate
mineralization in bones, lack of vitamin D
Pagets Disease- spotty weakening in the
bones, excessive and abnormal bone
remodeling
Rheumatoid arthritis- autoimmune
reaction
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• Avascular Necrosis
• Is a disease that results from the
temporary or permanent loss of blood
supply to the bone.
• When blood supply is cut off, the bone
tissue dies and the bone collapses. If
avascular necrosis occurs near a joint,
collapse of the joint surface may occur.
Symptoms
minimal early joint pain
increased joint pain as bone and joint begin
to collapse
limited range of motion due to pain
Treatments
Medications: Ibuprofin, Aleve to relieve pain.
Osteotomy - a surgical procedure to reshape the bone
and reduce stress on the affected area.
Bone graft - a surgical procedure in which healthy
bone is transplanted from another part of the patient's
body into the affected area.
Arthroplasty (total joint replacement) - a surgical
procedure to remove and replace an arthritic or
damaged joint with an artificial; may be considered only
after other treatment options have failed to provide
adequate relief from pain and/or disability
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Chondrosarcoma
Is a type of cancer that develops in cartilage
cells. Cartilage is the specialized,
connective tissue that is present in adults
and the tissue from which most bones
develop. Cartilage plays an important role in
the growth process.
Chondrosarcoma is the second most
common type of primary bone cancer. A
primary bone cancer is one that originates
from bone, as opposed to starting in another
organ and then spreading to the bone.
This type of cancer rarely affects individuals
under age 20 and continues to rise until age
75. The incidence between males and
females is equal.
-Large mass on the affected bone (tumor)
-Feeling of pressure around the mass
-Pain that is usually worse at night and may
be relieved by taking anti-inflammatory
medications such as ibuprofen
-Pain that is not usually relieved through
rest
-Pain that may be present for years but
increases gradually over time
-Surgery to remove the tumor
-Physical therapy to regain strength and use
of the affected area after surgery
-Chemotherapy, although not the primary
treatment, may be required if the cancer has
spread to other areas of the body.
Key Chemo (drug)- Doxorubicin, Ifosfamide.
Methotrexate, cisplatin.
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• Fibrous dysplasia is a chronic disorder
in which bone expands due to abnormal
development of fibrous.
• Any bone in the body can be affected
but more commonly affects, the femur,
tibia, ribs, skull, humerus, pelvis,
vertebrae.
• The exact cause of fibrous dysplasia is
not known, but it is believed to be due to
a chemical irregularity in a specific bone
protein.
•
This bone protein abnormality may be
due to a gene mutation present at birth,
but it is not known to be an inherited
disorder.
-a waddling walk
-bone pain (as a consequence of the
expanding fibrous tissue in the bone)
-bone deformity
-bone fractures
-scoliosis - a lateral, or sideways, curvature
and rotation of the back bones.
-uneven growth of bones
-pain
-brittle bones
-a waddling walk
-bone pain (as a consequence of the
expanding fibrous tissue in the bone)
-bone deformity
-bone fractures
-scoliosis - a lateral, or sideways, curvature
and rotation of the back bones.
-uneven growth of bones
-pain
-brittle bones
Surgery, including the following:
-removal of affected bone, followed by bone grafting
-removal of bone wedge
-placement of a rod down the shaft of the bone
-Medication: (bisphosphonates) Aredia, Fosamax, preserve
bone mass and even increase bone density reducing the risk
of fractures.
-Pain management
-Physical therapy
• Long Bones- metacarples,
metatarsals, phelangies, humerus,
ulna, radius, tibia, fibula
• Short Bones- carpals, tarsals
• Flat Bones- rib, scapula, skull, sternum
• Irregular Bones- vertebrae, some
facial bones
• Sesamoid- patella
spongy bone
Proximal
compact bone
epiphysis
Endosteum
diaphysis
epiphyseal line
yellow marrow
Sharpey’s fibers
Distal
epiphysis
hyaline cartilage
periosteum
Posterior View
Frontal Sinus
Ethmoid Sinus
Sphenoid Sinus
Maxillary Sinus
•
•
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Warm and moisten air
Lighten the skull
Enhance voice resonance
The Vertebral Column
Cervical Vertebrae
(7)
Thoracic Vertebrae
(12)
Lumbar Vertberae (5)
Sacrum
Coccyx
Cervical Vertebrae
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Disorder of the Day!
 Osteomyelitis
 Is
an inflammation or swelling of
bone tissue that is usually the
result of an infection.
Osteomyelitis, or bone infection,
may occur for many different
reasons and can affect children or
adults.
Symptoms
 fever
 pain
and tenderness in the affected area
 irritability
 swelling of the affected area
 redness in the affected area
 warmth in the affected area
 difficulty moving joints near affected area
 difficulty bearing weight or walking
Treatment





Medications:
Intravenous or oral antibiotic treatment for
osteomyelitis may be very extensive, lasting for many
weeks. I.E (Ancef, Ceftin, Azactam)
monitoring of successive x-rays and blood tests
pain management
bed rest or restricted movement of the affected area
Surgery
In some cases, surgical intervention may be
necessary to drain infectious fluid, or to remove
damaged tissue and bone.
Osteomyelitis
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The Thoracic Cage
Sternum
True Ribs (7)
False Ribs (3)
Floating Ribs (2)
Sacrum & Coccyx
Bones of the Pectoral Girdle
Humerus
Ulna
Radius
8 Carpals
5 Metacarpals
14 Phalanges
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Rare Disorder of the Day:
Von Hippel-Lindau (VHL)
 Von Hippel-Lindau disease (VHL) is said to
affect one in 35,000 people. It is an
extremely rare genetic condition that is
characterized by the growth of tumors in
different parts of the body.
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 Many of the tumors will grow within the
central nervous system and are often
benign. Different tumors are also known to
grow on the pancreas, adrenal glands, and
kidneys.
 If left untreated, the disease can cause
strokes, heart attacks, and cardiovascular
disease.
Symptoms
 Chronic Headaches.
 Problems with balance and walking, dizziness.
 Weakness of the limbs.
 Vision problems (retinal detachment
common)
 High blood pressure.
Treatment
 Laser coagulation of retinal occlusions.
 Cryotherapy to reduce swelling,
inflammation, also aids in removal of
tumor.
Symptoms
Looks like:
Pelvis
Pelvis (lateral view)
Ilium
Acetabulum
Obturator
foramen
Ischium
Pubis
Ischium
Male Pelvic Girdle
Female Pelvic Girdle
The Lower Limb
(Legs)
Femur
Patella
Tibia
Fibula
7 Tarsals
5 Metatarsals
14 Phalanges