Bodily Injury Claims: Study 3
Skeletal System
Introduction to Bones:
- 206 bones in human skeleton
- Skeleton forms the frame of the body and provides protection for organs
- Also provides framework for soft tissue (skin and muscle)
- Fully developed bones are composed of three main parts:
- Periosteum – membrane over bones. In joints this is called articular cartilage. Periosteum consists of outer layer of fibrous tissue and inner layer of cells called osteoblasts. Osteoblasts lay down new bone if it is injured or affected by certain diseases
- Compact or cortical bone (the cortex) – outer shell of tissue on a bone. Tightly packed layers of bony tissue with spaces containing blood vessels and nerves.
Locating Bones:
- Bone is identified as to whether it is on the right or left side of the body
- Long bones, such as humerus of the arm, are divided into three parts and referred to as the upper third, the middle third or the lower third.
- Specific terminology is used to further pinpoint location for bones and other structures of the body. Some commonly used terminology is:
- Proximal location is closer to the torso of the body. An upper arm fracture that is close to the shoulder area would be a proximal fracture of the humerus
- Distal location is further away from the torso. If the humerus were fractured closer to the elbow than the shoulder it would be called a distal fracture of the humerus
- Costal is used to show a relationship to a rib
- Dorsal is a position more toward the back surface. It is the same as posterior.
- Inferior refers to a lower surface of a structure, or to the lower of two or more structures
- Superior or Supra means upper or above and refers to the top end of a structure
- Anterior is a position nearer to the front of the body
- Posterior is a position nearer to the back of the body
- Medial means middle and refers to parts that are closer to the middle of the structure or the body
- Some bones have bumps that are called prominences or processes
Rib Cage:
- Encases and protects organs of the upper body (thorax)
- 24 ribs, twelve on each side
- Connected to the spine
- 14 of the upper “true ribs” are connected at the front of the chest to the sternum
- 6 of the lower “false ribs” are connected by cartilage to the rib above
- Bottom 4 ribs “floating ribs” are connected to the spine only
Shoulder:
- Each shoulder has 2 bones:
- Scapula: “Shoulder blade”. Broad flat bone in upper back. Forms a socket to accept the humerus (arm bone)
- Clavicle: “Collarbone”. Probably most fractured bone in the body.
Pelvis:
- Provides protection for lower organs and support for abdomen
- Located at lower border of the trunk and supports spinal column
- There are three main parts of a pelvis:
- Ilia: two large wing-shaped pieces. Sockets for the femurs (leg bones)
- Ischia: two forming loops of bone that extend downward from ilia and bear body weight when seated
- Pubes: two bones extend in front of the base of ilia forming arches above ischia
Limbs:
- Arm:
- Made up of 3 parts:
- Humerus: long upper arm bone attaches to scapula on proximal end and ends at elbow joint at distal end. It has prominences called Condyles
- Radius: attached to the lower end of humerus, extending to the hand in line with the thumb
- Ulna: attached to the lower end of humerus, extending to the hand
- Hand:
- Wrist, palm, and fingers consist of three groups of bones:
- Carpal Bones: 8 bones that make up wrist
- Metacarpal Bones: 5 long bones make up the palm. They join with carpal bones at proximal end and phalanges at distal end. Heads of these bones form knuckles.
- Phalanges: 14 bones make up digits. Three bones in each finger and two bones in each thumb.
- Dislocations of phalanges disability may last about 5-7 days
- Fractures of wrist, fingers or thumb may result in disability period of 9-10 weeks if both hands are needed to perform job functions
- Leg:
- Made up of four parts:
- Femur: extends from ilium to knee.
- Patella: is the knee cap which is a small bone that protects the knee
- Tibia: shin bone which extends from femur to ankle. Larger inner bone.
- Fibula: connected to the top of the Tibia and extends to the ankle on the outside of it. Long, slender, outer bone of the calf.
- Knee fractures may result in disability of 10-12 weeks if they are required to walk or stand on job. Patient who sits on job will usually be disabled for 6-8 weeks
- Foot:
- Composed of 26 bones and bears weight of the body
- 7 tarsal bones make up ankle
- 5 metatarsal bones make up instep
- 14 bones make up phalanges (toes) – big toe has two bones rest have 3
- Talus is the second largest tarsal bone and supports the tibia while resting on the calcaneus.
- Calcaneus is largest tarsal bone and forms the heel.
- Since the foot is a complicated structure involved principally with weight-bearing, disabilities are often protracted.
- Severe crushing injuries that involve lacerations of the soft tissue in addition to fractures may necessitate amputation
Joints:
are the points at which two or more bones meet or articulate. There are
movable and immovable joints. Immovable joints occur where the bones
are in direct contact with another.
- Hinge joints are found in knees and fingers
- Pivot joints are found in elbows and the head
- Ball and socket joints are found in the hip and shoulder
- Movable joints are protected by a layer of smooth cartilage at the ends of the bones
- Joints are lubricated by synovial fluid
- Bursae are small fluid-filled sacs between certain structures and facilitate movement. Bursae lubricate muscles or tendons where they glide over one another or are liable to rub on another muscle or tendon
- Joints are held together by ligaments which are bands of fibrous tissue that connect bones or cartilage.
- Trauma:
- Joints of the knee, elbow and finger are frequently injured
- Can result in permanent stiffness
- Artificial joints may be needed
- Knee injuries are particularly complex
- Sprains of joints may occur, a sprain is the partial tearing of ligaments
- The elbow is exposed to injury because:
- Body points are prominent
- Ligaments are tight
- Muscular attachments are crowded into restricted bony surfaces surrounded by important blood vessels and nerves
- Elbow injuries may be complicated by:
- Synovitis
- Circulation problems
- The formation of bony tissue (ectopic bone) in areas where no bone should be
Arthritis:
- The inflammation of the joints caused by either nontraumatic (unrelated to accident) or traumatic (related to accident) origins.
- Traumatic arthritis is caused by a blow or pulling of a joint such as the knee.
- The trauma disrupts the smooth movement of the joint by:
- Creating rough surfaces and irritation
- Interrupting the blood supply to the joint
- Interfering with the lubrication of the joint
- Injuring the guy wire tendons and muscles which keep the joint in proper alignment
Injuries to Extremities:
- Extremities refers to arms, hands, legs, feet and shoulders
- Subject to abrasions, contusions, lacerations, fractures, dislocations, sprains and strains
- Dislocations:
- The term subluxation refers to a partial dislocation
- Dislocation is a disturbance in the normal relationship of the bones which form a joint
- May not be visible
- Outstanding characteristic is loss of use of the affected joint
- Usually some injury to surrounding muscles and ligaments
- Proper reduction and aftercare are important for recovery
- Hip dislocations may cause flattening of femur head which will affect the normal rotation of the ball within the socket. This could cause avascular necrosis. This may occur 9 – 12 months after injury
Fractures:
- The two main types of fractures are:
- Simple or closed: fracture where the bone does not pierce the skin
- Compound: fracture where the bone is exposed to air, the skin is pierced. These are more prone to infection and healing is often slow
- If the fracture does not pass through the bone it is a partial or incomplete fracture
- If the fracture does pass through the bone it is a complete fracture
- These descriptive terms denote the shape or pattern of the fracture surfaces:
- Comminuted fracture: is a complete break into three or more fragments. The smaller fragments are found between the two main fragments
- Transverse fracture: is a complete break straight across, at right angles to the shaft of the bone
- Oblique fracture: is a complete break diagonally through the shaft of the bone
- Spiral fracture: is a complete break resembling the spiral in a corkscrew. It is usually the result of a twisting force to the bone.
- Greenstick fracture: is an incomplete break that splits in either direction from the break, resembling a break in a green twig. The unbroken side of the bone is bent. This fracture usually occurs in children.
- Longitudinal fracture: runs from the joint end of the bone towards the midsection.
- Impacted fracture: has the bone forced into itself splintering its midsection. This may result from landing heavily on the feet.
- Treatment consists of realigning or reducing the bones and immobilizing them to enable proper fusing
- Open Reduction: refers to surgical intervention to bring the bone into alignment
- Retention: is the process of holding reduced bone in alignment to ensure that proper union occurs. When retention apparatus has been applied the doctor will monitor whether the patient:
- has pain or discomfort
- demonstrates any sign of pressure on a nerve
- shows any indication that circulation in the distal part is inadequate
- Splintage: is the mechanical means of holding the reduced bone fragments in alignment
- Traction: involves using wights and pulleys to maintain the injured limb in a secure position
- Internal bone fixation: uses methods such as plates fixed by screws, wires, rods, and nails
- Union of the fracture usually occurs within a month or two
- Firm union will usually occur within three or four months
- When bone is damaged bone forming cells grow in blood clots around the fracture
- This forms a bony material called callus
- Bone ends must stay in contact for this to occur
- Imperfect healing can occur resulting in the following conditions:
- Partial Union: occurs when callus does not grow over the entire fracture area
- Fibrous Union: is the result of callus not hardening
- Mal-Union: occurs when fragments unite but the bone does not function normally. The bone may unite with another bone.
- Nonunion: Occurs when the bone does not heal and the fragments are held together by tissue alone.
- Recovery by elderly can be slow. Complications such as nonunion and delayed union are frequent and the possibility of partial permanent disability can be expected
Hip:
- It is common practice to replace both the ball and socket of the hip joint with synthetic parts in a procedure called arthoplasty.
- Common hip fractures include:
- Transcervical Fractures: pass through the neck of the femur at a slant. Surgical nails or pins are inserted into the fragments to maintain proper position. Disability can be lengthy.
- Intertrochanteric Fractures: extends across the head of the femur from the greater to the lesser trochanter at the base of the neck of the femur. The bone fragments are most difficult to hold in place and open reduction is usually required, with winged nails being driven into the exposed femur. Permanent disability is a possibility.
- Subtrochanteric Fractures: occur at the high point on the proximal end of the shaft of the femur just below the lesser trochanter. It is actually a fracture of the shaft of the femur, but because of its close proximity to the head, it is treated as a hip fracture since it involves the hip joint. Nails and pins are used to align the bone fragments.
Amputations:
- Amputations are done when the body part:
- Is practically severed by an accident
- Is badly mangled with extensive comminuted fractures and lacerations
- Has extensive injury to blood vessels associated with an open joint fracture wound
- Is not responding to treatment to arrest an aggressive destructive infection
- Loss of blood supply and bacterial infection of a wound may lead to gangrene which destroys and rots body tissue.
- Myoplastic Procedure is often used in amputation
- Removes circulation in extreme end of stump
- Helps achieve better muscular control
- Achieved by closing end of the bone with osteoplastic flap and connecting muscles to end of bone
- This technique is used for initial amputations and corrective surgery to improve stumps
Trauma during Pregnancy:
- Three conditions that can possibly occur in abnormal labour include:
- Placenta abruption is the premature detachment of a normally situated placenta
- Placenta previa is the implantation of the placenta in the lower uterine segment. The afterbirth delivers before the baby.
- Abnormal fetal presentation or unusual positioning of the fetus could cause abnormal labour
Definitions:
Cartilage: is a tough nonvascular connective tissue present in joints and certain other body structures
Nonvascular tissue: does not have blood vessels
Osteoporosis:
is a condition in which bones contain less bone tissue (calcium) than
normal bones. disease that results in decline of bone mass. Bones become
brittle and fracture easily. Often associated with aging.
Senile Osteoporosis:
found in elderly, leads to painless hip and vertebral multiple
wedge-type fractures that cause abnormal curvature of the spine.
Osteoporosis appears in women sooner and more often than men.
Post Traumatic Osteoporosis: occurs following an injury. Localized osteoporosis may occur if there has been local nerve damage. Slows the healing prosess.
Sternum: is a flat and narrow bone linked to the clavicles (collarbones) and the true ribs
Condyles: are rounded projections on the humerus, femur, tibia and scapula.
Synovitis: is the inflammation of the synovial membrane which lines the capsule of a joint
Bursitis: is the inflammation of bursae (small fluid-filled sacs between certain structures and facilitate movement)
Carpectomy: is the surgical removal of a carpal bone
Reduction: is the process of realigning bones when a dislocation or fracture occurs
Adhesion: is a fibrous band or structure abnormally uniting parts of the body
Avascular necrosis: is the death of bone from the absence or restricted flow of the blood
General Anesthesia: the patient loses consciousness and the entire body is numbed to pain
Local Anesthesia: the patient is conscious and only a particular part of the body is numbed
Fibrosis: is the formation of fibrous tissue
Amputation: is the deliberate surgical removal or the accidental cutting off of a body part
Septicemia: is a disease caused by pathogenic microorganisms invading the body
Abortion:
is the premature expulsion of the fetus before it is sufficiently
developed to survive outside the mother’s womb. Abortion and miscarriage
are synonymous terms and do not imply any illegal or unethical
practice.
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