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RECALL: The Four Primary Tissue Types that compose the body are:
-Epithelial Tissues: tissues that cover or line a structure, and that form Glands.
Hyaline Cartilage
Elastic Cartilage
Fibrocartilage
Hyaline Cartilages
Respiratory Cartilages, which form the skeleton of the Larynx and reinforce the Respiratory Passageways.
Elastic Cartilages occur in two locations: the External Ear. the Epiglottis, a laryngeal, flaplike structure that closes when we swallow so ingested substances do not enter the Larynx and airways.
Fibrocartilages occur at sites that are subjected to heavy pressure and stretch, such as the padlike cartilages (Menisci) of the Knee, the discs between the Vertebrae (Intervertebral Discs), and the Pubic Symphysis.
Cartilages
Cartilages
Cartilages grow in two ways: 1. Appositional Growth (outward expansion due to the production of new Cartilage Matrix on the outer surface of a cartilagenous structure). Cartilage-forming cells (Chondroblasts) in the surrounding Perichondrium secrete new Matrix on the surface of existing cartilage tissue. 2. Interstitial Growth: Chondroblasts in Lacunae divide and secrete new Matrix, thereby expanding a cartilagenous structure from within. Cartilage growth ends when the Skeleton stops growing. During old age, Calcium Salts may be deposited in the Matrix of Cartilage (Calcification), which causes the Cartilage to harden and become more rigid and brittle.
Functions of Bones
Support: bones support the body and cradles the bodys soft organs. Protection: bones encase many body structures, e.g., the Skull protects the Brain, the Vertebrae surround the Spinal Cord, the Rib Cage protects organs in the Thoracic Cavity, and the Pelvic Girdle cradles organs in the Pelvic Cavity. Movement: Skeletal Muscles attach to Bones by Tendons and use Bones as Levers to provide Movement.
Functions of Bones
Mineral Storage: Bone serves as a reservoir for Minerals, especially Calcium and Phosphate.
Blood Cell Formation: Blood Cells are formed in Bone Marrow by a process called Hematopoiesis.
Bones
Bones are Organs. [Recall: Organs are composed of different Tissues.] Bones contain Osseous Tissue (the most dominant tissue type), Nervous Tissue forms their Nerves, Cartilage is present in their Articular Cartilages, Fibrous Connective Tissue lines their surfaces and cavities, and Epithelial Cells and Smooth Muscle Cells are present in their Blood Vessels.
Appendicular Skeleton: bones of the upper and lower limbs, and the girdles (shoulder bones and hip bones) that attach the limbs to the Axial Skeleton.
Note: Bone Markings are anatomical landmarks that reveal sites of muscle attachments, points of articulation, and sites of blood vessels and nerve passageways.
Classification of Bones
Bones are classified by their shapes:
Long Bones: considerably longer than they are wide, e.g., long limb bones, finger bones.
Short Bones: roughly cube shaped, e.g., bones of the wrist (Carpals) and ankle (Tarsals). [Note: Sesamoid Bones: short bones that form in a tendon, most notably the Patella (kneecap). Flat Bones: thin, flattened and usually somewhat curved bones, e.g., the Sternum (breastbone), the Ribs, the Scapulae (shoulder blades), and most Skull Bones.
Irregular Bones: bones with complicated shapes, including the Vertebrae and hip bones (Coxae).
Diaphysis: the tubular shaft that forms the bones long axis.
The Diaphysis is constructed of a relatively thick collar of Compact Bone that surrounds a Medullary Cavity or Marrow Cavity. In adults, the Medullary Cavity contains Fat (Yellow Marrow).
Epiphyses (Epiphysis, singular): the more expanded bone ends. Compact Bone forms the exterior of the Epiphyses and the interiors of the Epiphyses contain Spongy Bone. The surfaces of Epiphyses at Joints are covered with a thin layer of Articular (Hyaline) Cartilage.
Periosteum
With exception of Joint surfaces, Long Bones (and other Bones) are covered by a double -layered membrane called the Periosteum. The Outer Fibrous Layer consists of Dense Irregular Connective Tissue. The inner or Osteogenic Layer abutting the bone surface consists of bone-forming cells called Osteoblasts, bone-destroying cells called Osteoclasts, and Stem Cells called Osteogenic Cells that give rise to Osteoblasts.
Periosteum
The Periosteum is attached to underlying bone by Perforating (Sharpeys) Fibers, which are Collagen Fibers that extend from the fibrous layer into the Bone Matrix. The Periosteum is supplied with Nerve Fibers and Blood and Lymphatic Vessels, which enter the Diaphysis via a Nutrient Foramen.
Internal bone surfaces, including Spongy Bone Cavities, are covered by a delicate connective tissue membrane called the Endosteum. The Endosteum also lines canals that pass through Compact Bone. Like the Periosteum, the Endosteum contains Osteoblasts and Osteoclasts.
Red Bone Marrow is present in the Spongy Bone. Short, Irregular, and Flat Bones have no Diaphysis or Epiphyses.
Hematopoietic Tissue called Red Bone Marrow, is found in the Trabecular Cavities of the Epiphyseal Spongy Bone of Long Bones. Hematopoietic Tissue is also located in the Spongy Bone of Short, Flat, and Irregular Bones (such as the Hip Bones). Yellow Marrow in Medullary Cavities can be replaced by Red Marrow in very Anemic individuals.
Micro-Anatomy of Compact Bone Though appearing dense and solid macroscopically, microscopy reveals that Compact Bone is riddled with passageways that contain Nerves, and Blood and Lymphatic Vessels.
Micro-Anatomy of Compact Bone The structural unit of Compact Bone is called the Osteon or the Haversian System.
An Osteon is a group of tubes of Bone Matrix, one placed outside the next like growth rings in a tree trunk. Each Osteon functions as a tiny weight bearing pillar.
Each matrix tube is a Lamella (little plate). Collagen Fibers in a particular Lamella run in a single direction, while Collagen Fibers in adjacent Lamellae are arranged in opposite directions. The tiny crystals of Hydroxyapatite align with the Collagen Fibers so they alternate in direction in adjacent Lamellae. The Collagen Fibers give Bones their tensile strength (ability to resist stretching) and the Hydroxyapatites make Bones hard.
The Osteocytes in the Lacunae are structurally and functionally linked via their cytoplasmic extensions into the Canaliculi and by way of the Gap Junctions they form with one another.
Compact Bone
Not all Lamellae are part of Osteons.
Incomplete Lamellae called Interstitial Lamellae occur between Osteons. They are formed between Oseons or are remnants of former Osteons that remain after Bone Remodeling. Circumferential Lamellae are located beneath the Periosteum. They extend around the entire circumference of the Diaphysis and effectively resist twisting of a Long Bone.
Spongy Bone
Intramembranous Ossification: formation of the Flat Bones (Cranial Bones) of the Skull (Frontal, Parietal, Occipital and Temporal Bones) and the formation of the Clavicles from Fibrous Connective Tissue.
Intramembranous Ossification begins at about Week 8 of Gestation. Bones formed by Intramembranous Ossification are called Membrane Bones.
2.
Endochondral Ossification: formation of all other Bones begins during the Second Month of Gestation and involves the replacement of Hyaline Cartilage structures with Bone Tissue.
Bones formed by Endochondral Ossification are called Endochondral Bones.
[Note: Before Week 8 of Gestation, the Skeleton of a Human Embryo is constructed entirely from Fibrous Membranes and Hyaline Cartilage.]
Intramembranous Ossification
The process begins at the center of a Hyaline Cartilage Shaft as the Perichondrium (not shown in figure) becomes infiltrated with Blood Vessels.
The Perichondrium converts into a vascularized Periosteum (also not shown in figure). Osteoblasts of the newly formed Periosteum secrete Osteoid against the Hyaline Cartilage Diaphysis, encasing it in a Bone Collar.
[RECALL: Osteoid is the organic part of the Bone Matrix consisting of Ground Substance (Proteoglycans and Glycoproteins) and Collagen Fibers).]
Chondrocytes within the shaft undergo Hypertrophy (enlarge in size) and signal the surrounding Cartilage Matrix to Calcify.
The Diffusion of nutrients becomes limited by the formation of the Calcified Matrix, so the Chondrocytes die and the Cartilage Matrix deteriorates, causing the formation of cavities.
During Month 3, the forming cavities are invaded by a collection of elements called the Periosteal Bud.
The Periosteal Bud contains a Nutrient Artery and Vein, Nerve Fibers, Red Marrow Components, Osteoblasts, and Osteoclasts.
Fetal Skeleton
By Birth, most Long Bones of the Skeleton are Ossified, except for their Epiphyses.
During infancy and youth, Long Bones lengthen by Interstitial Growth of the Epiphyseal Plates and all Bones grow in thickness by Appositional Growth. Most Bones stop growing during Adolescence.
However, some Facial Bones, such as those of the Nose and the Mandible (lower jaw), continue to grow almost imperceptively throughout life.
Long Bone Growth Longitudinal Bone Growth ceases when the Bone Tissue of the Epiphyses and Diaphysis fuses, called Epiphyseal Plate Closure, which usually occurs at ~18 and ~21 years of age in females and males, respectively.
Longitudinal Bone Growth is accompanied by almost continuous Remodeling of the Epiphyseal Ends to maintain the proper proportions between the Diaphysis and Epiphyses. [Note: Adult Bone can continue to increase in diameter or thickness by Appositional Growth if stressed by excessive muscle activity or body weight.]
Ossification
During Bone Growth, a bone undergoes Bone Remodeling to maintain its proper bone proportions.
During infancy and childhood, the most important stimulus of Epiphyseal Plate activity is Growth Hormone, which is secreted by the anterior lobe (Adenohypophysis) of the Pituitary Gland. Hypersecretion of Growth Hormone in children results in excessive height (Gigantism) Thyroid Hormones produced by the Thyroid Gland modulate the activity of Growth Hormone and helps ensure bones grow in proper proportions. Deficits in Growth Hormone and Thyroid Hormone produce characteristics of Dwarfism.
At Puberty, Sex Hormones (Testosterone in the male, Estrogen in the female) are produced in increasing amounts, initially producing the growth spurt typical of adolescence. Sex Hormones additionally cause the Masculinization of some bones in males and the Feminization of some bones in the female. Thereafter, the Sex Hormones induce Epiphyseal Closure, ending Longitudinal Bone Growth.
Bone Resorption/Remodeling
Small scale changes in bone architecture occurs continuously in our bodies as Bone is Resorbed and New Bone is formed. Every week, we recycle 5-7% of our Bone Mass and up to 0.5 g of Calcium may enter and/or leave the adult skeleton daily. Compact Bone is replaced ~every 10 years.
Spongy Bone is replaced ~every 3-4 years.
[Note: Bone Replacement is necessary because when bone remains in place for long periods, extensive Calcium Crystallizations over time make bone more brittle and subject to breakage.]
Wolffs Law: a bone grows or remodels in response to the demands placed on it.
Long Bones are thickest midway along the Diaphysis where bending stresses are greatest. Curved Bones are thickest where they are most likely to buckle. The Trabeculae of Spongy Bone forms struts along lines of compression.
Large, Bony Projections occur where heavy, active muscles are attached.
[Note: Wolffs Law explains the featureless bones of the fetus and the Atrophied of bones of bedridden people.]
Wolffs Law: a bone grows or remodels in response to the demands placed on it.
Regulation of Remodeling
Bone Remodeling is regulated by two control loops: Negative Feedback Hormonal ++ Mechanisms that maintain Ca levels in the Blood. Responses to Gravity and Mechanical Forces.
Details about the mechanism(s) by which Bones respond to Mechanical Stress remain unclear, but
Bone Deformation produces an Electrical Current, as do some minerals when stressed (Piezo Electric Effect). Stretched and compressed bone regions are oppositely charged. Bone Tissue is deposited in negatively charged regions of stress, and bone is absorbed in unstressed areas of positive charge.
Calcium Absorption from the Small Intestine is under the control of Vitamin D metabolites produced by the Skin.
Note: the role of physiologic concentrations of Calcitonin in regulating the deposition of Calcium Salts is now being seriously questions.
Bone Fractures
Bone Fractures
Fracture Classifications Nondisplaced Fractures: bone ends retain their normal positions. Displaced Fractures: bone ends are out of normal alignment. Complete Fracture: bone is broken through. Incomplete Fracture: bone is not completely broken through. Linear Fracture: bone break parallels the bones long axis. Transverse Fracture: bone break is perpendicular to the bones long axis.
Bone Fractures
Bone Fractures
Bone Fractures
Bone Repair
Closed Reduction: the bone ends are coaxed into place by the physician. Open Reduction: the bone ends are secured surgically with pins or wires or screws and plates. After a broken bone is Reduced, it is immobilized either by a cast or traction.
1. When a bone breaks, Blood Vessels in the Bone and Periosteum are torn and Hemorrhage, causing a mass of clotted blood (Hematoma) to form at the fracture site.
Bone Cells derived of nutrition die, the tissue at the injured site becomes swollen, painful, and inflamed.
2. Within a few days, Capillaries grow into the Hematoma, Phagocytic Cells endocytose debris, invading Fibroblasts produce Collagen Fibers that span the break, some Fibroblasts differentiate into Chondroblasts that secrete Collagen Matrix, and Osteoblasts begin forming Spongy Bone.
The entire mass of repair tissue, called the Fibrocartilaginous Callus, splints the broken Bone.
3. Within a week, new Trabeculae appear and the Fibrocartilaginous Callus converts to a Bony (hard) Callus of Spongy Bone. Bony Callus formation continues until a firm union between the broken Bone parts is formed over a two month period.
4. During Bony Callus formation and continuing for several months thereafter, the Bony Callus undergoes Remodeling. The Medullary Cavity is reformed and Compact Bone is laid down to reconstruct the walls of the Bone.
Osteoporosis
Osteomalacia: a condition in which bones are not adequately Mineralized. Osteoporosis: disease in which Bone Resorption outpaces Bone Deposition.
Bone Mass is reduced, causing bones to break easily.
Spongy Bone is most vulnerable, and Compression Fractures of the Vertebrae are common. The neck of the Femur is also very susceptible and prone to fracture (broken hip). [Note: Osteoporosis occurs most often in the aged, particularly in postmenopausal women.]
Osteoporosis
Osteoporosis is frequently treated with Calcium, Vitamin D supplements, weightbearing exercise, and Hormonal (Estrogen) Replacement Therapy (HRT).
Osteomalacia: Rickets
Rickets: analogous to Osteoporosis, but in children. Hallmarked by bowed legs and deformities of the pelvis, skull, and rib cage. Epiphyseal Plates cannot be calcified, so they continue to widen and the ends of long bones become visibly enlarged and abnormally long. Rickets is caused by insufficient Calcium in the diet or by Vitamin D deficiency. Treatment: Vitamin D-Fortified Milk and exposure to sunlight to stimulate Vitamin D production by the Skin.
Achondroplasia: a congenital condition involving defective Cartilage and Endochondral Bone Growth so that limbs are too short; a type of Dwarfism. Ostealgia: pain in a Bone.
Bony Spur: abnormal projection from a bone due to bony overgrowth; common in aging bones.
Osteosarcoma: a form of Bone Cancer typically arising in a Long Bone of a limb and most often in patients that are 10-25 years old. Osteosarcomas grow aggressively, they painfully erode bone, and they tend to Metastasize to the Lungs. Leukemias: a group of cancerous conditions involving the Bone Marrow and White Blood Cells. In all Leukemias, the Bone Marrow becomes almost totally occupied by Cancerous Leukocytes, and White Blood Cells flood the Bloodstream.