Chapter 7 (4)

• Orthopedics is a branch of medicine dealing with the prevention and correction of injuries and disorders of bones, joints, and muscles. The name implies its origin as a field treating skeletal deformities in children. It includes the design of artificial joints and limbs and the treatment of athletic injuries.
• Some fractures are: (1)Stress fractures which are breaks caused by abnormal trauma to a bone (e.g.: in a fall). (2)Pathological fracture which is a break or breaks in a bone weakened by disease (such as bone cancer or osteoporosis) they are usually caused by stress that would not break a healthy bone.
• Fractures are classified by structural characteristics: (1) The direction of the fracture line. (2) Break in the skin. (3) If it is in multiple pieces. Example: comminuted—three or more pieces.
• Some treatments for fractures include: (1) Closed reduction which is a procedure in which bone fragments are manipulated into their normal positions without surgery e.g. popping a joint back into its socket. (2) Open reduction which is a procedure in which bone fragments are manipulated into their normal positions with surgery. e.g. with plates, screws, or pins to realign the bone fragments. (3) Cast which is normally used to stabilize and immobilize healing bone.
• Fractures of the femur in children are often treated with traction (where they suspend the child in the air with wires like the exorcist) It aligns bone fragments by overriding the force of the strong thigh muscles.
• Hip fractures in older adults are usually pinned and early walking is encouraged. Fractures that take more than 2 months to heal may be treated with electrical stimulation which suppresses the effects of the parathyroid hormone.
• Osteoporosis is the most common bone disease. It is the severe loss of bone density.
• Bones lose mass and become brittle due to loss of organic matrix and minerals. It affects spongy bone the most since it is the most METABOLICALLY ACTIVE. It is subject to pathological fractures of the hip, wrist, and vertebral column. Kyphosis (widow’s hump) is a deformity of the spine due to vertebral bone loss. Complications that accompany the loss of mobility are pneumonia and thrombosis.
• With osteoporosis, estrogen maintains bone density in both genders. It inhibits resorption (breakdown) by osteoclasts though. In fact, postmenopausal white women are at the greatest risk because their ovaries cease to secrete estrogen. White women begin to lose bone mass as early as age 35, and by age 70, the average loss is 30% of bone mass. Risk factors for osteoporosis include: race, age, gender, smoking, diabetes mellitus, and diets that are poor in: calcium, protein, vitamins C and vitamin D.
• Osteoporosis is also seen in young female athletes with low body fat which causes them to stop ovulating and decreases estrogen secretion.
• Osteoporosis can be treated through; (1)Estrogen replacement therapy (ERT) which slows bone resorption but increases the risk of breast cancer, stroke, and heart disease. (2)Drugs Fosamax, and Actonel which destroy osteoclasts preventing the osteoclasts from reabsorbing and breaking down bone. And PTH slows bone loss if given as a daily injection. BUT the best treatment is prevention, so EXERCISE and have a good bone-building diet when you're between the ages of 25 to 40 years old. Best to start now more than later!
• The difference between a healthy bone and a bone suffering from osteoporosis.