1. 8
Orthopedics

2. Orthopedics
The medical specialty that studies the anatomy and physiology of the skeletal and muscular systems and uses diagnostic tests, medical and surgical procedures, and drugs to treat skeletal and muscular diseases. 2

3. Figure 8-1 The skeletal system3

4. Anatomy and Physiology
The Skeletal System
Bony framework on which the body is built
Composed of 206 bones, as well as cartilage and ligaments
Provides structural support for the body, works with the muscles to maintain body posture and produce movement, and protects the body's organs
Also known as the skeletomuscular system and the musculoskeletal system 4

5. Anatomy of the Skeletal System
Axial Skeleton
Consists of the bones of the head, chest, and spine
Appendicular Skeleton
Consists of the bones of the shoulders, arms, hips, and legs 5

6. Anatomy of the Skeletal System (cont’d)
Bones of the Head
Cranium
Facial bones 6

7. Anatomy of the Skeletal System (cont’d)
The cranium is made up of eight bones:
Frontal bone
Parietal bones
Occipital bone
Temporal bones
Sphenoid bone
Ethmoid bone 7

8. Figure 8-2 Side view of the cranium and facial bones

9. Anatomy of the Skeletal System (cont’d)
There are 12 bones in the face:
Nasal bones
Vomer
Lacrimal bones
Zygomatic bones
Maxillary bones
Palatine bones
Mandible 9

10. Figure 8-3 Front view of the cranium and facial bones10

11. Figure Fontanel
Reprinted from McMinn’s Color Atlas of Human Anatomy, 2/E. McMinn, Hutchings, Human Anatomy, 19,46,66,71,127,137,237,238. Copyright 2002, with permission from Elsevier. 11

12. Anatomy of the Skeletal System (cont’d)
Other bones of the head are found in the ear and are called ossicles or the ossicular chain because they are arranged in a row:
Malleus
Incus
Stapes
Hyoid bone (neck) 12

13. Anatomy of the Skeletal System (cont’d)
Bones of the Chest
The chest contains the thorax or rib cage.
12 pairs of ribs (true ribs, false ribs, floating ribs)
Within the thorax is the thoracic cavity that contains the heart, lungs, and other structures. 13

14. Anatomy of the Skeletal System (cont’d)
Bones of the Chest (cont’d)
The sternum, or breast bone, is in the center of the anterior thorax.
The sternum consists of the triangular-shaped manubrium, the body of the sternum, and the xiphoid process at the posterior tip. 14

15. Figure 8-5 Bones of the chest and shoulder15

16. Anatomy of the Skeletal System (cont’d)
Bones of the Neck and Back
Spine or backbone is a vertical column of bones that is also known as the spinal column or vertebral column
Composed of 24 individual vertebrae, plus the sacrum and coccyx
Supports the weight of the head, neck, and chest and protects the spinal cord 16

17. Anatomy of the Skeletal System (cont’d)
The spinal column is divided into five regions:
Cervical vertebrae
Thoracic vertebrae
Lumbar vertebrae
Sacrum
Coccyx 17

18. Anatomy of the Skeletal System (cont’d)
Cervical Vertebrae (C1-C7)
Cervical vertebrea are located in the neck.
C1 (the atlas) is directly below the occipital bone of the cranium.
C2 (the axis) fits into the atlas to form a joint that allows the head to move from side to side. 18

19. Anatomy of the Skeletal System (cont’d)
Thoracic Vertebrae (T1-T12)
Thoracic vertebrae are located in the chest.
Each thoracic vertebra joins with one of the 12 pairs of ribs. 19

20. Anatomy of the Skeletal System (cont’d)
Lumbar Vertebrae (L1-L5)
Located in the lower back
Larger than the cervical or thoracic vertebrae because they bear the weight of the head, neck, and trunk of the body 20

21. Anatomy of the Skeletal System (cont’d)
Sacrum
A group of five fused vertebrae
Joins with the hip bones in the posterior pelvis
Coccyx (tail bone)
A group of several small, fused vertebrae 21

22. Figure 8-6 Bones of the spinal column22

23. Figure 8-7 Lumbar vertebra
Text, pg. 9, says Fig. 8-7 shows that many of the vertebrae share common features. Does the figure above show “a vertebral body, a spinous process, two transverse processes and a vertebral foramen”?
Figure 8-7 Lumbar vertebra
Reprinted from McMinn’s Color Atlas of Human Anatomy, 2/E. McMinn, Hutchings, Human Anatomy, 19,46,66,71,127,137,237,238. Copyright 2002, with permission from Elsevier. 23

24. An anatomical illustration of the skeleton by Andreas Vasalius
Figure The skeleton
An anatomical illustration of the skeleton by Andreas Vasalius 24

25. Anatomy of the Skeletal System (cont’d)
Bones of the Shoulder
Include two clavicles and two scapulae
Clavicle or collar bone is a thin, rodlike bone on each side of the anterior neck
Connects to the manubrium of the sternum and laterally to the scapula 25

26. Anatomy of the Skeletal System (cont’d)
Bones of the Shoulder (cont’d)
Scapula, or shoulder blade, is a triangular-shaped bone on either side of the vertebral column in the upper back
Has a long, bony blade across its upper half that ends in a flat area (the acromion) that connects to the clavicle
The glenoid fossa, a shallow depression, is where the head of the humerus joins the scapula to make the shoulder joint 26

27. Figure 8-9 Bones of the shoulder27

28. Anatomy of the Skeletal System (cont’d)
Bones of the Upper Extremity
Upper and Lower Arm
Humerus
Radius
Ulna 28

29. Anatomy of the Skeletal System (cont’d)
Humerus
The long bone in the upper arm
Fits into the glenoid fossa of the scapula to form the shoulder joint and, at its distal end, joins with both the radius and the ulna to form the elbow joint 29

30. Anatomy of the Skeletal System (cont’d)
Radius
One of the two bones in the forearm.
Lies on the thumb side of the forearm, and at its distal end, connects to the bones of the wrist. 30

31. Anatomy of the Skeletal System (cont’d)
Ulna
Lies on the little finger side of the forearm.
At its proximal end is the olecranon, a large square projection that forms the point of the elbow.
At its distal end, the ulna connects to the bones of the wrist. 31

32. Figure 8-10 Bones of the upper extremity32

33. Anatomy of the Skeletal System (cont’d)
Wrist, Hand, and Fingers
Wrist contains eight small carpal bones arranged in two rows.
One row connects to the radius and ulna; the other row connects to the bones of the hand. 33

34. Anatomy of the Skeletal System (cont’d)
Wrist, Hand, and Fingers (cont’d)
Each hand contains five individual metacarpal bones, one for each finger.
Each finger or digit contains three individual phalangeal bones or phalanges (except the thumb, which contains two).
The distal phalanx is the final bone at the very tip of each finger.
The fingers are also known as rays. 34

35. Anatomy of the Skeletal System (cont’d)
Bones of the Hip
Pelvis includes the hip bones as well as the sacrum and coccyx of the vertebral column
Ilium
Ischium
Pubis or pubic bone 35

36. Anatomy of the Skeletal System (cont’d)
Ilium
Most superior of the hip bones
Broad, flaring rim known as the iliac crest
Contains the acetabulum (the deep socket of the hip joint) 36

37. Anatomy of the Skeletal System (cont’d)
Ischium
Most inferior of the hip bones
One of the “seat bones” that you sit on
Contains a large opening that is covered by a fibrous membrane and is the point of attachment for tendons of some muscles of the hip 37

38. Anatomy of the Skeletal System (cont’d)
Pubis or Pubic Bone
Most anterior of the hip bones
A small, bridgelike bone whose two halves meet in the midline, where they form the pubic symphysis
Pubis also forms the inferior part of the acetabulum 38

39. Figure 8-11 Bones of the hip39

40. Anatomy of the Skeletal System (cont’d)
Bones of the Lower Extremity
Upper and Lower Leg
Femur
Tibia
Fibula
Patella 40

41. Anatomy of the Skeletal System (cont’d)
Femur or Thigh Bone
The long bone in the upper leg
Head of the femur fits into the acetabulum to form the hip joint 41

42. Anatomy of the Skeletal System (cont’d)
Tibia or Shin Bone
The large bone on the medial side of the lower leg 42

43. Anatomy of the Skeletal System (cont’d)
Fibula
The very thin bone on the lateral side of the lower leg
Proximal end connects to the tibia, not to the femur, and it is not a weight-bearing bone in the leg 43

44. Anatomy of the Skeletal System (cont’d)
Patella or Kneecap
A small, round bone anterior to the knee joint
Most prominent in thin people and when the knee is partially bent 44

45. Figure 8-12 Bones of the lower extremity45

46. Anatomy of the Skeletal System (cont’d)
Ankle, Foot, and Toes
Each ankle contains seven tarsal bones:
Talus (the first tarsal bone)
Calcaneus or heel bone
Midfoot contains five metatarsal bones, one for each toe
Instep, or arch of the foot, contains both tarsal bones and metatarsal bones 46

47. Anatomy of the Skeletal System (cont’d)
Ankle, Foot, and Toes (cont’d)
Each toe or digit contains three phalangeal bones or phalanges (except the great toe, which contains two).
The distal phalanx is at the very tip of the toe.
The toes are also known as rays.
The great toe is known as the hallux. 47

48. Figure 8-13 Bones of the ankle and foot48

49. Anatomy of the Skeletal System (cont’d)
Joints, Cartilage, and Ligaments
A joint, or articulation, is where two bones come together.
Three types of joints:
Suture
Symphysis
Synovial 49

50. Anatomy of the Skeletal System (cont’d)
Joints, Cartilage, and Ligaments (cont’d)
A suture joint between two cranial bones is immovable and contains no cartilage.
A symphysis joint, such as the pubic symphysis or the joints between the vertebrae, is a slightly moveable joint and contains a fibrocartilage pad or disk.
A synovial joint is a fully moveable joint. 50

51. Figure Suture joint 51

52. Anatomy of the Skeletal System (cont’d)
Joints, Cartilage, and Ligaments (cont’d)
Two kinds of synovial joints:
Hinge joints (the elbow and knee)
Ball-and-socket joints (the shoulder and hip)
A synovial joint joins two bones whose ends are covered with articular cartilage. 52

53. Anatomy of the Skeletal System (cont’d)
Joints, Cartilage, and Ligaments (cont’d)
Ligaments hold the two bones together in a synovial joint.
The entire joint is encased in a joint capsule, with the synovial membrane producing synovial fluid that lubricates the joint. 53

54. Figure 8-15 Synovial joint54

55. Joint Classification Animation
Click on the screenshot to view an animation on the topic of joint classification.
Back to Directory 55

56. Joint Movement Animation
Click on the screenshot to view an animation on the topic of joint movement.
Back to Directory 56

57. The Structure of Bone
Bone, or osseous tissue, is a type of connective tissue.
The surface of a bone is covered with periosteum, a thick, fibrous membrane.
A long bone such as the humerus or femur has a straight shaft or diaphysis and two widened ends or epiphyses.
Bone growth takes place at the epiphysial plates. 57

58. The Structure of Bone (cont’d)
Along the diaphysis is a layer of dense compact cortical bone for weight bearing.
Inside this is the medullary cavity, which is filled with yellow bone marrow that contains fatty tissue.
In each epiphysis is cancellous bone, or spongy bone. 58

59. Figure 8-16 Structure of a bone59

60. Physiology of Bone Growth
Ossification is the gradual replacing of cartilage by bone that takes place during childhood and adolescence.
New bone is formed along the epiphysial growth plates at the ends of long bones as the body grows taller. 60

61. Physiology of Bone Growth (cont’d)
About 10% of the entire skeleton is broken down and rebuilt each year; this process occurs in areas that are damaged or subjected to mechanical stress.
Osteoclasts break down areas of old or damaged bone.
Osteoblasts deposit new bone tissue in those areas. 61

62. Physiology of Bone Growth (cont’d)
Osteocytes maintain and monitor the mineral content (calcium, phosphorus) of the bone.
Almost all of the body’s calcium is stored in the bones, but calcium is needed to help the heart and skeletal muscles contract. 62

63. Physiology of Bone Growth (cont’d)
As osteoclasts break down old or damaged bone, the calcium in that bone is released and made available to the rest of the body.

64. Figure 8-17 Pediatric growth chart
Insert Figs. 8-18, 8-19, and 8-20 for the labeling exercise on pg. 27.
Figure Pediatric growth chart 64

65. Diseases and Conditions
Diseases of the Bones and Cartilage
Avascular necrosis
Bone tumor
Chondroma
Chondromalacia patellae
Fracture 65

66. Table 8-1 Fracture Names and Descriptions66

67. Table 8-1 (cont’d) Fracture Names and Descriptions67

68. Table 8-1 (cont’d) Fracture Names and Descriptions68

69. Table 8-1 (cont’d) Fracture Names and Descriptions69

70. Table 8-1 (cont’d) Fracture Names and Descriptions70

71. Table 8-1 (cont’d) Fracture Names and Descriptions71

72. Diseases and Conditions (cont’d)
Diseases of the Bones and Cartilage (cont’d)
Osteomalacia
Osteomyelitis
Osteoporosis 72

73. Figure 8-19 Normal bone versus bone with osteoporosis
ESRF-CREATIS/Phanie Agency/Photo Researchers, Inc. 73

74. Diseases and Conditions (cont’d)
Diseases of the Vertebrae
Ankylosing spondylitis
Kyphosis
Lordosis
Scoliosis
Spondylolisthesis 74

75. Dr. P. Marizzi/Photo Researchers, Inc.
Figure Kyphosis
Dr. P. Marizzi/Photo Researchers, Inc. 75

76. Figure Scoliosis
Princess Margaret Rose Orthopaedic Hospital, Edinburgh, Scotland/Science Photo Library/Photo Researchers, Inc. 76

77. Diseases and Conditions (cont’d)
Diseases of the Joints and Ligaments
Arthralgia
Arthropathy
Dislocation
Gout
Hemarthrosis 77

78. Diseases and Conditions (cont’d)
Diseases of the Joints and Ligaments (cont’d)
Lyme disease
Osteoarthritis
Rheumatoid arthritis
Sprain
Torn meniscus 78

79. Figure 8-22 Osteoarthritis Custom Medical Stock Photo, Inc.79

80. Figure 8-23 Rheumatoid arthritis Custom Medical Stock Photo, Inc.80

81. Diseases and Conditions (cont’d)
Diseases of the Bony Thorax
Pectus excavatum 81

82. Diseases and Conditions (cont’d)
Diseases of the Bones of the Legs and Feet
Genu valgum
Genu varum
Hallux valgus
Talipes equinovarus 82

83. Figure 8-24 Bilateral hallux valgus
NMSB/ Custom Medical Stock Photo, Inc. 83

84. Figure 8-25 Bilateral clubfeet
Shea, MD/ Custom Medical Stock Photo, Inc. 84

85. Laboratory and Diagnostic Procedures
Laboratory Tests
Rheumatoid factor (RF)
Uric acid 85

86. Laboratory and Diagnostic Procedures (cont’d)
Radiology and Nuclear Medicine Procedures
Arthrography
Bone density tests 86

87. Laboratory and Diagnostic Procedures (cont’d)
Radiology and Nuclear Medicine Procedures
Bone scintigraphy
X-ray 87

88. Medical and Surgical Procedures
Medical Procedures
Cast
Closed reduction
Extracorporeal shock wave therapy (ESWT) 88

89. Medical and Surgical Procedures (cont’d)
Medical Procedures (cont’d)
Goniometry
Orthosis
Physical therapy 89

90. Medical and Surgical Procedures (cont’d)
Medical Procedures (cont’d)
Prosthesis
Traction 90

91. Patrick Watson/Pearson Education/PH College
Figure Goniometer
Patrick Watson/Pearson Education/PH College 91

92. Medical and Surgical Procedures (cont’d)
Amputation
Arthrocentesis
Arthrodesis 92

93. Medical and Surgical Procedures (cont’d)
Arthroscopy
Bone graft
Bunionectomy
Cartilage transplantation 93

94. Figure 8-31 Arthroscopic surgery Custom Medical Stock Photo, Inc.94

95. Medical and Surgical Procedures (cont’d)
Bunionectomy
External fixation
Joint replacement surgery
Open reduction and internal fixation (ORIF) 95