HUMAN ANATOMY – Part 2: Human Skeletal System – Osteoporosis – Scoliosis – Broken Bones

Part 1: Human Digestive System Overview – Anatomy, Function, Maintenance, Disruptions: Diarrhea, Constipation & Cancer

Published April 5, 2006


Tabacco: So both men and women today have 24 ribs. From religious teachings, based upon the Bible, logic would require that Adam had 25 ribs! After all, the Bible says “Eve was made by God from Adam’s rib”. That’s if you really believe that bit of fiction!


Is there heart tissue in ribs? How about brain tissue? And what about reproductive tissue? Today Humans clone with genetic manipulation, not ‘Ribs’! We save those for outdoor grilling as a Rule! Maybe God was only experimenting and forgot those facts. The Biblical God is not the original Scientist and Creator, but the original Houdini. God is not now, nor was He then STUPID! The beings, who advanced this specious theory as fact, assumed that any Human, who read their mythology, would be ignorant, unquestioning and, yes, STUPID. Sorry, but for the last 6,000 years apparently they were prescient!


It’s not that God could not have done it that way, but God doesn’t operate that way. That’s just propaganda by religious people, who attempt to demonstrate that they know what they do not know. Religious people have always been WRONG about scientific facts. You should not be surprised to learn that they were indeed WRONG about Adam & Eve.


And, if they are always WRONG about scientific facts, why should we assume they are ALWAYS RIGHT about HISTORICAL FACTS!


Tabacco concludes that most so-called Biblical “Facts” are nothing more than Myths! If someone or some group is usually WRONG about certain Facts, why would you conclude they are ALWAYS RIGHT about certain other Facts! That, as Mr. Spock would say, “is illogical”.


Don’t turn to so-called religious experts for cooking recipes, astronomical or historical facts; if you wish to learn about the history of mankind on earth, rely on Darwin, not Genesis. Scientific knowledge is not in the purview of theology.  “Intelligent Design” is not SCIENCE, but merely the statement of the obvious. If it were science, there would be texts, facts, repeatable experiments, and more than just the mere assertion.



1 : the state of knowing  : knowledge as distinguished from ignorance or misunderstanding
2 a : a department of systematized knowledge as an object of study  *the science of theology*  b : something (as a sport or technique) that may be studied or learned like systematized knowledge  *have it down to a science*
3 a : knowledge or a system of knowledge covering general truths or the operation of general laws especially as obtained and tested through scientific method  b : such knowledge or such a system of knowledge concerned with the physical world and its phenomena  : NATURAL SCIENCE
4 : a system or method reconciling practical ends with scientific laws  *cooking is both a science and an art*

Merriam-Webster’s 11th Collegiate Dictionary


Tabacco: “Christian Science” IS NOT SCIENCE any more than “Intelligent Design” is a science. These are not Science but MISNOMERS and deliberately deceptive Religious Propaganda.

“And he saith unto them, Whose is this image and superscription? They say unto him, Caesar’s. Then saith he unto them, Render therefore unto Caesar the things which are Caesar’s; and unto God the things that are God’s.”


 Bible quotes


The Human Body: An Online Tour

The human body is the most fascinating and fantastic machine in existence. No one understands all of its many mysteries; and no single source can do justice to its many parts. This week, Education World tours the Web to find the best “human body” sites. You won’t believe what we discovered! Included: Sites for all ages. Activities too!


    * more than half the bones in the human body are in the hands and feet?

    * the highest recorded “sneeze speed” is 165 km (102 miles) per hour?

    * the heart beats about 3 billion times in the average person’s lifetime?

    * a newborn baby has 350 bones, but a fully-grown adult has only 206?

    * blood is a liquid organ?

    * everyone is colorblind at birth?

    * the surface area of the lungs is approximately the same size as a tennis court?

    * food will get to your stomach even if you’re standing on your head?

    * skin is the largest body organ?

    * the average adult is made up of 100 trillion cells?

The Skeletal System

The skeleton is the name given to the collection of bones that holds our body up. Our skeleton is very important to us. It does three major jobs.


1. It protects our vital organs such as the brain, the heart, and the lungs.


2. It gives us the shape that we have. Without our skeleton we would just be a blob of blood and tissue on the floor.


3. It allows us to move. Because our muscles are attached to our bones, when our muscles move, they move the bones, and we move.


    When you were born your skeleton had around 350 bones. By the time you become an adult, you will only have around 206 bones. This is because, as you grow some of the bones join together to form one bone.  Our bones don’t simply work on their own. The bones join together to form joints. The end of each bone is covered by a tough, smooth, shiny substance called cartilage. The cartilage covered bone ends are kept apart by a thin film of slippery fluid. All of this happens so your bones won’t scratch and bump against each other when you move. Our bones are held together by strong stretchy bands called ligaments. These tissues prevent the bones from being dislocated or from extending beyond their proper range of movement.




The skeletal system is so important to me because without it we would just be flat on the floor. We would be like a jellyfish that you can see from the wharf. We wouldn’t be able to move at all. It gives us posture. It enables us to stand or sit. And it also protects us because most of our body is protected by bones. Without our skeletal system our body would be useless. Our skeleton is very, very important.

The Skeletal System

The Skeletal System serves many important functions; it provides the shape and form for our bodies in addition to supporting, protecting, allowing bodily movement, producing blood for the body, and storing minerals.



    Its 206 bones form a rigid framework to which the softer tissues and organs of the body are attached.


    Vital organs are protected by the skeletal system. The brain is protected by the surrounding skull as the heart and lungs are encased by the sternum and rib cage.


    Bodily movement is carried out by the interaction of the muscular and skeletal systems. For this reason, they are often grouped together as the musculo-skeletal system. Muscles are connected to bones by tendons. Bones are connected to each other by ligaments. Where bones meet one another is typically called a joint. Muscles, which cause movement of a joint, are connected to two different bones and contract to pull them together. An example would be the contraction of the biceps and a relaxation of the triceps. This produces a bend at the elbow. The contraction of the triceps and relaxation of the biceps produces the effect of straightening the arm.


    Blood cells are produced by the marrow located in some bones. An average of 2.6 million red blood cells are produced each second by the bone marrow to replace those worn out and destroyed by the liver.


    Bones serve as a storage area for minerals such as calcium and phosphorus. When an excess is present in the blood, buildup will occur within the bones. When the supply of these minerals within the blood is low, it will be withdrawn from the bones to replenish the supply.


Divisions of the Skeleton

The human skeleton is divided into two distinct parts:


The axial skeleton consists of bones that form the axis of the body and support and protect the organs of the head, neck, and trunk.


    The Skull

    The Sternum

    The Ribs

    The Vertebral Column


The appendicular skeleton is composed of bones that anchor the appendages to the axial skeleton.


    The Upper Extremities

    The Lower Extremities

    The Shoulder Girdle

    The Pelvic Girdle–(the sacrum and coccyx are considered part of the vertebral column)


Types of Bone

The bones of the body fall into four general categories: long bones, short bones, flat bones, and irregular bones. Long bones are longer than they are wide and work as levers. The bones of the upper and lower extremities (ex. humerus, tibia, femur, ulna, metacarpals, etc.) are of this type. Short bones are short, cube-shaped, and found in the wrists and ankles. Flat bones have broad surfaces for protection of organs and attachment of muscles (ex. ribs, cranial bones, bones of shoulder girdle). Irregular bones are all others that do not fall into the previous categories. They have varied shapes, sizes, and surfaces features and include the bones of the vertebrae and a few in the skull.


Bone Composition

Bones are composed of tissue that may take one of two forms. Compact, or dense bone, and spongy, or cancellous, bone. Most bones contain both types. Compact bone is dense, hard, and forms the protective exterior portion of all bones. Spongy bone is inside the compact bone and is very porous (full of tiny holes). Spongy bone occurs in most bones. The bone tissue is composed of several types of bone cells embedded in a web of inorganic salts (mostly calcium and phosphorus) to give the bone strength, and collagenous fibers and ground substance to give the bone flexibility

Human Anatomy Terms

The following terms are those, which are used to identify the location of parts of the human body in medicine and academic study. These terms are often used to describe a specific portion of a structure or to compare the locations of two different structures. “The hand is distal to the forearm” or “the medial portion of the frontal {short description of image} bone contains the frontal sinus” are examples of this. We have organized this list of terms by keeping similar pairs or groups of terms together instead of by alphabetical order so that you will find them easier to learn and remember.


    Superior – toward the head


    Inferior – away from the head


    Anterior – the front of the body or body part


    Posterior – the back of the body or body part


    Medial – toward the midline that divides left and right


    Lateral – to the side away from the midline


    Proximal – closer to the torso


    Distal – farther away from the torso




    Anatomical position – standing erect, facing the observer, arms are at the sides with palms facing forward.


(Image taken from Gray’s Anatomy Descriptive and Applied copyrighted 1946)

Human skeleton

From Wikipedia, the free encyclopedia

The human skeleton is made of individual or joined bones (such as the skull), supported and supplemented by a structure of ligaments, tendons, muscles, cartilage and other organs.


The skeleton is not unchanging; it changes composition over a lifespan. Early in gestation, a fetus has no hard skeleton; bones form gradually during nine months in the womb. At birth, all bones will have formed, but a newborn baby has more bones than an adult. On average, an adult human has 206 bones (according to Gray’s Anatomy, but the number can vary slightly from individual to individual), but a baby is born with approximately 300 bones. The difference comes from a number of small bones that fuse together during growth, such as the sacrum and coccyx of the vertebral column. An infant is born with pockets of cartilage between particular bones to allow further growth. The sacrum (the bone at the base of the spine) consists of five bones, which are separated at birth but fuse together into a solid structure in later years. Growing is usually completed between ages 13 and 18, at which point the bones have no pockets of cartilage left to allow more growth.


Not all bones are interconnected directly. There are 6 bones, the auditory ossicles (three on each side), in the middle ear that articulate only with each other. Another bone, the hyoid bone in the neck, does not touch any other bones in the body, and is supported by muscles and ligaments; it serves as the point of attachment for the tongue. Also some of the ribs called the floating ribs only hang by muscle and are not attached to the spine.


The longest and heaviest bone in the body is the femur and the smallest is the stapes bone in the middle ear. In an adult, the skeleton comprises around 20% of the total body weight.



The most obvious function of bone is to support the body. It is also the site of haematopoiesis, the manufacture of blood cells, that takes place in bone marrow (which is why bone marrow cancer is very often a terminal disease). It is also necessary for protection of vital organs. Movement in vertebrates is dependent on the skeletal muscles, which are attached to the skeleton by tendons. Without the skeleton to give leverage, movement would be greatly restricted. Bone also serves as a mineral storage deposit in which nutrients can be stored and retrieved.



The human skeleton can be divided into the axial skeleton and the appendicular skeleton.


The axial skeleton has five areas and consists of 80 bones in a typical adult:


    * Skull (22)

    * Ossicles (bones of the middle ear) (6)

    * Hyoid bone (bone in the throat) (1)

    * Vertebral column (26)

    * Chest (25)


The appendicular skeleton has six areas and consists of 126 bones in a typical adult:


    * Shoulder girdle (4)

    * Arms (6)

    * Hands (54)

    * Pelvic girdle (2)

    * Legs (8)

    * Feet (52)


Gender differences

There are many differences between the male and female human skeletons. Men tend to have slightly thicker and longer limbs and digit bones, while women tend to have narrower rib cages, smaller teeth, less angular mandibles, and less pronounced cranial features such as the brow ridges and occipital protuberance (the small bump at the back of the skull). Most striking is the difference in hipbones, owing to differences related to the process of reproduction, and very likely also to the biological process of sexual selection. There are a number of smaller differences between human male and female skeletons as well.


The book Genesis of the Bible tells that Eve was created from one of Adam’s ribs. This has led some people to assume that men have one fewer rib than women, but upon inspection this is false: men and women both have 12 pairs of ribs. In addition, removed ribs usually regenerate within 2-3 months of sectional surgery, as in the surgical procedure rib thoracoplasty.



The skeleton can be affected by many diseases that compromise physical mobility and strength. Skeletal diseases range from minor to extremely debilitating. Bone cancer and bone tumors are extremely serious and are sometimes treated by radical surgery such as amputation of the affected limb. Various forms of arthritis attack the skeleton, in particular the joints, resulting in severe pain and debility.


A fracture occurs when a bone is subjected to too much stress. Fractures are divided into “simple” and “compound” fractures, the meaning of which is not immediately apparent. A “simple” fracture means only that the damaged bone has not broken through the skin, and does not imply a single break. Likewise, a broken bone is called a “compound fracture” when it has broken through the skin, again not implying that the bone has broken in more than one place. Osteoporosis can increase the likelihood of fractures and broken bones, especially among post-menopausal women and the elderly.

Your bones are tough stuff – but even tough stuff can break. Like a wooden pencil, bones will bend under strain. But if the pressure is too much, or too sudden, bones can snap. You can break a bone by falling off a skateboard or crashing down from the monkey bars.


When a bone breaks it is called a fracture (say: frak-chur). There’s more than one way to break or fracture a bone. A break can be anything from a hairline fracture (a thin break in the bone) to the bone that’s snapped in two pieces like a broken tree branch.


Doctors describe fractures in the following ways:


    * A complete fracture is when the bone has broken into two pieces.

    * A greenstick fracture is when the bone cracks on one side only, not all the way through.

    * A single fracture is when the bone is broken in one place.

    * A comminuted (say: kah-muh-noot-ed) fracture is when the bone is broken into more than two pieces or crushed.

    * A bowing fracture, which only happens in kids, is when the bone bends but doesn’t break.

    * An open fracture is when the bone is sticking through the skin.


What Happens When You Break a Bone?

It hurts to break a bone! It’s different for everyone, but the pain is often like the deep ache you get from a super bad stomachache or headache. Some people may experience sharper pain – especially with an open fracture. And if the fracture is small, a kid may not feel much pain at all. Sometimes, a kid won’t even be able to tell that he or she broke a bone!


Breaking a bone is a big shock to your whole body. It’s normal for you to receive strong messages from parts of your body that aren’t anywhere close to the fracture. You may feel dizzy, woozy, or chilly from the shock. A lot of people cry for a while. Some people pass out until their bodies have time to adjust to all the signals they’re getting. And other people don’t feel any pain right away because of the shock of the injury (say: in-juh-ree).


If you think you or someone else has broken a bone, the most important things to do are to:


    * stay calm

    * make sure the person who is hurt is as comfortable as possible

    * tell an adult

    * if there are no adults around, call 911 or the emergency number in your area


The worst thing for a broken bone is to move it. This will hurt the person and it can make the injury worse! In the case of a broken arm or leg, a grown-up may be able to cushion or support the surrounding area with towels or pillows.


One super-important tip: If you’re not sure what bone is broken or you think the neck or back is broken, do not try to move the injured person. Wait until a trained medical professional has arrived!


What Does the Doctor Do?

To treat the broken bone, the doctor needs to know which kind of fracture it is. That’s where X-rays come in handy. X-rays give the doctor a map of the fracture so that he or she can set the bones back in their normal position.


With breaks in larger bones or when a bone breaks in more than two pieces, the doctor may need to put in a metal pin – or pins – to help set it. For this operation, you’ll get some medicine so you’ll be asleep and unable to feel any pain. When your bone has healed, the doctor will remove the pin or pins.


After your bone has been set, the next step is usually putting on a cast, the special bandage that will keep the bone in place for the 1 to 2 months it will take for the break to mend. Casts are made of bandages soaked in plaster, which harden to a tough shell (that’s why they last so long!).


Sometimes casts are made of fiberglass or plastic – and some are even waterproof, which means you can still go swimming and get them wet! And sometimes they come in cool colors or patterns that you can choose.


How Do Broken Bones Heal?

Your bones are natural healers. At the location of the fracture, your bones will produce lots of new cells and tiny blood vessels that rebuild the bone. These cells cover both ends of the broken part of the bone and close up the break until it’s as good as new.


What Should You Do When the Cast Comes Off?

Can you believe they use a saw to remove your cast? The funny thing is this saw doesn’t hurt your skin at all. It might even tickle! Once the cast is off, the injured area will probably look and feel pretty weird. The body part that was in a cast might look strange at first. The skin might be pale, dry, or flaky. Body hair might look darker and the body part itself might look smaller because you might have lost some muscle while it was healing.


Don’t worry. This is all temporary. Kids are great healers, so you’ll be back to normal soon. In some cases, your doctor might suggest you do special exercises to improve your strength and flexibility. You’ll want to go slow and ask the doctor if there are any activities you should avoid, such as hanging from the monkey bars. If you want to return to a sport, ask the doctor how soon you’ll be able to do it.


How can you be sure you don’t break any more bones? Accidents happen, but you often can prevent injuries by wearing safety helmets, pads, and the right protective gear for your activity or sport.


It’s also a smart idea to do what you can to build strong bones. How do you do that?


    * Get a lot of physical activity, especially stuff like jumping and running.

    * Feed your bones the calcium and vitamin D they need to stay strong. That means getting your share of milk and other calcium-rich foods and drinks, such as broccoli and calcium-fortified orange juice.


Updated and reviewed by: Barbara P. Homeier, MD

Date reviewed: April 2005


A fracture is a break in a bone, usually accompanied by injury to the surrounding tissues.

Fractures vary greatly in size, severity, and the treatment needed. They can range from a small, easily missed crack in a hand bone to a massive, life-threatening break of the pelvis. Serious injuries, including injuries to the skin, nerves, blood vessels, muscles, and organs, may occur at the same time as the fracture. These injuries can complicate treatment of the fracture.


Trauma is the most common cause of fractures. Low-energy trauma, such as a fall on level ground, usually causes minor fractures. High-energy trauma, such as high-speed motor vehicle accidents and falls from buildings, can cause severe fractures that involve several bones.


Certain underlying disorders can weaken parts of the skeleton so that breaks are more likely to occur. Such disorders include certain infections, benign bone tumors, cancer, and osteoporosis.


Symptoms and Complications

Pain is the most obvious symptom. Fractures hurt, especially when force is applied, such as when a person tries to put weight on an injured limb. The area around the broken bone is also tender to touch. Swelling of soft tissue around the fracture begins within a few hours. The limb may not function properly, so that moving an arm, standing on a leg, or gripping with a hand is very painful. For a person who cannot speak (for example, a very young child, a person with a head injury, or an older person with dementia), refusal to move an extremity may be the only sign of a fracture. People with pathologic fractures often experience steadily increasing pain beginning weeks before the fracture actually occurs.


Internal bleeding may occur with a closed fracture (one in which the skin is not torn). The bleeding may occur from the bone itself or from surrounding soft tissues. The blood eventually works its way to the surface, forming a bruise, which at first is purplish-black then slowly turns to green and yellow as the blood is broken down and reabsorbed back into the body. The blood can move quite a distance from the fracture, and the entire process takes a few weeks to complete. The blood can cause temporary pain and stiffness in surrounding structures. Shoulder fractures, for instance, can bruise the entire arm and cause pain in the elbow and wrist. Some fractures, especially hip fractures, can lose quite a lot of blood into the surrounding tissues, causing low blood pressure.


The person usually feels some discomfort with activities even after fractures have healed sufficiently to allow full weight bearing. For example, although a fractured wrist may be strong enough to allow some use in about 2 months, the wrist will not have completely undergone remodeling, and it will be painful with forceful gripping for up to 1 year. The person may also notice increased pain and stiffness when the weather is damp, cold, or stormy.


Most fractures heal with few problems. However, sometimes even with proper treatment, fractures can cause serious complications.    


How Bones Heal

When tissues, such as those of the skin, muscles, and internal organs, become injured, they tend to mend by having scar tissue take the place of healthy tissue. The scar tissue often compromises the tissue’s appearance or function in some way. In contrast, bone is unique in that it heals with its own tissue—bone—rather than with scar tissue. This unusual capacity for regeneration enables a mending bone to heal itself after a fracture. Even shattered fragments of bone, with proper treatment, can often be restored to their normal function.


Fractures heal in three overlapping phases: inflammation, repair, and remodeling. Healing begins immediately with the inflammatory phase. In this phase, damaged soft tissue, bone fragments, and lost blood caused by the injury are removed by cells of the immune system. The region around the fracture becomes swollen and tender as cell activity and blood flow increase. The inflammatory phase reaches peak activity in a couple of days, but takes weeks to subside. This process accounts for most of the early pain people experience with fractures.


The repair phase begins within days of the injury and lasts for weeks to months. New repaired bone, called the external callus, is formed during this phase. When first produced, the callus has no calcium; it is soft and rubbery and cannot be seen on an x-ray. This new bone is neither strong nor stable, so that during this period the fractured bone can easily collapse and become displaced (that is, slip out of its proper place). At 3 to 6 weeks, the callus calcifies and becomes much stiffer and stronger and becomes visible on x-rays.


The remodeling phase (in which the bone is built back to its normal state) lasts many months. The bulky external callus is slowly resorbed and replaced by stronger bone; in this phase, the normal contours and architecture of the bone are restored. It is not likely that the bone will fracture again during this phase; however, people may experience mild pain with exertion.


Compartment Syndrome: Compartment syndrome is a serious limb-threatening condition caused by excessive swelling of injured muscles, which may occur as a result of a fracture or crush injury to a limb. Muscles are surrounded by a fibrous covering that forms a closed space (compartment). An injured muscle swells; when the swelling is significantly confined by the muscle’s compartment, and particularly when it is further confined by a cast, the pressure within the muscle tissue may increase. This increase in pressure decreases the normal blood flow that provides oxygen to the muscle. When the muscle is deprived of oxygen for too long, further injury to the muscle occurs, which leads to further swelling and higher tissue pressures. After only a few hours, irreversible injury and death of muscle and nearby soft tissues may result.


A doctor becomes concerned about compartment syndrome when the person feels increasing pain in an immobilized limb after a fracture, pain when the fingers of an immobilized arm or toes of an immobilized leg are moved gently, or numbness in the limb. The diagnosis of compartment syndrome can be confirmed using a device that measures pressure in the muscles.


Pulmonary Embolism: Pulmonary embolism is the sudden blocking of a lung artery by an embolus, nearly always resulting from a blood clot that can travel to the lungs, especially from the deep veins of the leg (see Pulmonary Embolism (PE)). Pulmonary embolism is the most common fatal complication of serious hip and pelvic fractures. People with hip fractures are at high risk of pulmonary embolism because of the combination of trauma to the leg, forced immobilization for hours or days, and swelling around the fracture site blocking blood flow in the veins. Of people with a hip fracture who die, about one third die of pulmonary embolism. Pulmonary embolism occurs much less commonly with fractures of the lower leg and very rarely with fractures of the upper body.


Doctors may suspect pulmonary embolism based on a range of symptoms, including chest pain, cough, and shortness of breath. Confirmation may involve chest x-ray, electrocardiogram, and one or more of a variety of imaging studies.



X-rays are the most important tools for diagnosing a fracture. They not only show the fracture but also help a doctor understand how the fragments of bone are misaligned. Small or nondisplaced fractures can be difficult to see on routine x-rays, and sometimes additional x-rays are taken at special angles. Occult or stress fractures may take days or weeks to show clearly on x-rays. Pathologic fractures are diagnosed by x-rays that show bone abnormalities, such as punched-out (lytic) areas caused by infection, benign tumors, or cancer.


Computed tomography (CT) and magnetic resonance imaging (MRI) can show features not seen on routine x-rays. CT can show the fine details of a fractured joint surface or can reveal areas of a fracture hidden by overlying bone. MRI shows the soft tissue around the bone, which helps to detect injury to nearby tendons and ligaments, and can show evidence of cancer. MRI also shows injury (swelling or bruising) within the bone and can thus reveal occult fractures before they appear on x-rays.


Bone scanning (see Symptoms and Diagnosis of Musculoskeletal Disorders: Bone Scanning) is an imaging procedure that involves use of a radioactive substance (technetium-99m-labeled pyrophosphate) that is taken up by any healing bone. Occult fractures can be detected on bone scans 3 to 5 days after the injury. If a pathologic fracture is suspected, bone scans help to check for problems in other bones—ones that might not yet be producing symptoms.



Fractures require immediate attention because they cause pain and loss of function for the person. After initial emergency care, fractures usually require further treatment, including immobilization with casts or traction, or fixation with surgery.


Fractures in children are often treated differently than those in adults because bones in children are smaller, more flexible and less brittle, and most importantly, still growing. Treatment with casts or traction is often preferred over surgery to avoid damage to the growth plate.


Types of Fractures

Type                                    Description

Open          The skin and soft tissue covering the bone are torn; dirt, debris, or bacteria can easily contaminate the wound


Closed          The skin is not torn


Avulsion          Small fragments of bone detach from where tendons or ligaments attach to bones; usually affect hand, foot, ankle, knee, shoulder


Osteoporotic          Certain areas of the skeleton are selectively weakened by osteoporosis, making them more likely to break; occur in older people, usually in the hip, wrist, spine, shoulder, pelvis


Compression          The bone collapses into itself; occur in older people, most commonly affecting the spine


Joint (intraarticular)          Occur within a joint; lead to a loss of motion and gradually developing osteoarthritis


Pathologic          An underlying disorder (such as infection, a noncancerous bone tumor, cancer) weakens a bone, leading to a fracture


Stress          A bone becomes stressed repeatedly over time because of certain activities, such as walking with a heavy pack or running


Occult          Fractures that are difficult or impossible for a doctor to see on an initial x-ray; may appear as dark or white lines days to weeks after injury


Greenstick          A partial crack and a bend in the bone, but not a break through the bone completely, occur in children only


Growth plate          A break through part of the bone that allows bones to lengthen (growth plate); may cause a bone to stop growing or to grow crookedly; occur only in children


Simple transverse          A clean square break that divides a bone cleanly across


Displaced                   The broken ends of the bones are separated or bent at an angle


Nondisplaced                   The normal shape and alignment of a bone are maintained despite cracks completely through the bone


Spiral                   Sharp, triangular bone ends


Comminuted          The bone is broken into multiple pieces, often because of high-energy trauma or weakening by osteoporosis


Initial Treatment:When a fracture is suspected, the person should call his or her doctor, who will determine the appropriate facility for treatment. The choice of a facility depends on the severity of the injury. For example, people with minor wrist and shoulder fractures can be treated in medical offices. Because people with hip fractures are in severe pain and are unable to move, they must be transported by ambulance to a hospital with surgical facilities.


Open fractures need to be treated immediately with surgery to carefully clean and close the wound. Massive open fractures with great losses of the skin, muscle, and blood supply to the bone are the most serious and difficult to treat.


For most closed fractures, treatment with casts or surgery can be delayed up to 1 week without affecting the long-term result. However, there is usually no advantage to waiting, because until they are treated, people are troubled by pain and loss of function. Before seeing a doctor, the person should immobilize and support the injured limb with a makeshift splint, sling, or a pillow; elevate the limb to the level of the heart to limit swelling; apply ice to control pain and swelling; and take only acetaminophen to relieve pain. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) should not be taken because they may worsen bleeding (see Pain: Nonsteroidal Anti-Inflammatory Drugs).


The doctor may recommend the person continue to keep an injured arm or leg elevated to control swelling. For arm fractures, pillows are used for elevation. For leg fractures, the person should periodically lie flat with the leg on a pillow. The doctor compares the swelling of the injured limb with the normal appearance of the uninjured limb to help determine how long or often elevation is needed. During the later stages of healing, elastic stockings may be used during the daytime to help control swelling when the person is sitting or standing.


Immobilization: Most fractures can be treated without surgery. They are immobilized with a splint, sling, or cast until they heal sufficiently. Displaced fractures must be aligned (by a procedure called reduction) before being immobilized. When minor fractures (such as those of the fingers or wrist) are aligned, the person may need an injection of a local anesthetic, such as lidocaine, to prevent pain. When major fractures of the arm, shoulder, or lower leg are aligned, the person may need general or spinal anesthesia; this procedure is called closed reduction.


A splint is a long, narrow slab of plaster or fiberglass applied with elastic wrap or tape. The slab does not completely encircle the limb, which allows for some expansion due to tissue swelling. For this reason, splints are often used for initial treatment of fractures. For finger fractures, aluminum splints covered with foam are commonly used.


A sling by itself provides sufficient support for many shoulder and elbow fractures. The weight of the arm pulling downward helps to keep many shoulder fractures well aligned. A strap passing around behind the back can be added to keep the arm from swinging outward, especially at night. Slings permit some use of the hand.


A cast is made by wrapping rolls of plaster or fiberglass strips that harden once wetted. Plaster is often chosen for the initial cast when a displaced fracture is being treated. It molds well and has less of a tendency to cause painful contact points between the body and cast. Otherwise, fiberglass has the advantage of being stronger, lighter, and more durable. In either case, the cast is lined with soft cottony material to protect the skin from pressure and rubbing. If the cast becomes wet, it is often impossible to completely dry the lining; this can lead to skin softening and breakdown (maceration). For partially healed fractures, a special, more expensive and less protective waterproof lining is sometimes substituted.


After a cast is applied (especially for the first 24 to 48 hours), it should be kept elevated when possible to the level of the heart to combat swelling. Regular flexion and extension of the fingers or wiggling of the toes helps the blood to drain from the limb and also helps to prevent swelling. Pain, pressure, or numbness that remains constant or worsens over time should be reported to a doctor immediately. These conditions may be due to a developing bedsore or compartment syndrome.


Taking Care of a Cast

    * When bathing, enclose the cast in a plastic bag and carefully seal the top with rubber bands or tape. Commercially available waterproof covers are convenient to use and are more fail-safe. If a cast becomes wet, the underlying padding may retain moisture. A hair dryer can remove some dampness. Otherwise, the cast must be changed to prevent the breakdown of skin.


    * Never push a sharp or pointed object down inside the cast (for example, to scratch the skin).


    * Check the skin around the cast every day, and apply lotion to any red or sore area.


    * When resting, position the cast carefully, possibly using a small pillow or pad, to prevent the edge from pinching or digging into the skin. Chafing or pressure sores may develop where the skin is in contact with the edge of the cast. If the edge of the cast feels rough, it can be padded with soft adhesive tape, moleskin, tissues, or cloth.


    * Elevate the cast regularly, as directed by the doctor, to control swelling.


    * Contact a doctor immediately if the cast causes persistent pain or excessive tightness. Pressure sores or unexpected swelling may require immediate removal of the cast.


Traction: Traction is sometimes used to keep the bones aligned while a fracture heals. An array of ropes, pulleys, and weights are used to continuously pull on the limb. In adults, traction is used only until the fracture can be safely treated with a cast or surgery. In children, certain fractures are best treated with traction because the healing time is shorter than in adults. Also, traction does not injure the growth plate, whereas surgery may do so.


Surgical Treatment: Fractures sometimes require surgical treatment. For instance, the doctor must explore and carefully clean open fractures to ensure that no foreign material has contaminated the bone ends. When a bone fragment or a tendon is trapped in the bone ends, a doctor may not be able to align a displaced fracture and surgery is needed. Comminuted fractures are often too unstable for a cast to maintain alignment against the forces of muscle contraction, which can cause the bone to shorten or angle. Joint fractures require a near-perfect alignment of the joint surfaces or the person will later develop arthritis. If possible, pathologic fractures are stabilized surgically before they break through completely. This approach avoids the pain, disability, and the more complex surgery involved with a displaced fracture. Finally, if fractures of the femur (thighbone), which includes most hip fractures, are not treated surgically, they would require months of immobilization in bed before the person is strong enough to bear weight. In contrast, surgical stabilization usually permits the person to walk with crutches or a walker within days.


Surgical stabilization involves first accurately reducing the fracture to restore the bone’s original shape and length. The surgeon uses anesthesia to relax the muscles and x-ray equipment to help align the bones. A surgeon exposes the fracture to see and manipulate the fragments with special instruments. Then, the bone fragments are securely fixed using some combination of metal wires, pins, screws, rods, and plates. Metal plates are contoured and fixed to the outside of the bone with screws. Metal rods are inserted from one end of the bone into the marrow cavity. These implants are made of stainless steel, high-strength alloy metal, or titanium. All such implants made in the last 15 years are compatible with the strong magnets that are used for magnetic resonance imaging (MRI). Most will not set off security devices at airports.


A joint replacement procedure (arthroplasty) may need to be performed when fractures severely damage the upper end of the femur (thighbone) or humerus (armbone) that form the outer half of the hip and shoulder joints.


Bone grafting may be used to assist healing of fractures initially, if the gap between fragments is too large, or later, if the healing process has slowed (delayed union) or stopped (nonunion).


Treatment of Complications: For compartment syndrome, initial treatment consists of immediately removing or loosening anything that may be confining the limb, such as a splint or a cast. When the muscle compartment continues to cause increased pressure, an emergency surgery called fasciotomy must be performed to open this constricting tissue. Otherwise, the muscles and nerves could die because of a lack of oxygen. If this occurs, it may be necessary to amputate the limb.


Pulmonary embolism can be prevented with drugs such as heparin, low-molecular-weight heparin, warfarin, and fondaparinux (a new drug similar to heparin). These drugs reduce the tendency of the blood to clot, and are given to people with fractures that put them at risk of forming a pulmonary embolism. If an embolus occurs, emergency treatment is needed (see Pulmonary Embolism (PE): Treatment).


Rehabilitation and Prognosis

Children’s fractures heal much faster and more perfectly than adult fractures do. Several years after most fractures in children, the bone can look almost normal on x-ray. In addition, children develop less stiffness with cast treatment and are more likely to regain normal motion if a fracture involves a joint.


Healing in older people is often slower than in younger adults. Fractures significantly impair an older person’s ability to perform normal daily activities. Diminished strength, flexibility, and balance can impair a person’s independence in eating, dressing, bathing, and even walking (if the person is dependent on a walker). Nonuse of muscles can lead to stiffness, weakness, and further impairment. Nurses and caregivers must assist older people in regaining their ability to perform normal daily activities.


Older people with poor circulation are at risk for bedsores when an injured limb rests on the cast (see Peripheral Arterial Disease: Diagnosis). The areas in which the skin is in contact with the cast (contact points)—especially the heels—should be padded and inspected diligently for any sign of skin breakdown. Nurses and caregivers should be sure an older person periodically changes position to avoid stiffness. For example, prolonged sitting can lead to the hip and knee becoming fixed in a bent position. Periods of standing and walking or, in someone who is bedridden, lying down supine with the legs straight, alternating with periods of sitting with the knees bent, can help to prevent stiffness.


After surgery, people with leg fractures usually start walking with crutches or a walker for a time. Sometimes supplemental casting is needed as well. Healing time varies from days to weeks to months, depending on the nature of the fracture. People with arm fractures have similar initial activity restrictions.


Stiffness and loss of strength are natural consequences of immobilization. A joint of a fractured limb immobilized in a cast becomes progressively stiffer each week, eventually losing its ability to fully extend and flex. Wasting away of muscle (atrophy) also can be severe. For instance, after wearing a long leg cast for a few weeks, most people can insert their hand into the formerly tight space between the cast and their thigh. When the cast is removed, the weakness resulting from muscle atrophy is very apparent.


Daily exercise using range-of-motion and muscle-strengthening exercises (see Rehabilitation: Muscle-Strengthening Exercises) helps to combat stiffness and regain strength. While the fracture is healing, the joints outside the cast can be exercised. The joints within the cast cannot be exercised until the fracture has healed sufficiently and the cast can be removed. When exercising, the person should pay attention to how the injured limb feels and avoid exercising too forcefully. Passive exercises (in which a therapist applies external force (see Increasing the Shoulder’s Range of MotionFigures) must be used when muscles are too weak for effective motion and when strong muscle contractions might displace a fracture. Ultimately, active exercise (in which the person uses his own muscle force) against gravity or weight resistance is necessary to regain full strength of an injured limb.


Bone fractures

A broken bone or bone fracture occurs when a force exerted against bone is stronger than it can structurally withstand.


Bones are a form of connective tissue, reinforced with calcium and bone cells. Bones have a softer centre, called marrow, where blood cells are made. The main functions of the skeleton include support, movement and protection of vulnerable internal organs.


There are different types of bone fractures that vary in severity. Factors that influence severity include the degree and direction of the force, the particular bone involved, and the person’s age and general health.


Common sites for bone fractures include the wrist, ankle and hip. Hip fractures occur most often in elderly people. Broken bones take around four to eight weeks to heal, depending on the age, health of the individual, and the type of break.



The symptoms of a bone fracture depend on the particular bone and the severity of the injury, but may include:


    * Pain, with sweating and a pale face

    * Swelling

    * Bruising

    * Deformity

    * Inability to use the limb.



Basics Section

Osteoporosis is a term that means “porous bones.” It is a skeletal disease affecting women and men. Osteoporosis is a condition in which bones have lost minerals—especially calcium—making them weaker, more brittle, and susceptible to fractures (broken bones). Any bone in the body can be affected by osteoporosis, but the most common places where fractures occur are the back (spine), hips, and wrists.


Each year, osteoporosis causes an estimated 1.5 million fractures among women and men. Because the disease makes bones thinner and weaker, fractures can occur during ordinary movements like bending and lifting or from falls. These fractures can be painful, disfiguring, and may reduce a person’s ability to lead an active life. It is estimated that over the age of 50, one out of every two women will be affected by osteoporosis; so will one out of eight men.


Because of improvements in understanding osteoporosis, it is now treatable and devastating fractures may actually be preventable. Some treatment options available today not only prevent further bone loss, but also help you rebuild your bone mass. New research is underway that includes development of innovative treatments.


    * Bisphosphonates represent one such advance in the treatment and prevention of osteoporosis. Click to learn more about the first and only once-monthly bisphosphonate for the management of postmenopausal osteoporosis.


How Osteoporosis Develops

Some people may develop osteopenia, a condition characterized by low bone density. Osteopenia can eventually lead to osteoporosis, a more severe condition with even lower bone density. For someone with osteoporosis, low bone density makes bones brittle and weak, and the risk of fractures rises.


Not getting enough calcium and vitamin D, even during the childhood and teen years, can contribute to osteoporosis. And if bones did not reach the highest possible peak bone mass during developmental years, osteoporosis is even more likely to develop.


In addition, certain diseases, eating disorders, medications or medical treatments known to cause bone loss may also cause osteoporosis.


Risk Factors for Osteoporosis

About 10 million Americans (8 million women and 2 million men) have osteoporosis, and approximately another 13-17 million people have low bone mass, a condition that increases the risk of developing osteoporosis.


Although the majority of those with osteoporosis are women, osteoporosis is a problem for men too. (For a number of reasons, men are affected less.) The condition can affect people at any age regardless of ethnic background, but postmenopausal women who are of Caucasian or Asian descent face a higher risk.


A woman’s risk of hip fracture is equal to her combined risk of breast, uterine, and ovarian cancer. The overall risk of developing osteoporosis is higher if any of the following apply:


    * Being female and postmenopausal, and over the age of 50

    * Being thin or having a small frame

    * Having a family history of osteoporosis or fracture

    * Having certain health conditions, such as low bone mass; anorexia; estrogen deficiency related to menopause; or an abnormal absence of menstrual periods

    * Use of certain medications, such as oral corticosteroids and anticonvulsants

    * Lifestyle choices such as lack of exercise; cigarette smoking; or excessive consumption of alcohol


In the fall of 2004, the Surgeon General issued a report on bone health and osteoporosis. According to that report, you could be at risk for developing osteoporosis if you have certain conditions or risk factors. Here’s a quick checklist to print out, fill out and take to your doctor.


Osteoporosis: A debilitating disease that can be prevented and treated.

Osteoporosis is a disease in which bones become fragile and more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fractures, occur typically in the hip, spine, and wrist.


Any bone can be affected, but of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person’s ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity.


Millions of Americans are at risk. While women are four times more likely than men to develop the disease, men also suffer from osteoporosis.


What is scoliosis?

         Everyone’s spine has natural curves. These curves round our shoulders and make our lower back curve slightly inward. But some people have spines that also curve from side to side. Unlike poor posture, these curves can’t be corrected simply by learning to stand up straight.


This condition of side-to-side spinal curves is called scoliosis. On an X-ray, the spine of an individual with scoliosis looks more like an “S” or a “C” than a straight line. Some of the bones in a scoliotic spine also may have rotated slightly, making the person’s waist or shoulders appear uneven.


Who gets scoliosis?

Scoliosis affects a small percentage of the population, approximately 2 percent. However, scoliosis runs in families. If someone in a family has scoliosis, the likelihood of an incidence is much higher – approximately 20 percent. If anyone in your family has curvature of the spine, you should be examined for scoliosis.


    * Children – The vast majority of scoliosis is “idiopathic,” meaning its cause is unknown. It usually develops in middle or late childhood, before puberty, and is seen more often in girls than boys. Though scoliosis can occur in children with cerebral palsy, muscular dystrophy, spinal bifida and other miscellaneous conditions, most scoliosis is found in otherwise healthy youngsters.


    * Adults – Scoliosis usually develops during childhood, but it also can occur in adults. Adult scoliosis may represent the progression of a condition that actually began in childhood, and was not diagnosed or treated while the person was still growing. What might have started out as a slight or moderate curve has progressed in the absence of treatment.


In other instances, adult scoliosis can be caused by the degenerative changes of the spine. Other spinal deformities such as kyphosis or round back are associated with the common problem of osteoporosis (bone softening) involving the elderly. As more and more people reach old age in the U.S., the incidence of scoliosis and kyphosis is expected to increase.


If allowed to progress, in severe cases adult scoliosis can lead to chronic severe back pain, deformity, and difficulty in breathing.


The importance of early detection – tips for parents

Idiopathic scoliosis can go unnoticed in a child because it is rarely painful in the formative years. Therefore, parents should watch for the following “tip-offs” to scoliosis beginning when their child is about 8 years of age:


    * uneven shoulders


    * prominent shoulder blade or shoulder blades


    * uneven waist


    * elevated hips


    * leaning to one side


Any one of these signs warrants an examination by the family physician, pediatrician or orthopaedist.


Some schools sponsor scoliosis screenings. Although only a physician can accurately diagnose scoliosis, school screenings can help alert parents to the presence of its warning signs in their child.



In planning treatment for each child, an orthopaedist will carefully consider a variety of factors, including the history of scoliosis in the family, the age at which the curve began, the curve’s location and severity of the curve.


Most spine curves in children with scoliosis will remain small and need only to be watched by an orthopaedist for any sign of progression. If a curve does progress, an orthopaedic brace can be used to prevent it from getting worse. Children undergoing treatment with orthopaedic braces can continue to participate in the full range of physical and social activities.


Electrical muscle stimulation, exercise programs, and manipulation have not been found to be effective treatments for scoliosis.


If a scoliotic curve is severe when it is first seen, or if treatment with a brace does not control the curve, surgery may be necessary. In these cases, surgery has been found to be a highly effective and safe treatment.



Scoliosis is a common problem that usually requires only observation with repeated examination in the growing years. Early detection is important to make sure the curve does not progress. In the relatively small number of cases that need medical intervention, advances in modern orthopaedic techniques have made scoliosis a highly manageable condition. Orthopaedists, specialists in diseases of the muscles and skeleton, are the most knowledgeable and qualified group of physicians to diagnose, monitor and treat this condition.


Your orthopaedist is a medical doctor with extensive training in the diagnosis, and nonsurgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.


This information has been prepared by the American Academy of Orthopaedic Surgeons, in cooperation with the Scoliosis Research Society (SRS), and is intended to contain current information on the subject from recognized authorities. However, it does not represent official policy of the Academy and SRS and its text should not be construed as excluding other acceptable viewpoints.


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In the film “Looking For Mr. Goodbar”, Diane Keaton plays a teacher of deaf children, who has scoliosis.


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