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Description : Check out this medical presentation on Orthopaedics, which is titled "Skeletal System", to know about the Skeletal System (Bones/skeleton, Joints, Cartilages, and Ligaments).

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Skeletal System Dr.K.Satish Ravi, M.B.B.S.,M.D.,MAMS,PhD(Std) Associate Professor Department of Anatomy, AIIMS, Rishikesh
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SKELETON (skeletos) Bony & cartilaginous framework of the body Endoskeleton Exoskeleton Functions- Rigid framework of the body Protection to the viscera Provides leverage for body movements.
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The Skeletal System Parts of the skeletal system Bones (skeleton) Joints Cartilages Ligaments (bone to bone) (tendon=bone to muscle)
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Functions Shape & Support Protection Movement Storage Hematopoiesis Bone :- Highly vascular mineralized connective tissue , consisting of cells & dense intercellular organic matrix impregnated with organic salts.
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CLASSIFICATION of BONES cont’n. According to location A X I A L skull 22 hyoid 1 ossicles 6 vertebrae 26 ribs & sternum 25_ 80
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CLASSIFICATION of BONES cont’n. According to location APPENDICULAR Upper Extremities Lower Extremities clavicle 2 hip bone 2 scapulae 2 femur 2 humerus 2 patella 2 radius 2 tibia 2 ulna 2 fibula 2 carpals 16 tarsals 14 metacarpals 10 metatarsals 10 phalanges 28__ phalanges 28__ 64 62
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Fig. 6.10
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Table. 6.1
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AXIAL SKELETON I. SKULL = skeleton --- head & face = flattened & irregular = united by joints (sutures) cranium -- skull minus mandible calvarium -- skull after the bones of the face have been removed cavities: a. Cranial - contains the brain b. Orbital - contains eyeball & accessory organs c. nasal
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The Skull
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Bones of the Skull
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Human Skull, Superior View
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Human Skull, Inferior View Figure 5.9
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Divisions of the bones of the skull Cerebral / cranial bones / brain case (8 bones) unpaired (4) paired (4) 1. occipital 1. parietal 2. frontal 2. temporal 3. sphenoid 4. ethmoid b. Facial or visceral cranium paired (12) unpaired (2) a. Nasal a. Vomer b. Lacrimal b. Mandible c. Maxilla d. Zygomatic / malar / cheek bones e. Palatine f. Inferior nasal concha or turbinate
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Paranasal Sinuses Functions of paranasal sinuses Lighten the skull Give resonance and amplification to voice
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Fig. 6.13
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Fontanelle = membrane filled spaces found in the skull of newborn infants e.g.: 1. anterior = largest 2. posterior 3. anterolateral (sphenoidal) 4. posterolateral (mastoid)
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Fig. 6.37
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AXIAL SKELETON HYOID BONE = small U-shape; lies in front of the neck = base of the tongue is attached = lies between mandible & thyroid cartilage II. OSSICLES = small bones of the ear a. Stapes (stirrup) 2 b. Incus (anvil) 2 c. Malleus (hammer) 2
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Fig. 6.16
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AXIAL SKELETON VERTEBRAL COLUMN = long, curved, slightly movable pillar = united together by cartilage & ligaments = 71 – 75 cm. long = formed by series of bones -- vertebrae FUNCTION: 1. support of the trunk 2. contains & protects the spinal cord & nerves
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VERTEBRAL COLUMN Classification of vertebra young adult cervical 7 7 thoracic 12 12 lumbar 5 5 sacral 5 1 coccygeal 4 1 33 26 Intervertebral discs = flattened plates of fibrocartilage that are interposed between the adjacent surfaces of the bodies of vertebrae FUNCTION: 1. uniting medium between vertebrae 2. main shock absorber 3. give flexibility & movement to the whole vertebral column
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VERTEBRAL COLUMN General parts of vertebrae 1. body 5. transverse process 2. arch 6. articular process 3. pedicle or root 7. spinous process 4. lamina 8. spinal or vertebral foramen Special characteristics of individual vertebrae a. Cervical vertebrae (7) = forms the skeleton of the neck, all have transverse foramen atypical cervical vertebrae: 1. atlas -- 1st 2. axis or epistropheus = 2nd 3. 7th cervical vertebrae = spinous process not bifid, small transverse foramen b. Thoracic vertebrae (12) = costal pits - rib attachment = circular vertebral canal
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VERTEBRAL COLUMN Special characteristics of individual vertebrae cont’n c. Lumbar vertebrae (5) = presence of mamillary & accessory processes = triangular vertebral foramen d. Sacrum = inverted triangular bone situated between hip bones e. Coccygeal vertebrae (1) = 4 small incomplete vertebrae fused to form the coccyx / tail bone; triangular
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Fig. 6.17
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Fig. 6.18
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Fig. 6.20
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AXIAL SKELETON STERNUM (breast bone) = flat bone, found -- anterior thoracic wall = composed of 2 plates of compact bone with a layer of spongy bone in between containing red bone marrow PARTS: a. Manubrium b. Corpus or body c. Xiphoid process
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AXIAL SKELETON RIBS (12 pairs) = narrow arched flat bones with 2 ends 1. vertebral - posterior; attaches with thoracic 2. sternal - anterior; attaches with costal cartilages Classification of ribs: a. Sternal or true ribs (1st to 7th) - ribs whose costal cartilages are directly attached to sternum b. Asternal or false ribs (8th to 12th) - ribs whose costal cartilages are not attached directly to the sternum but to 7th subdivisions: 1. false rib proper - 8th, 9th, 10th ribs 2. floating or hanging ribs – 11th & 12th
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Fig. 6.21
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APPENDICULAR SKELETON BONES of the UPPER EXTREMITY (UE) 1. Clavicle (collar bone) 2. Scapula (shoulder blade) – articulates with humerus & clavicle 3. Humerus (arm bone) - longest & largest bone of UE articulates with scapula (above) radius & ulna (below) 4. Radius - lateral bone of the forearm; cup- shaped head 5. Ulna - principal bone of the forearm; longer & larger than radius
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APPENDICULAR SKELETON BONES of the UPPER EXTREMITY (UE) cont’n 6. Carpals (wrist bone) - 8 bones arranged into 2 rows - proximal & distal rows She Looks Too Pretty Try To Catch Her Scaphoid, Lunate,Triquetrum, Pisiform,Trapezium, Trapezoid Capitate, Hamate 7. Metacarpals (bones of the hand) - 5 long bones placed between carpals & phalanges - numbered from lateral to medial Phalanges (bones of the fingers) = 14 long bones of the fingers -- 3 bones except thumb - 2 bones
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Fig. 6.26
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Fig. 6.22
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Fig. 6.27
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APPENDICULAR SKELETON BONES of the LOWER EXTREMITY (LE) 1. Hip bone (innominate bone) right & left hip bones + sacrum = pelvic girdle 3 bones: 1. ilium* 2. ischium* 3. pubis* 2. Femur (thigh) = longest, strongest, largest bone in the body 3. Tibia (shin bone) = long bone; anterior, medial, & larger of the 2 bones of the leg 4. Fibula (peroneal bone) = long slender bone placed parallel with the tibia but located laterally *Converge on acetabulum  a concave fossa -- articulates with head of femur  form hip joint
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Fig. 6.29
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Fig. 6.30
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Fig. 6.31
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Fig. 6.32
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Fig. 6.33
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Fig. 6.34
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APPENDICULAR SKELETON BONES of the LOWER EXTREMITY (LE) cont’n 5. Tarsals (ankle bone) = short bones; 2 rows: internal & external rows # 6. Metatarsals (bones of foot) = 5 long bones numbered from medial to lateral 7. Phalanges (bones of toes) = similar to bones of the fingers # Cute Tina Never Could Cooperate
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Fig. 6.35
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CLASSIFICATION of BONES According to shape 1. long bones = length is greater than breadth = consists of shaft (diaphysis) & two extremities (epiphysis) diaphysis = filled with yellow marrow = cylindrical, large space or canal at the center = periosteum epiphysis = made up of cancellous tissue e.g.: femur, humerus, tibia, fibula, radius, ulna, phalanges Membranes: 1. periosteum 2. endosteum
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CLASSIFICATION of BONES cont’n. According to shape 2. short bones = cuboidal in shape = spongy bone with thin coat of compact bone e.g.: carpals (wrist), tarsal (ankle) bones 3. flat bones = broad or elongated flat plates = for protection & muscle attachments composition: 2 thin layers of compact tse. enclosing a thin layer of spongy bone e.g.: bones of the skull, sternum, ribs, scapula
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CLASSIFICATION of BONES cont’n. According to shape 4. Irregular bones = all other bones not assigned to the previous groups e.g.: vertebrae pelvic bones bones of the base of the skull 5. Sesamoid bone -- short bone embedded in a tendon e.g.: patella
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CLASSIFICATION of BONES cont’n. According to shape 6.Pneumatic bones- flat or irregular bones possessing a hollow space with in their body, contains air. e.g.: ethmoid maxilla mastoid part of temporal bone. 7. Accessory bones- (supernumerary) ununited epiphyses developed from extra centres of ossification. e.g.: Sutural bones Os trigonum.
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CLASSIFICATION of BONES cont’n. According to development 1. Membranous = starts as fibrous membrane, calcium gradually deposited until structure becomes ossified  intramembranous ossification e.g.: bones of the skull, mandible 2. Cartilagenous = starts as cartilage, gradually ossified enchondral or intracartilagenous ossification. e.g.: long bones
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2 Types of Bone Compact bone Spongy bone
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CLASSIFICATION of BONES According to structure 1. compact = solid mass; dense & hard = forms the outer layer of bone structure = functional unit --- Haversian system 2. cancellous or spongy = contain spaces filled with bone marrow = incomplete Haversian system
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Gross Anatomy of a Long Bone Diaphysis Shaft Composed of compact bone Epiphysis Ends of the bone Composed mostly of spongy bone Figure 5.2a
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Structures of a Long Bone Periosteum Outside covering of the diaphysis Fibrous connective tissue membrane Sharpey’s fibers Secure periosteum to underlying bone Arteries Supply bone cells with nutrients Figure 5.2c
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Structures of a Long Bone Articular cartilage Covers the external surface of the epiphyses Made of hyaline cartilage Decreases friction at joint surfaces Figure 5.2a
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Structures of a Long Bone Medullary cavity Cavity of the shaft Contains yellow marrow (mostly fat) in adults Contains red marrow (for blood cell formation) in infants Figure 5.2a
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Bone Markings Surface features of bones Sites of attachments for muscles, tendons, and ligaments Passages for nerves and blood vessels Categories of bone markings Projections and processes – grow out from the bone surface Depressions or cavities – indentations
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Composition of bone matrix Inorganic salts: the hardness of bone result from the deposition of high specialized chemical crystal of calcium & phosphorous called hydroxyapatite, the process called calcification in addition to mg, Na, sulphate and fluoride. Organic substance: collagen fiber & mixture protein and poly saccarids called ground substance, provide support and adhesion between cellular and fiberous. Chondroitin and glucosamine are required for repair and maintenance of bone and cartilage.
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Composition of bone matrix Ahmad ata 70
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This bone: a. Has been demineralized b. Has had its organic component removed
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Types of bone cells 1. Osteoblasts Bone-forming cells found in all bone surfaces Bone-building cells. Synthesize and secrete collagen fibers and other organic components of bone matrix. serve as a framework for the deposition of calcium and phosphate calcification 72 The blue arrows indicate the osteoblasts. The yellow arrows indicate the bone matrix they’ve just secreted.
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Types of bone cells 2. Osteoclasts Giant multinucleate cells Responsible for the active erosion of bone minerals Contain large numbers of mitochondria and lysosomes 73
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Types of bone cells 3. Osteocytes—mature, nondividing osteoblast surrounded by matrix, lying within lacunae Ahmad ata 74
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Bone Marrow Specialized type of soft, diffuse connective tissue; called myeloid tissue Site for the production of blood cells Found in medullary cavities of long bones and in the spaces of spongy bone
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Bone Marrow Two types of marrow are present during a person’s lifetime: Red marrow Found in virtually all bones in an infant’s or child’s body Functions to produce red blood cells Yellow marrow As an individual ages, red marrow is replaced by yellow marrow Marrow cells become saturated with fat and are no longer active in blood cell production
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Bone Marrow The main bones in an adult that still contain red marrow include the ribs, bodies of the vertebrae, the humerus, the pelvis, and the femur Yellow marrow can alter to red marrow during times of decreased blood supply, such as with anemia, exposure to radiation, and certain diseases
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Microscopic Structure of Compact Bone Contains many cylinder-shaped structural units called osteons, or Haversian systems Four types of structures make up each osteon: Lamella—concentric, cylinder-shaped layers of calcified matrix Lacunae—small spaces containing tissue fluid in which bone cells are located between hard layers of the lamella 79
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Microscopic Structure of Compact Bone Canaliculi—ultrasmall canals radiating in all directions from the lacunae and connecting them to each other and to the Haversian canal Haversian canal—extends lengthwise through the center of each osteon and contains blood vessels and lymphatic vessels 80
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Microscopic Structure of Compact Bone Ahmad ata 81
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Microscopic Anatomy of Bone Osteon (Haversian System) A unit of bone Central (Haversian) canal Opening in the center of an osteon Carries blood vessels and nerves Perforating (Volkman’s) canal Canal perpendicular to the central canal Carries blood vessels and nerves
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Microscopic Anatomy of Bone Figure 5.3
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Microscopic Anatomy of Bone Lacunae Cavities containing bone cells (osteocytes) Arranged in concentric rings Lamellae Rings around the central canal Sites of lacunae
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Microscopic Anatomy of Bone Canaliculi Tiny canals Radiate from the central canal to lacunae Form a transport system
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Changes in the Human Skeleton In embryos, the skeleton is primarily hyaline cartilage During development, much of this cartilage is replaced by bone Cartilage remains in isolated areas Bridge of the nose Parts of ribs Joints
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Specialized connective tissue Rigid, Elastic, Resilient - RESISTS COMPRESSION AVASCULAR – nutrients diffuse through matrix CARTILAGE
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PERICHONDRIUM Dense irregularly arranged connective tissue (type I collagen) Ensheaths the cartilage Houses the blood vessels that nourish chondrocytes
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CHONDROBLAST Progenitor of chondrocytes Lines border between perichondrium and matrix Secretes type II collagen and other components Chondroblasts build
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CHONDROCYTE Mature cartilage cell Reside in a space called the lacuna Clear areas = Golgi and lipid droplets
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Chondrocytes completely fill their lacunae RER and euchromatic nuclei Synthetically active, secrete matrix Cartilage matrix RER N
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MATRIX Provides the rigidity, elasticity, & resilience FIBERS Collagenous and elastic GROUND SUBSTANCE Glycosaminoglycans (chondroitin sulfates, keratin sulfate, hyaluronic acid) Proteoglycans: GAGs + core protein Water Basophilic Territorial matrix - high [ ] of sulfated proteoglycans
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CARTILAGE GROWTH Appositional Increasing in WIDTH; chondroblasts deposit matrix on surface of pre-existing cartilage Interstitial Increasing in LENGTH; chondrocytes divide and secrete matrix from w/in lacunae
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TYPES OF CARTILAGE HYALINE ELASTIC FIBROUS
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HYALINE CARTILAGE FUNCTION Support tissue and organs Model for bone development MATRIX Type II collagen (thin fibrils) Chondroitin sulfate, keratin sulfate, hyaluronic acid Water LOCATION Tracheal rings, nasal septum, larynx, articular surfaces of joints
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ELASTIC CARTILAGE FUNCTION Support with flexibility MATRIX Normal components of hyaline matrix plus ELASTIC fibers LOCATION External ear, external auditory canal, epiglottis STAINS Elastic fibers stain BLACK with Weigert stain perichondrium
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FIBROCARTILAGE Orcein van Giesen Elastic stain - fibrocartilage - reddish brown hyaline cartilage - yellow
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FIBROCARTILAGE FUNCTION Support with great tensile strength MATRIX Type I collagen - Oriented parallel to stress plane LOCATION Intervertebral disks, pubic symphysis
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FIBROCARTILAGE Chondrocytes align between collagen fibers Collagen fibers lie parallel to lines of stress
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Bone Growth Epiphyseal plates allow for growth of long bone during childhood New cartilage is continuously formed Older cartilage becomes ossified Cartilage is broken down Bone replaces cartilage
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Bone Growth Bones are remodeled and lengthened until growth stops Bones change shape somewhat Bones grow in width
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Long Bone Formation and Growth Figure 5.4a
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Bone Fractures A break in a bone Types of bone fractures Closed (simple) fracture – break that does not penetrate the skin Open (compound) fracture – broken bone penetrates through the skin Greenstick- frays, hard to repair, breaks like a green twig Bone fractures are treated by reduction and immobilization Realignment of the bone
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Common Fractures greenstick fracture = the bone does not break all of the way through. simple, or closed = when the bone breaks but the skin does not. compound, or open = when the broken bone tears through the skin, introducing the dangerous possibility of infection. The area around a break swells and discolors, but some fractures can be detected only by X-ray. The weakened bones of the elderly are especially susceptible to fractures.
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Fig. 6B
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Common Types of Fractures
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Repair of Bone Fractures Hematoma (blood-filled swelling) is formed Break is splinted by fibrocartilage to form a callus Fibrocartilage callus is replaced by a bony callus Bony callus is remodeled to form a permanent patch
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Stages in the Healing of a Bone Fracture
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Fig. 6C
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Table. 6.2
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Diseases and Conditions of the Skeletal System
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Arthritis
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Bursitis Inflammation of the Bursa (fluid filled sac surrounding the joint). A bursa can become inflamed from injury, infection (rare in the shoulder), or due to an underlying rheumatic condition. Bursitis is typically identified by localized pain or swelling, tenderness, and pain with motion of the tissues in the affected area.
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Tendonitis Sometimes the tendons become inflamed for a variety of reasons, and the action of pulling the muscle becomes irritating. If the normal smooth gliding motion of your tendon is impaired, the tendon will become inflamed and movement will become painful. This is called tendonitis, and literally means inflammation of the tendon. The most common cause of tendonitis is overuse.
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Carpal Tunnel Syndrome Any condition that causes swelling or a change in position of the tissue within the carpal tunnel can squeeze and irritate the median nerve. Irritation of the median nerve in this manner causes tingling and numbness of the thumb, index, and the middle fingers, a condition known as "carpal tunnel syndrome."
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Osteoporosis Osteoporosis is a term that means "porous bones." Skeletal disease affecting women & men. Osteoporosis is a condition in which bones have lost minerals especially calciumﾑ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.
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Scoliosis Scoliosis is an abnormal curvature of the spine. If your child has scoliosis, the view from behind may reveal one or more abnormal curves.Scoliosis runs in families, but doctors often don't know the cause. More girls than boys have severe scoliosis. Adult scoliosis may be a worsening of a condition that began in childhood, but wasn't diagnosed or treated. In other cases, scoliosis may result from a degenerative joint condition in the spine.
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Kyphosis With kyphosis, your spine may look normal or you may develop a hump. Kyphosis can occur as a result of developmental problems; degenerative diseases, such as arthritis of the spine; osteoporosis with compression fractures of the vertebrae; or trauma to the spine. It can affect children, adolescents and adults.
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Lordosis A normal spine, when viewed from behind appears straight. However, a spine affected by lordosis shows evidence of a curvature of the back bones (vertebrae) in the lower back area, giving the child a "swayback" appearance.
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Tuberculosis of the Spine- Pott’s Disease As a form of extrapulmonary tuberculosis that impacts the spine, Pott’s disease has an effect that is sometimes described as being a sort of arthritis for the vertebrae that make up the spinal column. More properly known as tuberculosis spondylitis, Pott’s disease is named after Dr. Percivall Pott, an eighteenth century surgeon who was considered an authority in issues related to the back and spine.Pott's disease is often experienced as a local phenomenon that begins in the thoracic section of the spinal column. Early signs of the presence of Pott’s disease generally begin with back pain that may seem to be due to simple muscle strain. However, in short order, the symptoms will begin to multiply.
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Rickets Rickets is the softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D deficiency. Some skeletal deformities caused by rickets may need corrective surgery.
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Bone Deformation Rickets can result from insufficient vitamin D in the diet or from insufficient amounts of ultraviolet radiation from the sun. It can lead to skeletal deformation, such as vertebral or leg curvature.
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Scurvy The human body lacks the ability to synthesize and make vitamin C and therefore depends on exogenous dietary sources to meet vitamin C needs. Consumption of fruits and vegetables or diets fortified with vitamin C are essential to avoid ascorbic acid deficiency. Even though scurvy is uncommon, it still occurs and can affect adults and children who have chronic dietary vitamin C deficiency.
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Gout Gout is a disease that results from an overload of uric acid in the body. This overload of uric acid leads to the formation of tiny crystals of urate that deposit in tissues of the body, especially the joints. When crystals form in the joints it causes recurring attacks of joint inflammation (arthritis). Chronic gout can also lead to deposits of hard lumps of uric acid in and around the joints and may cause joint destruction, decreased kidney function, and kidney stones.
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Acromegaly Acromegaly is a serious condition that occurs when the body produces too much of the hormones that control growth. ･The hormone most often affected is called growth hormone, or GH. Itﾊis produced by the pituitary gland, a tiny organ at the base of the brain.･･Growth hormoneﾊpromotes growth of bone, cartilage, muscle, organs, and other tissues.･･When there is too much growth hormone in the body, these tissues grow larger than normal. This excessive growth can cause serious disease and even premature death.
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Poliomyelitis Poliomyelitis (polio) is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. It can strike at any age, but affects mainly children under three (over 50% of all cases). The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. One in 200 infections leads to irreversible paralysis (usually in the legs). Amongst those paralysed, 5%-10% die when their breathing muscles become immobilized. Although polio paralysis is the most visible sign of polio infection, fewer than 1% of polio infections ever result in paralysis. Poliovirus can spread widely before cases of paralysis are seen. As most people infected with poliovirus have no signs of illness, they are never aware they have been infected. After initial infection with poliovirus, the virus is shed intermittently in faeces (excrement) for several weeks. During that time, polio can spread rapidly through the community.
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Spina Bifida Spina bifida is a birth defect that involves the incomplete development of the spinal cord or its coverings. The term spina bifida comes from Latin and literally means "split" or "open" spine.Spina bifida occurs at the end of the first month of pregnancy when the two sides of theﾊembryo's spine fail to join together, leaving an open area. In some cases, the spinal cord or other membranes may push through this opening in the back. The condition usually isﾊdetected before a baby is born and treated right away.
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Talipes Equinovarus- “Clubfoot” Clubfoot is a deformity of the whole foot that is present at birth. There are several types of clubfoot that are jointly known as 'talipes', as the deformity is mostly in the talus (a bone in the ankle). The most common of the talipes is what is known as "talipes equino varus" - it is so common that the word clubfoot is commonly used to refer to this. In talipes equino varus, the child is born with the foot pointing down and twisted inwards at the ankle.
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Sarcoma Osteosarcoma-The most common type of bone cancer. It arises in bone and is most commonly found in children and adolescents but a rare form occurs in adults, particularly in patients who have been cured of other cancers with radiation therapy.
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Myeloma Multiple myeloma is a cancer in which abnormal cells collect in the bone marrow and form tumors. Sometimes these abnormal cells (called myeloma cells) collect in only one bone and form a single tumor known as a plasmacytoma. However, in most cases, the myeloma cells collect in many bones, forming several tumors and causing other problems. When this happens, the disease is called multiple myeloma.
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Leukemia Leukemia is cancer of the blood cells. It starts in the bone marrow, the soft tissue inside most bones. Bone marrow is where blood cells are made.When you are healthy, your bone marrow makes:･White blood cells, which help your body fight infection.･Red blood cells, which carry oxygen to all parts of your body.･Platelets, which help your blood clot.When you have leukemia, the bone marrow starts to make a lot of abnormal white blood cells, called leukemia cells. They don't do the work of normal white blood cells, they grow faster than normal cells, and they don't stop growing when they should.
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Bone Marrow Biopsy