Bone Anatomy and Growth

Bone Anatomy

• Periosteum: Outer layer of bone, serving as an attachment point for tendons, ligaments, and nerves.
• Compact bone: Dense, strong, and mineralized outer layer of the bone, providing support and protection.
• Spongy bone: Inner layer of bone, containing bone marrow (fat deposits), keeping the bones light while offering strength. Also contains blood vessels.
• Long bone structure: Comprised of a shaft (diaphysis), and two ends (epiphyses). The diaphysis contains compact bone, while the epiphyses contain spongy bone.

Bone Growth

• Ossification: Begins at 8 weeks after conception. This ongoing process involves the development and formation of bone throughout life.
• Cell types involved:
  • Osteoblasts: Bone-forming cells which build new bone tissue.
  • Osteocytes: Mature bone cells, maintaining bone tissue.
  • Osteoclasts: Bone-resorbing cells which break down existing bone tissue.
• Bone growth is not uniform throughout the body
• Excess bone that is removed to ensure growth is controlled

Common Bone Disorders

• Congenital disorders
• Arthritic disorders : Soft tissue and autoimmune conditions, like inflammation of the bursae (fluid sacs), rheumatoid arthritis, gout and other conditions causing inflammation or damage.
• Osteoporosis: A condition leading to the gradual loss of bone mass, resulting in decreased bone density and increased risk of fractures.
• Degenerative Joint Disease (OA): Common condition causing cartilage damage and inflammation in joints.
• Tumors: Cancers that affect bones.
• Fractures: A break in the bone.

Bone Growth Post-Fracture

• Reactive phase: Inflammation and granulation tissue formation within 2–4 weeks post fracture. Key questions include immobilization needs, blood supply adequacy, and nutrition provision.
• Reparative phase: Osteoblasts and new tissue formation 4 weeks to 8 months after fracture
• Remodelling phase: Bone healing and remodelling 3 to 5 years after fracture, depending on age and health of the individual.

Bone Treatment and Medical Conditions

• Medical Conditions: Affecting bone growth and repair: diabetes, hormone imbalances, vascular diseases, and use of steroids.
• Treatment Options:
  • Closed reduction: Aligning bone fragments without surgery
  • Open reduction internal fixation (ORIF): Using surgical plates, screws, wires to stabilize the bone.
  • External fixation: Using an external frame to stabilize broken bones.
  • Implantation: Using implants such as screws, plates, and nails.
  • Prostheses: A replacement for a dysfunctional joint or bone.

OT Role

• Pre-Op Assess client's environmental needs(home, school, leisure), safety, equipment, and implement strategies for mobility, self care and dressing, and transfers.
• Post-Op: Provide education & demonstrate mobility, transfers, wound care, and ADLs.

Orthopedic Equipment

• Equipment like long handled reachers, shoehorns, raised toilet seats, grab bars, shower benches, tub transfer benches all help in effective mobility.

Bed Mobility & Bathing Tips

• Bed Mobility: Important to assist the patient in safe transfers, avoid injury by instructing on proper body mechanics for transfers.
• Bathing: Implement proper techniques for bathing, assist in use of necessary equipment to prevent injury/fall, or difficulty performing the task.

Car Transfers

• Instruct on proper car transfer technique, using the appropriate equipment.

Driving & House Work

• Driving: Return to driving as indicated by the physician with safe practices.
• House Work: Assist with light housekeeping, laundry, yard work based on the patient's needs and limitations.

Medical Conditions

• Slipped Capital Femoral Epiphysis (SCFE): A common condition in adolescents where the femoral head slips from its normal position. This occurs during periods of rapid growth, and it is often seen in overweight or obese children. This is typically a unilateral condition.
• Knee Arthroplasty: The replacement of a damaged knee joint. This procedure has specific movement precautions.

Knee Replacement

• Techniques involving removing damaged cartilage and inserting metal components to restore knee function.
• Movement and activity restrictions are essential for healing.

Ankle Fractures

• Classification such as Weber A, B, C based on location of fractures
• Treatment options include immobilization, reduction, and surgery.
• Pilon Fractures are fractures of the lower end of the tibia that often result from high impact trauma such as a fall from a height
• Maisonneuve Fracture is a fracture of the lower end of the tibia in association with disruption of the syndesmosis.

Shoulder

• Rotator Cuff Review: Rotator cuff muscles include supraspinatus, infraspinatus, and teres minor, and subscapularis. These control the humeral head movement for abduction, external rotation and controlled internal rotation.