Skeletal Development, Fractures and Disease

Skeletal system

Bone growth, development, anatomy, types of fractures and fracture healing

Diseases affecting skeletal system

• Congenital or developmental
• Traumatic
• Infective
• Bone tumours
• Metabolic/Systemic diseases

Arthritis/ Joint diseases

Plain X-rays remain the main imaging modality in skeletal disorders. Two views are obtained, usually at right angles to each other.

Bone growth and development (the primary ossification centre)

• Bones develop and grow through primary and secondary ossification centres.
• Virtually all primary centres are present at birth.
• The part of bone ossified from the primary centre is called the diaphysis.

In long bones the diaphysis forms most of the shaft.

The secondary ossification centre (epiphysis)

• Secondary ossification centres develop later in growing bones, most appear after birth.
• The secondary centre at the end of a long bone is termed the epiphysis.

The epiphysis is separated from the shaft of the bone by the epiphyseal growth plate.

The apophysis

An apophysis is another type of ossification centre, which forms a protrusion from the growing bone.

One example is the tibial tuberosity.

The diaphysis and metaphysis

The diaphysis and metaphysis are covered by periosteum and the articular surface of the epiphysis is covered by articular cartilage.

The metaphysis is that part of the bone between the diaphysis and the growth plate.

The growing bone

• Name the various parts of
• This bone. Define the words
• Primary and second
• Ossification centre, epiphysis,
• Metaphysis, diaphysis, apophysis,

Periosteum, cartilage

Longtitudinal and circumferential growth of bone

Longitudinal bone growth occurs at the metaphysis and periosteal activity along the diaphysis contributes to circumferential growth.

Appearance of secondary ossification centre

It is sometimes important to know the age at which various secondary ossification centres appear.

The most complex ones are at the elbow and can be remembered by the pneumonic “CRITOE”

Secondary centres around the elbow

• C = capitellum
• R = radius
• I = internal epicondyle
• T = trochlear
• O = olecronon
• E = eternal epicondyle
• C – 2yrs
• R – 5yrs
• I – 5yrs
• T – 10yrs
• O – 10yrs

E – 13yrs

Determination of bone age

Bone age is determined by X-ray of one hand and wrist.

The development of the carpal bones and phalangeal epiphyses are compared to a set standard for sex and age.

Girls mature faster than boys.

Anatomy of long bones

Identify the parts Labeled a-h, what are long, short flat, sesamoid bones/

Spine anatomy

How many bones make up each region of the spine?identify the parts labeled A-G.

What are posterior elements?what is theUnique articulation found in the cervical spine?what is the uncovertebral joint? What is the main determinant of vertebral stability?what are the 4 main ligaments which contribute to vertebral stability?what is th eposterior ligament complex? How many cervical nerves are there? Where do they exit form? How many lumbar roots are there and where do they exit from?

Spine: learn these parts

MRI picture of the lumbar spine

Shoulder anatomy

• Which bones comprise the shoulder girdle? What are
• The parts of the scapular? Is the coracoid process
• Anterior or posterior?is the acromion anterior or posterior
• What 3ligaments comprise the acromioclavicular joint?
• What 3 structures comprise the shoulder joint? Describe
• The glenohumeral joint.describe the rotator cuff.name the

Muscles of the rotator cuff.where is the subacromial bursa?

Shoulder anatomy

Elbow anatomy

What bones articulate at the elbow? How do the ulna And humerus articulate? How do the radius and humerus articulate? What are the key anatomical Relationships in the elbow

Wrist anatomy

Learn these bones

Hand anatomy

• What are the parts of the of a metacarpal?
• What are the joints in the hand called?

In terms of joints, how is the thumb unique/