Rodolf Gerone G.

Macahilos August 9, 2019

BSN – 1E Anatomy and Physiology

CASE STUDY NO. 3

Chief Complaint: A 14-year-old girl admitted with a broken leg.

History: Nicole Michaelson, a 14-year-old girl, was skiing when she fell and broke her leg. As
she fell, her left leg got caught under the body of another skier who ran into her. An X-ray revealed
that the fracture was a compound, tibial-fibular fracture just below the knee. The X-ray also
revealed a torn meniscal cartilage in the knee above the fracture. The girl remained in the hospital
for 14 days because of an infection of the leg in the area of the skin breakage. Her immobilized
leg was casted after the infection subsided. She remained in a full leg-length cast for 3 months,
after which the upper portion of the cast was removed and she was allowed to start bearing weight
on the leg. The bones ultimately healed, but the girl continued to have left knee swelling (water on
the knee) and pain made worse by walking. Arthroscopic examination of the knee revealed a
meniscus that was still torn 6 months after her injury.

Questions:

1. What does the term “tibial-fibular fracture” mean?

Answer:
A tibial fracture is a fracture of both the tibia and fibula in the lower leg. Tibia and Fibula
are the two long bones located in the lower leg. The tibia is a larger bone on the inside, while the
fibula is the smaller bone on the outside.

2. What is a compound fracture?

Answer:
A fracture is a break, usually in a bone. Fractures commonly happen because of accidents,
falls, or sport injuries. A compound fracture also known as “open fracture” is one in which the
broken bone is protruding or pierces through the skin, causing a risk of infection. Most often, this
wound is caused by a fragment of a bone breaking through the skin at the moment of the injury.

3. Why was her injury more likely to become infected than a routine fracture of the leg?
Answer:
Her injury is more likely to become infected than a routine fracture of the leg simply
because the bone is protruding through the skin. The skin is normally colonized with bacteria that
could infect underlying tissues when the skin is broken down.

4. Describe the microscopic features of osseous tissue that help long bones withstand lateral stress
without breaking.
Answer:
Osseous tissue is a tissue of the skeletal system otherwise commonly known as bone tissue.
It is the major connective tissue of the human body. It consist of two types of bone; Compact Bone
and Spongy Bone. Compact bone forms the outer layer of bones and various structure of long
bone. It is composed of bone marrow and medullary cavity which helps long bone to maintain the
weight of our human body. On the other hand, the Spongy Bone consists of a lattice and trabeculae.
Osseous tissue contains calcium and phosphate.

5. Describe the microscopic features of the osseous tissue that help long bones withstand
compressive stress without breaking.
Answer:
Long bones have bony collar that can withstand compressive stretch and support the weight
of the body. In the epiphyses is a spongy bone that helps withstand compressive forces by
strengthening a bone to add minimum weight. In spongy one tissue, there is trabeculae that can
balance and distribute the weight of the body evenly out to the bony collar of the diaphysis.
6. What features of the knee joint structure help minimize friction between the thigh bone and the
leg bone.
Answer:
The knee is a synovial joint filled with synovial fluid that reduces friction between the femu
and the tibia during flexion and extension of the knee. The joint surface of the femur and tibia are
covered with smooth hyaline cartilage, which also helps reduce friction. There are also two pieces
of fibrocartilage, the medial and lateral menisci. The shapes of these menisci match the shape of
the medial and lateral condyles on the distal side of the femur, allowing stabilization of the knee
joint and also shock absorbing function during weight-bearing.

7. Describe the changes a broken bone undergoes as it is healing.

Answer:
The immediate response to a fracture is bleeding form the blood vessels dotted throughout
our bones. The clotted blood collects around the bone fracture, this is called Hematoma. The
immune system now springs into action to orchestrate inflammation, which is essential part of
healing. Stem cells from the surrounding tissues, bone marrow, and blood will then respond to the
immune system’s call, and they migrate to the fracture. This when bone remodelling begins, where
osteoblasts and osteoclasts help to form bone along lines of maximal stress as weight is put on
bone again.

8.How does weight-bearing influences the bones repair process you described above? (i.e. what
effect does weight-bearing have on the orientation of the Haversian Systems?).
Answer:
Weight-bearing and strength exercises are usually recommended as a non-medicinal
treatment for broken bones during recovery. Wolff’s Law states that bone grows and remodels in
response to the forces that are placed upon it in a healthy person. After an injury to the bone,
placing specific stress in specific directions to the bone can help it remodel and get back to its
normal state.

9. Why did Nicole’s bones heal much more quickly than her cartilage?
Answer:
It is because Bones heal much more quickly than cartilage. The reason that bone injuries
heal faster than cartilage injuries is because of the ability of the bone cells to respond to injuries
and start dividing to repair the injury. Moreover, cartilage cells tend to be rather inactive once bone
has fully grown and the chondrocytes cells that live within cartilage do not respond to in injury
immediately, and they hardly divide after growth is complete. Wherein bone cells on the other
hand, are always active, because bones are constantly being renewed.