Bones and rheumatology

Human Skeletal System

The human skeletal system is a remarkable and complex structure that provides the framework for the body, enabling support, movement, and protection of vital organs. The adult human skeleton is typically composed of 206 bones, although the number can vary slightly due to anatomical variations such as extra ribs or fused bones.

Development and Composition

The human skeleton begins to form in the early stages of embryonic development. Initially, the skeleton is primarily cartilaginous, a flexible tissue that gradually ossifies, or turns into bone, through a process called endochondral ossification. By the time a person reaches adulthood, most of the cartilage has been replaced by bone.

Major Divisions of the Skeleton

The human skeleton can be divided into two main parts: the axial skeleton and the appendicular skeleton.

Axial Skeleton

The axial skeleton forms the central axis of the body and consists of 80 bones. It includes the following components:

  1. Skull: The skull, comprising 22 bones, protects the brain and forms the structure of the face. It is further divided into the cranial bones (8) and the facial bones (14). Notable cranial bones include the frontal bone, parietal bones, occipital bone, and temporal bones. The facial bones include the maxilla, mandible, nasal bones, and zygomatic bones.

  2. Vertebral Column: The vertebral column, or spine, consists of 33 vertebrae in children, but this number reduces to 24 individual vertebrae in adults due to the fusion of some vertebrae. It is divided into five regions: cervical (7 vertebrae), thoracic (12 vertebrae), lumbar (5 vertebrae), sacral (5 fused vertebrae), and coccygeal (4 fused vertebrae forming the coccyx).

  3. Thoracic Cage: The thoracic cage, or rib cage, comprises the sternum (breastbone) and 12 pairs of ribs, making a total of 25 bones. The ribs are classified into three types: true ribs (the first seven pairs that attach directly to the sternum), false ribs (the next three pairs that attach to the sternum indirectly via cartilage), and floating ribs (the last two pairs that do not attach to the sternum).

Appendicular Skeleton

The appendicular skeleton consists of 126 bones and includes the limbs and girdles that attach them to the axial skeleton. It can be further divided into the following components:

  1. Pectoral Girdle: The pectoral girdle, or shoulder girdle, consists of the clavicles (collarbones) and scapulae (shoulder blades). There are two clavicles and two scapulae, making a total of four bones.

  2. Upper Limbs: Each upper limb contains 30 bones, making a total of 60 bones for both arms. The upper limb is divided into the arm (humerus), forearm (radius and ulna), and hand (carpals, metacarpals, and phalanges). The hand itself comprises 27 bones: 8 carpals (wrist bones), 5 metacarpals (bones of the palm), and 14 phalanges (finger bones).

  3. Pelvic Girdle: The pelvic girdle consists of two hip bones (also known as coxal bones or os coxae). Each hip bone is formed by the fusion of three bones: the ilium, ischium, and pubis. The pelvic girdle, along with the sacrum and coccyx of the vertebral column, forms the pelvis.

  4. Lower Limbs: Each lower limb contains 30 bones, making a total of 60 bones for both legs. The lower limb is divided into the thigh (femur), leg (tibia and fibula), and foot (tarsals, metatarsals, and phalanges). The foot itself comprises 26 bones: 7 tarsals (ankle bones), 5 metatarsals (bones of the sole), and 14 phalanges (toe bones).

Bone Types and Structure

Bones can be classified based on their shapes into several types: long bones, short bones, flat bones, irregular bones, and sesamoid bones.

  1. Long Bones: These bones are longer than they are wide and include the femur, humerus, and phalanges. They consist of a shaft (diaphysis) and two ends (epiphyses) and are primarily composed of compact bone surrounding a central marrow cavity.

  2. Short Bones: These bones are roughly cube-shaped and include the carpals and tarsals. They are primarily composed of spongy bone surrounded by a thin layer of compact bone.

  3. Flat Bones: These bones are thin, flattened, and typically curved. They include the skull bones, ribs, sternum, and scapulae. Flat bones consist of two layers of compact bone enclosing a layer of spongy bone.

  4. Irregular Bones: These bones have complex shapes that do not fit into the other categories. Examples include the vertebrae and certain facial bones.

  5. Sesamoid Bones: These are small, round bones embedded within tendons. The patella (kneecap) is the largest and most well-known sesamoid bone.

Functions of the Skeletal System

The skeletal system serves several vital functions in the human body:

  1. Support: The skeleton provides a rigid framework that supports the body’s tissues and organs.

  2. Movement: Bones act as levers and points of attachment for muscles, enabling movement. Joints between bones allow for a range of motions.

  3. Protection: The skeleton protects vital organs. For example, the skull encases the brain, the rib cage shields the heart and lungs, and the vertebrae protect the spinal cord.

  4. Mineral Storage: Bones serve as a reservoir for minerals, particularly calcium and phosphorus, which are essential for various physiological processes.

  5. Blood Cell Production: The bone marrow, found within certain bones, is the site of hematopoiesis, the production of blood cells, including red blood cells, white blood cells, and platelets.

  6. Energy Storage: Yellow bone marrow, found in the central cavities of long bones, stores fat that can be used as an energy source.

Bone Remodeling and Repair

Bones are dynamic tissues that undergo continuous remodeling throughout life. Bone remodeling involves the removal of old bone (resorption) by osteoclasts and the formation of new bone (ossification) by osteoblasts. This process is crucial for maintaining bone strength and integrity, as well as for the regulation of calcium levels in the blood.

Bone repair following a fracture involves several stages:

  1. Hematoma Formation: Blood vessels in the broken bone tear and hemorrhage, forming a clot (hematoma) at the fracture site.

  2. Fibrocartilaginous Callus Formation: Within a few days, capillaries grow into the hematoma, and phagocytic cells begin to clean up debris. Fibroblasts and chondroblasts invade the site and begin to produce a fibrocartilaginous callus that spans the break and connects the broken bone ends.

  3. **Bony

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