Full transcript
0:00all right so we are looking at bones and
0:04skeletal tissues why is it important to
0:09understand tissues what do tissues
0:19created organs skin muscle heart system
0:29everything okay
0:30and if you can understand the basics of
0:32tissues you can build upon that so you
0:36can understand the basics of organs and
0:39us as a system anybody in you're
0:43interested in going into your research
0:47tissues
0:49you know if you're gonna do human
0:51studies you're going to be looking at
0:53cell psychology and histology and how
0:56they complement and function together a
0:58lot of the diseases that we have begin
1:01because of a dysfunction in the tissues
1:03and if you have a good grasp on that you
1:07can describe the disease or the
1:09pathology that goes along with it okay
1:12so that's fine oh you guys don't look
1:16but we talk about them okay so do we
1:20start as a little person you know I've
1:24told this to people I had last semester
1:26but I'll say it to my new people and I'm
1:30being taped right now so by making
1:31embarrassed later go see it there were
1:34scientists who believed that male
1:36ejaculate had little people in it and
1:41only a jacket would go into the woman
1:42and one of the little people are two or
1:44three is there
1:45your templates would embed into the
1:47uterus bro that's so much straight what
1:53what actually happens is the egg and the
1:55sperm unite we create a combination of
1:59that DNA we can Excel that cell
2:03replicates and it begins to form a
2:04tissue right well I should say it's more
2:08of a little ball of cells it grows it
2:10firms three layers of tissues and from
2:13those three layers of tissues we derive
2:15all the structures of the body okay so
2:18it's more of a gradual process how we
2:20develop these tissues and what happens
2:23with skeletal tissues is it either
2:25starts as a membrane which will touch it
2:27on a little bit or cartilage okay the
2:32majority if you have to dig out of the
2:34body of the skeleton is made from
2:37curtilage
2:37so all these bones that we have in our
2:40body begin as cartilage over time that
2:45curtilage philosophy what does that mean
2:49mass effect the nutritional yet to add
2:52minerals to bone right different sorts
2:55of calcium phosphates and you know what
2:57not okay that'll hurt in the bone and
3:00make it that strong skeletal structure
3:02that we need okay so calcification or
3:07ossification is that transition skill or
3:10curtilage now skeletal cartilages let's
3:14talk about different types of cartilage
3:15of the body once again if you have to
3:18guess that one new palin's a good guess
3:20because it's gonna form the majority of
3:22the skeletal structures of the body the
3:26ends of joints the connections between
3:28the ribs and the sternum it's the
3:31majority of the precursor and the
3:35skeleton is a majority of the curtilage
3:37of the body except for elastic cartilage
3:42way to remember that is we find a lasted
3:45cartilage and an ear and the epiglottis
3:48good morning
3:50okay the ear in the epiglottis so ii ii
3:55ii easy to remember right and fiber
4:00cartilage fiber cartilage is found in
4:03discs where we find discs in the body
4:07spine jaw elbow knee okay where we need
4:18that cushion between bones thank you so
4:21fiber cartilage discs e for elastic
4:25pylons everything else okay highlands
4:29everything else including the precursor
4:30of the the skeleton okay any questions
4:36on that
4:39why are they considered different
4:42cartilages to use and
4:48it doesn't like under pressure what
4:54pressure than others they'll have
4:55different compressive and tensile
4:56strengths excellent and in order to get
4:59those different shapes you will have
5:01different what in them yeah fibers okay
5:06you're gonna have different types of
5:07fibers
5:08there's collagen there's elastic and
5:11there's reticular okay collagen it
5:15sounds familiar doesn't it we've heard
5:17of collagen collagen is the buzzword for
5:20us older ladies right because the
5:22collagen is what breaks down to the
5:24dermis when you start to get but
5:26wrinkles collagen is a nice big fat
5:30juicy fiber that we'll find in different
5:33areas of the body including I'm going
5:35off notes Esther are you panicking no
5:37okay I start looking
5:39I've got off the notes a little bit okay
5:41collagen are based big fat juicy fibers
5:44that help to support the curtilage as
5:47well as the dermis of the skin in
5:49different areas of the body then we have
5:51elastic fibers which will be what more
5:56elastic will find more of those
5:58concentrated in their elastic cartilage
6:00okay and then we're take your leg fibers
6:05which are smaller fibers but these
6:10different fibers give different strength
6:13to these elastic cartilages fiber
6:16privileges and hyaline cartilage okay
6:18good
6:20any questions on that alright it's a
6:27classification of bones
6:30there's 206 bones the value some people
6:33see differently because we have what are
6:34called sesamoid bones which are these
6:36little bones that can actually form in
6:39tendons okay just so you know but if we
6:42go here Levite like 206 now the
6:45breakdown of the body and this should
6:47sound familiar is axial versus
6:50appendicular skeleton okay let's be
6:54really specific about that definition
6:56though okay
6:58axial skeleton will be the skull and the
7:02spine
7:04okay appendicular always remembered
7:07because it sounds like appendages for
7:09vintage
7:10great and it appendage is the what
7:13extremities okay so your shoulder girdle
7:18which is your clavicle and your scapula
7:20and your arms your pelvic girdle and
7:26your legs will be your
7:28appendicular skeleton okay point include
7:32ribs are on out okay so skull spine ribs
7:37axial appendicular or the girdles and
7:41the extremities are you with me yeah
7:54classification of shape I gotta tell ya
7:57I don't go nuts on that because I think
7:58it makes sense you know long bail on
8:02short felons a regular balance I really
8:04won't test you on those I want you to
8:07know the names and structures on the
8:10bones okay the only thing that we're
8:13going to talk about with bone shapes
8:16it's what's in long bones in just a
8:19minute or two because that's important
8:21okay I'll give you the basics of flatter
8:24or regular bones as well all right
8:33now this is an interesting concept for
8:36those who are new excuse me a little
8:41sidebar for those of you who are new and
8:44obviously can't drink my coffee but we
8:47do a different order than other and
8:51having classes so that's another reason
8:52to come see me I can easily get caught
8:55up with stuff that you need to know okay
8:56so a lot of this probably sounds
8:58familiar to people who have had you want
9:00somewhere else now in addition to where
9:04she these figures support is pretty
9:06obvious right protect pretty obvious
9:11movement got it
9:15mineral storage okay this is something
9:17to really think about now obviously we
9:21will use calcium in their calcium stores
9:24calcium phosphates in our bones and they
9:26also have hydroxyapatite when that's
9:28okay just go by what I give you
9:29okay so let's just talk about the
9:32Coliseum calcium it's stored in the
9:34bones okay who can tell me what else
9:37calcium is used for in the body
9:43everybody is doing it right now and it's
9:46going about 60 to 100 beats per minute
9:48muscle contraction heart skeletal even
9:53smooth you to use calcium for that
9:57contraction and function of muscles in
9:59the body great with me so we don't have
10:03enough calcium in our diet and then the
10:05food that we eat guess where we stuck it
10:08out of the bones because if it weren't
10:12for you to have a strong bone or keep
10:14your heart going harder different right
10:17so calcium is stored in the bone that's
10:21important because it's a huge part of
10:24how our muscles contract all of them so
10:27we need to make sure we have
10:28calcium in the blood stream in order to
10:31make those muscles function properly
10:33that's why we should have adequate
10:34levels of calcium okay as well as
10:38vitamin D k2 as well if you're
10:45interesting comes you okay so blood cell
10:48formation as nothing else that we will
10:52see in bones we have yellow marrow which
10:56stores fat but we also have red marrow
10:59and that's where we will have a network
11:01of creation of blood cells to be
11:04released out into the bloodstream in
11:09order to allow us to provide our body
11:15with enough oxygen and immunity to
11:18function properly okay we'll get to that
11:21in the future cool I questions okay bone
11:30structure bones are for heads
11:32bye what's your definition of an organ
11:36from game P 1 it is 2 or more tissues
11:44that function together for a specific
11:50physiology right so if we were to look
11:54at the bones they're not just made of
11:57calcium right they're made of a network
12:02of calcium and different minerals that
12:05create the bony structure and we also
12:07have a layer on the outside we have red
12:08marrow we have yellow marrow it's
12:11multiple tissues
12:12these functions good okay so when we
12:20look at bone I'm just gonna turn the
12:23lights off for two seconds here so we
12:27can see that picture really well and
12:29then I'll pop a background on the
12:33outside of bone we have what's called
12:37compact bone okay and guess what it's
12:40called compact bone right it's all
12:43smushed together yeah it's something
12:46that made sense and Anatomy on the
12:49inside we have spongy go the part of me
12:52it's spongy because obviously it looks
12:55like a sponge it's not nearly as compact
12:58which one will be stronger around all
13:03those different shaped bones that I
13:05mentioned earlier we have compact bone
13:08and on the inside you have spongy bone
13:11if we were to make them all spongy they
13:15fell apart if we were to make them all
13:18compact they'd be too heavy right so
13:22this is a nice combination of the two to
13:26create a very very strong bone but it's
13:30nice and length so we don't have to
13:31carry around the big heavy noggin all
13:33day right the other thing that stays
13:36about the spongy bone guys is what do we
13:38put in their blood vessels right bone
13:44marrow right give us little pockets to
13:47work with is bone vascular what do I
13:51mean by vascular well we're here talking
13:53to us what maybe it has blood vessels
13:56isn't it isn't that what you said I said
13:59yeah you absolutely talk okay yeah
14:02that's right yes masculine how do we
14:05know it's vascular
14:08make sure you're on the right track
14:12who's broken about how fast does it heal
14:16you wear casts for man forty six feet
14:20right whose twin your curtilage how fast
14:24to that he'll I did yeah because they
14:29fixed it great that was I'm an American
14:32if you tear curtilage it doesn't heal
14:35because there is no vascularity if you
14:38bring a bone and you got it button cast
14:41it it will heal because it's very
14:43vascular mmm great with me the more
14:48blood supply you have to at issue
14:50the better it is at repairing itself
14:57right
15:07we're going to look at the histology of
15:09compact bone a little bit excuse me well
15:13I want to talk to you about is a bit
15:15more of a concept with bone projections
15:18and marking so we're going to look at
15:20some of these markings and the actual
15:22bones themselves we going to lab hey if
15:27you have a raised area on a bone what do
15:32you think might attach their muscles
15:36specifically attendant ok muscles will
15:40attach to a bowl and by a tendon that
15:44pressure onto the bone tells the bone
15:49it's slightly stressed the bones
15:52response to that is to add more both I
15:56have people this and we strain use
15:59examples I have a very short leg just
16:03born that way have you guys done the
16:05genetics of they here where you do the
16:07one that's attached the one that's not a
16:11one of each they also have a shirt like
16:13I think it's all kind of genetically
16:17intertwining but anyway that's different
16:18but very short lady was born with it and
16:21they walked funny well I bone spur on
16:25this hip because I watched funny
16:27personal on that bone spur is additional
16:31bone that's in response to at normal
16:34pressure right but anytime you put
16:37pressure on a bone whether it's abnormal
16:38normal you'll deposit more bone there so
16:42where we have muscles attaching there's
16:44more pressure there's more stress and so
16:46the body puts a little more bone there
16:48to make it stronger are you with me but
16:50the same promise creates bone spurs
16:53because the body goes up there's stress
16:55here for some reason I'm going to put a
16:56little more bone there to try support up
16:58so it's an abnormal application of a
17:01oh yes okay all right fit with me okay
17:08how do I get there
17:10Oh markings ooh Betty jump chef okay now
17:15if you look at the bottom of the skull
17:17or when you look at the bottom of the
17:19school there's a ton of holes we're
17:20going over a whole bunch of them okay
17:22what do you think passes through the
17:24holes veins and arteries and nerves in
17:29the spinal cord so whenever you have an
17:32opening in a bone usually being artery
17:36or nerve will pass through it okay so
17:40that's a general gist when you start to
17:41look at bones in these structures and
17:43what's happening here
17:46any questions
17:57so I told you we're not going to go over
17:59you know all those shaped bones but I do
18:01want you to know the personal log bone
18:04it's an important concept an idea to get
18:06your head
18:08the ends are the epiphysis can you guys
18:13read this can you read the words like
18:15okay okay would it help if I turn the
18:18light off for this little part maybe
18:21yeah can you see enough to write if we
18:27turn the lights off okay so because I'm
18:30not quite sure you can read the words in
18:33your book and we're gonna write down
18:34most of this so can everybody see it now
18:37they're being about to be able to see an
18:39art Kate wait so the ads are the
18:43epiphysis T's as pro but the canvas dis
18:50is singular okay so this is one of the
18:53physicists this is two of Ephesus okay
18:56and I should actually point a little bit
18:57higher they are the ends usually they're
19:00slightly more rounded or expanded okay
19:04then the shaft which is the diathesis
19:07okay so ends our emphasis shaft is
19:14diathesis the c is for I won't mince
19:19those words
19:22between them is the epiphyseal line I
19:27mean gasps what that is
19:33yeah that's your growth plate I'm going
19:39to show you the development of thousands
19:40of a little bit but the basic gist is we
19:44have three different ossification
19:46centers they'll start here here and here
19:50and if you could imagine they grow out
19:52they're gonna do what grow close
19:54together and you leave a thin line of
19:58curtilage right here and until you've
20:02reached your full height that's really
20:06deposit bone making those long bones
20:08longer once you reach your full height I
20:14was this height by the time I was 18
20:18that's generally when our growth plates
20:20closed in a female okay it'll close up
20:26and fully calcify are ossified be with
20:29me
20:34ya know
20:37okay question
20:45now on the ends eat chicken wings
20:50please chicken wings hey grab away then
20:56real chewy right everybody loves this
20:59correlation guess what that chewy is
21:03it's this articular cartilage here it's
21:07that color economy I always get minor
21:09chewing cases it's very covering on the
21:13ends of those long bones and guess why
21:17we leave that cartilage there exactly
21:23because don't forget we're looking at
21:25one dome here
21:26this boat is gonna touch in with another
21:30dome you don't want them to be bone on
21:34bone that will be very uncomfortable and
21:36they are particular privileges there
21:38with other things to create a softened
21:41end to that bone so when you form the
21:45joint with the other bone it's pretty
21:47comfortable this is one of the things
21:50that wears away as we start to get
21:52arthritis the articular cartilage they
21:56do every to go together do okay all
21:59right on the inside of this diathesis
22:04you can see we have guess what that is
22:07yellow marrow on the ends we have spongy
22:11bone which is probably where the what's
22:14going to be red marrow
22:17that there but that would be where your
22:19red marrow is the ends of long bones you
22:22can also find it in the hip that's where
22:24they'd like to take it the iliac crest
22:27scapula sternum for two bodies but the
22:31place where they'd like to get that red
22:32marrow I believe is the hips iliac crest
22:35okay around the rest of the book Jeannie
22:43reader repeatedly you think guys are you
22:44good is Mississippi right yes and the
22:49ends of the bones of long bones yeah I
22:54think it's important to know it's also
22:57on the iliac crest which we'll get into
23:00in that if it doesn't all right that's
23:05where they liked her vast it should we
23:07need to get it all right and again
23:10please stop me sometimes they get off a
23:12little I love this stuff if we can talk
23:14about this set for hours sister Jessica
23:16well tangent I had a professor in high
23:19school who would do the tangent sign
23:20because he knew he would be you know so
23:22if I get too far off if you guys get
23:24lost just you know give me a like a real
23:27and any kind of Samoan I'm happy to go
23:29over stuff okay all right so Oh right
23:34now and about itself is something called
23:36the periosteum parry meeting around
23:39ostium meaning bone it's a dense
23:42irregular connective not dense and loose
23:45loose loose irregular connective tissue
23:49now the interesting thing about this is
23:52it encapsulates the whole bone and it's
23:57innervated what does that mean
24:01innervated what does it sound like
24:04do you have a track not a blood vessel
24:06and Internet has herbs in it alright so
24:13when I first started I politically
24:16trained as a chiropractor okay and
24:19somebody told me a long time ago ever
24:21see those tuning forks with the big
24:23round I don't know what hurts it is but
24:26the round ends gibberish see those like
24:27one of those in laughs I can pull it out
24:29freedom and they come with your SATA
24:32when you buy them for your clinical
24:34rotations and I'm like okay we're gonna
24:36do that and somebody I was working with
24:38the doctors say you're going to use it
24:40to check for fractures okay whatever he
24:43goes now I'm telling you it's the right
24:45hurts somebody has a fracture you think
24:48the fracture you know hit it put it on
24:51there he goes free not pain he'd learned
24:53it from a trainer and this little old
24:57lady come in Friday night lifting up a
25:02window heard a big pop when I move I'm
25:04like she's fractured a vertebrae she
25:06can't believe you know I will listen
25:11she wanted her fish fry that's why she
25:12wouldn't go to the ear what do you got a
25:14believer you get a fracture lady okay
25:18listen here's the deal I know this is an
25:21old trick hey go if I hit this tuning
25:23fork and I put it on there it's gonna
25:25use Sriman pain it's gonna hurt like the
25:27dickens promise me you're gonna go to
25:29the year right I just think it's never
25:31gonna work great fake hit it I've been
25:35on there she was on the floor she was
25:37like that hurt so bad because what it
25:39does is it vibrates the periosteum which
25:42is broken and it was interesting maybe
25:44they need anything
25:47so Matt's estate it was cool cuz she was
25:51in pain but she believed me you know me
25:53I gotta write something I go I'll buy
25:56you a right on the way I'll take
25:58you you need to open anyway it's because
26:01the ends of the periodic would rub up
26:04against each other so kind of it it's
26:07awful but it's a quick screen that's a
26:11difficult thing when you go into
26:13orthopaedics is every test you do want a
26:16patient hurts right which I you should
26:22broken that anyway work she created a
26:24huge desk I was just hoping it had some
26:26sort of proof furger to go you know I
26:29mean right now while we're on this
26:38picture you can see what's making in
26:42between this phone glads have red with
26:46blood vessels okay just sort of a side
26:49step and the blood vessel will have one
26:51come into the center of the bone and
26:52then branch off to all the different
26:53parts of the bone so we're able to
26:55deposit bone repair the bone and calcium
26:59out of bone okay
27:00whatever we need to do the other thing
27:04that's important with bone is you can't
27:06make bone and just leave it alone you
27:08need to constantly repair it or it will
27:10get brittle and give it fresh new
27:12nutrients and mineral salts agree with
27:14me okay
27:16all right so short bones contact bone
27:20and the outside was funny bones on the
27:22inside I think that it's common sense
27:24okay yellow arrows and the diaphysis red
27:26marrows and it appears the less good so
27:29I have a list of those
27:33other structures redefined not me okay
27:36thing over those bones in that let's see
27:41what's next okay let's do a quick little
27:44break all right we go into everybody's
27:50feed right baby loves a microscope once
28:00they learned how to actually look at
28:01them but microscopic anatomy of the bump
28:07excuse me
28:08so we're going to look at specific
28:11structures in the bone we'll look at
28:14them in lab 2 remember looking at them
28:17at the fault yeah so so everybody would
28:23love to have compact bone look cuz it
28:24looks like what trees trees it looks
28:28like a tree trunk right excuse me so
28:34we've got the circle in the center right
28:38and then the rings around it right wrap
28:45does that ring a bell
28:46right everybody loves how that looks now
28:50when we look at it microscopically
28:52though and this is important to think
28:55about important to think about as we get
28:57into using slides is this how bone is
29:03structured are there a bunch of circles
29:05making up the bone or is it a bunch of
29:09tubes agree with me so if we take have
29:15is money there's a whole bucket of
29:18pencils
29:19in the lab I usually grab a handful of
29:21right so if I take a whole bunch as if
29:26these were all the same wet of pads and
29:33bundle them together a whole bunch of
29:36geometric tubes or cylinders whatever
29:39would be specific right just like cut
29:42them all the same level and I am the
29:44Papio now you see a bunch of circles
29:47agree with me so it's not circles it's
29:50tubes that they've done a transverse cut
29:52of and we're looking down at n could you
29:56do a linear cut absolutely it's harder
29:59to look at all the structures oh that's
30:01why they do it this way when they create
30:03the slides all right so we're looking
30:06down it in on those tubes to look at the
30:10different structures that are within the
30:12bone we're talking about that content
30:15okay so if we look at one of those tubes
30:21it is called an osteon or haversian
30:25system I call it osteon if you want to
30:28pick one okay so we're looking at one
30:32complete tube it's an osteon okay we're
30:37gonna look at exactly how that structure
30:40those circles are lamellae about love
30:46for singular you got an e for plural
30:51don't drive yourself nuts
30:53hey those are the circles that we create
30:58now one thing that we didn't talk about
31:01in a mp1 is there's those nice fat
31:06collagen fibers and what happens at each
31:10circle with those fibers do they all go
31:13the same way yeah and what does that
31:16have is that
31:18you in all directions are you with me so
31:26look at these circles so what happens is
31:30blood vessels branch out into this
31:34tissue and from these blood vessels we
31:37create what's called an osteoma it's a
31:39softer precursor to mom and then we
31:42start to deposit those mineral salts
31:44that we spoke about into it right with
31:46me all the collagen fibers from layer
31:49one on the inside go this way and then
31:52we start to form a second layer on the
31:58outside same thing
32:00asteroid mineral salts collagen fibers
32:02but these collagen fibers go the
32:04opposite way are you with me then what
32:07happens the third layer reports asked we
32:10have mineral cells collagen fibers they
32:12go the opposite way so if we're creating
32:14opposite way we're creating stability in
32:17all directions if you were to put all of
32:20the collagen fibers in one direction
32:22just look up here for a second and I
32:25pull them all that way all the fibers
32:27went this way and I pulled this way be
32:30pretty strong right what would happen
32:32people this way come right apart just
32:35like the loosely weave sweater really
32:38strong the length that the fibers you
32:40pull right apart the other way so we
32:42criss cross those collagen fibers to
32:44make it all nice and strong okay does
32:46that make sense now and then we keep
32:49building those circles out just like the
32:51rings of a tree
33:00does that make sense
33:05the conversion canal is that Center
33:07canal where the neural vascular unit
33:11goes well it's a fancy word but what
33:14does it mean neuro means nerve vascular
33:18means a general term for arteries and
33:20things okay
33:22so through that her version canal runs
33:26at neurovascular unit okay
33:36osteocytes are the mature bone cells in
33:45bone all tough leader about the bones
33:49that help deposit or break bone tissue
33:51down right the osteocytes are the mature
33:59bone cells canaliculi is a really funny
34:08word and what that means is what's the
34:13center portion here what does that call
34:18emerging now what's in here again
34:23there's arteries veins can we just keep
34:28them in here and support the tissue no
34:32they need canals to get nerves arteries
34:37and dance out to the rest of the tissue
34:40those are called canaliculi and they
34:44look like little canals that's the last
34:46I think definition there or were there
34:48to be defined that come out from that
34:50center portion right and it provides
34:54that nourishment to the rest of the
34:56tissue and carries where the waste here
35:01with me now we also have in those
35:06lamellae the osteocytes you'll see that
35:10in there okay
35:12does that make sense
35:15any questions on that
35:29this brings you to a larger chunk of
35:34bone tissue and this is what it clicker
35:38through over that light sentence this is
35:42more what I look like on us out here
35:44perfect this is exactly how a little
35:46like undersides when we look at them but
35:50I like this picture because it shows how
35:52you have multiple of those osteons
35:56lumped together and then surrounding
35:59actually agriculture from French Lola
36:02belly which provide more like a uniform
36:04outer barrier on the compact bone itself
36:07then you see the vascularity
36:09and sneaking through okay yeah
36:19look who they are the space that
36:22osteocytes sit in they realize it was up
36:27there
36:28yep so it's a space that they stood up
36:33any other questions
36:38okay all right
36:49but not much to really say that's funny
36:52about is it haphazard appearance there's
36:55no step osteons like we saw in compact
36:57on has similar structures I would never
37:00show you a picture and ask what they are
37:01just know those general concepts so you
37:09know I've mentioned this sort of several
37:11times but here's the actual definition
37:13of the soft and the hard version of bone
37:16so the organic and that's not portion
37:19are cells in Ostia that's like that
37:21critter Lajeunesse well this kernel a
37:23genus precursor to bone itself and then
37:26we put the minerals into her Dannette so
37:29this is where we start to have some
37:30problems right if we have children that
37:33don't have enough calcium or vitamin D
37:36or magnesium and phosphorus they get the
37:40osteoid but what don't they get it
37:43the you get a soft a CoA that begins the
37:51formation of the skeleton but it doesn't
37:53what harden will see the outcome of that
37:58as we get further along okay so if those
38:02bones don't hurt it you know got those
38:04mineral salts the bones will be brittle
38:07and soft more brittle and Adeline space
38:09after in children it's kind of how it
38:11shows up okay yeah because we tend to
38:16not quite sure why children will get
38:18deformations yeah it is and then adults
38:23tend to get fractures don't get
38:25deformations as well
38:27so think for some reason adults it makes
38:30it a little more Braille
38:32but in children it does we get in a
38:33habit oh no we want to have that good
38:38balance as a patient
38:43osteogenesis is the formation of bone
38:50weak this close to eight your little
38:56baby is stirring departments hard
38:57skeleton okay now keep in mind the whole
39:06thing doesn't start to hurt it at one
39:08time we were called growth centers that
39:11will begin to harden and move out okay
39:15so it's not like it just immediately
39:17starts to hear it okay so we've hyaline
39:20cartilage and fibrous membranes so the
39:23majority of the bony skeleton comes from
39:26hyaline cartilage that is called
39:28endochondral ossification right I always
39:32remembered curtilage sounds like Kandra
39:35Kandra means cartilage endochondral is
39:37going to be crude alleged ossification
39:39okay
39:41that's majority at the bottom now we
39:43also have intramembranous ossification
39:46the major difference or the only
39:48difference is the tissue that's being
39:51hurt are you with me endochondral it's
39:56gonna be Highland curtilage with the
39:58interim member am I going too fast
40:00because these words are like huge is
40:02this making sense okay with the
40:05intramembranous this is a fibrous
40:07membrane it's a different type of tissue
40:09that's all it is and they all the areas
40:11that we worry about that is cranial and
40:13cranium and clavicle and luckily they
40:16started with the same letter so that
40:19should help you to remember
40:20okay so intramembranous will be found in
40:28the
40:28and clavicle the precursors at fibrous
40:31tissue the rest of the skeleton will be
40:35an island curtilage and undergo and no
40:37control ossification sound so smartly I
40:41see that don't I
40:43it's just a facade
40:47all right does that make sense so
40:50they've these little bitty growth
40:52centers that start to her them and move
40:53out and make the bones harder and more
40:56salad do they come out with their entire
40:59skeleton ossify and inherent it's crazy
41:09if you or your significant other ever
41:13gets pregnant there's several places you
41:17can go to see every illogical
41:19development I did my new baby Center
41:22where they second was every week they
41:24set the development of the baby and it
41:26was really cool watch especially after
41:28you've had a MP I would check it out
41:32okay so let's look at these steps with
41:35endochondral ossification I think that
41:45you don't need to know every step of
41:48this by any means okay I think what I
41:51want you to understand is that there's
41:55going to be primary and secondary
41:57ossification centers in long bones the
42:04primary will start in the middle ossify
42:07and then eventually hollow out so we can
42:09put that in yellow marrow into it and
42:11then the ester to ossified those are the
42:15secondary ossification centers are you
42:18with me and those will expand out with
42:22the secondary and the primary as they
42:26start to meet what do they form
42:32with the primary and the secondary as
42:35they start to confess they've worn that
42:39growth plate that growth plate stays
42:42curtilage and as female until they're 18
42:45give or take and a male until they're 21
42:50would that's further in the notes
42:52puberty okay we also leave a little bit
42:56of mainland cartilage on the ends of
42:58long bones right to work is that
43:00articular cartilage and protect the ends
43:03of long bones okay are you with me so
43:07it's kind of like the so process of
43:09calcification then I'll hollow out the
43:11center and then blood vessels will leave
43:12in and then you'll have the periosteum
43:14created on the outside all right I think
43:18that takeaway that I want you to know is
43:20primary versus secondary that the growth
43:23plate is left that the articular
43:25cartilage is left I think that's the
43:28takeaway from this okay any questions
43:36all right
43:41[Applause]
43:48PJF after all that the top two bullets
43:53while going to a lake him at the
43:55epiphyseal growth plate females will
43:57close about eight females are closed 21
44:00they always remember he remembered the
44:02Swedes I went to any school with the kid
44:03brother kind of all he's not a kid now
44:05by any means but he went away to school
44:09probably this short compared to me and
44:12he came back from college like this much
44:15bigger because he had his growth spurt
44:18when he was like 20 you know so males
44:24can grow all the way to 21 is that
44:28common not really
44:30usually we will have our growth spurt as
44:31a teenager and stop growing but you just
44:33met okay females generally close about
44:3718 you usually reached your phone about
44:4118 years of age those growth plates then
44:44calcified and your bones will stop
44:47growing length widens but you can have
44:51them grow with whites that is called
44:55appositional growth now are they gonna
44:59go from this to this
45:00no but they're gonna get a little
45:03thicker as we get older okay now
45:14I'm gonna have to draw this one off to
45:17leave the light on hopefully we can see
45:19this I'll try to make it nice and big
45:21for the video and I think this makes
45:26sense but I think it's a little helpful
45:27if they try it
45:28okay so we have osteoblasts and
45:39osteoclasts which are right on this
45:42slide okay osteoblasts deposit bone
45:49osteoclasts break bone down but I think
45:53it's Franklin oh this isn't right
45:55okay so osteoblasts deposit bone osteo
46:01class break bone down and your bones are
46:05constantly doing this so they regenerate
46:08themselves very slowly you understand
46:11right they're releasing calcium they're
46:14depositing more calcium they're
46:15restructuring the bones are fixing
46:17broken bones except our subhan be with
46:20me so if I were to take and osteoblast
46:26I'm just gonna put it back okay it would
46:29appear we're gonna do what we're going
46:32to deposit our bone okay with me inside
46:37this marrow cavity if I put a whole
46:39bunch of osteoclast on the inner portion
46:42of this club backbone the inner portion
46:46will be broken down so can you envision
46:50or understand that as it breaks down
46:53here and it builds up here it'll get
46:55lighter but the thickness of this long
47:01bone itself sees I mean this segment
47:03this half this adage will stay about the
47:06same width do you understand what I'm
47:08saying so it's almost like you're taking
47:10this and moving an owl
47:14me so it's getting wider but the bones
47:17don't get heavier great very with me
47:20does that make sense no yes no okay do
47:27any so it's like you're taking this
47:30width of compact bone from both sides
47:32because don't forget we're talking about
47:33a long bone we're talking about
47:34three-dimensional object and a
47:36two-dimensional picture if this is the
47:38thickness of the outside of the long
47:41bone and you're depositing here and
47:44you're eating a weight here you're going
47:45to move it out a little bit so you're
47:48making the size of that long bone wider
47:52but you're not changing how much it
47:55weighs
47:56yes now does that make more sense no
48:00rough router does that does that make
48:03sense okay if it doesn't make sense and
48:06you're not answering me code surgery I'm
48:08happy to talk to you about a positional
48:10problem okay all right so people don't
48:17feel comfortable answering or answering
48:20asking questions or spraying down if you
48:22want to come see me in a more than happy
48:24to answer them okay
48:26go osteoclasts are a little slower than
48:32the osteo gases blast film might get a
48:35little bit thicker but you gotta live
48:36for the most part of your bones
48:38Ernestina stands
48:39wait okay
48:44all right hormonal regulation so growth
48:55hormone in children is a big perpetuator
48:59of the increase in the size of our
49:02muscles and our bones that peaks at a
49:05certain age and then stops what doesn't
49:08stop completely
49:09but flows okay testosterone helps males
49:14bones and muscles grow big and strong
49:18slightly bigger than females okay
49:22estrogen and females is a big
49:24contributor to bone density that is why
49:28when we go through menopause our bones
49:31become more what as females know we
49:36don't know that's they become were cut
49:39off
49:39they'll become more brittle more apt to
49:42break this might be see so many females
49:45elderly females break their hips because
49:50that drop of estrogen is there be
49:52following me with that the drop of
49:54estrogen decreases our ability to keep
49:57our bones strong and healthy so they
50:00aren't as strong and healthy and females
50:02tend to be more prone to breaking bones
50:05as they get older okay that's why it's
50:11important as females get older to do
50:13weight-bearing exercises it's just super
50:16important for everybody really
50:18okay does that make sense males
50:21testosterone doesn't dip as much as it
50:24does as males get older it dips and into
50:27clients but not like females going
50:29through menopause so they tend to
50:31maintain their bone health a little bit
50:32better than us I like there's other
50:40hormones that can indirectly affect the
50:42bones but that's a that's a good it's a
50:46good start
50:59so bone remodeling for restructuring
51:02which we talked about the basics of this
51:04either regenerating the bone or
51:07releasing or depositing calcium occur
51:10the periosteum and the endosteum I'm
51:13sure bring one over and out stand I love
51:15bones with you guys let me go back and
51:18ostium is going to be this inner surface
51:22here okay the periosteum is the outer
51:27okay portion that's where the bone
51:31remodeling will happen to regenerate or
51:36restructure billon or to release calcium
51:38that we need for muscular function okay
51:4299% calcium is Jordan bone but that 1%
51:46that it's outside is very very important
51:48as we spoke about now this this was you
51:56know maybe these lectures God knows how
51:57long ago 14 years ago pretty much
52:02doesn't change a whole bunch over time
52:04but talking about specific hormones that
52:07are dealing with the devastation or the
52:09release of calcium they used to say that
52:12calcitonin which comes from the thyroid
52:14we're going to look at that when we do
52:16endocrine we're going to look at where
52:19it comes from specifically on
52:20microscopic sites we're gonna look at
52:22the thyroid that were parts and etc but
52:25there's a hormone that is released from
52:26the thyroid Clubhouse atoning they said
52:29they've done research and now shows that
52:32this does not put calcium into the bone
52:37sandé follow research
52:41Jerry look at research you can have one
52:45thing say one thing and then what
52:47another see another okay so I won't test
52:50you on this but realize that it used to
52:52be that causa toning wasn't her out that
52:55put calcium into the bones okay
52:58parathyroid hormone comes from the
53:00parathyroid glands I will tell you
53:02exactly where they are and we go to your
53:04endocrine in a few weeks okay that helps
53:07to release calcium from the bones are
53:12you with me okay
53:14so are you with me does it make sense
53:16yes okay so these are hormones that help
53:20specifically with a regulation of
53:22calcium in the blood stream be with me
53:25be strong a little fuzzy huh lot of
53:29stuff on the first day
53:34what is it negative feedback this man
53:44do we just continue to release
53:46parathyroid Marone no matter what no our
53:51body senses the level of calcium in the
53:54blood when the levels get too low
53:58parathyroid hormone is released until
54:00the levels are what flipped back to
54:04normal and then it stops that's what a
54:08negative feedback loop is okay it'll
54:12turn it off are you with me
54:23remember I talked to you about when we
54:25put stressors I've got a little posit
54:27more stress there it's called blows law
54:30this is the actual law that it is called
54:33its whole purpose is to keep bone strong
54:37in areas of stress so if we look at this
54:46is a good picture because it shows late
54:49compression onto this phone will
54:52actually create what's the chart when we
54:55got turned to this what's the charge of
54:57calcium if you were to write it see a
55:02plus plus the label it's just a plus so
55:06it's a positively charged ion right
55:10where we have areas of stress and bone
55:13it becomes negatively charged so it will
55:19draw calcium into it
55:22okay or it attracts those calcium ions
55:25so with Wolff's law we create a negative
55:28charge on the bone in areas of stress we
55:31deposit more calcium into it this is why
55:34we tell elderly people who are getting
55:36thin bones to do what weight-bearing
55:39exercise it'll put stress on their bones
55:44create a negative charge of draw more
55:45calcium through those areas
55:48okay
55:57sometimes this goes awry and we develop
56:01what's called a bone spur if you've been
56:04an athlete you've had an injury you've
56:07run into a door I don't know you've done
56:09something right you've created an injury
56:12somewhere that took a while to heal some
56:15of the side effects of that may be
56:16creating a bone spur a little extra lip
56:19of bone that your body is put there to
56:23try to protect itself but kind of did it
56:26the wrong way okay
56:27in the normal body it helps to keep
56:30bones just nice and strong and healthy
56:33okay all right let's do one more quick
56:42two-minute great from Ellie have one
56:48more quick break and then we'll go over
56:50fractures which is kind of fun all right
56:53and diseases so
57:03you guys right okay a picture in the
57:05lake okay cuz these will be easier to
57:08see we're gonna look at some extra high
57:11school so there's you know all different
57:14tables so fracture is let's go through
57:16these really quickly so non-displaced
57:18versus I started that back up right
57:21is it recording okay great thank you die
57:24just please don't be just my way no in
57:27this place versus displaced is pretty
57:29obvious right this is going to be if
57:30you're talking about a lawnmower or any
57:32type of home if the ends are what move
57:37why is that important to understand
57:41other than knowing it for the test
57:45yeah okay if the ends are displaced
57:56gracious don't hold back
57:59please any means we know each other we
58:04tease each other okay you okay did you
58:07ran in place okay for guys too much
58:13subway so nice it's important to get it
58:25surgically or manually replaced before
58:29it's casted okay I can't give out names
58:34but I know somebody who had a displaced
58:36clavicle fracture and yeah that bad one
58:41let me tell you by because it stays
58:44first of all it can affect the blood
58:45vessels there because you have your so
58:48play an artery and vein which were right
58:51there
58:52but what clavicles like to do if there
58:55we fixed is the form of feet join it so
58:59guess what he always has no movement
59:01that is clavicle so you've got a really
59:05make sure and that's a tricky one
59:07because if you push it too far down you
59:09go into the blood vessels but anyway
59:10you've got to have the ends approximated
59:12okay complete versus incomplete think we
59:15got that right whether it's through or
59:17not linear reverses chance first whether
59:20it goes the length of the bone or the
59:21width of the bone I'm going to go
59:23through these quickly because I think
59:24they make sense
59:25if anything doesn't drive through you
59:27just let me know open versus closed
59:29that's a fun one open open we don't bend
59:33yeah through the skin okay
59:36healing is usually six to eight weeks
59:39buying son fractured a little wrist bone
59:42and they let him out of the herb cast by
59:45three weeks and aware you know removable
59:49one for another couple weeks that was
59:51right before we went to Disney so they
59:53were kind enough to take that hurt cast
59:56off so
1:00:00yes yes yeah it's not linear transfers
1:00:04linear or transverse yes you could have
1:00:09both but all right great
1:00:14hematoma formation it's going to be the
1:00:17first thing that'll happen we'll send a
1:00:19blood clot there and guess what that
1:00:22blood clot does multiple things cleared
1:00:24all the junk out if there's any
1:00:26infectious agents and then it will send
1:00:30structures which will help to clean out
1:00:33the old debris it'll set new fibers in
1:00:37there to create that soft bones first
1:00:39which is the fibrocartilaginous callus
1:00:42and then after that gets established and
1:00:45we clear all the junk out we'll start to
1:00:48deposit new mineral salts okay toboni
1:00:51callus under your bony remodeling and
1:00:53the great thing about it is if the ends
1:00:56are approximated and pretty put together
1:01:00the new bone what looks pretty much like
1:01:03the old bulb if there were that better
1:01:06was a little more bone deposition there
1:01:08okay so we're pretty good at fixing
1:01:10bolts pretty good
1:01:15so some common types of fractures here's
1:01:23the one that my little old lady had a
1:01:26few of a patient especially an elderly
1:01:30female who's pushed up that's how she
1:01:33fractured her vertebra she was pushing
1:01:35up on a garage window you know how stuck
1:01:38those get you know sometimes you got to
1:01:40push in she was pushing up and she heard
1:01:42the pop so that compressive nature tends
1:01:46to lend itself to these compression
1:01:49fractures comminuted is multiple ear
1:01:53multiple fragments
1:01:55what's this poor guy under film yeah
1:01:59probably multiple surgeries would be my
1:02:02best with this I have a little bionic
1:02:05leg okay
1:02:08spiral where are we all in healthcare
1:02:14are we all going into healthcare for the
1:02:16most part some research maybe they
1:02:19spiral you should learn as a health care
1:02:23practitioner if seen in the arms of
1:02:26children may be indicative of what child
1:02:31abuse usually will see spiral in these
1:02:35cases because what is the adult doing to
1:02:38the child twisting okay you will be I
1:02:42think a mandated reporter right yeah so
1:02:47he will have to bylaw report that if you
1:02:49see that in a child if I've got my kids
1:02:54by the arm I huddle I have my little
1:02:58seven year old redhead did you stir it
1:03:02out into the road because he runs out
1:03:04into the road
1:03:09and I and I have wrapped you know the
1:03:13several times of course I had time with
1:03:15my pediatrician I'm planning like do you
1:03:16understand like I do not have used my
1:03:19children right like broken noses chip
1:03:21T's and the you go and rest broken this
1:03:24plaque is I'm like like no you know but
1:03:29I've grabbed his arm what he's run out I
1:03:31mean does it indicate abuse no but I'm
1:03:35just saying this it's sort of like guts
1:03:38flag if you see that repeatedly in a
1:03:41child okay that's fire electric and it
1:03:46spirals down the length of that bone
1:03:47epiphyseal fracture right would this be
1:03:51bad and children you really need to have
1:03:58a very good surgeon fix this if you have
1:04:02a fracture through that growth plate or
1:04:05that love will stop growing that would
1:04:10not be good
1:04:11not as dangerous in and out oh right I
1:04:14don't think I'm growing anymore I don't
1:04:17want to grow anymore
1:04:18good depressed fracture if some sort of
1:04:22force depresses into a bone that makes
1:04:25sense would have to be an external force
1:04:27obviously I would think you know the
1:04:29currents and something like that
1:04:31ball-peen hammer
1:04:35all right I said that what that looks
1:04:37like there yeah okay I'm gonna go
1:04:40off-topic but I think this is a great
1:04:42story ever tell you guys about the knife
1:04:44story my guy had dated in college had a
1:04:48cousin who was a nurse who had a patient
1:04:50come in with just awful migraine
1:04:53headaches he was in his 70s 80s
1:04:55something like that and excuse me you
1:05:01know asked him all these questions the
1:05:04headaches were new they had just started
1:05:06whatever the end of it sent him thank
1:05:08God for a cat scan he had a knife stuck
1:05:12in his head he had been in the Navy when
1:05:17he was young and got into a bar fight
1:05:20still a he's like you have a knife and I
1:05:22was healed it was like yeah is that
1:05:27crazy and it must have just gone right
1:05:31between the two lobes of his dream where
1:05:33it didn't affect anything he's like oh
1:05:36thank
1:05:37oh yeah I was in a bar fight when I was
1:05:39like 20
1:05:46[Music]
1:05:48I'm probably a little drunk would be my
1:05:51guess oh just wait for all the things
1:05:56you see as a health care practitioner
1:05:59all right has nothing to do with what
1:06:03we're talking about but I think it
1:06:05started greenstick you're playing out in
1:06:10the yard and you gotta stick that screen
1:06:12you try to break it to be you know
1:06:15whatever and it doesn't break okay
1:06:17we see this in softer bones great
1:06:19especially in children where their bones
1:06:22are not hurting yet and they get what's
1:06:25what a greenstick pressure and increase
1:06:26just a little partial break into the
1:06:28bone just like it would have been going
1:06:30to stick okay I don't think you're gonna
1:06:33hear people say that too much but it's
1:06:35kind of anyone - no - all different
1:06:38types of fractures so other things that
1:06:41can happen with the bones you guys see
1:06:43okay I think with these next couple of
1:06:46sites it's easier here we go this is
1:06:49what that we mentioned earlier rickets
1:06:52so rickets and children which luckily we
1:06:56don't see in children - of enough
1:07:00foodstuffs in our country because we
1:07:02have so many what in our country
1:07:05fortified foods right we've fortified
1:07:08formulas and brad's and supplements I
1:07:11mean I know that there's children who
1:07:13don't get out of food which breaks my
1:07:15hurt but we have enough fortified foods
1:07:18in our country with calcium and
1:07:21I am and phosphorus that our children
1:07:24luckily have strong bones if you have a
1:07:27child who doesn't get enough calcium and
1:07:30or vitamin D you do you understand what
1:07:34white vitamin D is important yes it
1:07:40helps us to survive it indeed absorbs
1:07:44calcium from the intestines okay there's
1:07:49a specific form of potassium as a side
1:07:52bar called k2 which deposits that
1:07:55calcium into the bones okay so a vitamin
1:07:59D absorbs it from where contestants came
1:08:02to deposits it into the bones because
1:08:05guess what they started finding series
1:08:07like Oh
1:08:08calcium great I'm gonna start taking
1:08:09supplements and people would take
1:08:11supplements well guess where the calcium
1:08:13was going was it going into the but what
1:08:15was going to thoughts but it was also
1:08:16going into the blood vessels and
1:08:19creating current blood vessels so you
1:08:22need to make sure you if you're gonna
1:08:23take calcium to take the proper
1:08:26supplements to help the absorption and
1:08:28the deposition of it I'm huge into
1:08:31vitamins my husband picks up or picks on
1:08:33me all the time all my jars and lotions
1:08:36and potions I will not take calcium from
1:08:38a bottle people that I get though I get
1:08:41yogurt I get cheese interesting it's the
1:08:44best way to go I really do and take a
1:08:46walk in the Sun for 15 minutes a day
1:08:48okay so why are the few things they
1:08:50won't supplement with another singer
1:08:52okay yeah I jet just coming from a
1:08:55bottle scares me anyway okay so back to
1:08:59this poor babies and it has enough
1:09:03calcium and vitamin D in what happens in
1:09:06it says they get that bowl lake do you
1:09:08understand what bullying is okay where
1:09:11they get that curving of the legs and
1:09:13yes unfortunately this would be a
1:09:15permanent effect for this child okay
1:09:19that is called rickets okay we can also
1:09:23get this an elderly elderly people don't
1:09:28do weight-bearing don't take their
1:09:30calcium don't get Sun you know they can
1:09:33get softened bones as well and that's
1:09:36osteomalacia which is a little different
1:09:39from osteoporosis which is on the next
1:09:41slide okay so it is the second so
1:09:44osteomalacia is when we have that soft
1:09:49osteoid precursor right but we don't get
1:09:55the calcium salts into it so you've got
1:09:59that structure but you don't hurt it and
1:10:02the bones can become soft you can't get
1:10:05some bowling with that it won't be quite
1:10:07as much as that bullying with the
1:10:08children what we tend to see is also
1:10:11some fractures in these patients with
1:10:13osteomalacia right so soften bones and
1:10:17adults osteomalacia and children in
1:10:19circuits Sybil care its milk
1:10:29now
1:10:34the difference with osteoporosis is the
1:10:37matrix or the structure of the phone is
1:10:40okay the composition I should say but
1:10:44there's what a lot it's a lot more
1:10:48courseware there's a lot less of it with
1:10:52osteoporosis so inherently you're not
1:10:56going to have as much to create that
1:10:58strength right with osteoporosis
1:11:09so we see this more often and elderly
1:11:13females that's what I was looking for on
1:11:14the screen
1:11:15okay elderly females never talked about
1:11:17the whole estrogen thing this is what it
1:11:19contributes to could also be due to lack
1:11:23of weight-bearing exercises indeed
1:11:25housemates understand kind of Park in
1:11:27the same song okay okay
1:11:29does that make sense so that's different
1:11:32from ice to Malaysia because that said
1:11:33softening so there's less of the matron
1:11:36system okay okay and they actual so not
1:11:44only do we have less of it the bone
1:11:46itself there's just not enough little
1:11:48these little indentations itself to
1:11:50create the strength of the strong bone
1:11:52matrix okay so you'd see you know we
1:12:03talked about most of this the thing to
1:12:06keep in mind I joke about this but I'm
1:12:08seriously don't do drugs right in many
1:12:12aspects you know to drugs but they don't
1:12:15teach drugs I don't teach an ecology is
1:12:17what I'm saying what I do want to say is
1:12:21a holistic practitioner is to always
1:12:23look at benefits versus cost or risk
1:12:26right so you can take estrogen to help
1:12:30with this strength of your bones but
1:12:32afternoon is linked with possibly higher
1:12:35levels of cancers - if you're prone to
1:12:40it so I do have this in the notes can't
1:12:43really talked about drugs it is we need
1:12:44to always research and think about
1:12:46benefits versus risks for every
1:12:48medication they can take okay Fosamax
1:12:51which is one of the drugs and theta4
1:12:53bone density I think absolute best is a
1:12:58seven percent increase in bone density
1:13:00if you do exercise and take calcium and
1:13:03oh maybe the exercise
1:13:06and what not is what's making your bonus
1:13:08Vickery's who I'm saying
1:13:09I'll probably get chastised for saying
1:13:13that's a pipe always look at better this
1:13:15versus of costs when you're looking at
1:13:16these medicines I'm not a big fan of
1:13:19these bone density medications I'm just
1:13:23and that new and that's out we get a
1:13:25shot like once a year I don't know
1:13:28okay thank so I have that up there and
1:13:31wouldn't touched you on it but just for
1:13:33your own edification right so when we
1:13:38talk about just as a refresher
1:13:45conception egg sperm we Pharma ball of
1:13:49cells those ball of cells develop
1:13:51there's several steps in between we're
1:13:52going on to the future we form three
1:13:55layers endoderm mesoderm octo term we're
1:14:00gonna go over all this towards the end
1:14:02of this semester mesoderm is up here
1:14:05okay mesoderm will be where we get bones
1:14:08and muscles from other structures as
1:14:11well other structures as well we know
1:14:14that we start to ossify by week eight
1:14:17everything is mostly ossified except for
1:14:21the epiphysis those growth plates at
1:14:23birth we also have what are called
1:14:25fontanelles we'll go over that in lab
1:14:28fontanelles are these soft spots and the
1:14:31child's head so when they come through
1:14:33the birth canal they had
1:14:36compress a little bit and can get
1:14:38through the birth canal fees here we'll
1:14:41go over that a lot sorry about it and
1:14:44then the rest of it I think makes sort
1:14:45of sense okay does that make sense any
1:14:48questions on that last cool did you see
1:14:56all those ossification centers and I
1:14:58liked that picture because it shows how
1:15:00they'll all grow towards each other and
1:15:02form that the nice solid loading
1:15:03skeleton in bone mass decreases with age
1:15:10beginning in the fourth decade 46 lose
1:15:14the balls okay rate applies is
1:15:17determined by genetics and environmental
1:15:18factors and old age more enthrone
1:15:20resorption predominance you lose more
1:15:22Mulhouse that's all common-sense stuff
1:15:24right alright so i questions if on
1:15:31tissues good excellent