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Q1

Outline the process of bone development. Include a well labelled diagram for your
illustration.

Osteogenesis and Ossification are synonyms referring to the process of bone formation.

In early stages of embryonic development, the embryo’s skeleton consists of fibrous


membranes and hyaline cartilage. By the sixth and seventh week of embryonic life, the actual
process of bone development, ossification (oesleogenesis begins).

There are two osteogenic pathways intramembranous ossification (osteogenesis) and


Endochondral ossification, but bone is the same regardless of the pathway that produces it.

Bone is a replacement tissue, that is, it uses a model tissue on which to lay down its mineral
matrix. For skeletal development the most common template is cartilage. During fetal
development, a framework is laid down that determines where bones will form. This
framework is a flexible semi solid matrix produced by chondroblats and consists of
hyaluronic acid, chondroitin sulfale, collagen fibres and water.

Throughout foetal development and into childhood growth and development, bone forms on
the cartilaginous matrix. By the time a foetus is born, most of the cartilage has been replaced
with bone. Some additional cartilage will be replaced throughout childhood and some
cartilage remains in the adult bone.

Intramembranous ossification

This is a process whereby bones derived from nonsomitic mesoderm usually are laid down
directly as bone within a connective tissue membranes.

During intramembranous ossification, compact and spongy bone develops directly from
sheets of mesenchymal (undifferentiated) connective tissue examples are bones of the skull
and the clavicles.

The process begins when mesenchymal cells in the embryonic skeleton gather together and
begin to differentiate into specialised cells some of the cells will differentiate into capillaries
while others will become osteogenic cells and then ostecblasts.

The osteoblasts secrete osteoid uncalcified matrix which calcifies (hardens) within few days
as mineral salts are deposited on it thereby entrapping the osteocytes. As osteoblasts
transform into osteocytes, osteogenic cells in the surrounding connective tissue differentiate
into new osteoblasts.

Osteoid (unmineralised bone matrix) secreted around the capillaries results in a trabecular
matrix while osteoblasts on the surface of the spongy bone become periosteum. The
periosteum then creates a protective layer of compact bone superficial to the trabecular bone.
The trabecular bone crowds nearby blood vessels which eventually condense into red
marrow.

Intramembranous ossification follows four steps:

(a) Mesenchymal cells group into clusters are ossification centres from
(b) Secreted osteoid traps osteoblasts which then becomes osteocytes
(c) Trabecular matrix and periosteum form
(d) Compact bone develops, superficial to the trabecular bone crowds nearby blood
vessels which eventually condense into red marrow.

Endochondral ossification

This is one of the two essential process during foetal development. Unlike intramembranous
ossification which is the process by which bone tissue is created, cartilage is present during
endochondral ossification. Endrochondral is an essential process during the rudimentary
formation of long bones.

The cartilage model will grow in the length by continuous cell division of chondrocytes
which is further of extra cellular matrix. This is called interstitial growth. The process of
oppositional growth occurs when the cartilage model also grows in thickness due to addition
of more extra cellular matrix on the peripheral cartilage surface which is accompanied by
new chondroblasts that develop from the perichondrium

The first sile of ossification occurs in the primary centre of ossification which is in the middle
of diaphysis shaft.

Then formation of periosteum

The perichondrium becomes the penosteum, which contains a layer of differentiated cells
which later become osteoblasts.

Formation of bone cellar


The osteoblasts secrete osteoid against the shaft of the cartilage model, which serves as a
support for the new bone.

Calcification of matrix

Chondrocytes in the primary centre of ossification begin to grow, they stop secreting collagen
and other proteoglycans and begin secreting alkaline phosphate, an enzyme essential for
mineral deposition. The calcification of matrix occur and osteoprogenitor cells that entered
the cavity via periosteal bud use the calcified matrix as a scaffold and begin to secrete osteoid
which forms the bone trabecula osteoclasts, formed from macrophages break down spongy
bone to form the medullary (bone marrow) cavity.

Secondary centre ossification

About time of birth, a secondary ossification centre appears in each end of long bones.
Periosteal buds carry mesenchyme and blood vessels in and the process is similar to that
occurring in primary ossification.

The cartilage between the primary and secondary ossification centres is called the epiphyseal
plale and it continues to form a new cartilage which is replaced by bone, a process that results
in an increase in the length of a bone.

Growth continues until the individual is about 20 years old. The point of which of the
primary and secondary centres is called epiphyseal line.

Oppositional bone growth

The growth in diameter of bones around the diaphysis occurs by deposition of bone beneath
the periosteum. Osteoclasts in the interior cavity continue to grow until its ultimate thickness
is achieved, at which point the rule of formation on outside and degradation from the inside is
constant.

Q2

Describe the surface markings of the thoracic contents. Citing the examples of the chest
radiography

The bones landmarks-The second costal cartilage corresponding to the sternal angle is to
readily found that it is used as a starting point from which to count the ribs. The lower border
of the pectoralis major at its attachment corresponds to the fifth rib. The upper most visible
digitation of serratus anterior indicates the sixth rib.

The jugular notch is in the same horizontal plane as the lower border of the body of the
second thoracic vertebra, the sternal angle is at the level of the fifth thoracic vertebra while
the junction between the body and xiphoid process of the sternum corresponds to the fibro
cartilage between the 9th and 10th thoracic vertebra.

The influence of obliquity of the ribs on horizontal levels in the thorax shown “if a horizontal
line be drawn around the body at the level of the inferior of the scapula, while the arms are at
the same sides, the line will cut the sternum in front between the fourth and the fifth ribs, the
fifth rib in the nipple line and the ninth rib at the vertebral column.

On the front of the thorax the most important vertical lines are the midsternal, the line of the
sternum and the better midclavicular which runs vertically downward from a point midway
between the centre of the jugular notch and the tip of acromion. This latter line if prolonged is
practically continuous with the lateral sternal margin.

On either side of the thorax, the anterior and posterior axillary lines are drawn vertically from
the corresponding axillary folds and mid axillary lines run downward from the apex of the
axilla.

On the posterior surface of the thorax the scapula line is drawn vertically through the inferior
angle of the scapula.

On the left side beginning at the sternoclavicular articulation it reaches the midpoint of the
junction between the manubrium and body of the sternum and extends down the midsternal
line in contact with that of the opposite side to the level of the fourth costal cartilage. It then
diverges lateral ward and is continued downward slightly lateral to the sternal border as far as
the sixth costal cartilage. Running downward and lateral ward from the point it crosses the
seventh costal cartilage and from this onward it is similar to the line on the right side.

Examples of chest radiograph

The lung field

A systematic examination of the lung fields in each intercostal space and any differences
should be ncted. Lung (parenchyma) being evidence of alveolar flooding.

The heart
Cardiac silhouette, detecting cardiac enlargement size and shape of the heart should be noted.
Radiology can detect enlargement of the heart which often due to heart failure or heart valve
disorder.

The mediastinum

Widening of mediastinum, vascular abnormality or mediastinal mass, shift of vessels and


gland at the nilium of the lung.

Bony cage

Exclude rib fractures, notchins of ribs by enlarged anastomic vessels. Count the ribs. Bony
cage should be clearly outlined and a large vessels nshalilfted in the lung field.

General shape

Pigeon chest-chest wall with prominent sternum and flat, is indicative of chronic respiratory
disease in childhood.

Funnel chest-is a chest wall with local sternum depression at lower end

Kyphosis-is forward bendins of spines


References

D.FCappell.(1994)Textbook ofPathology(8TH Edition)

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