Cv WRITING ARTICLE TASK (5%) – SIMPLE EVALUATION

1. Explain the component of the bone in the simple writing and diagnosis

Bone is made up of organic component (40% of dry weight) and inorganic component (60%
of dry weight).

Organic component include collagen in which it is represent 90% of organic component and
primarily type I collagen that provides tensile strength. Next is proteoglycans that responsible
in compressive strength and inhibit mineralization. It is composed of glycosaminoglycan-
protein complexes. Matrix proteins is another type of organic component that contains
noncollagenous proteins. Its functions are to promote mineralization and bone formation.
There are three main types of proteins involved in bone matrix, first is osteocalcin that
produced by mature osteoblasts that function in promoting mineralization and formation of
bone. It is also directly involved in regulation of bone density and attracts osteoclasts. The
second type of protein is osteonectin where it is secreted by platelets and osteoblasts and its
function is believed to have a role in regulating calcium or organizing mineral in matrix. The
last type is osteopontin functioning in cell-binding protein. The last type organic component
of the bone are cytokine and growth factors. They represent small amounts present in matrix
and aid in bone cell differentiation, activation, growth, and turnover.

The inorganic component include calcium hydroxyapatite (Ca10(PO4)6(OH)2 that provides

compressive strength and osteocalcium phosphate (brushite). Meanwhile, in femur there are
three parts of bone consist of :

 Head of femur

The highest part of the thigh bone (femur). It is supported by the femoral neck. The head is
globular and forms rather more than a hemisphere, is directed upward, medialward, and a
little forward, the greater part of its convexity being above and in front. Its surface is smooth,
coated with cartilage in the fresh state, except over an ovoid depression, the fovea capitis,
which is situated a little below and behind the center of the head, and gives attachment to the
ligament of head of femur. The diameter of the femoral head is generally larger in men than in
women.

 The greater trochanter

A large, irregular, quadrilateral eminence and a part of the skeletal system. It is directed
lateral and medially and slightly posterior. In the adult it is about 1 cm lower than the head.
Because the pelvic outlet in the female is larger than in the male, there is a greater distance
between the greater trochanters in the female.

 The lesser trochanter

A small protuberance of bone that projects from the posterior aspect of the femur,
inferomedially at the base of the femoral neck. Two muscles insert onto the lesser trochanter
are psoas major and iliacus.
If there is a fracture of the neck of the femur, the blood supply through the
ligament becomes crucial. In orthopedic surgery, the head of the femur is
important because it can undergo avascular necrosis and consequent
osteochondritis dissecans. The femoral head is removed in total hip
replacement surgery.

Morover, trochanteric fracture is frequent in adults, and mainly affects elderly

patients who risk loss of independence. Treatment for this fracture is surgical,
of various sorts. Open reduction internal fixation (ORIF) with intra- or extra-
medullary implants is the most frequent treatments in these fractures, which
usually heal easily. In elderly patients, arthroplasty is an alternative of choice
for some people. These different treatment modalities are presented, focusing
on technical details. Possible technical difficulties will be considered to choose
the desired trathment.

Fracture below the lesser trochanter occurs in a region that is between the
lesser trochanter and an area approximately 2 1/2 inches below. At the
subtrochanteric level, most fractures are managed with a long intramedullary
nail together with a large lag screw or they are managed with screws that
capture the neck and head of the femur or the area immediately underneath it,
if it has remained intact. In order to keep the bones from rotating around the
nail or from shortening on the nail, additional screws may be placed at the
lower end of the nail in the area of the knee. These are called interlocking
screws. In certain cases, the surgeon may choose to use a plate rather than a
nail. The plate will have screws that go into the bone from the lateral, or outer,
side of the femur. A single large screw goes into the neck and the head of the
femur and appears similar to the compression hip screw, but at a different
angle. Secondary screws are then placed through the plate into the bone to hold
the fracture in place.