OSTEOLOGY OF RIBS for anatomy in b.d chaurasia

Osteology of ribs

1. OSTEOLOGY OF RIBS .

2. INTRODUCTION: The ribs are the bony framework of the thoracic cavity: The ribs form the main structure of the   thoracic   cage protecting the thoracic organs, however their main function is to aid   respiration . There are twelve pairs of ribs. Each rib articulates posteriorly with two  thoracic vertebrae   by the   costovertebral   joint. An exception to this rule is that the  first rib   articulates with the first thoracic vertebra only.

3. Typical ribs : True ribs are those numbered 2 to 10 with ribs 1, 11 and 12 considered  atypical . Aty pical Ribs: Some authors however include ribs 2 and 10 also atypical.

4. According to their attachment to the sternum, the ribs are classified into 3 groups: true, false, and floating ribs. The true ribs are the ribs that directly articulate with the sternum with their costal  cartilage s - ribs 1-7. They articulate with the sternum by the sternocostal joints. The first rib is an exception to that rule; it is a  synarthrosis   and the first rib could uniquely articulate with the clavicle by the costoclavicular joint. The false ribs (8,9,10) are the ribs that indirectly articulate with the sternum, as their costal cartilages connect with the seventh costal cartilage by the costochondral joint. The floating ribs (11,12) do not articulate with the sternum at all (distal two ribs).

5. Typically, the ribs have the following anatomical components: Head with two articular facets. Tubercle. Neck. Shaft. Costal groove.

6. A broken rib is a common injury that occurs when one of the bones in the rib cage breaks or cracks. The most common causes are hard impacts from falls, car accidents or contact sports. Many broken ribs are simply cracked. Cracked ribs are painful. But they don't cause the problems that ribs that have broken into pieces can. The sharp edge of a broken bone can harm major blood vessels or lungs and other organs. Usually, broken ribs heal on their own in about six weeks. Pain control is important for being able to breathe deeply and avoid lung issues, such as pneumonia. OVERVIEW OF BROKEN RIBS :

7. Symptoms: The following can cause pain with a broken rib or make pain worse: A deep breath. Pressure on the injured area. A bend or a twist of the body. Risk factors: The following can increase the risk of breaking a rib: Osteoporosis.  This disease in which bones lose their bulk increases the risk of breaking a bone. Sports.  Playing contact sports, such as hockey or football, increases the risk of injury to the chest. Cancer in a rib.  Cancer can weaken the bone, making it more likely to break.

8. Complications: A broken rib can harm blood vessels and internal organs. Having more than one broken rib increases the risk. Complications depend on which ribs break. Possible complications include: Tear in the main artery of the body, known as the aorta :  A sharp end from a break in one of the first three ribs at the top of the rib cage could pierce a major blood vessel, including the aorta. Tear in a lung :  The jagged end of a broken middle rib can punch a hole in a lung and cause it to cave in. Ripped spleen, liver or kidneys : The bottom two ribs rarely break because they can move more than the upper and middle ribs. But the ends of a broken lower rib can cause serious harm to the spleen, liver or a kidney.

9. Prevention: To help keep a rib from breaking: Protect from athletic injuries : Wear protective equipment when playing contact sports. Reduce the risk of falls in the house :  Remove clutter from floors. Wipe up spills right away. Use a rubber mat in the shower. Keep your home well lit. Put backing on carpets and area rugs to keep them from sliding. Strengthen bones :  Getting enough calcium and vitamin D in the diet is important for strong bones. Get about 1,200 milligrams of calcium and 600 international units of vitamin D daily from food and supplements.

10. Paradoxical breathing is when the chest expands during inhalation and the abdomen is drawn inwards and then during exhalation the abdomen is pushed outwards. A new BPD classification, proposed by the authors of this commentary, is associated with a startle reflex Paradoxial breathing:

11. The spine, or vertebral column, is a segmental set of 33 bones and associated soft tissues in the subcranial portion of the axial skeleton. It is subdivided into 5 regions based on curvature and morphology: cervical, thoracic, lumbar, sacral, and coccygeal. The cervical spine has 7 articulating vertebrae, whereas the thoracic has 12, and the lumbar has 5. Despite their similar morphology, these regions have variable flexibility, movement, and joint articulation, giving rise to the spine's S-shaped curvature.  Meanwhile, the sacrum and the coccyx are 2 sets of fused caudal vertebrae that convey no motion. The sacrum has 5 fused vertebrae, while the coccyx has 4. Cervical vertebrae: The cervical spine comprises 7 vertebrae (C1 to C7) and is divided into 2 major segments. The 2 most cephalad vertebrae, the atlas (C1) and the axis (C2), form the  craniocervical junction (CCJ) together with the occiput. The 5 cervical vertebrae caudad, C3 to C7, comprise the subaxial spine and are referred to by number . The cervical spine supports the weight of the cranium and head and neck motion. VERTEBRAE:

12. In  vertebrates ,  thoracic vertebrae  compose the middle segment of the  vertebral column , between the  cervical vertebrae  and the  lumbar vertebrae . [1]  In humans, there are twelve thoracic  vertebrae  and they are intermediate in size between the cervical and lumbar vertebrae; they increase in size going towards the lumbar vertebrae, with the lower ones being much larger than the upper. [ citation needed ]  They are distinguished by the presence of  facets  on the sides of the bodies for  articulation  with the  heads of the ribs , as well as facets on the  transverse processes  of all, except the eleventh and twelfth, for articulation with the  tubercles of the ribs . By convention, the human thoracic vertebrae are numbered T1–T12, with the first one (T1) located closest to the skull and the others going down the spine toward the lumbar region.: THORACIC VERTEBRAE:

13. The lumbar spine consists of the five bones (vertebra) in your lower back. Your lumbar vertebrae, known as L1 to L5, are the largest of your entire  spine . Your lumbar spine is located below your 12 chest (thoracic) vertebra and above the five fused bones that make up your triangular-shaped sacrum bone. Compared with other spine vertebrae, your lumbar vertebrae are larger, thicker and more block-like bones. Your lumbar vertebrae provide stability for your back and spinal column and allow for a point of attachment for many muscles and ligaments. Your lumbar vertebrae support most of your body’s weight. It’s also the center of your body’s balance. Your lumbar spine and the muscle and ligaments that attach to them allow you to walk, run, sit, lift and move your body in all directions. Your lumbar spine has a slight inward curve called a lordotic curve. Lumbar vertebrae:

14. The sacral vertebrae—also called the sacral spine—consists of five sacral vertebrae bones. These bones fuse together to form the  sacrum,  the shield-shaped bony structure located at the base of the  lumbar vertebrae  (the five cylindrical bones forming the spine of the lower bank) and connected to the pelvis. The sacral vertebrae are represented by segments S1 through S5 and located between the lumbar vertebrae and the  coccyx  (tailbone)—the lowest part of the vertebral column. Sacral vertebrae :

15. The first three vertebrae of the sacral region form the wide lateral wings called the alae. The alae (also called the ala or wing of sacrum) connect with the blades of pelvis—called the  ilium . The sacrum also forms the back wall of the pelvis and the joints at the hip bones called the  sacroiliac joints . There are a series of four openings on each side of the sacrum where the sacral nerves and blood vessels run. The sacral canal runs down the center of the sacrum, representing the end of the vertebral canal. The five segments of the sacral vertebrae affect nerve communication to the lower part of the body. There, numerical levels are often mentioned in imaging studies of the spine. S1 refers to the first sacral bone, S2 to the second sacral bone, and so on. S1 is at the top and S5 is towards the bottom. Each number corresponds with the nerves in that part of the spinal cord. S1 nerves  affect the hips and groin. S2 nerves  affect the back of the thighs. S3 nerves  affect the medial buttock area. S4 and S5 nerves  affect the perineal area. The perineum is between the legs. It is the diamond-shaped area containing the anus, and in females, the vagina.

16. The human coccyx is the final portion of the vertebral column, typically comprised of three to five vertebral segments.Its proximal vertebral segment articulates with the sacrum via a fibrocartilaginous joint; however, the fusion of the sacrum and coccyx has been a feature in many cases, with prevalence differing by age and sex. Each inter-vertebral segment has also been shown to differ in the incidence of fusion with its superior and inferior counterparts. Distally, the coccyx maintains a concave-shaped curve and anteriorly angles into the pelvis. Though not readily visible, each coccygeal vertebrae does contain a transverse process and, when fused, forms what is known as the anterior and posterior transverse grooves of the coccyx. However, the coccygeal vertebrae do not contain any pedicle, lamina, or spinous processes. The coccyx serves as the attachment site for multiple pelvic ligaments and tendons and contains an extensive plexus of coccygeal nerves. Damage to any one of these components can have implications in several clinical conditions. Coccyx vertebrae:

17. Open surgery is the traditional type of surgery in which an  incision  is made using a scalpel. You may have seen procedures on television or in the movies where a surgeon makes an incision, then performs surgery through that large incision. These incisions can range from 3-4 inches to very large, depending upon the procedure being performed. OPEN SURGERY:

18. Open surgeries are less common than they used to be due to the creation of " minimally invasive " surgical techniques that involve smaller incisions or even (in some cases) no incision at all. These surgeries use multiple incisions less than an inch in length, with a camera and instruments inserted into the small incisions, and the surgeon is able to watch the procedure on a large monitor as if playing a very technical video game. While minimally invasive surgery has become increasingly popular, there are a number of situations in which open surgery is still necessary.

19. Pros and Cons of Open Surgery: Open surgery is on the wane because of new technologies that make it so much easier to avoid large incisions and the risks that come with them. For example, with an open approach, the incision for a typical appendectomy is approximately 4 inches long. But according to the Society of American Gastrointestinal and Endoscopic Surgeons, "In most laparoscopic appendectomies, surgeons operate through 3 small incisions (each 1/4 to 1/2 inch) while watching an enlarged image of the patient’s internal organs on a television monitor."As a result, recovery time is quicker and pain is often reduced.

20. But that doesn't mean that open surgery is obsolete. In some cases, for example: Repairs simply cannot be made effectively using minimally invasive techniques Only open surgery provides the visual information required to completely remove tissues or accurately diagnose a condition Some types of surgeries require access to larger areas in order to insert materials such as in the case of an aortic aneurysm repair when a patient's anatomy does not allow a stent to be place.

21. A ngiogram is a scan that shows blood flow through arteries or veins, or through the heart, using X-rays, computed tomography angiography (CTA) or magnetic resonance angiography (MRA). The blood vessels appear on the image after a contrast dye is injected into the blood, which lights up on the scan wherever it flows. Angiography may be the first step of a procedure to find and fix a blood vessel blockage, aneurysm, structural heart or valve disease. Angiogram:

22. Heart Surgery: Heart-related problems do not always require surgery. Sometimes they can be addressed with lifestyle changes, medications, or nonsurgical procedures. For example, catheter ablation uses energy to make small scars in your heart tissue to prevent abnormal electrical signals from moving through your heart. Coronary angioplasty is a minimally invasive procedure in which a stent is inserted into a narrowed or blocked coronary artery to hold it open. Nonetheless, surgery is often needed to address problems such as heart failure, plaque buildup that partially or totally blocks blood flow in a coronary artery, faulty heart valves, dilated or diseased major blood vessels (such as the aorta), and abnormal heart rhythms.

23. some types of heart surgery: There are many types of heart surgery. The National Heart, Lung, and Blood Institute, which is part of the National Institutes of Health, lists the following as among the most common coronary surgical procedures. Coronary artery bypass grafting (CABG):  In CABG — the most common type of heart surgery — the surgeon takes a healthy artery or vein from elsewhere in your body and connects it to supply blood past the blocked coronary artery. The grafted artery or vein bypasses the blocked portion of the coronary artery, creating a new path for blood to flow to the heart muscle. Often, this is done for more than one coronary artery during the same surgery. CABG is sometimes referred to as heart bypass or coronary artery bypass surgery.

24. Heart valve repair or replacement : Surgeons either repair the valve or replace it with an artificial valve or with a biological valve made from pig, cow, or human heart tissue. One repair option is to insert a catheter through a large blood vessel, guide it to the heart, and inflate and deflate a small balloon at the tip of the catheter to widen a narrow valve. Insertion of a pacemaker or an implantable cardioverter defibrillator (ICD) :  Medicine is usually the first treatment option for arrhythmia, a condition in which the heart beats too fast, too slow or with an irregular rhythm. If medication does not work, a surgeon may implant a pacemaker under the skin of the chest or abdomen, with wires that connect it to the heart chambers. The device uses electrical pulses to control the heart rhythm when a sensor detects that it is abnormal. An ICD works similarly, but it sends an electric shock to restore a normal rhythm when it detects a dangerous arrhythmia.

25. Maze surgery :   The surgeon creates a pattern of scar tissue within the upper chambers of the heart to redirect electrical signals along a controlled path to the lower heart chambers. The surgery blocks the stray electrical signals that cause atrial fibrillation — the most common type of serious arrhythmia. Aneurysm repair :   A weak section of the artery or heart wall is replaced with a patch or graft to repair a balloon-like bulge in the artery or wall of the heart muscle .

26. Heart transplant :   The diseased heart is removed and replaced with a healthy heart from a deceased donor. Insertion of a ventricular assist device (VAD) or total artificial heart (TAH): A VAD is a mechanical pump that supports heart function and blood flow. A TAH replaces the two lower chambers of the heart.

27. In addition to these surgeries, a minimally invasive alternative to open-heart surgery that is becoming more common is  transcatheter structural heart surgery . This involves guiding a long, thin, flexible tube called a catheter to your heart through blood vessels that can be accessed from the groin, thigh, abdomen, chest, neck, or collarbone. A small incision is necessary. This type of surgery includes transcatheter aortic valve implantation to replace a faulty aortic valve with a valve made from animal tissue,  placement for mitral valve abnormalities, and  placement for nonvalvular atrial fibrillation patients.

28. THANK YOU