> For the complete documentation index, see [llms.txt](https://docs.snomed.org/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://docs.snomed.org/snomed-ct-specifications/snomed-ct-editorial-guide/readme/authoring/domain-specific-modeling/procedure/index-2/skeletal-system.md). # Skeletal system Since the skeletal system includes bones and cartilage, it is possible to have a procedure on the skeletal system, i.e. on cartilage, that is not a procedure on bone. * For example, * 77825002 |Division of cartilage of wrist (procedure)| is a procedure on the skeletal system (procedure) {% hint style="info" %} **Skeletal system subdivision** SNOMED CT considers the *skeletal system subdivision* part of the entire bone (system). This may change if there are procedures on cartilaginous skeleton that involve skeletal system subdivisions. {% endhint %} ### Osteotomy O*steotomy* is defined as *cutting into or through a bone*; there are 3 meanings in SNOMED CT: 1. Cutting into a bone, regardless of whether the bone is divided (incision, general meaning). Model using Method, Incision - action (qualifier value), and Procedure site - Direct (attribute), bone structure (or subtypes). 1. For example, 1. 118483001 |Incision of rib (procedure)| 2. Cutting through a bone and dividing it (division by cutting). Model using Method, Division - action (qualifier value), and Procedure site - Direct (attribute), bone structure (or subtypes). 1. For example, 1. 447867002 |Division of ulna (procedure)| 3. Cutting into a bone without cutting through it and therefore without dividing it (incision without division). 1. This is unnecessary; procedures that do not explicitly involve division are modeled simply as *Incision*. ### Reduction and fixation of fractures *Reduction and fixation* has two actions by two different means; open reduction of a fracture and insertion of an orthopedic fixation device. This provides an opportunity for general concept inclusion axioms (GCIs) in order to fully represent the meanings without heavy postcoordination modeling. *Open reduction of a fracture* necessarily involves open manipulation of the fracture and *internal fixation of a fracture* necessarily involves the insertion of an orthopedic internal fixation device. * For example, * 74011006 |Open reduction of fracture of tibia and fibula with internal fixation (procedure)| Provide Feedback --- # Agent Instructions This documentation is published with GitBook. GitBook is the documentation platform designed so that both humans and AI agents can read, navigate, and reason over technical content effectively. Learn more at gitbook.com. ## Querying This Documentation If you need additional information that is not directly available in this page, you can query the documentation by asking a question. Perform an HTTP GET request on the following URL with the `ask` and `goal` query parameters: ``` GET https://docs.snomed.org/snomed-ct-specifications/snomed-ct-editorial-guide/readme/authoring/domain-specific-modeling/procedure/index-2/skeletal-system.md?ask=&goal= ``` `ask` is the immediate question: it should be specific, self-contained, and written in natural language. `goal` is what the user is ultimately trying to achieve, the reason they need the answer. Sharing it helps GitBook give you a better, more relevant answer. A goal is most helpful when it describes the outcome the user wants rather than restating the question. For example, with `ask=how do I create an API token`, a goal like `automate deployments from our CI pipeline` lets GitBook tailor the answer to that use case. The response will contain a direct answer to the question and relevant excerpts and sources from the documentation. Use this mechanism when the answer is not explicitly present in the current page, you need clarification or additional context, or you want to retrieve related documentation sections.