THE HEALTH | JANUARY-FEBRUARY , 2023

BONE TO PICK

Wolff ’ s idea at that time , which still holds , is that naturally healthy bones will adapt and change to the stress it is subjected to .

It ’ s fascinating how much our bones can change , whether for the good or otherwise . In medical terms , this ability to “ shape back to its original self ” is termed “ remodelling ”.

Although the adult or mature bone poses this ability to a certain degree , it is in children that it is most pronounced .

Before we go further into how that happens , let us first consider what makes a child ’ s bone more impressive . A child isn ’ t born with all its bones fully formed . Instead , they have what we coin as primary and secondary ossification centres .

What this simply means is that newborn children develop adultlike bones as they grow older . One fascinating example is the patella bone . The next time you visit your newborn nephew or niece , have a feel at their knees . You would not be able to feel the “ knee cap ”.

FRACTURES INVOLVING CHILDREN

In addition to forming new bones , immature bones also have what we call “ physis ”, or the growth plate . The physis is often referred to as the factory of the bone . They ’ re found at the ends of long bones like the femur ( thigh ) and humerus ( arm ).

When looked at under a microscope , they can be divided into a few distinct zones , each playing an essential role in normal growth . Short stature or dwarfism occurs when there ’ s a congenital disability involving the physis .

Because of how different the skeleton of a child is , fractures involving them also tend to be different to those of adults . They tend to have more incomplete fractures , meaning that the fracture isn ’ t through and through .

This happens as their bones tend to be more plastic . As such , their bones will tend to bend and deform more before breaking . These incomplete

fractures are called “ greenstick ” or “ torus ” fractures . The other type of fracture unique to children involves the growth plate .

So where does Wolff ’ s Law come into all of these ? As mentioned in my earlier column titled “ To Be or Not to Be ”, there are guidelines to follow in terms of just how much deformity a fractured bone can be left to heal by itself before surgical intervention becomes necessary .

It is also true in children , except that one can accept a lot more deformities in kids .

KEEP HEALTHY AND DEVELOP SOLID BONES

Why is this ? It is because of the body ’ s extraordinary ability to not only

Dr Jonas Fernandez is an Orthopaedic Surgeon at Putrajaya Hospital . He is also a member of the Malaysian Arthroscopy Society ( MAS ). heal itself but also , to reshape the bone back to its original form . It is especially true in children who have the most growth years left ahead of them .

This means the younger one is , the better the potential for the body to remodel a bone that has been left deformed by a fracture .

Apart from age , other factors that play a role include the distance of the fracture to the growth plate and the direction of the deformity . For the distance of the fracture to the growth plate , the closer the fracture to the growth plate , the better the outcome .

As for the direction of the deformity , better remodelling is seen if the direction of the deformation is in the same plane as the adjacent joint .

Lastly , fractures involving the growth plate might have their worst prognosis as the trauma might have caused permanent damage to the “ bone factory ”.

It truly is fantastic that our body can reshape itself just from the stresses applied to it . The remodelling of fractured bones is just one way Wolff ’ s Law applies .

Bones also get more robust when stresses like exercise act on it . So there you have it , prevention is better than cure . Let ’ s start by keeping healthy and developing solid bones .

And if it fractures , then let nature take its course and allow it to remodel back . – The Health