The Law of Bone Remodelling

I Concept of the Law of Bone Remodelling.- II The Internal Architecture of Normal Bone and Its Mathematical Significance.- 1 Historical.- 2 The Internal Architecture of the Proximal End of the Human Femur.- 2.1 Architecture of the Coronal Section.- 2.2 Architecture of the Sagittal Section Sawn from the Centre of the Bone.- 2.3 Architecture of the Sagittal Section Away from the Axis of the Bone.- 2.4 Architecture of the Cross Section at the Level of the Lesser Trochanter.- 2.5 Architecture of the Cross Section Through the Middle of the Femoral Head.- 2.6 Overall Picture of the Architecture of the Proximal End of the Femur.- 3 The Stress Trajectories in Graphic Statics.- 4 Calculations of Culmann for the Crane Similar to a Femur.- 5 Significance of the Internal Architecture of Bone.- 6 Possibility of Predicting Anatomical Features Mathematically.- III Remodelling of the Internal Architecture and External Shape of Bones.- 1 Remodelling of the Internal Architecture of Bones After Pathological Alterations of Their External Shape.- 2 Secondary Modifications of the External Shape of the Bone After Primary Pathological Alterations of This Shape.- 3 Modifications of the Architecture and Shape of Bones After Pathological Alterations of Their Static Stressing.- 4 Modifications in Shape of Bones After Intentional Alterations of Their Static Stressing.- 5 Pathological Bone Specimens and Clinical Observations Demonstrating the Remodelling of the Internal Architecture and External Shape of Bones.- 5.1 Specimens of Malunited Fractures.- 5.1.1 Extracapsular Fracture Through the Neck of the Femur and the Greater Trochanter (Figs. 22-26).- 5.1.2 Extracapsular Fracture Through the Neck of the Femur and the Greater Trochanter (Fig. 27).- 5.1.3 Extracapsular Fracture Through the Neck of the Femur and the Greater Trochanter (Fig. 28).- 5.1.4 Extracapsular Fracture Through the Neck of the Femur and the Greater Trochanter (Fig. 29).- 5.1.5 Extracapsular Fracture Through the Neck of the Femur and the Greater Trochanter (Fig. 30).- 5.1.6 Extracapsular Fracture Through the Neck of the Femur and the Greater Trochanter with Important Displacement of the Head Distally (Fig. 31).- 5.1.7 Extracapsular Fracture Through the Neck of the Femur and the Greater Trochanter (Fig. 32).- 5.1.8 Extracapsular Fracture at the Base of the Neck (Fig. 33).- 5.1.9 Intracapsular Fracture of the Neck of the Femur (Fig. 34).- 5.1.10 Intracapsular Fracture of the Neck of the Femur (Fig. 35).- 5.1.11 Subtrochanteric Fracture of the Femur (Fig. 36).- 5.1.12 Subtrochanteric Fracture of the Femur (Figs. 37, 38).- 5.1.13 Fracture of the Surgical Neck of the Humerus (Figs. 39, 40).- 5.1.14 Fracture of the Neck of the Femur in the Process of Healing (Fig. 41).- 5.1.15 Fracture of the Shaft of the Femur (Figs. 42, 43).- 5.1.16 Fracture of the Shaft of the Femur (Fig. 44).- 5.1.17 Fracture of the Shaft of the Femur (Fig. 45).- 5.1.18 Fracture of the Shaft of the Tibia (Fig. 46).- 5.1.19 Fracture of the Shaft of the Tibia (Fig. 47).- 5.1.20 Fracture of the Two Bones of the Lower Leg (Fig. 48).- 5.1.21 Pseudarthrosis of the Tibia with Compensatory Hypertrophy of the Fibula (Fig. 49).- 5.2 Specimens of Ankyloses.- 5.2.1 Ankylosis of the Right Knee (Figs. 50-54).- 5.2.2 Ankylosis of the Right Knee (Fig. 55).- 5.2.3 Cross Section of the Femur and Tibia of an Ankylosed Left Knee (Figs. 56, 57).- 5.2.4 Ankylosis of the Left Elbow (Fig. 58).- 5.2.5 Ankylosis of the Right Hip (Fig. 59).- 5.2.6 Ankylosis of the Left Hip (Fig. 60).- 5.2.7 Ankylosis of the Left Hip with Hypertrophy of the Ilium (Figs. 61-64).- 5.2.8 Ankylosis of the Right Ankle (Fig. 65).- 5.2.9 Arthrodesis of the Right Knee Healed by Bony Union (Fig. 66).- 5.3 Specimens of Bones Deformed by Rickets.- 5.3.1 Tibia Curved by Rickets at Mid-shaft (Figs. 67, 68).- 5.3.2 Femur Curved by Rickets at Mid-shaft (Fig. 69).- 5.3.3 Femur Curved by Rickets at Mid-shaft (Fig. 70).- 5.3.4 Femur Curved by Rickets at Mid-shaft (Fig. 71).- 5.3.5 Tibia Curved by Rickets at Mid-shaft (Figs. 72, 73).- 5.3.6 Femur Enormously Curved by Rickets (Fig. 74).- 5.3.7 Tibia Curved by Rickets. Section Through the Neutral Fibre Layer (Fig- 75).- 5.3.8 Tibia Curved by Rickets. Neutral Fibre Layer (Fig. 76).- 5.3.9 Tibia Curved by Rickets in Its Lower End (Fig. 77).- 5.4 Specimens of Deformities.- 5.4.1 Tibia of a Specimen of Genu Valgum (Figs. 78-80).- 5.4.2 Tibia of a Specimen of Genu Valgum (Fig. 81).- 5.4.3 Femur and Tibia of a Specimen of Genu Valgum (Fig. 82).- 5.5 Specimens of Amputation Stumps.- 5.5.1 Amputation Stump of a Thigh (Fig. 83).- 5.5.2 Amputation Stump of a Lower Leg (Fig. 84).- 5.6 Remodelling in Experimental Bone Specimens.- Specimens with Longitudinal Wires.- 5.6.1 Bending of the Tibia of a Rabbit by a Longitudinal Wire (Fig. 85).- 5.6.2 Bending of the Tibia of a Rabbit by a Longitudinal Wire (Figs. 86,87).- Specimens with du Hamel's Loop.- 5.6.3 Bending of the Tibia of a Sheep by a du Hamel's Loop. First Stage of the Process. Primary Alteration in Shape (Fig. 88).- 5.6.4 Constriction of the Metacarpal of a Calf by a du Hamel's Loop. Second Stage of the Process. Secondary Remodelling of Shape (Fig. 89).- 5.6.5 Loop Experiment on the Femur of a Rabbit. Third Stage of the Process. Disappearance of the Inwards Bent Bone Statically Superfluous (Fig. 90).- 5.6.6 Loop Specimen in the Second Stage Under the Microscope (Fig. 91).- 5.7 Clinical Demonstration of Bone Remodelling after Therapeutic Modification of the Static Stressing of the Bone.- 5.7.1 Severe Congenital Club Foot in a 19-Year-Old Male and the Result 6½ Years After Completion of the Treatment (Figs. 92, 93).- 5.7.2 Severe Congenital Club Foot in a 22-Year-Old Male and the Result 4½ Years After Completion of the Treatment (Figs. 94, 95).- 6 Remodelling of the Internal Architecture and External Shape of Bone by the Trophic Stimulus of Function.- 7 Histological Process of Bone Remodelling.- IV Functional Shape of Bone.- 1 Previous Opinions Concerning the Reasons for the Shape of Bones.- 2 Critical Analysis of the Previous Opinions Concerning the Reasons for the Shape of Bones, Particularly of the "Compression Theory".- 2.1 Refutation of the Compression Theory on Mathematical Grounds.- 2.2 Refutation of the Compression Theory on Anatomical Grounds.- 2.3 Refutation of the Compression Theory on Clinical Grounds.- 3 Basis of the Theory of the Functional Shape of Bone.- 3.1 Mathematical Foundation of the Theory of the Functional Shape of Normal and Pathological Bones.- 3.2 Anatomical Foundation of the Theory of the Functional Shape of Bones Pathologically Altered.- 3.3 Anatomical Foundation of the Theory of the Functional Shape of Normal Bones.- 4 Summary and Conclusion.- V On the Remodelling Force and Its Therapeutic Use.- 1 The Remodelling Force in the Wide Sense of the Word.- 2 The Remodelling Force in a More Restricted Sense of the Word.- 3 The Theory of the Remodelling Force as Opposed to Previous Concepts for Getting Rid of Bone Deformities.- 4 Possibility of Predicting Therapeutic Results Mathematically.- Appendix to Chapter II- V: Overall View of the Topics of Bone Theory Predictable Mathematically 87.- VI Consequences Drawn from the Law of Bone Remodelling.- 1 Consequences of the Law of Remodelling on Bone Growth.- 2 Consequences of the Law of Remodelling on Fracture Healing.- 2.1 Type and Degree of Functional Incapacity of Broken Bones.- 2.2 How Nature Eliminates the Incapacity of Broken Bones.- 2.3 Previous Opinion Concerning the Processes Occurring at the Fracture Site.- 2.3.1 Conceiving the Processes at the Fracture Site as an Inflammatory Process.- 2.3.2 Conceiving the Processes at the Fracture Site as Analogous to Normal Osteogenesis.- 2.3.3 Conceiving the Processes at the Fracture Site as One Process Sui Generis with a Precursor and an Involution Step.- 2.4 The Healing Process of Fracture According to the Law of Remodelling.- 2.4.1 The Inflammatory or Uniting Process.- 2.4.2 The Remodelling Process.- 2.5 Goals for Histological Research.- 2.6 Restoring Broken Bones to Shapes as Normal as Possible.- 2.7 Duration Discrepancies in the Healing of Different Fractures.- 3 Consequences of the Law of Bone Remodelling on Rickets.- 3.1 Bending of Tubular Bones at Mid-shaft by Rickets.- 3.2 Architecture of the Bones Bent by Rickets Near Their Lower End.- 4 Consequences of the Law of Bone Remodelling on the Pathogenesis and Development of Deformities.- 4.1 Deformities in the Wide and in the Narrow Sense of the Word.- 4.2 Previous Concepts and Grouping of Deformities.- 4.3 Grouping of Deformities According to the Law of Remodelling.- 4.4 Specific Pathogenesis of Deformities in the Narrow Sense of the Word.- 4.4.1 Pathogenesis of Club Foot.- 4.4.2 Pathogenesis of Genu Valgum.- 4.4.3 Pathogenesis of Scoliosis.- 5 Consequences of the Law of Remodelling for the Treatment of Deformities.- 5.1 Correction Without Osteotomy.- 5.2 Correction Using Osteotomies Additionally.- 5.3 Functional Orthopaedics.- 6 Consequences of the Law of Bone Remodelling on the Other Tissues of the Organism.- Appendix to Section 6: The Structure of Plants and the Question of Its Remodelling.- 7 Consequences of the Law of Remodelling on the Metabolism.- 8 Consequences of the Law of Remodelling on Inflammation and Regeneration.- 9 The Teleological Concept of Nature in the Law of Bone Remodelling.- 10 The Law of Remodelling and the Theory of Mechanics.- 11 The Law of Remodelling and "Organ Projection".- 12 Consequences of the Law of Bone Remodelling on the Theory of Heredity.- References.- Name and Subject Index.