By Alexander Germanis
Perfection in construction is a thing rarely achieved without some additional work. Anyone who has tried hanging a door knows that in order to attain a level door with flawless movement, numerous adjustments need to be made. Wedges of wood, called shims, often need to be inserted within the doorframe to make it square. Only then will the door hang and, therefore, perform properly.
Unfortunately for some, whether due to a birth defect or severe injury, their “frame” — skeletal structure — is not “square,” and therefore, not providing the proper support.
To compound the problem, if the soft tissue surrounding the bone is not in its proper shape, the support structure beneath the surface will conform to that improper shape. “It’s called Wolff’s Law,” explains Dr. David Efaw, MD, DDS, of an oral and maxillofacial surgery group in Bloomington.
A principle first described by the 19th century German anatomist and surgeon, Julius Wolff, Wolff’s Law states that bone will adapt, that is, change its structure — both in density and shape — based on the load that is placed upon it.
Dr. Efaw’s colleague, Dr. Stephen Doran, DMD, continues, “It’s kind of counterintuitive. Instead of the flesh hanging on our skeleton, the flesh dictates what shape our skeleton is.”
This dictation is due to skeletal turnover. The bones in our bodies are constantly refreshing themselves. Meaning, in simplest terms, the bone in your arm is not the exact same bone it was even just eight months ago.
Skeletal turnover, in conjunction with Wolff’s Law, can then result in bones developing more densely due to consistent use. On the flip-side, however, it means a lack of use will result in smaller, brittle, and weaker bones.
In the early 1900’s, a Russian orthopedic surgeon named Gavriil Ilizarov put his understanding of Wolff’s law and bone physiology to work, developing a technique still used to this day. Now called distraction osteogenesis, Ilizarov’s method was used to fix “patients with limb length discrepancies, orthopedic defect, skeletal deformities or malunion of fractures that weren’t fixed,” Dr. Doran says. Ilizerov’s work concentrated on the long bones of the body, specifically those in the leg.
“For a bone to heal,” the doctor continues, “it has to be anatomically reduced; that means the broken parts have to line up with each other again. Then it has to be stabilized and fixated or immobilized for a period of time for the bone physiology to take over and heal itself.”
Dr. Efaw describes the Ilizerov process further, “He would create a surgical cut in the bone, separate it, and let it sit for a couple weeks. What’s happening microscopically is the bone cells are trying to repair the fracture, but they’re still soft. The thing it’s trying to create is called a callus — a football shaped growth around the [broken ends] made of soft woven bone. Ilizerov never let that bone set. If you let that fracture repair itself,” the doctor explains, “that football shape eventually gets smaller and smaller, and the soft tissue will dictate that it will go back to its normal anatomic shape.”
Ilizerov’s goal was to make a new anatomic shape, specifically a perfected limb, without deformity. In order to accomplish this, he put pressure against the bone, fixating it with an adjustable framework worn by the patient. As the bone healed, Dr. Doran adds, “He just stretched that [framework] out and then he held it. So, he was drawing that healing process along.”
Although Ilizerov’s work was largely successful, it was a painful process, leaving the patient prone to infection. But nearly a hundred years later, the work he pioneered paved the way for vast improvements in the field of distraction osteogenesis, as well as opened doors to new locations of the body where it could be put to use to achieve better bone perfection.
To learn more about distraction osteogenesis and how it is being employed by modern medicine to rebuild and repair facial deformities and injuries, read “Building Bone Perfection, Part 2 — Distraction Osteogenesis” in next month’s issue of Healthy Cells Magazine.
Drs. Doran, Capodice, Efaw, and Ocheltree provide a full scope of oral and maxillofacial surgery, with expertise ranging from wisdom tooth removal and dental implants to bone grafting procedures, corrective jaw surgery, and cosmetic facial surgery. Their office is located at 109 Regency Drive in Bloomington, with satellite offices in Watseka and Lincoln. For more information, you may call 309-663-2526, or visit them online at www.dceooms.com.