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Remodeling :

Remodeling of a fracture or deformity is a process that is carried out more efficiently in the child than in the adult. A deformity corrects itself by asymmetrical appositional formation of new bone.

Remodeling is influenced by a number of factors, including the following:

1.  Age – The younger the age, the better the remodeling potential
2. Proximity to the physis – Fractures closer to the physis remodel better than those away from the physis
3.  Relation to the axis of joint motion – Deformities in the axis of joint motion remodel better than deformities outside the axis of joint motion
4.  Rotational versus nonrotational deformity – Rotational deformities do not remodel and correct themselves

An injury to a long bone can stimulate excessive growth and effectively create a temporary limb length discrepancy. The most common example is the stimulation of growth at the proximal femur after a fracture in the shaft of the femur. This phenomenon allows the surgeon to accept some shortening in the treatment of these fractures, given that they would be expected to correct with time.

In contrast, a physeal injury can cause severe growth arrest and lead to limb length discrepancies and deformities that can require years of treatment to correct. The most devastating of these injuries is seen in the aftermath of pediatric infections. Septic arthritis of the hip leads to severe limb length discrepancies and loss of function and stability.

Please note many questions were asked recently in the entrance examination from this topic.

By Dr. Tushar Mehta

MBBS , DNB (Ortho), MNAMS, PGDCR, http://www.facebook.com/orthopaedicsplus.in

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