The growth (i.e. increase of external dimensions) of long bones and vertebrae occurs longitudinally by endochondral ossification at the growth plates, and radially by apposition of bone at the periosteum. It is thought that mechanical loading influences the rate of longitudinal growth. The 'Hueter-Volkmann Law' proposes that growth is retarded by increased mechanical compression, and accelerated by reduced loading in comparison with normal values. The present understanding of this mechanism of bone growth modulation comes from a combination of clinical observation (where altered loading and growth is implicated in some skeletal deformities) and animal experiments in which growth plates of growing animals have been loaded. The gross effect of growth modulation has been demonstrated qualitatively and semi-quantitatively. Sustained compression of physiological magnitude inhibits growth by 40% or more. Distraction increases growth rate by a much smaller amount. Experimental studies are underway to determine how data from animal studies can be scaled to other growth plates. Variables include: differing sizes of growth plate, different anatomical locations, different species and variable growth rate at different stages of skeletal maturity. The two major determinants of longitudinal growth are the rate of chondrocytic proliferation and the amount of chondrocytic enlargement (hypertrophy) in the growth direction. It is largely unknown what are the relative changes in these key variables in mechanically modulated growth, and what are the signaling pathways that produce these changes.



Polls results
1

On a scale of 1 to 10, rate how much this article will change your clinical practice?

NO change
BIG change
88% Article relates to my practice (24/27)
3% Article does not relate to my practice (1/27)
7% Undecided (2/27)
2

Will this article lead to more cost-effective healthcare?

40% Yes (11/27)
48% No (13/27)
11% Undecided (3/27)
3

Was this article biased? (commercial or personal)

0% Yes (0/27)
96% No (26/27)
3% Undecided (1/27)
4

What level of evidence do you think this article is?

7% Level 1 (2/27)
11% Level 2 (3/27)
44% Level 3 (12/27)
18% Level 4 (5/27)
18% Level 5 (5/27)