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General Orthopaedics

THE ‘OSTEOSTASIS’ AND ITS FIVE PRINCIPLES: APPLICATION IN LIMB LENGTHENING

The British Limb Reconstruction Society (BLRS) Annual Meeting 2024, Glasgow, Scotland, 14–15 March 2024.



Abstract

Introduction

Humans Functions (locomotion, protection of organs, reproduction) require a strong support system (bones). The ‘Osteostasis’ is the ability of maintaining the bone structure, its mechanical characteristics and function. Five principles are required for an efficient bone system:

Basic Requirements:

1) Stability and 2) Function. Repair System (like house building in desert or sea):

3) Roads (vessels), 4) Materials (calories, proteins), 5) Workers (bone cells).

Analysis of bone problems through these principles bring to optimised treatments.

Materials & Methods

Measurements (>700 lengthening, 32-year follow-up, Full WB Albizzia/G-Nails FWBAG): Bone-DEXA, WB conditions, muscle, fat, etc.

Principle-1. Solid bone replacement with a 100% biocompatible and reliable FWBAG with sports (POD0).

Principle-2. Bone, Muscle & neural integrity for function Principle-3. Vascular flow lesions induce non-healing (arteriography). Muscle activity accounts for 90% of bone blood flow, ×10 by sports. Required: Checks (arteriography) and treatments (training)

Principle-4. Food (NRV Kcal × 2–3, 20–25% proteins).

Principle-5. Maintain bone cells and increase them. Suppress ‘opening’, ‘venting’, ‘drainages’.

Results

Principle1. Nail fracture (1.2%), nail dysfunction (0%) with FWBAG.

Principle2. Intensive sports preop and from POD0 - Principle3. Increased preop vascular supply & muscle force, postop resistance sports fasten recovery. Wheel-chair or low activity decreases healing.

Principle4. 6–9 cm circumference loss (non WB-nails or no proper training); 0 cm circumference loss (gain <10 cm) with intense resistance training + high calory intake. - Principle5. Bone cells preservation (no opening, IM saw, increasing bone cells) allow Healing Index down to 8D/cm.

Conclusions

The ‘5P’ allow reaching treatment targets by optimisation of problem solving, maintaining Osteostasis. What would I like or tolerate for me? How can I reach it? Full WB and sports from POD0 was a target 38 years-ago, still not enforced by most of us. Resistance sports, high-calory intake suppress muscle loss and fasten healing, thanks to muscle blood flow and the ‘5P’.