BONE GROWTH AND MATURATION

ALEX F. ROCHE

1. Introduction.

Growth is commonly defined as increase in size, but more specificity is needed. An

increase in size of the whole body or of an organ such as bone may be caused by one or a
combination of three processes: (1) Hyperplasia, or an increase in cell number, wich
involves duplication of DNA and cellular division; (2) Hypertrophy, or an increase in cell
size, with true hypertrophy implying an increase in the size of the active functional
elementsof a cell, such as occurs in skeletal muscle with exercise; and (3)Storage of
organic or nonorganic materials within or among cells. Each of these three processes
occurs during bone growth, but the extent to which any one of them dominates depends
on age or maturity and a part of the bone considered.

Furthermore, these processes are often reversed in localized areas. While the overall
change is an increase in size, some parts of a bone may become smaller or may be
removed completely. In such areas, there is reduction in cell number or cell size or in the
amounts of organic or nonorganic material that are stored. Commonly, all these processes
are combined.

Maturation is a more difficult concept. A widely used American dictionary defines

maturation as: the process of becoming mature. Unfortunately that source defines
mature as having undergone maturation. In regard to bone, maturation refers to
sequential alterations in this tissue as it changes from an embryonic anlage of a bone until
each of its parts attains adilt from and functional lecel. The characteristics of adult
maturity are common to all norma lyoung adults and do not show individual variation.

This chapter considers the growth and maturation of a typical long bone and an
irregularly shaped bone from early prenatal period to early adulthood. The changes
during the growth and maturation of these typical bones occur in most other parts of the
skeleton, with modifications that involve the extent and timing of the changes rather than
their type or sequence. Separate descriptions are necessary for two complex regions: the
craniofacial area and the pelvis. The former area is considered elsewhere in this treatise
(Chapter 11), while the latter has been described in detail by several workers, including
Reynolds (1945, 1947), Harrison (1958a.b, 1961), Coleman (1969), Moerman (1981,
1982). Attention is not given to factos that regulate bone growth- these have received
adequate attention elsewhere, e.g., Bourne (1971), Ritzen et al. (1981), and Krabbe et al.
(1982).
2. Prenatal Growth and Maturation of a Long Bone

The following description is appropriate for most long bones, although the timing of
changes differs among these bones. Timing before birth is expressed as postconceptional
age. Some alternative schemes are based on either crown- rump length or maturity
horizons of Streeter(1951); all these classification criteria are closely correlated.