Wolff served with the Prussian campaign against Denmark in 1864, against Austria in 1866, and against France 1870/1871, and received the Iron Cross [5]. He completed his habilitation in 1868 and subsequently lectured at the University (“privatdocent”) and opened a private practice and then his own institute: Privatinstitut für orthopädische Erkrankungen. He became professor extraordinaire in 1884. Orthopaedics at the time was beginning to separate as a discipline from surgery, and in 1889 Wilhelm Waldeyer-Hartz (1836–1921), dean of the Charité, petitioned the government to incorporate Wolff’s Institute [4]. Various other faculty members (including the pathologist Rudolf Virchow, the surgeon Ernst von Bergmann, the internist Ernst von Leyden, and the pediatrician Eduard Enoch) who stood to benefit from Wolff’s research were supportive and in 1890, his institute was combined with the Friedrich Wilhelm Universität as a provisional private clinic with him as director; his institute became the Poliklinik für orthopädische Chirurgie in 1894. In 1899 he received an appointment as Privy Medical Councilor (Geheime Medizinalrat—reflecting outstanding contributions to medicine) in the medical school. The Poliklinik was then fully integrated into Charité in 1902 with a thirty bed unit only a few months before he died, three days after suffering a stroke [4].
“The law of bone remodeling is that mathematical law according to which observed alterations in the internal architecture and external form of bone occur as a consequence of the change in shape and/or stressing of bone.” (Translation mine, not that of Maquet and Furlong [10].) (“Es ist demnach unter dem Gesetze der Transformation der Knochen dasjenige Gesetz zu verstehen, nach welchem im Gefolge primärer Abänderungen der Form Inanspruch-nahme, oder auch bloß der Inanspruchnahme der Knochen, bestimmte, nach mathematischen Regeln eintetrende Umwandlungen der innerer Architectur und ebenso bestimmte, denselben mathematischen Regeln folgenden secondäre Umwandlungen der äusseren Form der betreffenden Knochen sich vollziehen.”)
Wolff briefly considered the tissue mechanisms by which remodeling might occur, and in particular that related to the active turnover of bone recognized by von Volkmann. He anticipated the role of cytokines and growth factors (“It is possible that some molecules from the debris of the product of inflammation are used to form the product of the remodeling process” [10]) and the role of what we now call the “regional acceleratory phenomena” described by Frost [2] (“The seat of the remodeling process is, besides the fracture site, everywhere in the fragments of the fractured bone and, in some circumstances, everywhere in the adjacent bones” [10]). Some of Wolff’s deductions are all the more remarkable when one realizes his observations were made prior to the discovery of xrays and modern techniques of tissue and cell biology. However, Wolff overlooked the fact that the concept of tensile and compressive stresses applies to solid structures while he was considering the overall organization of a nonsolid structure (trabeculae with intervening spaces). While he briefly discussed tissue changes, he ignored exploring the role of cells, a peculiar oversight given his acquaintance with Virchow.
However, Wolff essentially established the concept of bone adaptation occurring in response to mechanical stress. If the nascent ideas had existed in the literature prior to the two articles we reproduce here, Wolff unquestionably pursued them and made them (and ultimately his name) a part of today’s orthopaedic lexicon.
References
| 1. | Brand RA, Claes L. Book Review: Julius Wolff - The Law of Bone Remodelling. Translated by P. Maquet and R. Furlong. J Biomech. 1989;22:185–187. |
| 2. | Frost HM. The regional acceleratory phenomenon: a review. Henry Ford Hosp Med J. 1983;31:3–9. |
| 3. | Julius Wolff. 2009. Who Named It? Web site. Available at: http://www.whonamedit.com/doctor.cfm/2963.html. Accessed January 2, 2010. |
| 4. | Meyer B. Porträt: Mit ihm beginnt die eigenständige Orthopädie: Der Arzt Julius Wolff (1836–1902) 1997. Luisenstadtlicher BildungsVerein e.V. Available at: http://www.luise-berlin.de/bms/bmstxt97/9702pord.htm. Accessed January 25, 2010. |
| 5. | Mostofi SB, ed. Who’s Who in Orthopedics. Heidelberg, Germany: Springer-Verlag; 2005. |
| 6. | von Meyer. Die Architectur der Spongiosa. Reichert und Du Bois-Reymond’s Archiv. 1867;8:627. |
| 7. | Wolff J. Ueber die innere Architectur der Knochen und ihre Bedeutung für die Frage vom Knochenwachsthum. Virchows Archiv Pathol Anat Physio. 1870;50:389–450. |
| 8. | Wolff J. Zur Lehre von der Fracturenheilung. Langenbecks Arch Klin Chir Ver Dtsch Z Chir. 1873;2:546–551. |
| 9. | Wolff J. Das Gesetz der Transformation der Knochen. Berlin, Germany: Verlag von August Hirschwald; 1892. |
| 10. | Wolff J. The Law of Bone Remodelling. Berlin, Germany: Springer-Verlag; 1986. |

