Re-engineering Colles: Form, function and fragility fractures

Abstract

Of the twenty nine anatomy professors in the Royal College of Surgeons in Ireland, primus inter pares is Abraham Colles. In his 1811 book A Treatise on Surgical Anatomy he revolutionised the subject by teaching it topographically, seeking "to describe the relative position of the parts and to point out the subservience of anatomical knowledge to surgical practice". Today we have extended this to 'clinical practice' and, in the Anatomy Room, students are guided through each region by clinically trained staff, from surface anatomy via three-dimensional dissection to radiological images. This is augmented by online histology and radiology courses and DVDs in which dissection footage, edited by a content analysis engine, is used to preview and review practical classes. In the same book, Colles also wrote that 'the fixed and immutable laws of mathematics are little applicable to the science of medicine'. Computer-aided learning argues against this. So does research which links fatigue microdamage to bone remodelling and the development of algorithms to predict, and thus prevent, osteoporotic fractures. Mechanical principles are being used to develop scaffolds for tissue engineering and to optimise the mechanical environment of seeded mesenchymal stem cells. While Colles' teaching approach holds true, in biomechanics, tissue engineering and computing, mathematical laws are now being successfully applied to medical science.