Radiological Assessment of Hand and Wrist Bones in Malnourished Children

Abstract

Abstract Background Protein energy malnutrition (PEM) is still an important health problem that is responsible for childhood morbidity and mortality leading to permanent impairment of physical and mental growth. Objective This study is designed to assess the appearance of ossification centers of lower end of radius and ulna, carpals, metacarpals and phalanges in normal children and malnourished children then comparing between them, to detect early changes in bone growth in malnourished children. Subjects and Methods This case-control cross-sectional study included 45 malnourished children and 45 age and sex matched controls whose ages ranged between 6 months and 5 years. The patients were recruited from Pediatric Nutrition Clinic of Ain Shams University. All children (malnourished and control) were examined for anthropometric parameters (weight, height, body mass index (BMI) and mid upper arm circumference (MUAC)), investigated for serum calcium, phosphorus, alkaline phosphates and had a plain X-ray done on left hand and wrist (posteroanterior (P-A) view), the X-ray was analyzed by using A Digital Atlas of Skeletal Maturity. Results The plain X-ray hand and wrist showed delayed appearance of ossification centers in malnourished infants and children (97.8% had delayed bone age) when compared to controls (25.5% had delayed bone age) which was statistically highly significant with P-value < 0.01. Signs of vitamin D deficiency rickets together with serum calcium, phosphorus and alkaline phosphatase were statistically significantly lower in the cases when compared to the controls with P-value < 0.01. The statistical measurements of mean ± SD regarding weight of case group and control group was (9.05 ± 2.48, 13.54 ± 3.81) with P-value < 0.01 which is highly significant, regarding length or height was (79.51 ± 12.78, 88.94 ± 15.02) with P-value < 0.01 which is highly significant, regarding MUAC was (11.38 ± 1.91, 16.02 ± 1.26) with P-value < 0.01 which is highly significant. Conclusion X-ray hand and wrist for malnourished infants and children showed delayed appearance of ossification centers when compared to matched controls.