Hand-wrist Bone Research Articles

Digital radiographic evaluation of hand-wrist bone maturation and prediction of age in South Indian adolescents.

In the growing years, indicators of the level of maturational development of the individual provide the best means for evaluating biologic age and the associated timing of skeletal growth. The relative stage of maturity of a child may be determined by comparing the child's hand-wrist radiograph to the known standards of skeletal development. In this study, we assessed various levels of skeletal maturation and also identified the relationship between chronological age (CA) and maturation stage using the hand-wrist radiographs in adolescents of Indian origin. Three hundred and thirty hand-wrist digital radiographs of individuals aged 8 to 18years were evaluated for skeletal maturity levels using Fishman's method. The data was analysed using the SPSS software package (version 12, SPSS Inc., Chicago, IL, USA). Regression analysis was performed for calculating bone age of both males and females. Spearman's rank-order correlation coefficients were estimated separately for males and females to assess the relation between CA and maturation level. An association between skeletal maturation indicator stages and CA (r = 0.82) was significant. Interestingly, female subjects were observed to be advanced in skeletal maturity compared to males. Regression equations were derived to calculate bone age in males, females and the whole sample. The results of this study showed significant association between hand-wrist skeletal maturation levels and CA. Digital radiographic assessment of hand-wrist skeletal maturation can be used as a better choice for predicting average bone age of an individual because of its simplicity, reliability and lesser radiation exposure.

An Evaluation of Skeletal Maturation by Hand-Wrist Bone Analysis and Cervical Vertebral Analysis: A Comparitive Study

An Evaluation of Skeletal Maturation by Hand-Wrist Bone Analysis and Cervical Vertebral Analysis: A Comparitive Study

The frontal sinus enlargement as an indicator of growth maturity in class III patients- A pilot study

Background: Diverse indicators have been used to predict growth in children. Skeletal parameters, such as hand wrist bones ossification, have been considered to cause an additional radiation exposure. To avoid such situation, new approaches as the cervical vertebrae maturation have been proposed. Aims & Objective: The aim of this study was to investigate a correlation between the enlargement of the frontal sinus and the body height peak in Angle Class III patients, and whether a sinus peak would serve as an indicator of growth maturity. Material and Methods: 20 Class III female patients were selected. Records of body height and serial lateral cephalograms taken for orthodontic treatment from 7 to 17 years old were used. By using the method of Ertuk, the Nasion – Sella line was oriented and the peripheral border of the sinus was traced. The highest (Sh) and the lowest (Sl) points related to S-N line were located. A perpendicular line to Sh-Sl was drawn and the maximum width of the sinus was assessed. Tracings were analyzed and the sinus growth was determined. Results: The frontal sinus enlargement was closely related to body height. One year after the body height peak occurred, the frontal sinus also reached a peak that coincided with the maximum amount of sinus width enlargement. The frontal sinus growth peak velocity was about 1.02mm/yr. Nevertheless, there was a small remaining growth one year after the sinus peak in few cases. Conclusion: Because of the close relationship between the body height growth and the enlargement of frontal sinus during puberty, the frontal sinus development could be used as an indicator of growth maturity.

Objective Evaluation of Cervical Vertebral Bone Age— Its Reliability in Comparison with Hand-Wrist Bone Age: By TW3 Method

The aim of this study was to establish the validity of a new method for evaluating skeletal maturation by assessing the 3rd and 4th cervical vertebrae seen in the cephalometric radiograph. This study consisted of a sample of 50 patients in the age group of 8 to 14 years of age. Chronologically, they were divided into six groups, based on the age consisting of a minimum of six to a maximum of 10 subjects. All the patients included in the study were females. The selected subjects were clinically examined and then age and date of birth of the patient in years and months was noted. Then lateral cephalograms and hand-wrist radiographs of the patient were taken on the same day with good clarity and contrast. The results suggested that cervical vertebral bone age on cephalometric radiographs calculated with this method is as reliable at estimating bone age as is the Tanner-Whitehouse 3 (TW3) method on hand-wrist radiographs. By determining the cervical vertebral bone age, skeletal maturity can be evaluated in a detailed and objective manner with cephalometric radiographs. The ability to accurately appraise skeletal maturity from cervical vertebral maturation, without the need for additional radiographs, has the potential to improve orthodontic diagnostic and therapeutic decisions. The technique's simplicity and ease of use should encourage this method as a frst level diagnostic tool to assess skeletal maturation. Clinical signifcance: This study revealed that the timing and sequence of ossifcation of the bones in hand and wrist and cervical vertebrae were able to relate the skeletal development of the various skeletal maturity indicators to a child's development. This method provided a mean with which one can determine the skeletal maturity of a person and thereby determine whether the possibility of potential growth existed.

An Evaluation of Skeletal Maturation by Hand-Wrist Bone Analysis and Cervical Vertebral Analysis: A Comparitive Study

Objective: To evaluate the reproducibility of the concordance between skeletal maturity index stages of hand-wrist radiograph (Fishman) and cervical vertebral maturity index stages of lateral cephalogram (Hassel and Farman). Materials and methods: A radiographic hand-wrist bone analysis and cephalometric cervical-vertebral analysis of 48 patients (24 males and 24 females; 7–18 years of age) were examined. The hand-wrist bone analysis was evaluated by the Fishman index, whereas the cervical vertebral analysis was assessed by the Hassel and Farman (CVMI) method. These measurements were then compared with the hand-wrist bone analysis, and the results were statistically analyzed by the Cohen  concordance index. Results: The Cohen  index obtained (mean ± SD) was 0.70 ± 0.02, which is in the good range of agreement. The results also show a correlation of CVMI I with Fishman stages 1-2, CVMI II with Fishman stages 3-4, CVM III with Fishman stages 4-5, CVMI IV with Fishman stages 6- 7,CVMI V with Fishman stages 9-10 and CVMI VI with Fishman stage 11.

Bone age estimation by cervical vertebral dimensions in lateral cephalometry

ObjectivesA critical issue in contemporary orthodontics is bone age estimation. The most reliable method for skeletal age evaluation is hand–wrist radiography; but it requires further radiation. There is an increasing attention for evaluating cervical vertebrae to reduce the radiation to the patients. The aim of this study was to estimate bone age by measuring 3rd and 4th cervical vertebrae (C3, C4) dimensions. Materials and methodsWe conducted a correlational study on 91 Iranian individuals aged 8-18 years. After taking lateral cephalometry and hand-wrist radiographs, C3 and C4 were measured using Vixwin 2000 software. Hand-wrist bone age, determined on Greulich Atlas, was the reference test. Stepwise multiple linear regression model demonstrated the correlation between the two measurements. ResultsAnterior height of the fourth cervical vertebrae (AH4) had the strongest simple correlation with hand-wrist bone age (r=0.831, P<0.001) and was the only variable that remained in stepwise multivariate regression model. The regression model was:Bone age=0.989×AH4+3.308. Adjusted R2 was 0.686 (p<0.001). ConclusionsLateral cephalometric radiographs are useful for bone age estimation, and might be an alternative for hand-wrist radiography, with the advantage of radiation reduction.

Computer-assisted analysis of cervical vertebral bone age using cephalometric radiographs in Brazilian subjects

The aims of this study were to develop a computerized program for objectively evaluating skeletal maturation on cephalometric radiographs, and to apply the new method to Brazilian subjects. The samples were taken from the patient files of Oral Radiological Clinics from the North, Northeast, Midwest and South regions of the country. A total of 717 subjects aged 7.0 to 15.9 years who had lateral cephalometric radiographs and hand-wrist radiographs were selected. A cervical vertebral computerized analysis was created in the Radiocef Studio 2 computer software for digital cephalometric analysis, and cervical vertebral bone age was calculated using the formulas developed by Caldas et al.17 (2007). Hand-wrist bone age was evaluated by the TW3 method. Analysis of variance (ANOVA) and the Tukey test were used to compare cervical vertebral bone age, hand-wrist bone age and chronological age (P < 0.05). No significant difference was found between cervical vertebral bone age and chronological age in all regions studied. When analyzing bone age, it was possible to observe a statistically significant difference between cervical vertebral bone age and hand-wrist bone age for female and male subjects in the North and Northeast regions, as well as for male subjects in the Midwest region. No significant difference was observed between bone age and chronological age in all regions except for male subjects in the North and female subjects in the Northeast. Using cervical vertebral bone age, it might be possible to evaluate skeletal maturation in an objective manner using cephalometric radiographs.

Relationship Between Age at Menarche and Skeletal Maturation Stages in Taiwanese Female Orthodontic Patients

Background/Purpose The age at menarche reflects a pubertal girl's physiologic maturity. The aims of this study were to evaluate the relationship between the age at menarche and skeletal maturation in female orthodontic patients. Methods Hand-wrist radiographs and lateral cephalometric radiographs from 304 adolescent female subjects (age, 8–18.9 years) were selected from the files of the Department of Orthodontics, National Taiwan University Hospital (NTUH). Hand-wrist bone maturation stages were assessed using the NTUH Skeletal Maturation Index (NTUH-SMI). Cervical vertebral maturation stages (CVMS) were determined using the latest CVMS Index. Menarcheal ages were self-reported by the patients and verified by the patients' mothers. The relationships between the NTUH-SMI or CVM stages and menarcheal status were investigated. Results More than 90% of the 148 subjects who had already attained menstruation had skeletal maturation beyond the NTUH-SMI stage four or CVMS III. However, the subjects who had never experienced menarche mostly had skeletal maturation before NTUH-SMI stage five or CVMS IV. During the period of orthodontic treatment, 19 females experienced their menarche. The mean age at menarche for the 167 female patients in total was 11.97 years. In average, menarche occurred between NTUH-SMI stages four and five or between CVM stages III and IV. The percentage of girls with menses increased from 1.2% at age 9 to 6.6% at age 10, 39.5% at age 11, 81.4% at age 12, 97% at age 13, and 100% at age 14. Compared with the results obtained 20 years previously, we found a downward shift of 0.47 years per decade for the mean age at menarche in female orthodontic patients. Conclusion The majority of female orthodontic patients have passed the pubertal growth spurt when they experience their menarche. Menarche usually follows the pubertal growth spurt by about 1 year and occurs after NTUH-SMI stage four or CVMS III.

Radiographic Assessment of Skeletal Maturation Stages for Orthodontic Patients: Hand-wrist Bones or Cervical Vertebrae?

The skeletal maturation status of a growing patient can influence the selection of orthodontic treatment procedures. Either lateral cephalometric or hand-wrist radiography can be used to assess skeletal development. In this study, we examined the correlation between the maturation stages of cervical vertebrae and hand-wrist bones in Taiwanese individuals. The study group consisted of 330 male and 379 female subjects ranging in age from 8 to 18 years. A total of 709 hand-wrist and 709 lateral cephalometric radiographs were analyzed. Hand-wrist maturation stages were assessed using National Taiwan University Hospital Skeletal Maturation Index (NTUH-SMI). Cervical vertebral maturation stages were determined by the latest Cervical Vertebral Maturation Stage (CVMS) Index. Spearman's rank correlation was used to correlate the respective maturation stages assessed from the hand-wrist bones and the cervical vertebrae. The values of Spearman's rank correlation were 0.910 for males and 0.937 for females, respectively. These data confirmed a strong and significant correlation between CVMS and NTUH-SMI systems (p less than 0.001). After comparison of the mean ages of subjects in different stages of CVMS and NTU-SMI systems, we found that CVMS I corresponded to NTUH-SMI stages 1 and 2, CVMS II to NTUH-SMI stage 3, CVMS III to NTUHSMI stage 4, CVMS IV to NTUH-SMI stage 5, CVMS V to NTUH-SMI stages 6, 7 and 8, and CVMS VI to NTUH-SMI stage 9. Our results indicate that cervical vertebral maturation stages can be used to replace hand-wrist bone maturation stages for evaluation of skeletal maturity in Taiwanese individuals.

A Comparison of Hand-wrist Bone and Cervical Vertebral Analyses in Measuring Skeletal Maturation

To compare skeletal maturation as measured by hand-wrist bone analysis and by cervical vertebral analysis. A radiographic hand-wrist bone analysis and cephalometric cervical vertebral analysis of 30 patients (14 males and 16 females; 7-18 years of age) were examined. The hand-wrist bone analysis was evaluated by the Bjork index, whereas the cervical vertebral analysis was assessed by the cervical vertebral maturation stage (CVMS) method. To define vertebral stages, the analysis consisted of both cephalometric (13 points) and morphologic evaluation of three cervical vertebrae (concavity of second, third, and fourth vertebrae and shape of third and fourth vertebrae). These measurements were then compared with the hand-wrist bone analysis, and the results were statistically analyzed by the Cohen kappa concordance index. The same procedure was repeated after 6 months and showed identical results. The Cohen kappa index obtained (mean +/- SD) was 0.783 +/- 0.098, which is in the significant range. The results show a concordance of 83.3%, considering that the estimated percentage for each case is 23.3%. The results also show a correlation of CVMS I with Bjork stages 1-3 (interval A), CVMS II with Bjork stage 4 (interval B), CVMS III with Bjork stage 5 (interval C), CVMS IV with Bjork stages 6 and 7 (interval D), and CVMS V with Bjork stages 8 and 9 (interval E). Vertebral analysis on a lateral cephalogram is as valid as the hand-wrist bone analysis with the advantage of reducing the radiation exposure of growing subjects.

Bone age in children with hemiplegic cerebral palsy.

Children with hemiplegic cerebral palsy may develop differences in limb length; when severe, limb length equalization may be recommended. Serial bone ages are necessary to predict when to perform equalization procedures. By convention, the left hand is always used to determine bone age. There is little information regarding the effect of hemiplegia on bone age. It was postulated that children with left hemiplegia will show a delay in bone age compared with those with right hemiplegia, and it was the purpose of this study to review this question. A retrospective review of 38 children (27 boys, 11 girls) with hemiplegic cerebral palsy between 1980 and 2000 was performed. The hemiplegia involved the right side in 21 and the left side in 17. The hand-wrist bone age was determined by one observer using the Greulich and Pyle atlas. The paired t test was used to analyze for differences between bone age and chronologic age. There was no difference between the average chronologic age (12.0+/-3.5 years) and average bone age (12.0+/-3.7 years) (P=0.83). There was no difference between the chronologic and bone age for either those with right hemiplegia (P=0.65) or left hemiplegia (P=0.87). It is not necessary to obtain radiographs of both hands in children with hemiplegia during routine monitoring of limb length discrepancies.

Analysis of Bone Age Data From National Cooperative Growth Study Substudy VII

National Cooperative Growth Study substudy VII was conducted 1) to compare standardized hand-wrist and knee bone age determinations in pubertal children treated with growth hormone (GH); 2) to compare local determinations of bone ages with centrally determined bone ages; 3) to relate the response to GH therapy to the bone age determinations; and 4) to ascertain the predictive value of each type of bone age determination. Eligible subjects were those in the National Cooperative Growth Study who were at Tanner pubertal stage 2 or greater for breasts (girls) or genitals (boys). Radiographs of the hand-wrist were taken annually, and radiographs of the knee were taken at the beginning and the end of the study. Separate bone age determinations were made from these radiographs. A combined hand-wrist and knee bone age determination also was derived. There were 990 patients in the study; in 925 (677 boys), there were both hand-wrist and knee bone age determinations from the baseline pubertal radiographs. There was only one radiographic assessment in 496 patients, two in 205 patients, and three to eight in the remaining patients. The strongest correlation was between the hand-wrist bone age and the hand-wrist plus knee bone age (r =.995). Also strongly correlated were knee with hand-wrist (r =.872) and knee with hand-wrist plus knee (r =.914). For none of these bone age methods was any statistically significant difference found between the methods. The locally determined bone ages correlated strongly with the centrally determined bone ages for knee (r =.850), hand-wrist (r =.928), and hand-wrist plus knee (r =.930); however, the locally determined knee and hand-wrist values were less (by approximately 0.3 year) than the centrally determined values. These differences, however, do not appear to be clinically significant.

BONE AGE (BA) AS PERFORMED BY THE TANNER-WHITEHOUSE (TO) METHOD. IIL RELIABILITY OF THE 5B-TECHNIQUE.

In the II Latin American Symposium on Pediatric Endocrinology (Buenos Aires, 1986) a short-cut method -the 5B technique- for radiographic BA estimation was discussed. Five hand-wrist bones were chosen:the epiphyseal proximal phalange of the fifth finger (5), the great bone (G), the trapezius bone (T), the distal epiphysis of the radius (R), and the distal epiphysis of the ulna (U). Scores were calculated as follows: P (t)=P (R)+P (U)+11P(5)+4P (G)+3P (T);were P(t) was the total score and P the scores for each bone. In the present study, 5B was compared against TW1, TW2, RUS and CAR methods by analysis of variance and Tukey test for unequal sample sizes. Non significant differences were obtained when 5B-mean bone ages were compared against those from TW1 and TW2 methods. 5B-means gave, however, highly significant differences when compared against those from the RUS and CAR methods. It was concluded that: (a)BA estimation by the 5B-technique is as reliable as -and easier to do than- those from both TW variants; (b)RUS and CAR methods estimate BA differently than 5B and TW ones.

The Tanner-Whitehouse II Skeletal Maturity Method: Rationale and Applicability

The problem of skeletal maturity assessment is to measure, stage by stage, the metamorphosis of the cartilaginous and membranous skeleton of the foetus into the fully ossified bones of the adult. Whilst skeletal maturation is a continuous process its assessment requires the identification of discrete indicators of development that are sequential, invariate between individuals, universal, and that cover the full range of development from birth to full maturity. The Tanner-Whitehouse II method is a bone-specific scoring technique in which a numerical score is assigned to selected hand-wrist bones depending on the appearance of certain well defined maturity indicators. The advantage of this technique over previous Atlas methods is that the maturational differences between bones is statistically minimised thus reducing disagreement between bones. The resulting bone maturity score is indicative of a specific maturational level in the sample to which the bone maturity scores are compared. Whilst the TW II technique has been applied to a variety of samples from many countries it is accepted that population and geographic differences exist in rate of maturation and that, therefore, there is a need to develop population specific “standards”. Such national standards would allow the sensitive diagnosis and treatment of children with growth disorders.