Wrist Region Research Articles

Comparing Cervical Vertebra Maturation and Modified Middle Phalange of Finger Maturation(MP3) for Assessment of Pubertal Growth Spurt

Objective: To assess the pubertal growth spurt by keeping Cervical Vertebra Maturation Index as standard and comparing modified middle phalange of 3rd finger maturation (MP3) stages with it. Study Design: Comparative cross- sectional study. Place and Duration of Study: Orthodontic Department, Sandeman Provincial Hospital, Quetta Pakistan, from Jan to Jun 2019. Methodology: One hundred and ten patients, aged 9 to 19 years with an evident appearance of bones on radiograph. First four cervical vertebrae with evident inferior border were included. Patients with previous history of bone disease and major illness, muscular dystrophy cases, congenital malformation of hand, cervical vertebrae, and wrist region cases and low quality X-ray with poor contrast were excluded. Results: Cervical Vertebra Maturation Index and modified middle phalange of 3rd finger maturation (MP3) were occurring earlier in the females (36 patients (33%) & (36 patients (33%) respectively in the comparison of males (13 patients (11%) & (13 patients (12%) respectively; moreover, there was the significant association between the Cervical Vertebra Maturation Index and modified middle phalange of 3rd finger maturation (MP3) stages as found by the chi-square test (p-value= <0.001). Conclusion: The significant association was found in the Cervical Vertebra Maturation Index stages and the MP3 stages. Females showed earlier signs of physiological maturity with same chronological age.

Extravasation Identification and Management in Neonates and Pediatrics: A Cross Sectional Survey.

To explore current practice and guidelines surrounding the identification and management of extravasation injuries in Australian and New Zealand neonatal and pediatric settings. Between February and September 2023, an internet-based descriptive cross-sectional survey was distributed to Australian and New Zealand neonatal and pediatric clinicians using exponential nondiscriminative snowball sampling. Survey data domains included demographics, extravasation identification, management, local guidelines, and resources. Of the 141 responses, the majority of respondents were registered nurses (n = 96, 68.1%), with greater than 20 years of experience (n = 51, 36.2%). Over two-thirds of respondents had no extravasation identification and management training (n = 98, 69.5%). Half of the respondents (n = 70, 49.6%) reported that increased presentation of risk factors did not alter monitoring frequency. Extravasations were primarily associated with the hand and wrist region (n = 118, 43.7%). Maintenance fluids, antibiotics and parenteral nutrition accounted for extravasation events. Acute management practices (immediate cessation of infusion) showed consistency (n = 124, 87.9%), whereas varying degrees of adoption were observed for aspirating the residual fluid. The majority of respondents (n = 119, 84%) reported the absence of a formal grading scale for extravasation severity. Clinicians reported challenges and inconsistencies in neonatal and pediatric extravasation injury identification and management. This underscores the need for effective monitoring and identification, standardized management practices, and education to minimize the burdens of extravasation for patients, families, and the health care system.

Imaging of dorsal wrist pain.

Pain on the dorsal side of the wrist is a common clinical presentation, comparable to pain experienced on the ulnar and radial aspects of the wrist. The dorsal wrist region has distinct anatomical features and is associated with a wide spectrum of pathologies, including conditions affecting the bones, cartilage, ligaments, and tendons. Accurate diagnosis often depends on imaging techniques such as radiographs and ultrasound, with a growing trend towards the use of magnetic resonance imaging (MRI) for more detailed assessment of complex cases. The role of imaging in diagnosing dorsal wrist pain is expected to expand further in the future. To the best of our knowledge, there has not been a comprehensive review paper that specifically addresses the imaging findings related to dorsal wrist pain. This review aims to fill that gap by discussing the imaging characteristics of both common and uncommon pathologies that can cause dorsal wrist pain. It provides an overview of the most appropriate imaging modalities to evaluate various causes of dorsal wrist pain, highlights key imaging findings, and discusses differential diagnoses. By doing so, this review seeks to enhance the understanding and interpretation of imaging results, ultimately aiding in the accurate diagnosis and management of dorsal wrist pain. This comprehensive approach underscores the critical role of advanced imaging in contemporary clinical practice.

Designing a Hybrid Energy-Efficient Harvesting System for Head- or Wrist-Worn Healthcare Wearable Devices.

Battery power is crucial for wearable devices as it ensures continuous operation, which is critical for real-time health monitoring and emergency alerts. One solution for long-lasting monitoring is energy harvesting systems. Ensuring a consistent energy supply from variable sources for reliable device performance is a major challenge. Additionally, integrating energy harvesting components without compromising the wearability, comfort, and esthetic design of healthcare devices presents a significant bottleneck. Here, we show that with a meticulous design using small and highly efficient photovoltaic (PV) panels, compact thermoelectric (TEG) modules, and two ultra-low-power BQ25504 DC-DC boost converters, the battery life can increase from 9.31 h to over 18 h. The parallel connection of boost converters at two points of the output allows both energy sources to individually achieve maximum power point tracking (MPPT) during battery charging. We found that under specific conditions such as facing the sun for more than two hours, the device became self-powered. Our results demonstrate the long-term and stable performance of the sensor node with an efficiency of 96%. Given the high-power density of solar cells outdoors, a combination of PV and TEG energy can harvest energy quickly and sufficiently from sunlight and body heat. The small form factor of the harvesting system and the environmental conditions of particular occupations such as the oil and gas industry make it suitable for health monitoring wearables worn on the head, face, or wrist region, targeting outdoor workers.

Course of the extensor pollicis longus tendon considering the different functional positions of the wrist and the first ray-an anatomical study.

The aim of this anatomical study was to evaluate the course of the extensor pollicis longus (EPL) tendon, its positional relationship to adjacent structures, and the resulting clinical relevance under consideration of various functional positions. Twenty upper extremities from ten adult human cadavers embalmed using Thiel's method were included in this study. The greatest possible movement/slippage of the EPL tendon, the angle at which the tendon wraps around Lister's tubercle, and its course across the extensor carpi radialis longus and brevis (ECRL and ECRB) were recorded and defined in all functional positions. Our findings demonstrate ahigh range of motion of the tendon in relation to clinically relevant structures. Understanding the anatomical course of the EPL tendon, its potential extent of movement, and its resulting positional changes is essential for the diagnosis and surgical treatment of patients with complaints or injuries in the dorsoradial wrist region.

#865 Autologous cephalic vein transposition in the placement of forearm arteriovenous fistulas

Abstract Background and Aims The autologous vein transposition was commonly used for hemodialysis vascular access (VA) in selected patient. The saphenous vein was used as a vascular graft; while, the contralateral cephalic vein was used as a bridge. We describe a new technique of autologous cephalic vein transposition to create a native AVF in hemodialysis patients. Method Patients referred to our hospital for a vascular access placement. US vascular mapping of upper extremities revealed small arteries, but adequate forearm veins in all patients. Specifically, the radial artery luminal diameter was < 1.4 mm and < 1.6 mm, respectively at wrist and at middle-arm. While, at bend of the elbow, the ulnar artery diameter (>2.5 mm) in one case, and the brachial artery diameter (>3.5 mm) in two cases, were deemed adequate as feeding arteries of a possible AVFs. Furthermore, the diameter of the forearm cephalic vein ranged from 2.0 to 2.4 mm; in the upper arm the veins were obstructed or stenotic in one of the two arms. The basilic vein was patent in both arms of the patients; the internal diameter varied from 2.5 to 2.7 mm. Due to difficulty to create a traditional fistula, and higher risk of primary failure, it was decided to transpose the cephalic vein, from the forearm not suitable for the AVF, to the contralateral arm chosen for the AVF placement. Results With local anesthesia, an approximately 10-cm stretch of cephalic vein was harvested from the arm contralateral to the site chosen for AVF. Then, the transposed veins, reversed in their cranio-caudal position, were tunneled subcutaneously and anastomosed, in an end-to-end fashion, with cephalic vein at wrist region, and subsequently in a side-artery to end-vein at the elbow crease. The transposed AVFs were created in three patients with ESKD (2M/1F), mean age 47± 3.6 years, (two in the non-dominant arm), without complications. After 4 weeks, all the AVF were patent and the access flow was 660±120 ml/min. All the three AVF was deemed mature and usable for hemodialysis. Conclusion In selected cases, autologous transposition of the cephalic vein can be used to create an AVF, providing a long segment for cannulation. This type of AVF can be an alternative to prosthetic fistula, sparing the central venous catheter.

Convolutional Neural Network to Classify Infrared Thermal Images of Fractured Wrists in Pediatrics.

Convolutional neural network (CNN) models were devised and evaluated to classify infrared thermal (IRT) images of pediatric wrist fractures. The images were recorded from 19 participants with a wrist fracture and 21 without a fracture (sprain). The injury diagnosis was by X-ray radiography. For each participant, 299 IRT images of their wrists were recorded. These generated 11,960 images (40 participants × 299 images). For each image, the wrist region of interest (ROI) was selected and fast Fourier transformed (FFT) to obtain a magnitude frequency spectrum. The spectrum was resized to 100 × 100 pixels from its center as this region represented the main frequency components. Image augmentations of rotation, translation and shearing were applied to the 11,960 magnitude frequency spectra to assist with the CNN generalization during training. The CNN had 34 layers associated with convolution, batch normalization, rectified linear unit, maximum pooling and SoftMax and classification. The ratio of images for the training and test was 70:30, respectively. The effects of augmentation and dropout on CNN performance were explored. Wrist fracture identification sensitivity and accuracy of 88% and 76%, respectively, were achieved. The CNN model was able to identify wrist fractures; however, a larger sample size would improve accuracy.

Examining the Prevalence of Musculoskeletal Problems Related to Mobile Phone Usage and Providing Corrective Solutions to Dental Students of Jundishapur University of Medical Sciences, Ahvaz

Objectives: The present study aimed to assess the prevalence of musculoskeletal problems related to mobile phone usage and provide corrective solutions for dental students of Jundishapur University of Medical Sciences, Ahvaz. Methods: The current study was conducted based on an analytical cross-sectional design. In order to collect relevant data, such as the presence of pain in the upper limbs, back, and neck, questionnaires and instrumental methods were used. Students were examined in two groups: the first group included 150 dental students up to the 4th semester, and the second group encompassed 150 dental students from the 5th semester onwards (3rd, 8th, 5th, and 6th year). Data collection instruments were demographic characteristic form, nomophobia questionnaire (NMP-Q), neck disability index (NDI), and Cornell hand discomfort questionnaire (CHDQ). Results: According to the results of the present study, the prevalence of nomophobia among dental students of Jundishapur University of Medical Sciences in Ahvaz was at an average level. The mean NDI score was 16.20, and the mean pain score among the students was 1.72. Moreover, 46.5% of students had pain in the hand area, and the highest amount of pain was reported in the F area. The mean score of Cornell's musculoskeletal disorders was reported as 2.72. Conclusion: Examining the relationship between the pain area and the year of entry to the university demonstrated a significant relationship between the year of entry to the university and the pain area. In this regard, the incoming students 2021-22 had the greatest amount of pain. According to the results of the corrective intervention on skeletal disorders in the wrist and neck region, the mean scores of the variables increased significantly after the intervention and corrective measures.

Application of the Bair Hugger™ core body temperature at wrist region with upper body warming blanket: a prospective observational study.

Body temperature monitoring is essential during the perioperative period. However, core body temperature measurement requires invasive device that may cause complications. This study aimed to evaluate the accuracy of non-invasive Bair Hugger™ core body temperature monitoring system (BHTMS) at the wrist compared with esophageal temperature under general anesthesia. Twenty adult patients of the American Society of Anesthesiologists physical status I or II were enrolled. BHTMS sensor was applied at wrist region. After tracheal intubation, an esophageal probe was inserted. Bair Hugger™ upper body warming blankets were used. Esophageal temperature (Teso) and BHTMS at wrist (Twrist) were recorded every 10 min. Total of 257 pairs of data sets were analyzed: Teso and Twrist had no statistically significant difference (P = 0.103). Median of Teso and Twrist were 36.5°C and 36.4°C. Bland-Altman analysis showed Teso - Twrist of 0.14°C ± 1.44. Subsequently, 99 pairs of 0-40 min data set were analyzed and showed significant difference at 0 and 10 min (P < 0.001) but no significant difference at 20, 30 and 40 min. Bland- Altman plot by times showed difference (Teso - Twrist) of 1.49°C ± 2.00, 0.82°C ± 1.30, 0.29°C ± 1.32, -0.03°C ± 0.84, and -0.12°C ± 0.82 at 0, 10, 20, 30 and 40 min respectively. BHTMS at wrist area under the upper body warming blanket is a potential alternative other than esophageal temperature for monitoring body temperature after 30 min of anesthesia induction.

Comparison of Hand Grip Strength Between Physiotherapy Students and Dental Students

occupations, having a strong grip is a necessary requirement for success. Differences in the nature of the work,the workplace, and the things that professionals handle may be responsible for these behaviors. A good hand gripis highly helpful in a variety of hand-intensive occupations like physiotherapy and dentistry. Musculoskeletaldisorders, especially in the hand and wrist region, are common and have a great impact on work life.Purpose: The need for this study is to evaluate and compare the differences in hand grip strength betweenphysiotherapy and dental students and to see if clinical training for physiotherapy students and dental studentswill have an impact on their hand grip strength.Materials and methods: 100 subjects were selected from Saveetha Institute of Medical and Technical Sciencesbased on the selection criteria where 50 subjects were physiotherapy students(interns) and 50 subjects were dentalstudents(interns). The hand grip strength of the subjects was assessed with the help of a hand dynamometer andthe measurements were recorded. The entire study was conducted from November 2022 to March 2023.Result: The results of this study shows that there was a difference between both the groups and that physiotherapystudents have better hand grip when compared to the dental students.Conclusion: The results and the data obtained from this research concluded that grip strength of physiotherapystudents is more than that of dental students.

Fixation of Terrible Triad Fracture in Young Adult through Anterior Approach – A Case Report

Introduction: The terrible triad of the elbow is defined as the combination of fractures of the radial head and ulnar coronoid process and dislocation of the elbow joint, and is often associated with collateral ligaments injuries. Objective: The objective is to report the clinical outcomes of an anterior surgical approach for coronoid fracture with plate fixation in the management of a case of terrible triad fracture with undisplaced radial head. Case Details: A 23 years old male presented with complaints of pain and swelling in right wrist and left elbow region since 1 day. He had a history of fall from height 1 day back with no known comorbidities or DNVD. Conclusion: Terrible triad fracture can be treated successfully with plate fixation through an anterior surgical approach in cases of undisplaced radial head with physiological range of motion at elbow which allows for accurate reduction and rigid internal fixation and early functional exercise, resulting in a favourable outcome.

A Pyramid Deep Feature Extraction Model for the Automatic Classification of Upper Extremity Fractures.

The musculoskeletal system plays a crucial role in our daily lives, and the accurate diagnosis of musculoskeletal issues is essential for providing effective healthcare. However, the classification of musculoskeletal system radiographs is a complex task, requiring both accuracy and efficiency. This study addresses this challenge by introducing and evaluating a pyramid deep feature extraction model for the automatic classification of musculoskeletal system radiographs. The primary goal of this research is to develop a reliable and efficient solution to classify different upper extremity regions in musculoskeletal radiographs. To achieve this goal, we conducted an end-to-end training process using a pre-trained EfficientNet B0 convolutional neural network (CNN) model. This model was trained on a dataset of radiographic images that were divided into patches of various sizes, including 224 × 224, 112 × 112, 56 × 56, and 28 × 28. From the trained CNN model, we extracted a total of 85,000 features. These features were subsequently subjected to selection using the neighborhood component analysis (NCA) feature selection algorithm and then classified using a support vector machine (SVM). The results of our experiments are highly promising. The proposed model successfully classified various upper extremity regions with high accuracy rates: 92.04% for the elbow region, 91.19% for the finger region, 92.11% for the forearm region, 91.34% for the hand region, 91.35% for the humerus region, 89.49% for the shoulder region, and 92.63% for the wrist region. These results demonstrate the effectiveness of our deep feature extraction model as a potential auxiliary tool in the automatic analysis of musculoskeletal system radiographs. By automating the classification of musculoskeletal radiographs, our model has the potential to significantly accelerate clinical diagnostic processes and provide more precise results. This advancement in medical imaging technology can ultimately lead to better healthcare services for patients. However, future studies are crucial to further refine and test the model for practical clinical applications, ensuring that it integrates seamlessly into medical diagnosis and treatment processes, thus improving the overall quality of healthcare services.

Ergonomic Risk Assessment of Nigerian Teaching Personnel: Cases of a Secondary School and a Tertiary Institution in Ibadan, Nigeria

Educators often spend a lot of time carrying out repetitive motions of the upper limbs and prolonged standing on a daily basis, exposing them to hours of ergonomic risks. This is due to awkward postures, caused by significant deviation of some major body members from the normal neutral positions. Poor ergonomics can lead to various Musculoskeletal Disorders (MSDs), which are of serious concern for workplace safety, especially in jobs that require repetitive motions. It thus became necessary to assess the stress level associated with teaching postures and the prevalent musculoskeletal discomfort in different parts of the body. In this study, ergonomic assessment of teaching personnel at an International Secondary School and University of Ibadan, Nigeria was conducted to determine the prevalent musculoskeletal discomfort in different parts of the body. The study utilised two ergonomic assessment tools- Rapid Entire Body Assessment (REBA) and Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) to gather qualitative and quantitative data about posture and motions during teaching activities. It was discovered that both university lecturers and secondary school teachers in Nigeria face significant ergonomic risks, primarily in the neck, shoulders, and lower back. Further comparison revealed that educators in the secondary school experienced higher severity of musculoskeletal discomfort and exposure to MSD risks, compared to those in the tertiary institution. The educators of the International School had an average REBA score of 4.57, while those at the University of Ibadan had a score of 3.73. These scores indicated a medium level of MSD risk for both groups, but the educators of the International School were at a higher risk. On comparing the CMDQ outcome, it was discovered that there were major differences in the regions where discomforts were reported. While secondary school revealed higher average scores in the neck, right shoulder, and left shoulder regions, and with the neck region having a mean score of 7.003; right shoulder having a mean score of 4.550; and left shoulder having a mean score of 1.600; outcome from University of Ibadan revealed higher mean scores in the lower back and left wrist regions, with the lower back region having a mean score of 7.450 and left wrist region having a mean score of 1.030. These scores indicated a mild to moderate level of discomfort for both groups, with each facing major discomfort in unique body regions. This research highlights the significance of ergonomic evaluation and the combination of quantitative and qualitative data to identify potential interventions.

TW3-based ROI detection and classification using a chaotic ANN and DNN-EVGO architecture for an automated bone age assessment on hand X-ray images

ABSTRACT Bone illnesses arise at a young age itself, so bone age assessment (BAA) is primarily utilized in paediatrics to identify their growth. Several BAA-related methods are employed to determine bone maturity; however, they do not give accuracy and the rate of error increases. To overcome this issue, in this manuscript, TW3-based Region of Interest (ROI) identification and classification with Chaotic ANN (CANN), as well as Deep Neural Network optimized with Evolved Gradient Direction optimizer (EVGO) architecture, is proposed for an Automated BAA classification. In this, Hand X-Ray images are taken from the Digital Hand Atlas (DHA) dataset and the Radiological Society of North America (RSNA) database. Here, Tanner-Whitehouse (TW3) and Shallow convolution neural network (SCNN) is utilized for extracting the ROI regions such as radius, ulna, and short bones (RUS) from the wrist region of the left hand. After that, the extracted ROI feature data are given to CANN for predicting BAA. Then, the predicted data are classified using the DNN-EVGO network. The bone age evaluation is then classified depending on maturity phases. The proposed approach is activated in MATLAB. Simulation outcomes of TW3- SCNN- CANN- DNN-EVGO- BAA methods for DHA database attain higher accuracy of 45.75%, 37.64%, 24.64% when analysed to the existing models, such as Faster Region-Convolutional Neural network oriented feature learning with optimal trained Recurrent Neural Network for BAA for paediatrics (TW3-F-R-CNN-AF-SFO), Multi-objective segmentation approach for BAA under parameter tuning- U-net architecture, and TW3-based fully automated bone age assessment system using deep neural networks (TW3-F-R-CNN-VGGNet-CNN-BAA).

Ultrasound Imaging and Guidance for Distal Peripheral Nerve Pathologies at the Wrist/Hand.

Ultrasound has emerged as a highly valuable tool in imaging peripheral nerve lesions in the wrist region, particularly for common pathologies such as carpal tunnel and Guyon's canal syndromes. Extensive research has demonstrated nerve swelling proximal to the entrapment site, an unclear border, and flattening as features of nerve entrapments. However, there is a dearth of information regarding small or terminal nerves in the wrist and hand. This article aims to bridge this knowledge gap by providing a comprehensive overview concerning scanning techniques, pathology, and guided-injection methods for those nerve entrapments. The median nerve (main trunk, palmar cutaneous branch, and recurrent motor branch), ulnar nerve (main trunk, superficial branch, deep branch, palmar ulnar cutaneous branch, and dorsal ulnar cutaneous branch), superficial radial nerve, posterior interosseous nerve, palmar common/proper digital nerves, and dorsal common/proper digital nerves are elaborated in this review. A series of ultrasound images are used to illustrate these techniques in detail. Finally, sonographic findings complement electrodiagnostic studies, providing better insight into understanding the whole clinical scenario, while ultrasound-guided interventions are safe and effective for treating relevant nerve pathologies.

A favorable donor site in microsurgery: Nerve and vein graft harvest from the dorsum of the foot.

In complex hand traumas nerves and vessels are often destructed without the possibility for primary repair. For bridging defects of nerves, veins and arteries grafts are necessary. Commonly nerve and vein grafts from adjacent donor sites as the wrist, forearm or cubital region are harvested. This study is a retrospective cohort study. Between 2017 and 2019, 10 patients with complex hand injuries were treated. There were 8 males and 2 females, with an average age of 39 years (range 8-63 years). In all cases grafts were used of the dorsum of the foot for reconstructing of the severed digital nerves and arteries. All donor sites could be closed primarily. In 100% of cases nerves and veins of the dorsum of the foot showed a good size match as well as adequate length for a sufficient repair. The overall Hand Injury Severity Score (HISS) was determined with a median of 86 (range 57 to 286). In the area of the donor site no relevant complications were seen. In complex hand injuries the dorsum of the foot is a favorable donor site for nerve and vein graft harvest.

Dual-Channel Capsule Generative Adversarial Network Optimized with Golden Eagle Optimization for Pediatric Bone Age Assessment from Hand X-Ray Image

Bone age assessment (BAA) is mainly utilized for detecting the growth of pediatrics because a large number of bone diseases occur at young age. Several algorithms related to BAAs were used for detecting the maturity of bones, but it does not provide sufficient accuracy, and also increased the error rate. To deal with these problems, the dual-channel capsule generative adversarial network optimized with Golden eagle optimization (GEO) is proposed in this paper for pediatric BAA from hand X-ray image (DCCGAN-GEO-BAA-HX-ray). Initially, the input hand X-ray imageries are collected from the dataset of Radiological Society of North America (RSNA) pediatric bone age (BA). Then, region of interest (RoI) of input hand X-ray imageries is segmented based on Tsallis entropy-based multilevel 3D Otsu thresholding (TE-3D-Otsu). Here, TE-3D-Otsu method segments the RoI region of wrist, thumb, middle finger, little finger, which enhance the classification accuracy. Moreover, the segmented RoI is given to DCCGAN that predicts the BAA. Generally, the DCCGAN does not reveal any adoption of optimization methods to scale the optimum parameters to ensure accurate classification. Therefore, GEO is used for optimizing the weight parameters of DCCGAN. The proposed DCCGAN-GEO-BAA-HX-ray method is executed in MATLAB and its performance is examined under performance metrics such as accuracy, precision, sensitivity, F-scores, specificity, concordance correlation coefficient (CCC) and computational time. Finally, the proposed DCCGAN-GEO-BAA-HX-ray approach attains 14.68%, 7.142%, 9.23% and 4.65% higher accuracy, 38.18%, 12.02%, 11.56% and 7.59% lower computational time is compared with existing FRCNN-AF-SFO-BAA-HX-ray, DCNN-W-CTO-BAA-HX-ray, CNN-MLP-BAA-HX-ray and CNN-BAA-HX-ray methods.

Bone-specific median age of hand-wrist maturation from Sudan

Background Maturation of bones in the hand–wrist region varies among individuals of the same age and among world groups. Although some studies from Africa report differences to other ethnic groups, the lack of detailed bone-specific maturity data prevents meaningful comparisons. Aim The aim of this study was to describe bone-specific maturity for developing hand–wrist bones in individuals in Khartoum, Sudan. Subjects and methods The sample was selected from healthy patients attending a dental hospital in Khartoum with known age and ancestry (males = 280, females = 330; aged between 3 and 25 years). Bones were assessed from radiographs of the left hand and wrist after the Greulich and Pyle Atlas (1959). Median ages of attainment for bone stages were calculated using probit analysis for each stage in males and females separately. Results Maturity data for stages of the phalanges, metacarpals, carpals and radius and ulna in males and females are presented. Median ages in females were earlier compared to males for all stages. These results are largely earlier than previously published findings or where these could be calculated. Conclusion These results of individual maturity stages of phalanges, metacarpals, carpals and the distal epiphyses of the radius and ulna are useful to assess maturity in growing individuals from Sudan.

ANÁLISE SOBRE O MÉTODO DE TACADA E A FORÇA DO PULSO DE TENISTAS ESTUDANTES

ABSTRACT Introduction: Wrist joint strength is important in tennis for angle control and racquet direction. Objective: Study the changes in muscle strength in the wrist region and the characteristics of joint movement under different tennis stroke styles. Methods: 50 students from a professional tennis club team at a university were selected as study subjects, and systematic professional wrist strength training was performed in the experimental group. In contrast, routine training was performed in the control class. The experimental training lasted for six weeks. During this period, the learning time of all groups remained the same, and no additional training or learning was added. Results: The experimental group's stability increased significantly, from 1.78 ± 0.67 to 2.25 ± 1.34 before training, and backstroke strength increased significantly, from 6.21 to 10.21; total stroke score also increased from 8.02 to 12.69. Conclusion: Improving wrist strength in tennis students may improve overall sports performance. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Fibrolipomatous Hamartoma of the Median Nerve: A Case Report

Fibrolipomatous hamartoma, also known as fibrofatty overgrowth or perineural lipoma, or neural fibrolipoma, is a rare, benign, congenital lesion that occurs due to an abnormal overgrowth of mature fat and fibroblasts within the perineurium. This leads to the expansion of the nerve and separation of fascicles. It is more commonly observed in the median nerve at the wrist or hand level. Here, the authors presented the case of a 32-year-old female patient, who complained of swelling in the left wrist region for the past two years. The swelling gradually increased in size over one year and caused pain and paresthesia. Magnetic Resonance Imaging (MRI) of the left wrist revealed fibrolipomatous hamartoma of the median nerve. Surgical management was advised, but the patient declined and opted for conservative treatment for two months. Knowledge of this rare condition helps radiologists make an accurate diagnosis and may eliminate the need for invasive biopsy.