Assessment of two entry points for S2 alar-iliac screw in a Japanese cohort using three-dimensional computed tomography scan.

BACKGROUND CONTEXT: Lumbosacral fusion supplemented with sacropelvic fusion has recently been increasingly employed for correcting spinal deformity and is associated with lower incidence of pseudarthrosis and implant failure. To date, few studies have evaluated anatomical parameters and technical feasibility between different entry points for S2 alar-iliac screws. PURPOSE: To compare anatomical parameters and technical feasibility of two entry points for the S2 alar-iliac screw (S2AIS) in a Japanese cohort using three-dimensional (3D) computed tomography (CT). STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Fifteen men and 15 women aged 50-79 years who underwent pelvic CT at our hospital in 2013. OUTCOME MEASURES: Screw length, lateral angulation, caudal angulation, angle range, distance from the entry point to the sacroiliac joint, distance from the S2AIS to the acetabular roof, distance from the S2AIS to the sciatic notch, and insertion difficulty. METHODS: We used 30 pelvic CT images (15 men and 15 women). We selected two entry points from previous studies: one was 1 mm distal and 1 mm lateral to the S1 dorsal foramen (A group) and the other was the midpoint between the S1 and S2 dorsal foramen (B group). We resliced the plane in which the pelvis was sectioned obliquely from these entry points to the anterior inferior iliac spine in the sagittal plane. We placed the shortest and longest virtual S2AISs bilaterally in this plane using a 4-mm margin. We measured screw length, lateral angulation, caudal angulation, angle range, distance from the entry point to the sacroiliac joint, distance from the S2AIS to the acetabular roof, distance from the S2AIS to the sciatic notch, and insertion difficulty. These measurements were compared between Groups A and B. RESULTS: In group A, the angle in the sagittal plane was significantly smaller and the distance from the entry point to the sciatic notch was significantly longer than in group B. Group B demonstrated a significantly longer screw length, longer distance from the entry point to the sacroiliac joint, and longer distance from the entry point to the acetabular roof than group A. The rate of insertion difficulty of S2AIS was much higher in group A. CONCLUSIONS: Insertion of S2AIS from the midpoint between the S1 and S2 dorsal foramen compared with the entry at distal and lateral to S1 foramen enables insertion of longer screws with low insertion difficulty.

An evaluation of statistical models for age estimation and the assessment of the 18-year threshold using conventional pelvic radiographs.

The developmental patterns of the pelvic epiphyses are one of the anatomical markers used in the assessment of skeletal age and the legally relevant age threshold. In this study, four regression models and five classification models were developed for forensic age estimation and the determination of the 18-year threshold, respectively. A total of 2137 conventional pelvic radiographs (1215 males and 922 females) aged 10.00-25.99 years were analyzed, and the ossification and fusion of the iliac crest and ischial tuberosity epiphyses were scored separately. The epiphyses on both sides were used as inputs for all models. The accuracy of the regression models was compared using the mean absolute error (MAE) and root mean square error. The percentages of correct classifications were evaluated for the determination of the 18-year threshold. Support vector regression (SVR) and gradient boosting regression (GBR) showed higher accuracy for age estimation in both sexes. The lowest MAE was 1.38 years in males when using SVR and 1.16 years in females when using GBR. In the demarcation of minors and adults, the percentage of correct classification was over 92%, and the area under the receiver operating characteristic curves was over 0.91 in all models, except the Bernoulli naive Bayes classifier. This study demonstrated that the present models may be helpful for age estimation and the determination of the 18-year threshold. However, owing to the high effective dose of ionizing radiation used during conventional radiography of the pelvis, it is expected that these models will be tested with pelvic MRI for age estimation.

Assessment of osseous corridor for transiliac-transsacral screws and clinical applications: Computational simulation study.

BACKGROUND: Transiliac-transsacral (TITS) screw fixation might be necessary in some cases involving the vertical shearing injuries with transforaminal fracture and bilateral posterior ring injuries. However, the possibility of S1 TITS screw should be preoperatively assessed because the pelvic ring injuries with sacral dysmorphism had the insufficient osseous corridors. HYPOTHESIS: AxWS2 may predict the possibility of TITS screw fixation and be used as the new indicator to discriminate the sacral dysmorphism. MATERIALS & METHODS: The conventional CT images of eighty-two cadaveric pelvis imported into Mimics® software to reconstruct three-dimensional (3D) models. A 7.0 mm-sized screw was processed into a 3D model using a 3D-sensor at actual size and virtually implanted as S1 and S2 TITS screw using Mimics® software. The cortical violation around screw path was evaluated using 3D biplanar and conventional CT images. The osseous corridor widths around TITS screws were measured in the axial plane images and defined as AxWS1 and AxWS2, respectively. RESULTS: Despite no cortical violation in S2 of all models, cortical violation of S1 TITS screw was found in 20 models. Of them, 14 models (impossible models) were identified in the 3D biplanar images, and all 20 models (CT-violation models) were identified only in CT axial plane images. AxWS1 was<7mm in the impossible models and<9.0mm in the CT-violation models. AxWS2 negatively correlated with AxWS1 (R -0.450, p<0.01). By receiver operating characteristic curve analysis to identify the CT-violation model using AxWS2, the cut-off value of AxWS2 was 13.32mm (sensitivity 0.70, specificity 0.70). DISCUSSION: By using AxWS2, the possibility of S1 TITS screw fixation could be predicted and safely placed without cortical violation, if AxWS2 was less than 13mm. Considering the negative relationship with AxWS1, AxWS2 should be used as a new indicator to predict safe S1 TITS screw fixation. LEVEL OF EVIDENCE: III, controlled laboratory study.

MRI Assessment of Subspine Impingement: Features beyond the Anterior Inferior Iliac Spine Morphology.

Background The MRI manifestations of subspine impingement (SSI) other than morphologic features of anterior inferior iliac spine (AIIS) have not been extensively explored and validated. Purpose To determine the MRI findings associated with SSI, including AIIS morphologic features, femoral distal cam, and associated soft-tissue injuries. Materials and Methods This is a retrospective study of symptomatic patients who underwent arthroscopic treatment for femoroacetabular impingement between December 2014 and March 2017, with preoperative MRI within 6 months before surgery. The SSI group included patients with clinical and intraoperative findings of SSI; the remaining patients comprised the non-SSI group. Preoperative MRI findings were independently assessed by two radiologists who were blinded to clinical information. Interreader agreement was assessed, and multivariable logistic regression was also used. Results A total of 62 patients (mean age ± standard deviation, 42.1 years ± 11.9; 38 women) were included. SSI was diagnosed in 20 of the 62 patients (32%) (mean age, 43 years ± 12); 42 patients (68%) did not have SSI (mean age, 41 years ± 10). Reader 1 detected distal cam in 16 of the 20 patients with SSI (80%) and eight of the 42 patients without SSI (19%), and reader 2 detected distal cam in 15 of the 20 patients with SSI (75%) and eight of the 42 patients without SSI (19%) (P < .001 for both). Reader 1 detected signs of impingement on the distal femoral neck (IDFN) in 18 of the 20 patients with SSI (90%) and seven of the 42 patients without SSI (16%), and reader 2 detected signs of IDFN in 13 of the 20 patients with SSI (65%) and nine of the 42 patients without SSI (21%) (P < .001 and P = .001, respectively). Reader 1 detected superior capsular edema in 15 of 20 patients with SSI (75%) and three of 42 patients without SSI (7%), and reader 2 detected superior capsular edema in 17 of 20 patients with SSI (85%) and 22 of 42 patients without SSI (52%) (P < .001 and P = .02, respectively). Distal cam was a predictor of SSI after adjustment for IDFN. Interreader agreement was substantial for distal cam (κ = 0.80) and moderate for IDFN (κ = 0.50). Conclusion Soft-tissue injuries and osseous findings other than morphologic features of the anterior inferior iliac spine were associated with subspine impingement. © RSNA, 2019 See also the editorial by Guermazi in this issue.

[Bone age - alternatives for skeletal maturity assessment for the EOS scanner]. / Csontkor ­ a csontrendszeri érettség mérésének lehetosége EOS készülékkel.

INTRODUCTION: Hand and wrist bone age assessment methods cannot be performed when using the recommended patient position within the EOS scanner. AIM: We aimed to assess alternative methods for use with the EOS. METHOD: After investigating 9 alternatives, five methods were selected - cervical vertebra (Hassel-Farman), iliac crest (Risser 'plus'), hip (Oxford), knee (O'Connor), calcaneus (Nicholson) - and applied to EOS scans of 114, 2-21-year-old normal individuals. Intraclass correlation coefficient tests for reliability and Spearman correlation with calendar age were assessed. RESULTS: Intra- and interobserver reliabilities were all excellent, except with the knee method (0.865 - 'good'). Calcaneal and cervical methods were the fastest to apply (mean 17.5 s, 33.4 s per evaluation), however, calcanei were unassessable in 14% of scans (versus 1% of cervical). All methods correlated significantly with calendar age (r>0.829, p<0.05). Difficulties were principally absent (12%) or obscured (23%) landmarks. CONCLUSION: Bone age assessment is possible with all 5 methods, however, the Hassel-Farman method proved to be easily useable, fast and reliable. Orv Hetil. 2019; 160(16): 619-628.

Teriparatide Treatment Increases Mineral Content and Volume in Cortical and Trabecular Bone of Iliac Crest: A Comparison of Infrared Imaging With X-Ray-Based Bone Assessment Techniques.

Teriparatide increases bone mass primarily through remodeling of older or damaged bone and abundant replacement with new mineralizing bone. This post hoc analysis investigated whether dual-energy X-ray absorptiometric (DXA) areal bone mineral density (aBMD) measurement adequately reflects changes of mineral and organic matrix content in cortical and trabecular bone. Paired biopsies and aBMD measurements were obtained before and at end of 2 years of teriparatide treatment from postmenopausal women with osteoporosis who were either alendronate pretreated (mean, 57.5 months) or osteoporosis-treatment naive. Biopsies were assessed by micro-computed tomography (µCT) to calculate mean cortical width (Ct.Wi), cortical area (Ct.Ar), and trabecular bone volume fraction (BV/TV). Fourier transformed infrared imaging (pixel size ∼6.3 × 6.3 µm2 ) was utilized to calculate mineral and organic matrix density (mean absorption/pixel), as well as total mineral and organic contents of cortical and cancellous compartments (sum of all pixels in the compartment). Effect of pretreatment over time was analyzed using mixed model repeated measures. µCT derived Ct.Wi and BV/TV increased, accompanied by similar increases in the overall mineral contents of their respective bone compartments. Mineral density did not change. Marked increases in the total content of both mineral and organic matrix associated with volumetric growth in both compartments consistently exceeded those of aBMD. Increases in organic matrix exceeded increases in mineral content in both cortical and trabecular compartments. For percent changes, only change in Ct.Wi correlated to change in femoral neck aBMD (r = .38, p = 0.043), whereas no other significant correlations of Ct.Wi or BV/TV with lumbar spine, total hip, or femoral neck aBMD were demonstrable. These data indicate that 2 years of teriparatide treatment leads to an increased bone organic matrix and mineral content in the iliac crest. The magnitude of these increases in the iliac crest were not detected with conventional aBMD measurements at other skeletal sites. © 2018 American Society for Bone and Mineral Research.

Anterior inferior iliac spine morphology: quantitative and qualitative assessment in an asymptomatic population.

PURPOSE: To assess the prevalence of anterior inferior iliac spine (AIIS) types, and to investigate the quantitative measurements that characterize AIIS morphology in an asymptomatic adult population. METHODS: In this prospective study, 358 hips from 179 consecutive subjects (age range, 19-82 years; 91 males, 88 females), who underwent CT examination for reasons other than hip problems and were negative for hip impingement test, were analyzed. AIIS types were determined (1, flat wall of the ilium between distal end of AIIS and acetebular rim; 2, bony eminence between distal end of AIIS and acetebular rim; and 3, extension of AIIS to the anterior superior acetebular rim) and AIIS tip angle (TA), direct distance (DD) of the anterior acetabular rim to AIIS as well as projectional distances in vertical (VD) and horizontal (HD) planes were measured. Age- and gender-related factors were searched using two-way ANOVA test under three age groups (18-39, 40-59, and ≥ 60 years). RESULTS: There were 238 (66.5%) type 1, 118 (33.0%) type 2, and two (0.5%) type 3 AIISs, with significant difference between AIIS types among age groups and genders (P < 0.001). VD and DD showed age- and gender-related (P < 0.001, P < 0.001), and TA demonstrated gender-related differences (P < 0.001). Inter-observer agreement was good for TA and moderate to poor for other measurements. CONCLUSIONS: Type 1 AIIS is the most common shape across all age groups in adult females and in young and middle-aged adult males. TA, DD, and VD might be reliably used for the evaluation of AIIS morphology.

Apophyseal Ossification of the Iliac Crest in Forensic Age Estimation: Computed Tomography Standards for Modern Australian Subadults.

This study contrasts the ontogeny of the iliac crest apophysis using conventional radiography and multislice computed tomography (MSCT), providing probabilistic information for age estimation of modern Australian subadults. Retrospective abdominopelvic MSCT data acquired from 524 Australian individuals aged 7-25 and surveillance radiographs of adolescent idiopathic scoliosis patients included in the Paediatric Spine Research Group Progression Study (n = 531) were assessed. Ossification scoring of pseudo-radiographs and three-dimensional (3D) volume-rendered reconstructions using Risser (1958) quantitative descriptors indicate discrepancies in age estimates, stage allocation, and conflicting morphological progression. To mitigate visualization limitations associated with two-dimensional radiographs, we provide and validate a modified 3D-MSCT scoring tier of ossification, demonstrating complete fusion between 17.3-19.2 and 17.1-20.1 years in males and females. Legal demarcation for doli incapax presumption and age of majority (18 years) can be achieved using probability estimates from a fitted cumulative probit model for apophyseal fusion using the recalibrated standards.

Ultrasound assessment of the vertebral level of the intercristal line in pregnancy.

BACKGROUND: The intercristal line is known to most frequently cross the L4 spinous process or L4-5 interspace; however, it is speculated to be positioned higher during pregnancy because of the exaggerated lumbar lordosis. Clinical estimation of vertebral levels relying on the use of the intercristal line has been shown to often be inaccurate. We hypothesized that the vertebral level of the intercristal line determined by palpation would be higher than the level determined by ultrasound in pregnant women. METHODS: Fifty-one term pregnant patients were recruited. Two experienced anesthesiologists performed estimates of the position of the intercristal line by palpation. Using ultrasound, another anesthesiologist who was blinded to the clinical estimates, determined the position of the superior border of the iliac crest in the transverse and longitudinal planes and then identified the lumbar vertebral levels. The vertebral level at which the clinical estimates of the intercristal line crossed the spine was recorded and compared with the ultrasound-determined level of the superior border of the iliac crest. RESULTS: The clinical estimates of the spinal level of the intercristal line agreed with the ultrasound measurement 14% of the time (14 of 101; 95% confidence interval [CI]: 8%, 22%). The clinical estimates were 1 level higher than the ultrasound measurement 23% of the time (23 of 101; 95% CI: 16%, 32%) and >1 level higher 25% of the time (25 of 101; 1-tailed 95% CI: >18%). The distribution of the clinical estimates found clinicians locating the intercristal line at L3 or L3-4 54% of the time (54 of 101; 95% CI: 44%, 63%) and at L2-3 or higher 27% of the time (27 of 101; 1-tailed 95% CI: >20%). CONCLUSION: The anatomical position of the intercristal line was at L3 or higher in at least 6% of term pregnant patients using ultrasound. Clinical estimates were found to be ≥1 vertebral level higher than the anatomical position determined by ultrasound at least 40% of the time. This disparity may contribute to misidentification of lumbar interspaces and increased risk of neurologic injury during neuraxial anesthesia.

The effect of a technical quality assessment of hip-extended radiographs on interobserver agreement in the diagnosis of canine hip dysplasia.

Experienced and inexperienced observers evaluated the assessability of 50 radiographs (25 dogs) and determined the hip status (dysplasia/nondysplasia and final scoring according Fédération Cynologique Internationale [FCI]-criteria) individually. A radiographic technical quality assessment was performed in a separate reading session. Interobserver agreement in determining dysplasia/nondysplasia and FCI-scoring did not significantly increase with the increasing quality of a radiograph, irrespective whether these observers are experienced or not. There was a significant agreement between the technical quality assessment and assessability (P < 0.0005). Despite the effort to objectify radiographic quality and to present high-quality radiographs to observers, interobserver agreement on dysplasia/nondysplasia and final scoring, remains low, even in the experienced group. Although increased radiographic quality narrows the range of scoring, the range remains unacceptably high.

Feline ilial fractures: assessment of screw loosening and pelvic canal narrowing after lateral plating.

OBJECTIVE: To report the incidence of (1) screw loosening and (2) severity of pelvic canal narrowing in cats after repair of ilial fractures by a lateral bone plate. STUDY DESIGN: Case series. ANIMALS: Cats (n=21) with ilial fractures. METHODS: Medical records (June 1994 to February 2004) and radiographs were reviewed. Retrieved data were: signalment, fracture description, screw purchase, screw loosening, complications, and clinical outcome. Sacral index (SI) was used to objectively assess degree of pelvic canal narrowing. Long-term follow-up was by owner telephone interview or postal questionnaire. RESULTS: Screw loosening occurred in 13 cats (62%), with a mean loss of total screw purchase of 13% (range, 0-46%). Pelvic canal narrowing (mean decrease, 25%; range, 5-60%) occurred in all cats. Six cats (28%) had severe pelvic canal narrowing (mean, 52%); 5 of these had signs of recurrent constipation within 12 months postoperatively. Mean loss of total screw purchase in cats with severe pelvic narrowing was 28% compared with 9% for all other cats with narrowing. CONCLUSIONS: Lateral plating of ilial fractures in cats is associated with a high incidence of screw loosening. CLINICAL RELEVANCE: Pelvic canal narrowing >45% is associated with a high risk of recurrent constipation.

A three-dimensional medical imaging model for quantitative assessment of proximal tibia vs. anterior iliac crest cancellous bone.

The proximal tibia metaphysis is a potential alternative donor site for a sufficient amount of cancellous bone, associated with low morbidity and complication rate. We performed an observational computed tomography imaging study to determine the volume of cancellous bone that can be harvested from the proximal tibia compared to the anterior iliac crest, based on an advanced three-dimensional medical imaging model. Results of this study support the findings that a sufficient amount of cancellous bone can be harvested from the proximal tibia compared to the anterior iliac crest. By using a computed tomography imaging technique, the volume of cancellous bone can be precisely determined. However, this study does not show how much bone is safe to remove before increasing the tibial fracture risk.

Can MIBG scan replace the need for bone marrow assessment at diagnosis and reassessment in stage 4 neuroblastomas?

UNLABELLED: Complete staging (extensive marrow investigation and meta-iodo benzylguanine (MIBG) scan) is considered as mandatory both at diagnosis and after chemotherapy for assessment of metastases in neuroblastomas. However the correlation between bone marrow invasion and uptake of MIBG at metastatic sites remains unclear. This study investigates whether MIBG alone is sufficiently sensitive to make these procedures redundant. PATIENTS AND METHODS: 20 children over one year of age, with histologically proven metastatic neuroblastoma were studied. Extensive bone marrow assessment and MIBG bone scan performed both at diagnosis and after completion of induction chemotherapy were reviewed. RESULTS: At diagnosis metastases were detected by marrow investigation alone in 2, MIBG alone in 2 and both procedures in 16. After induction chemotherapy metastases were detected by only marrow investigation in 2, by only MIBG in 3, by both procedures in 6 patients, and by none in 9. CONCLUSIONS: Whether marrow investigations and MIBG scan explore the same phenomenon remains unclear. However it appears that marrow disease that is histologically detectable may remain MIBG negative both at diagnosis and after treatment. Both procedures are still justified at time of diagnosis and evaluation of response.

Assessment of trabecular bone structure in postmenopausal and senile osteoporosis in women by image analysis.

OBJECTIVE: The aim of the study was to assess bone trabecular structure in postmenopausal and senile osteoporosis. METHODS: The study was performed on transiliac specimens obtained from women with postmenopausal (n=10) and senile osteoporosis (n=10) and on normal autopsy bone (n=7). Digitalized microradiographs were analysed using dedicated software allowing for selection of longitudinal and transversal elements. RESULTS: Significant differences between transversal and control, as well as between longitudinal and control trabecular areas were observed in senile osteoporosis (p<0.005). In postmenopausal osteoporosis, such differences were found for longitudinal trabeculae only (p<0.005). Mean longitudinal trabecular area loss in senile and postmenopausal osteoporosis as compared to control group was 57.2% and 25.7%, respectively. Respective values for transversal trabecular area were 35.0% and 59.4%. CONCLUSION: Structural anisotropy of trabecular bone is greater in postmenopausal than in senile osteoporosis and control group. The method developed allows the evaluation of bone structures in radiographs with uneven exposure.

Assessment of porcine bone metabolism by dynamic.

UNLABELLED: The aim of this study was to quantify regional bone blood flow and [(18)F]fluoride ion influx with [(18)F]fluoride ion PET and correlate the results with specific static and dynamic indices of bone metabolism in healthy pigs. METHODS: During continuous ventilation (fractional concentration of oxygen in inspired gas = 0.3), dynamic PET scans 120 min in duration were obtained for 9 mini pigs after intravenous injection of 10.0 +/- 1.2 MBq (mean +/- SD) of [(18)F]fluoride ion per kilogram of body weight. Iliac crest bone biopsies were performed immediately before the PET scan to determine static and dynamic indices of bone metabolism (i.e., the mineral apposition rate) by bone histomorphometry. Kinetic rate constants describing influx (K(1)) and efflux (k(2)) of [(18)F]fluoride as well as chemisorption and incorporation of [(18)F]fluoride (k(3)) and reverse transport (k(4)) were determined for 6 vertebral bodies in each animal. Blood flow estimates (f) were derived from K(1) values corrected for the permeability-surface area product using a previously derived correction algorithm. A rate constant describing the net forward transport rate of fluoride (K(i)) and the fluoride volume flux (K(flux)) derived from a 2-tissue-compartment model was calculated and compared with the results of Patlak graphic analysis (K(pat)). RESULTS: A significant correlation was found between mineral apposition rate and K(i) (P < 0.005), K(flux) (P < 0.01), K(pat), K(1), and f (P < 0.05). The values of f, K(i), K(flux), and K(pat) did not correlate significantly with other static or dynamic histomorphometric indices or with age, serum alkaline phosphatase, or parathyroid hormone levels. The values of f and K(i) correlated linearly (y = 0.023 + 0.32x; r(2) = 0.74; P < 0.001). CONCLUSION: PET bone studies using [(18)F]fluoride ion provide quantitative estimates of bone blood flow and metabolic activity that correlate with histomorphometric indices of bone formation in the normal bone tissue of the mini pig. Therefore, it seem reasonable to assume that [(18)F]fluoride ion PET can reduce the number of invasive bone biopsies, thus facilitating follow-up of patients with metabolic bone diseases.

The use of color Doppler imaging for the assessment of sacroiliac joint stiffness: a study on embalmed human pelvises.

PURPOSE: The validity and reproducibility of an instrumented dynamic examination method to measure sacroiliac (SI) joint stiffness was tested in vitro. METHODS: Four embalmed human female pelvises were excitated by a pelvic vibrator. A color Doppler imaging (CDI) scanner was used to image the amplitude of vibrations at different sites of the pelvis. Vibrations were applied to the anterior superior iliac spines unilaterally and were received by CDI all over the ipsilateral SI region. Three different stability conditions were created in the SI joints: no intervention, screwed and ligaments cut. Test results were quantified by taking the minimum threshold levels of the bones. The relative difference of vibration intensity between ipsilateral ilium and sacrum at each stability condition is accepted as the stiffness level for the SI joint. RESULTS: Statistics showed high reproducibility and significant differences between the stability conditions. Dynamic testing based on the use of vibrations provides visible and quantifiable intra- and inter-individual differences between SI joint stiffnesses. CONCLUSIONS: This new method is objective and reproducible. Future in vivo application is promising since there are no technical and safety restrictions.

Quantitative computed tomography--a new method in the assessment of autologous augmentation of the mandible.

Following autologous alveolar ridge augmentation with microsurgically revascularized iliac crest segments, quantitative computed tomography was used for the first time to examine mandible and graft. The results are shown by the example of 2 cases. Sufficient mineralization of the graft could be demonstrated macromorphologically as well as by means of bone densitometry. Insignificant variations of the grade of mineralization in the separate segments of the graft may exist, caused by the operation. There were no distinct reactive scleroses indicating an extensive process of transformation and adaptation.

Sonographic measurement of the fetal iliac bone: growth and relation to femur length in assessment of gestational age.

Diagnostic ultrasonography has given us the opportunity to diagnose several congenital malformations in utero. Skeletal dysplasias is a heterogeneous group of disorders of the skeleton. Although disorders of bone growth are often diagnosed in utero, it is usually a general diagnosis because the exact syndrome cannot be specified. This is due to the fact that many anomalies of the skeleton have similar features. The wing of the iliac bone can be either affected or normal in skeletal dysplasias and its appearance may help in the differential diagnosis. This study was undertaken to establish values for the width of the iliac bone wing during normal gestations and thus enable us to use it in the evaluation of fetal growth and the recognition of specific congenital anomalies.

Roentgenographic assessment of skeletal ages of Asian junior youth football players.

Skeletal age of 50 football players participating in the Asian Junior Youth Tournament was assessed in an attempt to verify their stated chronological age to have a fair competition. Roentgenograms of hand and wrist (Greulich - Pyle standards), ilium and ischium were used for evaluation. More than half of the players had a bone age over the 16 year age limit of the Tournament and 30 percent of them had reached the maximum skeletal maturity of 19 years of age or over. Skeletal age is a reliable and dependable guide for assessing the physical maturity in this age group provided that proper local or international standards are set up.