Radiological Evaluation of Volar Cortical Angle in the Anatolian Population / Evaluación Radiológica del Ángulo Cortical Volar en la Población Anatoliana

SUMMARY: Distal radius fractures are the most common fractures of the upper limb. The most commonly used method in the repair of these fractures is volar locking plates. Recently, the frequency of removal of volar locking plates after surgery has increased. There are many factors in its reduction. Anatomically, incompatibility of the distal end of the radius with volar locking plates is one of them. In previous studies, different volar cortical angle (VCA) values were found in other races. For this reason, this study aimed to determine the mean values by making VCA measurements of the Anatolian population. The study was designed retrospectively. In the study, measurements were made on computed tomography (CT) images of the distal end of the radius of 53 men and 28 women. Radial width, intermediate volar angle, and radial volar angle were measured in the images. On average, the radius width was 23.35±1.96 mm, and the intermediate volar angle was 26.02±.3.83°, radial volar angle was 24±3.07°. Radial width, intermediate volar angle, and radial volar angle differed significantly by gender (p<0.001). A significant correlation was found between radius width, intermediate volar angle, and radial volar angle values (p<0.001). It has been determined that the Anatolian population has a different VCA value than the European, Asian, and other populations. When using volar locking plates in distal radius fracture surgery, volar locking plates should be selected by considering the average values of the races.

Las fracturas del radio distal son las fracturas más comunes del miembro superior. El método más utilizado en la reparación de estas fracturas son las placas de bloqueo volar. Recientemente, ha aumentado la frecuencia de extracción de placas de bloqueo volar después de la cirugía. Existen muchos factores en su reducción y anatómicamente, la incompatibilidad de la extremidad distal del radio con las placas de bloqueo volar es una de ellas. En estudios anteriores, se encontraron diferentes valores del ángulo cortical volar (VCA) en otras grupos. Por esta razón, este estudio tuvo como objetivo determinar los valores medios, realizando mediciones de VCA de la población de Anatolia. El estudio fue diseñado de manera retrospectiva. En el estudio, se realizaron mediciones en imágenes de tomografía computarizada (TC) de la extremidad distal del radio de 53 hombres y 28 mujeres. En las imágenes se midieron el ancho radial, el ángulo volar intermedio y el ángulo volar radial. En promedio, el ancho del radio fue de 23,35 ± 1,96 mm, el ángulo volar intermedio fue de 26,02 ± 3,83° y el ángulo volar radial fue de 24 ± 3,07°. El ancho radial, el ángulo volar intermedio y el ángulo volar radial difirieron significativamente según el sexo (p<0,001). Se encontró una correlación significativa entre los valores del ancho del radio, el ángulo volar intermedio y el ángulo volar radial (p<0,001). Se ha determinado que la población de Anatolia tiene un valor de VCA diferente al de las poblaciones europeas, asiáticas y otras. Cuando se utilizan placas de bloqueo volar en cirugía de fractura de la extremidad distal del radio, las placas deben seleccionarse considerando los valores promedio de los individuos de diferentes grupos.

Variantes anatómicas del tubérculo de Lister. Presentación de una clasificación imagenológica y su utilidad clínica / Anatomical variants of Lister's tubercle. Presentation of an imaging classification and its clinical utility

Objetivo: Evaluar, en forma retrospectiva, las diferentes variantes de los tubérculos de Lister y el extensor largo del pulgar en imágenes de resonancia magnética de muñecas y, sobre la base de dichos hallazgos, proponer variables a la clasificación. Materiales y métodos: Estudio retrospectivo utilizando imágenes de resonancia magnética entre el 1 de marzo y el 10 de noviembre de 2019. Se incluyeron imágenes de muñeca de pacientes sanos (cortes axiales, sagitales y coronales de 1 mm de espesor), >18 años, sin fractura de muñeca o del carpo, previa o actual, y se excluyó a quienes no cumplían estos criterios. Se analizaron el tubérculo de Lister, la altura de los picos radial y cubital, el ángulo, la longitud del tubérculo, la profundidad de los valles y la altura del tabique. Se evaluó el extensor largo del pulgar analizando la altura, el espesor, la superficie y la presencia o no inflamación asociada. Resultados: Se analizaron 500 imágenes de muñeca, y se obtuvieron 11 subtipos de tubérculo de Lister: 411 tipo 1, 58 tipo 2 y 26 tipo 3. Dentro de estos, el más frecuente fue el tipo 1B. El 26,6% tenía inflamación asintomática en el tercero y cuarto compartimento. Conclusiones: El tubérculo de Lister es importante en muchos procedimientos y sirve como punto de referencia anatómico; por lo tanto, es preciso conocer su patrón más frecuente y sus variantes anatómicas. Proponemos una ampliación de la clasificación, adicionando nuevos tipos de tubérculo por conocer y su relación con el extensor largo del pulgar. Nivel de Evidencia: IV

Objective: To retrospectively evaluate the different variants of Lister's tubercle (LT) and extensor pollicis longus (EPL) using magnetic resonance imaging (MRI) of the wrists, and based on these findings propose variables for classification. Materials and Methods: Retrospective study using images from MRI database files between 03/01/19 to 11/10/19. We included MRI of the wrist of healthy patients (axial, sagittal, and coronal slices of 1 mm thickness) who were older than 18 years, with no history of previous or current wrist or carpal fracture, excluding those who did not meet these criteria. We analyzed LT, height of the radial and ulnar peaks, the angle, tubercle length, depth of the grooves and septum height. We evaluated the EPL, analyzing the height, thickness, surface, and presence of associated inflammation. Results: We evaluated 500 MRI of the wrist, obtaining 11 different subtypes of LT. We found 411 type 1 Lister tubercles, 58 type 2, and 26 type 3. Among these, the most frequent were types 1b. 26.6% presented asymptomatic inflammation in 3rd and 4th compartments. Conclusion: Lister's tubercle is of importance in many procedures and serves as an anatomical landmark, meriting to know its most frequent pattern and its anatomical variants. We propose an extension of the classification, adding new types of tubercles to be known and their relationship with the EPL. Level of Evidence: IV

Review of MRI wrist results at KAUH

Background: Magnetic resonance imaging [MRI] is defined as one of the most important modalities used for diagnosing lesions of small and complex structures in the body [1]. We aimed to investigate the most common wrist pathologies detected by MRI in KAUH [King Abdulaziz University Hospital] in Jeddah

Methodology: A retrospective study was done with a total sample size of 127 individuals who underwent wrist MRI investigation at KAUH in Jeddah [Saudi Arabia], between 2010-2016. The data entry was performed by using Microsoft Excel 2014, and statistical analysis was performed by SPSS V21

Results: The results of the analysis showed that the most common wrist pathology was ganglion cysts, constituting 17.8% of the 157 findings we observed. Other common findings were Tenosynovitis [10.2%], TFCC [Triangular fibrocartilage complex] tear [10.2%], TFCC degeneration [5.7%] and subchondral cysts [3.8%]. There was also a significant relation between normal/abnormal findings in individuals and their age of presentation. Age mean was 29.27 [ +/- 7.46 SD] for those with normal findings, and 37.33 [ +/- 15.62 SD] for those with abnormal findings, [P value less than 0.001]. Regarding X-ray investigation, we found that most of the sample [65.4%] did not undergo X-ray prior to MRI

Conclusion: It has been found that there is variance between all findings that were discovered by MRI, that there are differences between our study and those of others, and that due to the different sorts of cases that were presented to the hospital. We also found that most of the individuals with wrist pathologies did not get X-rays before MRI, so we recommend a clear policy of ordering MRI, also proper history and examination should be the essential tool to reach hand and wrist diagnoses. That will help in saving resources

Tuberculosis monoarticular de la muñeca: comunicación de un caso / Monoarticular tuberculosis of the wrist: a case report

Resumen La tuberculosis monoarticular aislada de la muñeca es una forma infrecuente de presentación de esta enfermedad, siendo más común el compromiso vertebral. Las formas extravertebrales representan sólo 2 a 3% de las infecciones óseas por Mycobacterium tuberculosis. Presentamos el caso clínico de una mujer de 49 años, con antecedentes de trabajar en labores de aseo en un hospital, que posterior a un trauma de baja energía evolucionó con un cuadro de dolor en la articulación de la muñeca derecha. Diagnosticada inicialmente como una tendinopatía flexora, recibió tratamiento con antiinflamatorios y fisioterapia. Ocho meses después la paciente continuó con dolor a la movilización por lo que se realizó un estudio imagenológico, biopsia y cultivos de tejido óseo. El estudio histopatológico y de biología molecular del tejido confirmó una tuberculosis de muñeca derecha. Se trató con terapia anti-tuberculosa y fisioterapia, consiguiéndose la recuperación funcional de la muñeca.

Monoarticular tuberculosis of the wrist is a rare presentation of primary tuberculosis, being more common skeletal forms involving the spine. Extraspinal tuberculous osteomyelitis is rare and comprises only 2 to 3% of all cases of osteoarticular Mycobacterium tuberculosis infections. We present a case of a 49 years old female patient, who worked as an hospital cleaning employed without other comorbidity. After a low energy injury of the wrist she suffered pain syndrome diagnosticated as a flexor tendinopathy, managed with nonsteroidal antiinflammatory drugs and physical therapy. Eight months later patient evolves with chronic pain in range of motion of right wrist joint, leading to a complete radiological, surgical biopsy and cultures. Histology, and molecular biology confirmed the wrist joint tuberculosis diagnosis. Pharmacological treatment and physical therapy were initiated with appropriated response.

Sonographic Findings of the Bifid Median Nerve and Persistent Median Artery in Carpal Tunnel: A Preliminary Study in Chinese Individuals

OBJECTIVE: The aim of this study was to investigate the prevalence of anatomic variations of the bifid median nerve, persistent median artery and persistent median vein in Chinese individuals and their relationship with carpal tunnel syndrome. METHODS: One hundred and sixty median nerves were examined using ultrasonography and colour Doppler ultrasonography. The location, shape, and size of the bifid median nerve, persistent median artery and persistent median vein were recorded. The cross-sectional area of the bifid median nerve (two trunks) was measured at the level of the pisiform. RESULTS: Among the 160 wrists examined, a bifid median nerve was observed in 15 (9.4%) wrists, and a persistent median artery was observed in 12 (7.5%) wrists. These two variations either coexisted or were observed independently, and the probability of coexistence (6.3%) was higher than the probability of existing independently (bifid median nerve only 3.1%, persistent median artery only 1.3%). The cross-sectional area of the radial trunk was greater than (13 in 15, 86.7%) the cross-sectional area of the ulnaris trunk. Persistent median vein was observed in 9 wrists (5.6%). CONCLUSIONS: The persistent median artery and bifid median nerve tend to coexist, and the persistent median vein sometimes runs parallel to the persistent median artery. Their positional relationship in carpal tunnel is uncertain, and thus, preoperative ultrasound is necessary. These three variations do not present any additional risk for the development of carpal tunnel syndrome.

Evaluación radiológica de muñeca para visualizar la superficie articular del radio / Wrist X ray for analysis of the articular surface of distal radius

Resumen: En la fractura del radio distal se requieren proyecciones radiológicas que permitan ver adecuadamente la superficie articular sin interposición de estructuras. El objetivo fue determinar si las proyecciones radiológicas laterales a 7 y 22o mejoran el análisis de esta superficie. Método: Serie de casos con radiografías de pacientes sanos y operados para identificar las facetas del semilunar y escafoides en las proyecciones lateral y anteroposterior, igualmente se evaluó con tornillos. Se analizaron cualitativamente los hallazgos obtenidos en las radiografías de 7 y 22o para la proyección lateral y de 11o en la anteroposterior. Resultados: 14 radiografías de voluntarios sanos, 10 pacientes con fractura de radio que recibieron osteosíntesis y dos piezas anatómicas. En los 14 sanos y los 10 pacientes se encontró que en las proyecciones a 7 y 22o pueden apreciarse mejor las carillas radio-semilunar y radio-escafoides respectivamente, observando imágenes con menor superposición de estructuras en la radiografía de 22o tanto en los sanos como en los pacientes con fracturas. Discusión: Las proyecciones radiológicas son importantes para poder determinar los resultados inmediatos de una osteosíntesis realizada en una fractura de radio distal. En este estudio se observa que la proyección lateral a 7o identifica mejor la posición de los tornillos ubicados en la carilla semilunar del radio. La proyección lateral a 22o muestra mejor la carilla con el escafoides. Por último en la proyección anteroposterior a 11o nos permite ver la articulación radiocarpiana con menor superposición de imágenes.

Abstract: In the distal radius fracture requires radiographic views that allow you to see the articular surface without interposition. The objective was to determine whether lateral radiographic projections 7 and 22o improve the analysis of this surface. Method: Case series study with radiographs of healthy and operated patients, in order to identify the lunate and scaphoid facets in lateral and anteroposterior projections. Qualitative analysis was made on the radiographs of the distal radius with wedges of 7 and 22o in the lateral views and 11o in the anteroposterior view. Results: There were evaluated 14 radiographs of the distal radius of healthy volunteers and 10 patients with distal radius fractures who recieved surgery with internal fixation, and also two anatomical models. In 14 healthy and 10 patients, it was found that the views at 7 and 22o can be better appreciated radio lunate and radio scaphoid surface respectively, observing images with less overlapping in the radiograph of 22o in both groups. Discussion: Radiographic views are important to determine the immediate results of fixation on a distal radius fracture. We observe that the lateral view at 7o is better to show the screws on the lunate facet of the radius. The lateral view at 22o is better to show the facet of the radius with the scaphoid. Finally, the anteroposterior projection at 11o allows us to see the radio carpal joint with lower image overlay.

Comparación de dos métodos radiológicos para evaluación de densidad ósea en mujeres posmenopáusica / Comparison of two radiological methods for evaluation of bone density in postmenopausal women

Debido a la importancia del diagnóstico precoz de osteoporosis, fue objeto de este estudio realizar la comparación de dos métodos radiológicos convencionales para la evaluación de la densidad ósea en mujeres posmenopáusicas. Fueron seleccionadas imágenes de radiografía panorámica y de radiografía carpal, correspondiente a 68 pacientes de sexo femenino, con edades comprendidas entre los 49 y 80 años de edad, realizadas en la Clínica de Radiología Odontológica, para evaluación previa a la colocación de implantes. Para la interpretación de la densidad ósea en la mandíbula a través de las radiografías panorámicas fue utilizado el método del espesor cortical mandibular (PMI). Para la evaluación de las imágenes radiológicas obtenidas por la radiografía carpal, fue aplicado el método de la radiogrametría. Se concluye que existe correlación entre la presencia de una baja densidad ósea a nivel mandibular observada en la radiografía panorámica en las pacientes de la muestra, con la baja densidad ósea presentada en la radiografía carpal.

Due the importance of diagnosis precocious of osteoporosis, this study carried out the comparison of two conventional radiological methods for the evaluation of bone density in postmenopausal women. X-ray images of panoramic and carpal were selected, corresponding to 68 women between 49 and 80 years old, obtained at the Clinic of Dental Radiology, for holding dental implant. The interpretation of bone density in jaw on panoramic radiography was the method to determine mandibular cortical thickness. The carpal radiography was evaluated for the radiogrammetry method. It was concluded that there was a correlation between low bone density observed in the mandibular panoramic radiography with low bone density on carpal radiography.

role of wrist magnetic resonance arthrography in diagnosing triangular fibrocartilage complex tears. Experience at King Hussein Medical Center, Jordan

The aims of the study were to evaluate the role of magnetic resonance arthrography [MRA] of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex [TFCC] and to compare the results of the magnetic resonance arthrography [MRA] with the gold standard arthroscopic findings. The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients [35 males and 7 females] who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography [MRA] and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. After comparison with the arthroscopic findings, the MRA had three false-negative results [sensitivity = 93%] and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactory pain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% [39], and specificity was 80% [16/20]. The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% [29/34]. These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries

Comparison of MR images for age determination; T1 weighted images [T1WI] versus T2* weighted images [T2*WI]

T1WI [T1 weighted image] was acquired in order to grade bone fusion following the studies by FIFA [Federation Internationale de Football Associations]. Research using images other than T1WI has not been reported. The aim of this study is to evaluate the grade of epiphyseal fusion by T2* weighted images [T2*WI] and to investigate new findings on T2*WI as compared with T1WI. A total of 87 subjects, all junior football players between the ages of 12 and 17 years old, were examined. T1 and T2* WI were obtained using a 1.2T Open type MR system. The T1WI and T2*WI were rated twice randomly by four radiologists using the FIFA grading system. The intra-rater reliability for grading was higher in T1WI [The Intraclass Correlation Coefficient [ICC]=0.949-0.985] than in T2*WI [ICC=0.917-0.943]. The inter-rater reliability for grading was also higher in T1WI [ICC=0.923] than in T2*WI [ICC=0.867]. This research showed that T1WI is a better sequence than T2*WI to evaluate bone fusion following FIFA protocol. It was speculated that the reason for this is that T1WI has higher tissue contrast resolution and enables clearer images of the epiphyseal fusion than T2*WI and the grading system by T1WI was not suitable for T2*WI

Puberty growth spurt age in local population - a study

The biologic aspects of facial growth are fundamentally important in dentofacial orthopedics. The beginning, intensity, onset, and duration of the pubertal peak of facial growth have great variations among patients. The aim of the present study was to find the puberty growth spurt age in local population for diagnostic and optimum treatment planning issues. Hand- wrist radiographs of 200 patients were evaluated according to Bjork's method of assessment to determine the puberty growth spurt age. The spearman rank correlation between chronologic age and skeletal maturation intervals was 0.731 [P<.001] for both the genders combined. The mean chronological age of females in accelerating, peak and decelerating growth spurt was less than male subjects

Comparative evaluation between cervical vertebrae and hand-wrist maturation for assessment of skeletal maturity orthodontic patients

The aim of the study was to find a correlation between the evaluation of skeletal maturation performed by the study of cervical vertebrae maturation indicators and the evaluation obtained by the hand and wrist maturation indicators. A radiographic hand-wrist bone analysis and cephalometric cervical vertebral analysis of 100 patients [36 males and 64 females] ranging from 9 to15 years 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 stages method of Bacetti. To define vertebral stages, morphological evaluation of three cervical vertebrae [2nd to 4th] was done. Bjork's nine stages were reduced to five growth intervals [A-E] to relate to five stages [I-V] of cervical vertebral maturation method. The spearman correlation coefficient was 0.944 [P<.01] between cervical vertebral maturation and hand-wrist maturation for sexes combined and 0.936 [P<.01] for males and 0.912 [P<.01] for females respectively. The result shows that cervical vertebrae can be used with the same confidence as hand-wrist radiographs to evaluate skeletal maturity, thus avoiding the need for an additional radiograph

Analysis for skeletal age less than "age" in judicial expertise in 303 cases / 法医学杂志

OBJECTIVE@#To discuss the phenomenon and the possible causes for the skeletal age less than the "real age" in the judicial expertise.@*METHODS@#With referring to the skeletal age verification value provided by the inspection sample pertaining to CHN scoring method, combining with the relevant materials such as "age" and "residence" information provided by the police authority while performing expertise, as well as tracking down and re-visiting some cases, we retrospectively analyzed 829 cases.@*RESULTS@#There were 303 cases for the skeletal age less than "real age" in total, which accounted for 36.6% (303/829), and accounted for 40.8% (303/742) in 742 cases with "age" cases. If the normal age range between both was less than 0.5 year (including 0.5), the numbers of such cases decreased to 190 cases, which accounted for 22.9% (190/829) and 25.6% (190/742), respectively. When the difference was within 0.5, the "age" close to the skeletal age would be more reliable. It was difficult to confirm which one was wrong if the difference was 0.6-2.0 years. However, the error possibility in "age" would increase with increasing the difference value.@*CONCLUSION@#Many uncertain factors may lead to that the skeletal age was less than the "age". The occurring rate for the skeletal age less than "age" is not low. The identification conclusion shall be made with caution after comprehensive assessment.

Development of hand-wrist bones of 14 year-old adolescents. II. Standard of bony age for girls / 法医学杂志

OBJECTIVE@#To study the current development of hand-wrist bones of adolescents in China, and establish special forensic bony age standard for estimating 14 years of criminal responsible age in female adolescents.@*METHODS@#One hundred and ten healthy girls aged from 13 years and 9 months to 14 years and 3 months in Lengshuijiang district of Hunan province were enrolled in this study. X-ray films of their left hand-wrists were taken dorsaventrally, and 15 sites on the wrist x-ray films were examined and measured under standard condition. The development grade was confirmed by maximal percentage to establish a method to estimate the bony age, which was then checked by single blind method.@*RESULTS@#Development grade of the radius, the middle third phalanx and the fourth phalanx was partially closed (> 2/3), and the rest was wholly-closed with existence of the epiphyseal line. The development grade of the middle third phalanx and fourth phalanx was different between the younger group (< 14 years, partially closed, > 2/3) and the older group (> 14 years, mostly closed with existence of only epiphyseal line). The cross diameter of the osteoepiphysises were wider than that of all the diaphysises. The confirmed accuracy (in 30 girls) was 83.3%.@*CONCLUSION@#Our study seemes to be feasible in establishing the estimation standard for bony age determination. The standard established by developmental metaphysis and authropometry may be particularly helpful in forensic practice for estimation of accurate criminal responsible age in adolescents.

survey on current methods of carpal height ratio measurement and suggestion of a new method

Two famous methods are commonly used for the measurement of carpal height ratio. Both methods are performed on anteroposterior radiogram and have some shortcomings. We are going to introduce a new method for measuring this index in lateral view of the wrist radiogram. This cross-sectional and case-control study was conducted on 100 anteroposterior and lateral radiograms of asymptomatic individuals and then 20 radiograms of patients with Kienbock disease in various stages of the disease. After determining new reference points on the radiograms of the [normal] group, it was tried to define the ratio by new method. In the next stage the interobserver and intraobserver agreement of the new index was assessed along with previous defined indices. All three methods had some limitations, but overall it seems that the new method has more precise reference points. With regard to inter and intraobserver variability the new index was better than the Natrass group index, but not than the Youm group index. The new index can be used as a substitute or an alternative in carpal height measurement

[Bone age: when how why]

The determination of the bone age is an evaluation method of a child's growth and maturation without including his theoric age, height or weight. Nevertheless, several practicians try to obtain the most precise maturation data, which are unreachable with actual methods, neglecting the evaluation given by the hand and wrist X ray. Several informations of bone maturation, morphology, and also mineralization, are given by X ray images allowing the diagnosis of a delay or an advance child's height. We will resume in this article, the bone age indications, and several methods and data given by the most important one, which's the left hand and wrist X ray

Association between chronological and skeletal ages among a sample of Saudi male children

Assessment of skeletal maturity is a necessary clinical need in orthodontics and other health professions. The aim of this study was to detect the association between chronological age and skeletal age in a selected Saudi male sample and to compare their skeletal maturity rate with other populations. Hand-wrist radiographs were obtained for 115 subjects and the skeletal age for each subject was determined using a standard hand-wrist radiographic atlas. Also, the skeletal maturity stage for each subject was established using Bjork assessment method. Statistical tests were performed to detect signifcant differences between chronological and skeletal ages at different skeletal maturity stages. The rate of skeletal maturity of the participating Saudi sample was also compared to analogous values that were previously established for other populations. The fndings of the present study indicated that the participating Saudi children had a tendency towards late maturation with the mean skeletal age of the participating subjects being signifcantly lower [P<0.05] than the chronological age at various skeletal maturity stages. When considering the rate of skeletal maturity, the participating Saudi children demonstrated a comparable maturity rate to that of other children from different populations. The results of the present study could enhance the diagnosis and treatment planning in orthodontics, pedodontics, and other health disciplines

Considering the second primary molar as the sole clinical index of growth condition

Assessment of skeletal maturity is an integral part of interceptive diagnosis and treatment planning. The present method of skeletal maturity assessment like handwrist or cervical vertebrae radiographies are expensive,require elaborate equipment and account for high radiation exposure, especially for growing children. This study tried to consider the value of the 2nd primary molar in growth stage. 40 samples aged 8-13 were tested by their panoramic and handwrist radiographs. there was a coincidence between presence calcified sesamoid and 2nd primary molar as the last tooth. The result showed that it could be a reliable index to predict the growth stage in 1st visit without radiography

Age of high growth rate in adolescent period of development

The aim of this study was to assess the chronological age of different skeletal maturity events in young adolescents. A total of 100 subjects [50 males 50 females] visiting the children's hospital and the Institute of Child Health, Lahore, were included in the study. The mean age of these subjects was 12.23+ 2.33years. Skeletal maturity was assessed with left hand-wrist radiograph through method described by Fishman. Chronological age was determined by knowing the exact date of birth of adolescent. Result showed that the females were advanced than males in about 1.2 years in attaining peak growth velocity. The peak growth velocity of females arrived at the age 12.78+ 1.73 and that of males is at 13.9+1.37 years. The study also showed racial differences. Through these results the simple information of patient's chronological age aids the clinician in evaluating the patient's growth potential and facilitates establishment of appropriate timing and types of orthodontic treatment, retention needs, and proper timing for surgical intervention