Computed tomography medical image analysis of basketball players' bone geometry / Análise de imagens médicas por tomografia computadorizada da geometria óssea de jogadores de basquete / Análisis de imágenes médicas por tomografía computarizada de la geometría ósea de jugadores de baloncesto

ABSTRACT Introduction: Basketball sports will effect on the morphology and structure of the hand bones and joints. Objective: The article selected nine professional basketball players (basketball group) and 11 non-basketball players (control group) in the provincial youth team. A 64-row spiral computed tomography scan was used to scan the wrist and three-dimensional reconstruction. The volume of each carpal bone and the computed tomography value (bone density) were measured. Methods: To explore the influence of basketball sports on the hand bones and joints' morphological structure, the paper analyzes the structural characteristics of the computed tomography images of young male basketball players' wrist bones. Results: Compared with the carpal bones in the control group, the volume of the right navicular bone and the small polygonal bone, the left-hand navicular bone, the large triangular bone, and the small polygonal bone in the basketball group increased significantly (P<0.05). Conclusions: Basketball can increase the volume of the part of the wrist bones of adolescent male athletes and reduce the bone density; the morphological structure of the non-smashing wrist bones of basketball players has similar changes to that of the spikers. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: O basquetebol afetará a morfologia e a estrutura dos ossos e articulações da mão. Objetivo: o artigo selecionou nove jogadores profissionais de basquete (grupo de basquete) e 11 não jogadores de basquete (grupo de controle) da equipe juvenil da província. Uma tomografia computadorizada espiral de 64 linhas foi usada para digitalizar o punho e a reconstrução tridimensional. O volume de cada osso do carpo e o valor da tomografia computadorizada (densidade óssea) foram medidos. Métodos: Para explorar a influência dos esportes de basquete sobre os ossos da mão e a estrutura morfológica das articulações, o artigo analisa as características estruturais das imagens de tomografia computadorizada de ossos do punho de jovens jogadores de basquete do sexo masculino. Resultados: Em comparação com os ossos do carpo no grupo de controle, o volume do osso navicular direito e o osso poligonal pequeno, o osso navicular esquerdo, o osso triangular grande e o osso poligonal pequeno no grupo de basquete aumentaram significativamente (P <0,05). Conclusões: O basquete pode aumentar o volume dos ossos do punho de atletas adolescentes do sexo masculino e reduzir a densidade óssea; a estrutura morfológica dos ossos do pulso que não se quebram em jogadores de basquete tem mudanças semelhantes às dos espigões. Nível de evidência II; Estudos terapêuticos- investigação dos resultados do tratamento.

RESUMEN Introducción: el baloncesto afectará la morfología y la estructura de los huesos y articulaciones de la mano. Objetivo: El artículo seleccionó nueve jugadores de baloncesto profesionales (grupo de baloncesto) y 11 jugadores no baloncesto (grupo de control) en el equipo juvenil provincial. Se utilizó una tomografía computarizada en espiral de 64 filas para escanear la muñeca y la reconstrucción tridimensional. Se midieron el volumen de cada hueso del carpo y el valor de la tomografía computarizada (densidad ósea). Métodos: Para explorar la influencia de los deportes de baloncesto en la estructura morfológica de los huesos de la mano y las articulaciones, el artículo analiza las características estructurales de las imágenes de tomografía computarizada de los huesos de la muñeca de los jóvenes jugadores de baloncesto. Resultados: En comparación con los huesos del carpo en el grupo de control, el volumen del hueso navicular derecho y el hueso poligonal pequeño, el hueso navicular izquierdo, el hueso triangular grande y el hueso poligonal pequeño en el grupo de baloncesto aumentaron significativamente (P <0,05). Conclusiones: El baloncesto puede aumentar el volumen de los huesos de la muñeca de los deportistas varones adolescentes y reducir la densidad ósea; la estructura morfológica de los huesos de las muñecas que no se rompen de los jugadores de baloncesto tiene cambios similares a los de los atacantes. Nivel de evidencia II; Estudios terapéuticos- investigación de los resultados del tratamiento.

Bone age estimation with the Greulich-Pyle atlas using 3T MR images of hand and wrist.

The age estimation of the hand bones by means of X-ray examination is a pillar of the forensic age estimation. Since the associated radiation exposure is controversial, the search for ionizing radiation-free alternatives such as MRI is part of forensic research. The aim of the current study was to use the Greulich-Pyle (GP) atlas on MR images of the hand and wrist to provide reference values for assessing the age of the hand bones. 3T hand MR images of 238 male participants between the ages of 13 and 21 were acquired using 3D gradient echo sequences (VIBE, DESS). Two readers rated the images using the X-ray-based GP atlas method. A descriptive analysis and a transitional analysis were used for the statistical processing of the data. The agreement between and within the raters was assessed. In addition, a comparison was made with the chronological age and with X-ray studies. The descriptive analysis and the transition analysis showed similar results. Both evaluations showed good agreement with X-ray studies. The comparison with the chronological age showed a difference of 0.37 and 0.54 years for the two readers. The age estimate based on the cross-validated transition analysis showed a mean error of -0.28 years. Inter- and intra-rater agreement were good. In summary, it can be concluded that age estimation of hand bones with MR images is routinely applicable with the GP atlas as an alternative without ionizing radiation. However, in order to reduce the estimation error, a multi-factorial assessment based on examinations of several body regions is still recommended.

[Post-traumatic growth impairment following pediatric distal radius fractures resulting in an ulnar variance : A case report]. / Posttraumatische Wachstumsstörung nach kindlichen distalen Radiusfrakturen mit Entwicklung einer Ulnalängenvarianz : Ein Fallbeispiel.

BACKGROUND: Fractures of the distal forearm are common in children. While we treat adults by trying to anatomically reconstruct the wrist joint, in children, fracture treatment is predominantly conservative due to the high correction potential of the distal growth plate. However, the presentation of young adults with post-traumatic wrist pain is not unusual. OBJECTIVES: Do pediatric distal forearm fractures really heal without consequences despite a large tolerance of axial deviation? MATERIALS AND METHODS: Review of the literature, discussion of results and case report. RESULTS: Positive ulnar variance is the most common sequelae of pediatric distal forearm fractures. A positive variance of as little as >2 mm frequently causes ulnar-sided wrist pain and loss of motion, as is also shown in our case. CONCLUSIONS: Careful follow-up is advisable beyond fracture union following pediatric distal forearm fractures, especially after transphyseal osteosynthesis or growth plate involvement. Reconstructively corrective osteotomy of the ulna should be considered in patients with corresponding clinical symptoms, radiological findings and a positive ulnar variance of >2 mm.

A Comparison of 3 Established Skeletal Age Estimation Methods in an African Group From Benin and an Italian Group From Southern Italy.

Age estimation is a crucial matter in several forensic and legal instances. The literature recommends carrying out hand and wrist radiograph to assess skeletal age. Much research has been conducted to examine the application of various methods in different categories. Our study aims to evaluate the reliability of Greulich and Pyle, Tanner-Whitehouse 2, and FELS methods in Beninese and Italian samples, with a total of 204 subjects, 102 (51 were male and 51 were female) from Benin and 102 (51 were male and 51 were female) from Italy, aged between 4 and 19 years. Hand-wrist radiographs were carried out at Saint Luc Hospital in Cotonou for the African sample and in 2 hospitals in Southern Italy for Italian sample. Skeletal maturity was obtained, applying the 3 methodologies. The arithmetic mean of the 3 ages obtained was calculated, as well as the possible difference between the known chronological age and the estimated mean skeletal age. Data were analyzed statistically using the χ test, Student t test, and Bland-Altman plots. There are no significant statistical differences between real age and skeletal age calculated using the Greulich and Pyle and FELS methods. Comparison between Tanner-Whitehouse 2 and the average of the methods used results in statistically significant, but clinically insignificant, differences.

Early Maturity as the New Normal: A Century-long Study of Bone Age.

BACKGROUND: Epiphyseal fusion (EF) marks the completion of longitudinal bone growth, a critical milestone monitored during treatment of skeletal growth and/or developmental disorders. Recently, a trend toward accelerated skeletal maturation in children has been documented. Because current methods for assessing skeletal maturation include children in their reference populations born as early as the 1930s, the timing of EF events in contemporary patients may differ substantially from those standards. QUESTIONS/PURPOSES: (1) Do children today initiate the process of EF in the hand and wrist earlier than past generations on which maturity standards are based? (2) Do children today complete EF in the hand and wrist earlier than past generations on which maturity standards are based? METHODS: A total of 1292 children (665 males, 627 females) participating in the Fels Longitudinal Study, born between 1915 and 2006, were included in this retrospective, observational study. Each participant had between one and 39 serial left hand-wrist radiographs during childhood obtained specifically for research purposes. Main outcomes were the chronological age at the first sign of EF initiation (EF-I) and the first chronological age when EF was complete (EF-C) in the radius and ulna, and metacarpals and phalanges of the first, third, and fifth rays according to criteria of the Fels method. EF is a reliable metric with an average κ agreement statistic of 0.91. Penalized B-splines were used to model the changes in EF-I and EF-C ages and to identify changes across continuous birth years with major comparisons between children born in 1935 and 1995. RESULTS: Approximately half of the epiphyses of the hand and wrist examined exhibited earlier EF-I and/or earlier EF-C in children born in 1995 compared with those born in 1935. The age at each milestone (EF-I and EF-C) decreased by as much as 6.7 and 6.8 months in males and 9.8 and 9.7 months in females, respectively. This change occurred gradually over the past century. The more proximal traits (EF of the distal radius, distal ulna, and metacarpals) were more likely to experience a shift in timing, whereas timing of EF in the phalanges remained relatively stable across birth years. CONCLUSIONS: A trend has occurred over the past century in the timing of EF, in both initiation and completion of the process, for many of the bones of the hand and wrist. Earlier EF reflects modern population advances in both skeletal and sexual maturation. Shifts in the timing of EF have the potential to influence treatment strategies for skeletal growth and/or developmental disorders such as scoliosis or leg length inequality, moving treatment windows to earlier ages. Earlier EF-I and EF-C identified in this study signals a need to reevaluate the timing of maturational milestones and current standards for skeletal assessment. LEVEL OF EVIDENCE: Level II, prognostic study.

Physeal Bar Resection Under Guidance With a Navigation System and Endoscopy for Correction of Distal Radial Deformities After Partial Growth Plate Arrest.

Partial growth plate arrest caused by trauma may lead to severe deformity and dysfunction. The Langenskiöld method is a surgical technique that involves resection of the physeal bar causing partial growth plate arrest. However, it is a technically demanding procedure. We used the Langenskiöld method under guidance with a navigation system and endoscopy and obtained good results in 2 cases. We consider that use of these tools can be a helpful adjunct to the carrying out this procedure.

A practical formula for determining growth.

PURPOSE: We aimed to establish a practical method to evaluate skeletal age using cervical vertebrae. METHODS: The study consisted of hand-wrist and cephalometric radiographs of 324 subjects (167 girls, 157 boys; age range, 7.3-17.2 years). Skeletal ages of the subjects were calculated from hand-wrist radiographs, and cervical vertebral bodies were measured using cephalometric radiographs. A single formula based on C3 and C4 vertebral body heights with different coefficients for each gender was derived using ridge regression analysis. RESULTS: The correlation coefficients for vertebral and hand-wrist bone age were 0.825 and 0.856 for girls and boys, respectively. The correlations among vertebral bone age and C3 and C4 vertebral body heights were also found to be significant. The intraclass correlation (ICC) score was found to be 0.914, which shows high consistency between the two measurements of the same investigator for each C3 and C4 vertebral body height result. CONCLUSION: The formula derived for evaluating skeletal age in cephalometric radiographs is reliable and can be applied to both girl and boy subjects for legal requirements or therapeutic needs of age estimation.

Do Secular Trends in Skeletal Maturity Occur Equally in Both Sexes?

BACKGROUND: Skeletal maturity assessment provides information on a child's physical development and expectations based on chronological age. Given recently recognized trends for earlier maturity in a variety of systems, most notably puberty, examination of sex-specific secular trends in skeletal maturation is important. For the orthopaedist, recent trends and changes in developmental timing can affect clinical management (eg, treatment timing) if they are currently based on outdated sources. QUESTIONS/PURPOSES: (1) Has the male or female pediatric skeleton experienced a secular trend for earlier maturation over the past 80 years? (2) Do all indicators of maturity trend in the same direction (earlier versus later)? METHODS: In this retrospective study, a total of 1240 children were examined longitudinally through hand-wrist radiographs for skeletal maturity based on the Fels method. All subjects participate in the Fels Longitudinal Study based in Ohio and were born between 1930 and 1964 for the "early" cohort and between 1965 and 2001 for the "recent" cohort. Sex-specific secular trends were estimated for (1) mean relative skeletal maturity through linear mixed models; and (2) median age of maturation for individual maturity indicators through logistic regression and generalized estimating equations. RESULTS: Overall relative skeletal maturity was significantly advanced in the recent cohort (maximum difference of 5 months at age 13 years for girls, 4 months at age 15 years for boys). For individual maturity indicators, the direction and magnitude of secular trends varied by indicator type and sex. The following statistically significant secular trends were found: (1) earlier maturation of indicators of fusion in both sexes (4 months for girls, 3 months for boys); (2) later maturation of indicators of projection in long bones in both sexes (3 months for girls, 2 months for boys); (3) earlier maturation of indicators of density (4 months) and projection (3 months) in carpals and density in long bones (6 months), for girls only; and (4) later maturation of indicators of long bone shape (3 months) for boys only. CONCLUSIONS: A secular trend has occurred in the tempo of maturation of individual components of the pediatric skeleton, and it has occurred in a sex-specific manner. The mosaic nature of this trend, with both earlier and later maturation of individual components of the skeletal age phenotype, calls for greater attention to specific aspects of maturation in addition to the overall skeletal age estimate. The Fels method is currently the most robust method for capturing these components, and future work by our group will deliver an updated, user-friendly version of the Fels assessment tool. CLINICAL RELEVANCE: Appreciation of sex-specific secular changes in maturation is important for clinical management, including treatment timing, of orthopaedic patients, because children today exhibit a different pattern of maturation than children on whom original maturity assessments were based (including Fels and Greulich-Pyle).

Can the Greulich and Pyle method be used on French contemporary individuals?

Forensic age estimation of living individuals has become increasingly important in forensic practice with the constant increase of migration movements to developed countries. The method of Greulich and Pyle is one of the most frequently used methods for age determination. The aim of our study was to verify the reliability of this method on a French contemporary population. We retrospectively analyzed 190 frontal hand and wrist radiographs of living subjects aged between 10 and 19 years (100 males and 90 females) performed in the Radiology Department of the University Hospital of Tours. These radiographs were compared with the Greulich and Pyle atlas to determine the skeletal age (SA) and to compare it to the chronological age (CA). We calculated the coefficient of correlation and the coefficient of determination for each sex group. The SA of our subjects was also inserted in the graphs provided by Greulich and Pyle in their atlas. Intra- and inter-observer variabilities were good, demonstrating the reproducibility and repeatability of the method. The correlation coefficients were high (0.98 for males and 0.93 for females) and comparable with published data. The mean difference between CA and SA was -2.29 months for males and -6.44 months for females, showing an overestimation of CA for both sexes. No statistical difference was found between CA and SA for both male and female samples. We concluded that the method of Greulich and Pyle can be used on a contemporary French population but not without caution because of a tendency for this method to overestimate age. A fully developed hand and wrist does not allow to state that the 18th year of life is completed beyond a reasonable doubt. We recommend using it in association with other methods.

Comparison between Greulich-Pyle and Girdany-Golden methods for estimating skeletal age of children in Pakistan.

OBJECTIVE: To compare Greulich-Pyle (GP) and Girdany-Golden (GG) methods for estimation of Skeletal Age (SA) in children referred to a tertiary care hospital in Karachi, Pakistan. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan, from July 2010 to June 2012. METHODOLOGY: Children up to the age of 18 years, who had undergone X-ray for the evaluation of trauma were included. Each X-ray was interpreted using both methods by two consultant paediatric radiologists having at least 10 years experience, who were blinded to the actual Chronologic Age (CA) of children. RESULTS: A total of 283 children were included. No significant difference was noted in mean SA estimated by GP method and mean CA for female children (p=0.695). However, a significant difference was noted between mean CA and mean SA by GG method for females (p=0.011). For males, there was a significant difference between mean CA and mean SA estimated by both GP and GG methods. A stronger correlation was found between CA and SA estimated by GP method (r=0.943 for girls, r=0.915 for boys) as compared to GG method (r=0.909 for girls, r=0.865 for boys) respectively. Bland- Altman analysis also revealed that the two methods cannot be used interchangeably. Excellent correlation was seen between the two readers for both GP and GG methods. CONCLUSION: There was no additional benefit of using GP and GG methods simultaneously over using GP method alone. Moreover, although GP was reliable in estimating SA in girls, it was unable to accurately assess SA in boys. Therefore, it would be ideal to develop indigenous standards of bone age estimation based on a representative sample of healthy native children.

A comparison of the simplified olecranon and digital methods of assessment of skeletal maturity during the pubertal growth spurt.

Assessment of skeletal age is important in children's orthopaedics. We compared two simplified methods used in the assessment of skeletal age. Both methods have been described previously with one based on the appearance of the epiphysis at the olecranon and the other on the digital epiphyses. We also investigated the influence of assessor experience on applying these two methods. Our investigation was based on the anteroposterior left hand and lateral elbow radiographs of 44 boys (mean: 14.4; 12.4 to 16.1 ) and 78 girls (mean: 13.0; 11.1 to14.9) obtained during the pubertal growth spurt. A total of nine observers examined the radiographs with the observers assigned to three groups based on their experience (experienced, intermediate and novice). These raters were required to determined skeletal ages twice at six-week intervals. The correlation between the two methods was determined per assessment and per observer groups. Interclass correlation coefficients (ICC) evaluated the reproducibility of the two methods. The overall correlation between the two methods was r = 0.83 for boys and r = 0.84 for girls. The correlation was equal between first and second assessment, and between the observer groups (r ≥ 0.82). There was an equally strong ICC for the assessment effect (ICC ≤ 0.4%) and observer effect (ICC ≤ 3%) for each method. There was no significant (p < 0.05) difference between the levels of experience. The two methods are equally reliable in assessing skeletal maturity. The olecranon method offers detailed information during the pubertal growth spurt, while the digital method is as accurate but less detailed, making it more useful after the pubertal growth spurt once the olecranon has ossified.

Skeletal age estimation for forensic purposes: A comparison of GP, TW2 and TW3 methods on an Italian sample.

BACKGROUND: Paediatricians, radiologists, anthropologists and medico-legal specialists are often called as experts in order to provide age estimation (AE) for forensic purposes. The literature recommends performing the X-rays of the left hand and wrist (HW-XR) for skeletal age estimation. The method most frequently employed is the Greulich and Pyle (GP) method. In addition, the so-called bone-specific techniques are also applied including the method of Tanner Whitehouse (TW) in the latest versions TW2 and TW3. AIM: To compare skeletal age and chronological age in a large sample of children and adolescents using GP, TW2 and TW3 methods in order to establish which of these is the most reliable for forensic purposes. MATERIAL AND METHODS: The sample consisted of 307 HW-XRs of Italian children or adolescents, 145 females and 162 males aged between 6 and 20 years. The radiographies were scored according to the GP, TW2RUS and TW3RUS methods by one investigator. The results' reliability was assessed using intraclass correlation coefficient. Wilcoxon signed-rank test and Student t-test were performed to search for significant differences between skeletal and chronological ages. RESULTS: The distributions of the differences between estimated and chronological age, by means of boxplots, show how median differences for TW3 and GP methods are generally very close to 0. Hypothesis tests' results were obtained, with respect to the sex, both for the entire group of individuals and people grouped by age. Results show no significant differences among estimated and chronological age for TW3 and, to a lesser extent, GP. The TW2 proved to be the worst of the three methods. CONCLUSIONS: Our results support the conclusion that the TW2 method is not reliable for AE for forensic purpose. The GP and TW3 methods have proved to be reliable in males. For females, the best method was found to be TW3. When performing forensic age estimation in subjects around 14 years of age, it could be advisable to use and associate the TW3 and GP methods.

[Automated assessment of developmental levels of epiphysis by support vector machine].

OBJECTIVE: To realize the automated assessment of the levels of epiphysis of distal radius and ulna by support vector machine (SVM). METHODS: The X-ray films of the left wrist joints were taken from 140 teenagers aged from 11 to 19 years old as training samples. The levels of epiphysis of distal radius and ulna were divided into five developmental levels. Each level contained 28 samples. Another 35 cases were selected as independent verifying samples. SVM classification models of the five developmental levels of epiphysis of distal radius and ulna were established. The internal cross validation was made by leave one out cross validation (LOOCV), while the external validation was made by histogram of oriented gradient (HOG), and then the accuracy (PA) of testing results was calculated, respectively. RESULTS: The PA of SVM, LOOCV and HOG of distal radius epiphyseal level were 100%, 78.6%, and 82.8%, respectively; whereas the PA of SVM, LOOCV and HOG of distal ulna epiphyseal level were 100.0%, 80.0% and 88.6%, respectively. CONCLUSION: The SVM-based automatic models of the growth stage of distal ra- dius and ulna appear to have certain feasibility, and may provide a foundation for software development of bone age assessment by forensic medicine.

Automated assessment of developmental levels of epiphysis by support vector machine / 法医学杂志

OBJECTIVE@#To realize the automated assessment of the levels of epiphysis of distal radius and ulna by support vector machine (SVM).@*METHODS@#The X-ray films of the left wrist joints were taken from 140 teenagers aged from 11 to 19 years old as training samples. The levels of epiphysis of distal radius and ulna were divided into five developmental levels. Each level contained 28 samples. Another 35 cases were selected as independent verifying samples. SVM classification models of the five developmental levels of epiphysis of distal radius and ulna were established. The internal cross validation was made by leave one out cross validation (LOOCV), while the external validation was made by histogram of oriented gradient (HOG), and then the accuracy (PA) of testing results was calculated, respectively.@*RESULTS@#The PA of SVM, LOOCV and HOG of distal radius epiphyseal level were 100%, 78.6%, and 82.8%, respectively; whereas the PA of SVM, LOOCV and HOG of distal ulna epiphyseal level were 100.0%, 80.0% and 88.6%, respectively.@*CONCLUSION@#The SVM-based automatic models of the growth stage of distal ra- dius and ulna appear to have certain feasibility, and may provide a foundation for software development of bone age assessment by forensic medicine.

Age assessment using the Greulich and Pyle method on a heterogeneous sample of 300 Italian healthy and pathologic subjects.

The exponential growth of the illegal immigration phenomenon, the requests for asylum, and the increasing number of migrant settlements on Italian territory have strong repercussions on the legal system. One important aspect of this problem is age assessment. In the case of living individuals, identification may be focused on ascertaining their age, more directly if they can attest their age but are not registered (foreigners who claim to be minors or under 14 years of age). These have entered our country as illegal immigrants and have an interest in declaring a younger age (as a minor or under 14) rather than their true age because they can obtain the benefits specifically provided by Italian law for such categories. Since the most frequently used method in age assessment is the Greulich and Pyle Atlas, the objective of this study was to evaluate the consistency and accuracy of the method on a sample of Italian teenagers, in order to ascertain whether or not the Atlas is suitable for the purpose, especially in the critical threshold between 14 and 18 years of age. A total of 300 radiographs of the left wrist and hand of individuals between 10 and 20 years of age were obtained from the outpatient Pediatric Radiology Department of the Papa Giovanni XXIII Hospital in Bari. The results showed that the Greulich and Pyle Atlas, used on the Italian population, provide a good match with the chronological age, showing no statistically significant differences. The Greulich and Pyle Atlas is usable on the Italian population since there were no significant differences in skeletal age determination with this method as compared to the chronological age; however, one must allow for a possible standard deviation equal to more or less 13 months.

The reliability of skeletal age determination in an Iranian sample using Greulich and Pyle method.

BACKGROUND: Since introduction of Greulich and Pyle (GP) method for bone age determination, several studies have been performed for evaluation of applicability of this method in different geographic and ethnic groups. In this study we investigated the accuracy of this method in Iranian population. MATERIALS AND METHODS: 425 (303 male and 122 female) healthy children aged between 6 and 18 years old, without genetic, metabolic, endocrine, growth or nutritional disorders who had plain hand and wrist radiographs were enrolled. All radiographs were taken for an indication of trauma from January 2009 to August 2010. Both sexes were divided into three subgroups (6-10, 10-14, 14-18 years old). Skeletal age (SA) was determined according to GP atlas by a radiologist who was blind to chronological age (CA). Mean CA was compared with mean SA in whole population, each sex group and in each age subgroup. Difference score (DS) was calculated by subtracting SA from CA and determined for whole population, each sex group and also for each age subgroup. Statistical analysis was performed using t-test and ANNOVA correlation test. RESULTS: Considering whole study population, mean SA was 12.15±4.16 years and mean CA was 12.4±4.09 years and mean difference score (CA-SA) was 0.25±0.95 years. In male subjects mean SA was 12.68±4.07 years and mean CA was 13.04±3.93 years and mean difference score was 0.37±0.98 years (equal to 4.5 months). In female subjects mean SA was 10.84±4.11 and mean CA was 10.81±4.06 and mean difference score of girls was -0.04±0.78 years (equal to -0.5 month). DS shows no significant difference among three age subgroups in either male (P(value)=0.63) and female (P(value)=0.59) group. CONCLUSION: According to this study skeletal age of boys was 4.5 months less than chronological age, but in girls skeletal age was 0.5 month more than it. Considering the possibility of few months difference, GP atlas could be applicable in Iranian children with acceptable accuracy.

Does mirror imaging a radiograph affect reliability of age assessment using the Greulich and Pyle atlas?

Age estimation is routinely undertaken by comparing radiographs of the individual in question to published reference samples of individuals of known age. This study examines the reliability of age estimation utilizing the Greulich and Pyle atlas in relation to both left- and right-hand/wrist radiographs and explores whether reversing right-hand/wrist radiographs, so that they are in the same anatomical orientation as those images used in the atlas affects reliability. A total of 403 left-hand/wrist radiographs and 415 right-hand/wrist radiographs were age assessed using the Greulich and Pyle atlas. Analysis showed that there is no significant loss in reliability when radiographs of the right hand (women R(2) = 0.887 and men R(2) = 0.907) are utilized instead of the left (women R(2) = 0.939 and men R(2) = 0.940) or when they are assessed as mirror images to those printed in the reference atlas (reversed female left hand R(2) = 0.929 and reversed male left hand R(2) = 0.931).

Interrelationship of the Risser sign, knee epiphysis, and bone age in determining skeletal maturity: a case-control study.

The purpose of our study was to correlate the chronological age with Risser staging, knee epiphyseal closure, and bone age by the Tanner and Whitehouse (TW3) or Greulich and Pyle (GP) method simultaneously, to find out the most correlated methods used to calculate the age in a Korean population. A case-control study was carried out in 293 children between the age of 9 and 18 years. Skeletal age was estimated by using the atlas of the GP and TW3 methods; knee epiphysis closure and the Risser staging were also noted. Spearman's correlation coefficient test showed that in both the sexes the GP method is more correlated (r=0.58 for female patients, range: 0.55-0.61; and 0.58 for male patients, range: 0.54-0.61) with the Risser staging and physeal stages of the knee joint than the TW3 method (r=0.52 for female patients, range: 0.44-0.61; and 0.55 for male patients, range: 0.48-0.61) in Korean children. Our results suggested that by using the combination of Risser sign, knee epiphyseal closure, and GP bone age, one can calculate a person's chronological age most accurately.

Older adults exhibit more intracortical inhibition and less intracortical facilitation than young adults.

BACKGROUND: Aging results in decreased neuromuscular function, which is likely associated with neurologic alterations. At present little is known regarding age-related changes in intracortical properties. METHODS: In this study we used transcranial magnetic stimulation (TMS) to measure intracortical facilitation (ICF), short- and long-interval intracortical inhibition (SICI and LICI), motor evoked potential amplitude, and silent period duration in young and older adults (21.4+/-0.8years and 70.9+/-1.8years). These variables were assessed from the flexor carpi radialis muscle of the non-dominant arm under resting conditions, and during a submaximal contraction (intensity 15% maximum strength). RESULTS: Older adults exhibited increased SICI and LICI in comparison to young adults (SICI: 29.0+/-9.2% vs. 46.2+/-4.8% of unconditioned pulse; LICI: 6.5+/-1.7% vs. 15.8+/-3.3% of unconditioned pulse; P=0.04), and less ICF under resting conditions (74.6+/-8.7% vs. 104.9+/-6.9% of unconditioned pulse; P=0.02). These age-related differences disappeared during contraction, although the older adults did exhibit a longer silent period during contraction (112.5+/-6.5 vs. 84.0+/-3.9ms; P<0.01). CONCLUSIONS: Collectively, these findings suggest increased GABA mediated intracortical inhibition with age.

Madelung's deformity: treatment with radial osteotomy and insertion of a trapezoidal wedge.

This article describes a modification of the double-osteotomy radial technique that has been described previously and summarizes our clinical experience with this method in 4 female patients. All patients had improvement in functional motion and were satisfied with the improved appearance of their wrist after surgery.