Estimación de la osificación de los huesos del pie sobre población extremeña. Estudio observacional / Estimation of the ossification of the bones of the foot about the population of Extremadura. Observational study

Objetivos: La estimación de la edad de un individuo es un tema de interés dentro del ámbito de la Medicina Legal y Forense. Una de las herramientas más utilizadas para este fin es la Radiología. Los objetivos son la cuantificación de las edades de osificación de cada hueso del pie y determinar si existe relación entre la osificación de los huesos y el sexo del individuo. Pacientes y métodos: La población de estudio se compuso de 2476 radiografías digitales, pertenecientes a un total de 816 sujetos en periodo de crecimiento. El análisis de las imágenes se realizó mediante la aplicación del método validado y diseñado para la estimación de la edad en meses sobre la radiografía del esqueleto del pie.Resultados: Sí existe diferencia en la osificación ósea de la población extremeña frente a la literatura (p valor < 0.05). Todos los huesos que forman el Tarso poseen significación estadística en la comparación por sexos a excepción del cuboides, el cuneiforme medial y el cuneiforme lateral. Conclusiones: Sí existe diferencia significativa en la osificación de hueso del pie entre sexos y entre poblaciones de diferente raza.(AU)

Objectives: The estimation of the age of an individual is a topic of interest within the field of Legal and Forensic Medicine. One of the most used tools for this purpose is Radiology. The objectives of the present work are the quantification of the ages of ossification of each bone of the foot and to determine if there is a relationship between the ossification of the bones and the sex of the individual.Patients and methods: The study population was made up of 2476 digital radiographs, belonging to a total of 816 subjects in the growth period. The analysis of the images was carried out by applying the method validated and designed for the estimation of age in months on the X-ray of the skeleton of the foot. Results: If there is a difference in the bone ossification of the population of Extremadura compared to the literature (p value < 0,05). All the bones that form the tarsus have statistical significance in the comparison by sex, except for the Cuboid, the Medial Cuneiform and the Lateral Cuneiform. Conclusions: If there is a significant difference in foot bone ossification between sexes and between populations of different races.(AU)

Development of the long bones in the hands and feet of children: radiographic and MR imaging correlation.

The long bones of the hands and feet in children have an epiphyseal end with a secondary center of ossification and an adjacent transverse physis. In contrast to other long bones in the body, the opposite end in the hands and feet, termed the non-epiphyseal end, is characterized by direct metaphyseal extension of bone to complete terminal ossification. The purpose of this pictorial essay is to illustrate the developmental stages of each end of the long bones of the hands and feet with radiographic and MR imaging to provide a foundation from which to differentiate normal from abnormal growth.

A test of the Whitaker scoring system for estimating age from the bones of the foot.

Within the literature pertaining to skeletal age estimation, there is a paucity of statistically validated methods of age estimation from the foot. Given the prevalence of recovery of pedal elements in isolation, it is critical that methods exist to facilitate the estimation of age from this anatomical region and that those methods be tested to ensure they are reliable, repeatable and statistically robust. A study was carried out to determine the validity of using the Whitaker method of age estimation from the bones of the foot as a tool in forensic age estimation within a modern Scottish population. Two-hundred and sixty radiographs from individuals aged between birth and 18 years were assessed according to the Whitaker method; the results were compared with chronological age. The results of this study suggest that the method of Whitaker et al. is highly unlikely to estimate the age of females below 16 years of age or males below 18 years of age correctly. When the methodology was altered to correspond with best practice principles of age estimation, the estimated age ranges were found to be too wide to be of practical value in forensic age estimation. The results of this study therefore suggest that the Whitaker method for estimating age from the bones of the foot should not be used in forensic age assessment.

Effects of alendronate and pamidronate on cultured rat metatarsal bones: failure to prevent dexamethasone-induced growth retardation.

Bisphosphonates are widely used anti-resorptive drugs in the adult population. In children, their use has mainly been limited to patients with osteogenesis imperfecta. However, the powerful effects of bisphosphonates on bone turnover have raised concern about their long-term effects on the growing skeleton. We aimed to study the effects of two commonly used bisphosphonates, alendronate (Aln) and pamidronate (Pam) on normal bone growth as well as their potential to prevent glucocorticoid-induced growth retardation. Effects on bone growth were studied in fetal rat metatarsal bones (day E20) that were cultured for 5-47 days and measured every 2-7 days. Cellular mechanisms were investigated in metatarsal bones and also in the human chondrocytic cell line HCS-2/8. Chondrocyte viability (WST-1), proliferation (BrdU incorporation), differentiation (collagen type X immunohistochemistry) and apoptosis (TUNEL and Cell Death ELISA) were determined. At a clinically relevant concentration of bisphosphonates (1 microM), metatarsal bone growth was stimulated by both Aln (p<0.001 for length and p<0.05 for width) and Pam (p<0.05 for both length and width) from day 19 of culture. The growth-stimulatory effect was associated with increased chondrocyte proliferation (+21% with Aln and +24% with Pam), while cell differentiation and apoptosis were not affected. Despite the finding that both Aln and Pam (1 muM) rescued HCS-2/8 cells from undergoing dexamethasone-induced apoptosis, neither of them was able to prevent dexamethasone-induced growth retardation of fetal rat metatarsal bones. Aln and Pam have the capacity to stimulate the growth of cultured fetal rat metatarsal bones; an effect associated with increased proliferation of growth plate chondrocytes. Our experimental data suggest that bisphosphonates are ineffective in preventing glucocorticoid-induced growth retardation. Nevertheless, based on our in vitro data, both Aln and Pam appear safe to use in growing children, at least with regard to their effects on linear bone growth.

Constant and continuous growth reduction as a possible cause of ageing.

Post-embryonic growth is characterized by a constant reduction of some growth parameters in relation to other growth parameters. Comparison of growth in chickens, rats and nematodes reveals an identical growth pattern, so a theory about the growth process in general is presented. It is presumed that the same growth promoting and growth inhibiting substances regulate not only growth but also ageing and that it is the equilibrium between growth promoters and growth inhibitors which is constantly changed.

Inter-generation differences in foot morphology: aging or secular change?

Inter-generation differences in foot dimensions were examined using ANCOVA to determine whether aging or secular change is the more important causal factor. In examining the results, bone size was assumed not to change after the end of linear growth, while foot arches were assumed to become flatter rather than higher if there were any changes in skeletal structure. Changes in overall body build according to age were examined using statistical data collected by the government through population-follow-up. Secular changes in foot length (FL) and foot breadth, diagonal (FB) as well as the changes with age in FB were examined using data measured at ages younger than 50 years. The effects of overall body build were examined using the body mass index (BMI). Compared to the 1970 group (birth year: 1960-78) of the same FL, the 1930 group (birth year: 1909-39) had larger foot circumferences, wider breadth measurements, higher dorsal arches and ball, and greater toe 5 angle, but had shorter fibular instep lengths and shorter 5th metatarsal bones. The 1930 groups tended to have larger FB than the 1970 group of the same foot circumference. No inter-generation differences were observed in the heights at the medial and lateral malleoli, toe 1 angle, or the relationship between FB and heel breadth. These findings are discussed in terms of the effects of weight increase after the end of linear growth, changes in skeletal structure, overall body build as young adults, socioeconomic status during the growth period, as well as differential growth rates of foot bones. The conclusions are 1) changes in foot length and longitudinal arches due to aging are negligible, 2) the large circumferences, breadths, and higher dorsal arches and ball of the 1930 group for their foot length are better explained by their robust bones than by the increase in soft tissue after the end of linear growth, and 3) the larger FB of the 1930 group for their foot circumference is partly explained by their shorter fibular instep length. As a whole, factors affecting growth (secular change) are more important than changes after the end of growth (aging) in the inter-generation differences in foot morphology.

The neglected clubfoot: a salvage procedure.

The study included 18 patients (28 feet), between 4 and 14 years of age. Complete homogeneous correction of the neglected clubfoot was achieved by performing a trapezoid resection osteotomy from the cuboid bone after performing an extensive posteromedial soft-tissue release. The procedure did not sacrifice any articular cartilage and allowed realignment of the forefoot. Tibialis anterior tendon transfer to the cuboid was performed in all feet to eliminate its deforming action and to help maintain the desired degree of correction. A Dwyer calcaneal lateral closing wedge osteotomy was needed in 12 feet and was performed concomitantly with the other procedures. After an average follow-up of 26 months (range 8-31 months) 14 (50%) feet had a good result with normal features, 11 (39.3%) feet had a fair result with definite improvement, and three (10.7%) feet had a poor result with limited improvement. Both good and fair results were considered satisfactory. Patients with tight ligaments were significantly more likely to have a poor outcome (p < .0005). However, neither the patient's age at the time of surgery nor the severity of the deformity was significantly associated with unsatisfactory results. The procedure is strongly recommended in supple feet with resilient ligaments, even in teenagers with severe deformity. In severely deformed rigid feet, the procedure serves to minimize bone resection, thus preventing excessive shortening of the foot if a triple arthrodesis should become necessary at a later date.