Metacarpal Indices and Their Association with Fracture in South African Children and Adolescents.

This prospective study assessed whether metacarpal indices predict fracture risk in children and adolescents. Radiogrammetry was performed at the second metacarpal midshaft on annual hand-wrist radiographs of 359 South African (SA) children aged 10-17 years. Bone length, bone width, and medullary width were measured, and the following proxies for bone strength calculated: metacarpal index (MCI), bone mineral density (BMD), section modulus (SM), stress-strain index (SSI), and slenderness index (SLI). Height and weight were measured annually. Self-reported physical activity (PA) and fracture history were obtained at ages 15 years (for the preceding 12 months) and 17 years, respectively. At 17 years, 82 (23%) participants (black, 16%; white, 42%; p < 0.001) reported a previous fracture. None of the bone measures or indices were associated with fracture in black participants. In white females, after adjusting for PA, a 1 standard deviation (SD) greater SLI doubled the fracture risk [odds ratio (OR) 2.08; 95% confidence interval (CI) 1.08, 3.98]. In white males, a 1 SD greater BMD was associated with a 2.62-fold increase in fracture risk (OR 3.62; 95% CI 1.22, 10.75), whilst a 1 SD greater SM (OR 2.29; 95% CI 1.07, 4.89) and SSI (OR 2.23; 95% CI 1.11, 4.47) were associated with a more than twofold increase in fracture risk, after height, and PA adjustment. No single index consistently predicted fracture across the four groups possibly due to ethnic and sex differences in bone geometry, muscle mass, and skeletal loading. Metacarpal radiogrammetry did not reliably predict fracture in SA children.

A longitudinal comparison of appendicular bone growth and markers of strength through adolescence in a South African cohort using radiogrammetry and pQCT.

To compare growth patterns and strength of weight- and non-weight-bearing bones longitudinally. Irrespective of sex and ethnicity, metacarpal growth was similar to that of the non-weight-bearing radius but differed from that of the weight-bearing tibia. Weight- and non-weight-bearing bones have different growth and strength patterns. INTRODUCTION: Functional loading modulates bone size and strength. METHODS: To compare growth patterns and strength of weight- and non-weight-bearing bones longitudinally, we performed manual radiogrammetry of the second metacarpal on hand-wrist radiographs and measured peripheral quantitative computed tomography images of the radius (65%) and tibia (38% and 65%), annually on 372 black and 152 white South African participants (ages 12-20 years). We aligned participants by age from peak metacarpal length velocity. We assessed bone width (BW, mm); cortical thickness (CT, mm); medullary width (MW, mm); stress-strain index (SSI, mm3); and muscle cross-sectional area (MCSA, mm2). RESULTS: From 12 to 20 years, the associations between metacarpal measures (BW, CT and SSI) and MCSA at the radius (males R2 = 0.33-0.45; females R2 = 0.12-0.20) were stronger than the tibia (males R2 = 0.01-0.11; females R2 = 0.007-0.04). In all groups, radial BW, CT and MW accrual rates were similar to those of the metacarpal, except in white females who had lower radial CT (0.04 mm/year) and greater radial MW (0.06 mm/year) accrual. In all groups, except for CT in white males, tibial BW and CT accrual rates were greater than at the metacarpal. Tibial MW (0.29-0.35 mm/year) increased significantly relative to metacarpal MW (- 0.07 to 0.06 mm/year) in males only. In all groups, except white females, SSI increased in each bone. CONCLUSION: Irrespective of sex and ethnicity, metacarpal growth was similar to that of the non-weight-bearing radius but differed from that of the weight-bearing tibia. The local and systemic factors influencing site-specific differences require further investigation. Graphical abstract.

Differences in third metacarpal trabecular microarchitecture between the parasagittal groove and condyle at birth and in adult racehorses.

BACKGROUND: The aetiology of equine metacarpal condylar fractures is not completely understood and a developmental cause has been postulated. OBJECTIVES: To investigate the subchondral bone trabecular microarchitecture of the lateral parasagittal groove and condyle in equine neonates and its adaptation with maturation and athletic activity. STUDY DESIGN: Ex vivo observational study. METHODS: Distal metacarpi of neonates, yearlings and adult racehorses (n = 24) were harvested. Dorsal and palmar frontal histological sections, containing the lateral parasagittal groove and condyle, were studied. The sections were digitalised and subchondral trabecular bone quantity and quality parameters and trabecular orientation in the frontal plane were measured. RESULTS: Trabecular spacing and length were greater (P = 0.004 and P = 0.0005 respectively) whereas bone fraction, trabecular number and connectivity were all lower (P = 0.0004, P = 0.0001 and P = 0.001 respectively) in the lateral parasagittal groove compared with the condyle in neonatal foals. Trabecular thickness and bone fraction increased with age in racehorses and trabecular spacing decreased. The predominant trabecular orientation had a consistent pattern in neonates and it changed with maturity and the cumulative effect of racing at all the ROIs except for the palmar lateral parasagittal groove that retained a more 'immature' pattern. MAIN LIMITATIONS: Samples were investigated in 2D. 3D processing could have provided more information. CONCLUSIONS: Already at birth there are striking differences in the subchondral bone trabecular microarchitecture between the lateral parasagittal groove and condyle in foals. Adaptation of trabeculae is confirmed with maturity in racehorses, with the greatest adaptation measured in bone quantity parameters. The trabecular orientation had a unique and more immature orientation pattern in the lateral palmar parasagittal grooves in adult racehorses and may reflect a weaker structure at this site.

The missing segment of the autopod 1st ray: new insights from a morphometric study of the human hand.

Whether the 1st segment of the human autopod 1st ray is a 'true' metapodial with loss of the proximal or mid phalanx or the original basal phalanx with loss of the metacarpal has been a long-lasting discussion. The actual knowledge of the developmental pattern of upper autopod segments at a fetal age of 20-22 weeks, combined with X-ray morphometry of normal long bones of the hand in the growing ages, was used for analysis of the parameters, percentage length, position of epiphyseal ossification centers and proximal/distal growth rate. The symmetric growth pattern in the fetal anlagen changed to unidirectional in the postnatal development in relation to epiphyseal ossification formation. The percentage length assessment, the distribution of the epiphyseal ossification centers, and differential proximal/distal growth rate among the growing hand segments supported homology of most proximal segment of the thumb with the 2nd-5th proximal phalanges and that of the proximal phalanx of the thumb with the 2nd-5th mid phalanges in the same hand. Published case reports of either metanalysis of 'triphalangeal thumb' and 'proximal/distal epiphyseal ossification centers' were used to support the applied morphometric methodology; in particular, the latter did not give evidence of growth pattern inversion of the proximal segment of the thumb. The presented data support the hypothesis that during evolution, the lost segment of the autopod 1st ray is the metacarpal.

Growth of the New Thumb Metacarpal After Pollicization for Thumb Hypoplasia.

PURPOSE: To investigate the radiographic length and width of the new thumb metacarpal in relation to the middle finger proximal phalanx; to assess the incidence of premature physeal closure of the new metacarpal; and to consider whether there is a relationship between growth characteristics and the presence of union or nonunion of the new trapezium to the retained index finger metacarpal base. METHODS: Forty pollicizations were assessed with preoperative or immediate postoperative radiographs and follow-up radiographs to establish the growth characteristics of the new thumb metacarpal. Functional outcomes comprising grip strength, pinch strength, and range of motion were correlated with radiological findings of presence or absence of open physes and presence or absence of union of the new trapezium to the metacarpal base. RESULTS: The new thumb metacarpal physis was open in 28 pollicizations and closed in 12. In the latter group, all physes of the hand had closed indicating skeletal maturity. The length and width indices of the new thumb metacarpal in relation to the middle finger proximal phalanx were equivalent to or greater than the perioperative growth indices. There was a reduced postoperative length ratio in those patients with nonunion of the new trapezium to the base of the metacarpal. There was no change in strength and range of motion parameters with growth other than that related to normal improvement with age. CONCLUSIONS: We are unable to demonstrate premature physeal closure following routine pollicization. The growth of the metacarpal continues in a normal manner to skeletal maturity. A failure of union of the new trapezium to the metacarpal base may compromise growth. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Exploring the existence of better hands for manipulation than the human hand based on hand proportions.

Human exhibits the most dexterous manual manipulation among the anthropoids. The sophisticated dexterity of human hand has been linked to its distinctive morphology compared to the nonhuman anthropoids. The human hand is derived from the ancestral hands after longtime evolution. However, there are more possible morphologies that the hands could take during the evolutionary process. It remains unknown whether better hands for manipulation than the human hand exist among these possible hands. To answer the question, the relationship between the manipulative capability and hand morphology need to be investigated in the region of more possible hands. Here we employ a kinematic model to quantitatively assess the manipulative ability of the possible hands from the aspect of hand proportions. The segment length proportions of each possible hand are reconstructed by the major evolutionary patterns of the anthropoid hands. Our results reveal that too long and too short thumbs relative to fingers both hamper the manual dexterity, though the long thumb of human hand is traditionally thought to be beneficial to manipulation. The results promote the understanding of the link between hand morphology and function. Furthermore, we find out the optimal hand for dexterous manipulation within the region reconstructed by the major evolutionary patterns of the anthropoid hands. The optimal hand is more dexterous than the human hand. Compared to the optimal hand, the human hand has shorter metacarpals relative to phalanges, which is thought to be advantageous to the prehensility. It suggests that the human hand is not an organ exclusive for the dexterous manipulation, but a trade-off between multiple functions.

Radiography of the distal extremity of the manus in the donkey foal: Normal images and quantitative characterization from birth to 2 years of age: A pilot study.

This study describes a radiographic survey of the anatomical development of the distal extremity of the manus in the donkey from 0 to 2 years of age. The right distal limb of 10 donkey foals, born in the spring of 2012, underwent radiographs every month for the first 6 months of age and every 3 months during the following 18 months. Latero-medial radiographs with and without barium marker at the coronary band and dorso-palmar radiographs with both front feet in weight bearing were obtained. The distal physis of the third metacarpal bone and the proximal physis of the proximal phalanx (phalanx proximalis) were closed at the mean age of 18.6 months. The distal physis of the proximal phalanx appeared as a clear radiolucent line at 2 weeks of age and was still subtly visible in some donkeys at 24 months. The proximal physis of the middle phalanx (phalanx media) was closed at the mean age of 16.7 months. The distal physis of this phalanx was visible at birth, but closed at 4 days. The distal phalanx (phalanx distalis) was triangular at birth. At the age of 20-21 months, the palmar processes (processus palmares) were both developed. The navicular bone (os sesamoideum distalis) was developed at the mean age of 9 months. The proximal sesamoid bones (ossa sesamoidea proximalia) were seen in continuously development during the 24 months. It seems that the physes in the distal extremity of the manus in the donkey close at an older age than the physes in the horse.

Metacarpal Growth During Adolescence in a Longitudinal South African Cohort.

To monitor the drift of the periosteal and endocortical surfaces during metacarpal growth longitudinally, radiogrammetry was carried out on hand-wrist X-rays of 572 children from the Birth to Twenty Bone Health Cohort annually from ages 9 to 21 years. This is the largest collection of longitudinal X-rays in African children. The second metacarpal bone length, bone width, and medullary width were measured using digital vernier calipers on a total of 4730 X-rays. Superimposition by Translation and Rotation (SITAR) was used to obtain age at peak metacarpal length velocity (PLV). Bone width and medullary width were modeled using SITAR against both chronological age and age from PLV. In black and white females, tempo and velocity of metacarpal length growth was synchronized. Black males, however, attained PLV 7 months later than white males (p < 0.0001). Compared to white males, black males had a longer second metacarpal (p < 0.05), and greater bone width size (p < 0.02), tempo (p < 0.0009), and velocity (p < 0.0001). Medullary width growth velocity in black participants peaked 2 years prior to attainment of PLV and exceeded that of their white peers (p < 0.0001) in whom it peaked 6 to 12 months post-PLV attainment. Black adolescents therefore had wider bones with relatively thinner cortices and wider medullary cavities than their white peers. Ethnic and sex differences also occurred in the timing of medullary width contraction that accompanied expansion in bone width and cortical thickness. In black males, medullary width contraction commenced approximately 3 years later than in black females, whereas in white males this occurred a year later than in white females. The ethnic and sex differences in bone acquisition reported in this study may differentially affect bone mass in later life. © 2017 American Society for Bone and Mineral Research.

Acquired Upper Extremity Growth Arrest.

This study reviewed the clinical history and management of acquired growth arrest in the upper extremity in pediatric patients. The records of all patients presenting from 1996 to 2012 with radiographically proven acquired growth arrest were reviewed. Records were examined to determine the etiology and site of growth arrest, management, and complications. Patients with tumors or hereditary etiology were excluded. A total of 44 patients (24 boys and 20 girls) with 51 physeal arrests who presented at a mean age of 10.6 years (range, 0.8-18.2 years) were included in the study. The distal radius was the most common site (n=24), followed by the distal humerus (n=8), metacarpal (n=6), distal ulna (n=5), proximal humerus (n=4), radial head (n=3), and olecranon (n=1). Growth arrest was secondary to trauma (n=22), infection (n=11), idiopathy (n=6), inflammation (n=2), compartment syndrome (n=2), and avascular necrosis (n=1). Twenty-six patients (59%) underwent surgical intervention to address deformity caused by the physeal arrest. Operative procedures included ipsilateral unaffected bone epiphysiodesis (n=21), shortening osteotomy (n=10), lengthening osteotomy (n=8), excision of physeal bar or bone fragment (n=2), angular correction osteotomy (n=1), and creation of single bone forearm (n=1). Four complications occurred; 3 of these required additional procedures. Acquired upper extremity growth arrest usually is caused by trauma or infection, and the most frequent site is the distal radius. Growth disturbances due to premature arrest can be treated effectively with epiphysiodesis or osteotomy. In this series, the specific site of anatomic growth arrest was the primary factor in determining treatment. [Orthopedics. 2017; 40(1):e95-e103.].

Contribution of magnetic resonance imaging of the wrist and hand to forensic age assessment.

Forensic age estimation of living individuals is a controversial subject because of the imprecision of the available methods which leads to errors. Moreover, young persons are exposed to radiation, without diagnostic or therapeutic advantage. Recently, non-invasive imaging techniques such as magnetic resonance imaging (MRI) have been studied in this context. The aim of this work was to study if the analysis of wrist/hand MRI enabled determination of whether a subject was 18 years old. Two observers retrospectively analyzed metaphyseal-epiphyseal fusion of the distal epiphysis of the radius and the ulna and the base of the first metacarpus in wrist/hand MRI of living people between 9 and 25 years of age. A three-stage scoring system was applied to all epiphyses. Intra- and inter-observer variability was excellent. Staging of the distal radial epiphysis allowed the subjects to be correctly evaluated with regard to the 18-year-old threshold in more than 85 % of cases. Analysis of the radius alone was as good as the analysis of the three epiphyses together. Evaluation of the metaphyseal-epiphyseal fusion of the distal radius in wrist MRI gave good results in forensic age estimation. Wrist MRI could meet ethical expectations with regard to the link between the benefit and risk of practicing radiologic examination on individuals in this context.

Validity of the assessment method of skeletal maturation by cervical vertebrae: a systematic review and meta-analysis.

OBJECTIVES: To perform a systematic review with meta-analysis to answer the question: is the cervical vertebrae maturation index (CVMI) effective to replace hand-wrist radiograph (gold standard) in determining the pubertal growth spurt in patients undergoing bone growth? METHODS: A search in three databases was performed, in which studies were selected that compared one of the two main assessment methods for cervical vertebrae (Hassel B, Farman AG. Skeletal maturation evaluation using cervical vertebrae. Am J Orthod Dentofacial Orthop 1995; 107: 58-66, or Baccetti T, Franchi L, McNamara JA Jr. An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod 2002; 72: 316-23) to a carpal assessment method. The main methodological data from each of the texts were collected and tabulated after. Later, the meta-analysis of the correlation coefficients obtained was performed. RESULTS: 19 articles were selected from an initial 206 articles collected. Regardless of the method used, the results of the meta-analysis showed that every article selected presented a positive correlation between skeletal maturation assessment performed by cervical vertebrae and carpal methods, with discrepancy of values between genders indicating higher correlation for the female gender (0.925; 0.878) than for the male (0.879; 0.842). When the assessment was performed without gender separation, correlation was significant (0.592; 0.688) but lower in the cases when genders were separated. CONCLUSIONS: With the results of this meta-analysis, it is safe to affirm that both CVMIs used in the present study are reliable to replace the hand-wrist radiograph in predicting the pubertal growth spurt, considering that the highest values were found in female samples, especially in the method by Hassel and Farman.

Metacarpal thickness, width, length and medullary diameter in children--reference curves from the First Zürich Longitudinal Study.

SUMMARY: Metacarpal thickness (T), width (W), length (L) and medullary diameter (M) were measured in 3,121 X-rays from 231 healthy Caucasian children aged 3 to 19 years and analysed for bone age, age, height, weight and gender-related characteristics, showing highly differentiated growth patterns with prepubertal dips. Reference data for the four metacarpal measures are presented. INTRODUCTION: The aim of the study was to create and explore a reference database for metacarpal T, W, L and M in children. METHODS: Three thousand one hundred twenty-one left-hand X-rays (1,661 from boys) from 231 healthy Caucasian subjects (119 boys) aged 3 to 19 years were analysed by BoneXpert, a programme for automatic analysis of hand X-rays and bone age (BA; in years). RESULTS: In boys, growth of T, W and L shows a prepubertal decrease from BA 7 to 13 and then accelerates again. In girls, the same is seen only for T starting from BA 8 to 11, whereas W and L grow at a declining rate. M shows steady growth until BA 10.5 in girls and BA 13.5 in boys and then grows smaller in both. W is greater in boys from BA 6 onwards, while L is greater in girls from BA 9 to 13 and T from BA 11 to 14. BA is reflected best by L until start of puberty and by T and L thereafter. CONCLUSION: T, W, L and M show highly differentiated growth patterns. These reference data provide a basis for further research into skeletal development and the management of hormone therapies in children.

The first metacarpal is the thumb first phalange: EvoDevo implications / El primer metacarpiano es la primera falange del pulgar: implicaciones en EvoDevo

We examined the status of the first metacarpal bone whose shape, fetal and post-natal development correspond to those of the thumb proximal phalanx. Galen already described this, circa 170 CE. Our radiographic data confirm that the pre-axial (radial or anterior) side of the hand matures, later than the post-axial (ulnar or posterior) side, both, pre- and post-natally. A new perspective on thumb primate and human ontogeny is discussed and comparative observations on the Evolutionary Development (EvoDevo) of the thumb and the first toe are proposed along with a nomenclature honoring Galen's original roposition.

Se analiza el estado del primer metacarpiano cuya forma y desarrollo embrionario, fetal y postnatal corresponde a los de la primera falange del pulgar. Galeno notó que éste era la primera falange del pulgar cerca de 170 DC. Esto no es un simple cambio de nomenclatura, ya que da una nueva luz a los problemas evolutivos de ontogenia (EvoDevo). Nuestros datos radiográficos confirman que el lado radial (anterior o pre-axial) de la mano madura, pre y post-natalmente, mas tardíamente que el lado cubital (posterior o post-axial). Se discuten nuevas perspectivas sobre la ontogenia y filogenia humana y de primates, y se proponen estudios comparativos del desarrollo del pulgar y del ortejo mayor.

Growth of severely hypoplastic phalanges and metacarpals in symbrachydactyly: an experimental study in mice.

PURPOSE: Severely hypoplastic phalanges and metacarpals in symbrachydactyly are often associated with a delay or failure of primary ossification evident by radiography at birth. However, little is known about the ossification pattern and further growth of severely hypoplastic bones in symbrachydactyly. To clarify this mechanism, we observed development during ossification of the hypoplastic phalanges in brachypodism mice (which carry functional null mutations of growth differentiation factor 5 and exhibit hypoplastic phalanges) as a model of the bone hypoplasia in symbrachydactyly. METHODS: Forelimbs of wild-type and brachypodism mice from embryonic day 16.5 to 21 days after birth were sectioned. We used radiography to examine the progression of ossification; safranin O fast green-iron hematoxylin staining and in situ hybridization for type II collagen to demonstrate cartilage; the transferase-mediated nick end-labeling assay to identify apoptosis; and tartrate-resistant acid phosphatase staining to demonstrate osteoclastic activity. RESULTS: In brachypodism mice, radiography showed markedly delayed ossification of the proximal phalanges in comparison with wild-type mice. Safranin O staining and type II collagen in situ hybridization showed that the cartilage anlagen of the proximal phalanges were extremely small, with diffuse endochondral ossification throughout, resulting in lack of growth plate and chondroepiphysis formation. Apoptotic cells were present under the perichondrium on the plantar side of the proximal phalanges from day 7 after birth and had spread randomly by day 14. Diffuse osteoclastic activity was evident throughout the proximal phalanges from days 7 to 14 after birth. CONCLUSIONS: These results indicate that severely hypoplastic proximal phalanges in brachypodism mice, although showing an endochondral ossification pattern, lack a growth plate and have no potential for secondary growth. These findings may be relevant to the treatment of symbrachydactyly with severely hypoplastic bones, which are not evident radiographically at birth.

Postnatal bone elongation of the manus versus pes: analysis of the chondrocytic differentiation cascade in Mus musculus and Eptesicus fuscus.

Bones elongate postnatally by endochondral ossification as cells of the cartilaginous growth plate undergo a differentiation cascade of proliferation, cellular hypertrophy and matrix synthesis. Interspecific comparisons of homologous bones elongating at different rates has been a useful approach for studying the dynamics of this process. The purpose of this study was to measure quantitative stereological parameters of growth plates of the third digit of the manus and pes of the laboratory mouse, and make comparisons to chondrocytic performance parameters in the homologous bones of the big brown bat, Eptesicus fuscus, where extremely rapid postnatal elongation of bones of the manus is associated with skeletal modifications for powered flight. Measurements were made across all zones of forelimb and hindlimb autopod growth plates by dividing each growth plate into strata of equal height (from thirteen 200-mum-high strata in the metacarpus to five 40-mum-high strata in phalangeal bones of the pes). Results indicate that all chondrocytic performance parameters known to quantitatively contribute to the elongation potential of a growth plate change together. A significant finding was that in growth plates of the chiropteran manus, final hypertrophic cell size and shape were achieved early in the zone of hypertrophy, indicating that interstitial expansion of the growth plate resulting from the incremental chondrocytic height increase in the direction of elongation was completed soon after the transition from the cessation of proliferation to the initiation of hypertrophy. This is unlike what has been reported in most mammalian growth plates previously analyzed, but is the situation in the proximal tibial growth plate of rapidly growing frogs and precocial birds. This suggests that a similar adaptation for stabilization of a rapidly elongating bone has evolved independently in three widely separated groups that have in common rapid growth in limbs to be used for early active, powered locomotion.

Growth plate formation and development in alligator and mouse metapodials: evolutionary and functional implications.

Mammalian metapodials (metacarpals and metatarsals), unlike most long bones, form a single growth plate, and undergo longitudinal growth at only one end. The growth dynamics of non-mammalian tetrapod metapodials have not been systematically examined in order to determine if unidirectional growth is unique to mammals. Here we compare murine metapodial ossification in growth stages that parallel those of embryonic, juvenile and subadult American alligators (Alligator mississippiensis). Safranin O staining was used for qualitative histology, and chondrocyte differentiation and proliferation were assessed via immunohistochemistry for type X collagen and proliferative cell nuclear antigen (PCNA). We establish that growth plates form at both ends of alligator metapodials and are maintained in the subadult. PCNA results show that alligators and mice share common patterns of chondrocyte proliferation during growth plate formation. In addition, while alligators and mice differ initially in the degree of organization and pace of chondrocyte differentiation, these parameters are largely similar in established growth plates. However, the replacement of cartilage by bone is highly irregular throughout growth in the alligator, in contrast to the more uniform process in the mouse. These results indicate that while alligators and mammals share common mechanisms of chondrocyte regulation, they differ substantially in their processes of ossification. Phylogenetic analysis indicates that the direct ossification of one epiphysis and reliance on a single growth plate is a derived character (synapomorphy) in therian mammals and likely indicates an adaptation for erect quadrupedal gait.

Response of plasma CNP forms to acute anabolic and catabolic interventions in growing lambs.

Using a novel marker of C-type natriuretic peptide (CNP) synthesis [amino-terminal pro-CNP (NT-proCNP)], we have recently shown that plasma NT-proCNP is strongly correlated with skeletal growth and markers of bone formation and is reversibly reduced by glucocorticoids. The effects on CNP of other catabolic or anabolic factors, known to affect skeletal growth, are unknown. Accordingly, we have studied the response of plasma CNP forms to acute catabolic (caloric restriction) and anabolic [growth hormone (GH) stimulation] interventions in lambs and related the findings to circulating IGF-I levels, growth velocity, and markers of bone formation. Lambs fed a reduced caloric intake (25% of normal) for 6 days exhibited reduced live weight, plasma urea, and IGF-I (P < 0.001 for all) compared with control lambs. Basal levels of NT-proCNP (40.1 +/- 0.9 pmol/l) fell promptly to a nadir (28.1 +/- 0.8 pmol/l, P < 0.001) on day 6, returning rapidly to basal levels upon refeeding. Although plasma alkaline phosphatase (ALP) fell (P < 0.001), reductions in metacarpal growth velocity were not significant within the 12-day period of study. In contrast to caloric restriction, long-acting bovine recombinant GH (2.5 mg/kg on days 0 and 6), as expected, increased plasma IGF-I more than twofold above control for 12 days (P < 0.001). Growth velocity did not differ during the 30 days of observation, and, consistent with unchanged growth velocity, plasma NT-proCNP and ALP were also unaffected. In conclusion, CNP synthesis and markers of bone formation are acutely sensitive to catabolism but unaffected by doses of GH that fail to stimulate skeletal growth.

[Study on development of hand-wrist bone in 14 year-old adolescents I: bone age standard for boys].

OBJECTIVE: To study the bone development in adolescents in China, and establish forensic skeletal age standard for estimation of the criminal responsible age in 14 years old male adolescents. METHODS: One hundred and three healthy boys aged from 13 years and 9 months to 14 years and 3 months in Lengshuijiang, Hunan, China were enrolled in this study. X-ray films of their left hand-wrist were taken dorsaventrally, and 15 selected sites on the wrist X-ray films were examined and measured under standard condition. The development grade was confirmed by maximum percentage to establish a method to estimate the bone age, which was then checked by single blind method. RESULTS: Development grade of the first metacarpal bone and the first phalanx IV was partially closed (less than 1/3), but the rest was non-closed. The cross diameters of all the osteoepiphysis were wider than that of all the diaphysis. The development grade of the fourth metacarpal bone and the fifth metacarpal bone as well as the adjacent third phalanx were different in both younger age group (<14 years, mostly non-closed) and the older age group (>14 years, mostly closed). The confirmed accuracy (in 30 boys) was 80%. CONCLUSION: Our study seems to be feasible in establishing the estimation standard for skeletal age determination using developmental metaphysis and anthropometry. The standard may be particularly helpful in forensic practice for estimation of accurate criminal responsible age in adolescents.

Study on development of hand-wrist bone in 14 year-old adolescents I: bone age standard for boys / 法医学杂志

OBJECTIVE@#To study the bone development in adolescents in China, and establish forensic skeletal age standard for estimation of the criminal responsible age in 14 years old male adolescents.@*METHODS@#One hundred and three healthy boys aged from 13 years and 9 months to 14 years and 3 months in Lengshuijiang, Hunan, China were enrolled in this study. X-ray films of their left hand-wrist were taken dorsaventrally, and 15 selected sites on the wrist X-ray films were examined and measured under standard condition. The development grade was confirmed by maximum percentage to establish a method to estimate the bone age, which was then checked by single blind method.@*RESULTS@#Development grade of the first metacarpal bone and the first phalanx IV was partially closed (less than 1/3), but the rest was non-closed. The cross diameters of all the osteoepiphysis were wider than that of all the diaphysis. The development grade of the fourth metacarpal bone and the fifth metacarpal bone as well as the adjacent third phalanx were different in both younger age group (<14 years, mostly non-closed) and the older age group (>14 years, mostly closed). The confirmed accuracy (in 30 boys) was 80%.@*CONCLUSION@#Our study seems to be feasible in establishing the estimation standard for skeletal age determination using developmental metaphysis and anthropometry. The standard may be particularly helpful in forensic practice for estimation of accurate criminal responsible age in adolescents.

A comparison of hand-wrist bone and cervical vertebral analyses in measuring skeletal maturation.

OBJECTIVE: To compare skeletal maturation as measured by hand-wrist bone analysis and by cervical vertebral analysis. MATERIALS AND METHODS: A radiographic hand-wrist bone analysis and cephalometric cervical vertebral analysis of 30 patients (14 males and 16 females; 7-18 years of age) 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 stage (CVMS) method. To define vertebral stages, the analysis consisted of both cephalometric (13 points) and morphologic evaluation of three cervical vertebrae (concavity of second, third, and fourth vertebrae and shape of third and fourth vertebrae). These measurements were then compared with the hand-wrist bone analysis, and the results were statistically analyzed by the Cohen kappa concordance index. The same procedure was repeated after 6 months and showed identical results. RESULTS: The Cohen kappa index obtained (mean +/- SD) was 0.783 +/- 0.098, which is in the significant range. The results show a concordance of 83.3%, considering that the estimated percentage for each case is 23.3%. The results also show a correlation of CVMS I with Bjork stages 1-3 (interval A), CVMS II with Bjork stage 4 (interval B), CVMS III with Bjork stage 5 (interval C), CVMS IV with Bjork stages 6 and 7 (interval D), and CVMS V with Bjork stages 8 and 9 (interval E). CONCLUSIONS: Vertebral analysis on a lateral cephalogram is as valid as the hand-wrist bone analysis with the advantage of reducing the radiation exposure of growing subjects.