Entheseal variation and locomotor behavior during growth.

Entheses are acknowledged as skeletal markers capable of revealing several biological and behavioral aspects of past individuals and populations. However, entheseal changes (ECs) of juvenile individuals have not yet been studied with a systematic approach. This contribution aims at investigating the morphological changes occurring at the femoral insertion of the gluteus maximus and tibial origin of the soleus muscles to highlight a potential link between the morphological features of those entheses and skeletal maturity in relation to sex, age, and locomotor developmental patterns. The sample consisted of 119 skeletons (age-at-death: 0-30 years) belonging to the Documented Human Skeletal Collection of the Certosa Cemetery (Bologna, Italy). The entheseal variation during the last stages of skeletal maturation in young adults was assessed using existing recording standards. A recording protocol for each enthesis was developed for immature individuals to subdivide the morphological variability into discrete categories. Univariate, bivariate, and multivariate statistical analyses were performed to investigate the variation of entheseal morphologies and measurements in relation to bone metrics, degree of epiphyseal closure, sex, age, and locomotor developmental patterns. A statistically significant relationship was observed between ECs morphological patterns and age for both entheses, while sexual differences were negligible. A relationship between ECs morphological pattern and locomotor milestones emerged only for the gluteus maximus. Even though further testing is needed on other documented skeletal collections, our protocol could be usefully applied in forensic and archaeological fields and serving as important reference for evolutionary investigations.

Forensic age estimation at the University Center of Legal Medicine Lausanne-Geneva: a retrospective study over 12 years.

With the undeniable increase in asylum requests from unaccompanied alleged minors, age estimation of living individuals has become an essential part of the routine work in European forensic centers. This study aims to review the forensic age estimations performed in our center since 2010, to evaluate the state-of-the-art of this practice in Switzerland with the evolution of the methodology according to upcoming recommendations. Our institute's expert reports performed between 2010 and 2022 were retrospectively analyzed. We gathered the following parameters: demographic data, morphological characteristics, alleged age compared with the assessed minimum age, sexual maturation, dental and bone age. When available, we collected personal and family history, medical history, records of torture-related/self-inflicted injuries, and information about eating habits that might affect skeletal development. Data collection amounted to 656 cases. Forensic age estimations ordered by the Swiss Secretariat for Migration (SEM) represented 76.4% of cases, with 23.6% of them ordered by the Court/Public Prosecutor. Most alleged minors were male (94.5%) and came from Afghanistan (53.4%). Adjunction of CT scans of the sternoclavicular joints was necessary in 86.4% of cases. Only 25.2% of our reports concluded on most probable minority, with 55.6% of definite majors; in 19.2% of our cases, minority could not be excluded. This study aspires to further broaden our expertise regarding forensic age estimations. Given the increasing migratory flows, we can expect a notable increase in the frequency of these requests. Consequently, this study aims to promote a multidisciplinary approach and the international standardization of the methodology of these estimations.

Does ethnicity influence bone health index in children? A pilot study.

BACKGROUND: Several pathological conditions can lead to variations in bone mineral content during growth. When assessing bone age, bone mineral content can be estimated without supplementary cost and irradiation. Manual assessment of bone quality using the Exton-Smith index (ESI) and automated assessment of the bone health index (BHI) provided by the BoneXpert® software are available but still not validated in different ethnic groups. OBJECTIVE: Our aim is to provide normative values of the ESI and BHI for healthy European Caucasian and first-generation children of North Africans living in Europe. MATERIALS AND METHODS: A sex- and aged-match population of 214 girls (107 European-Caucasian and 107 North African) and 220 boys (111 European-Caucasian and 109 North African) were retrospectively and consecutively included in the study. Normal radiographs of the left hand and wrist from healthy children were retrieved from those performed in a single institution from 2008 to 2017 to rule out a left-hand fracture. Radiographs were processed by BoneXpert® to obtain the BHI and BHI standard deviation score (SDS). One radiologist, blinded to BHI values, manually calculated ESI for each patient. The variability for both methods was assessed and compared using the standard deviation (SD) of the median (%) for each class of age and sex, and ESI and BHI trends were compared by sex and ethnic group. RESULTS: The final population comprised 434 children ages 3 to 15 years (214 girls). Overall, BHI was lower in North African children (mean = 4.23 for girls and 4.17 in boys) than in European Caucasians (mean = 4.50 for girls and 4.68 in boys) (P < 0.001). Regardless of ethnicity, 29 girls (13.6%) and 34 boys (15.5%) had BHI more than 2 SD from the mean. While correlated to BHI, ESI has a higher variability than BHI and is more pronounced from 8-12 years for both sexes (mean ESI in European Caucasian girls and boys 17.47 and 20.87, respectively) (P < 0.001). ESI showed more than 15% variability in European girls from 8-12 years and a plateau in North African boys from 12 years to 16 years. However, the BHI has less than 15% variability regardless of age and ethnic group. CONCLUSION: BHI may be a reliable tool to detect children with abnormal bone mineral content, with lower variability compared to ESI and with specific trends depending on sex and ethnicity.

Evaluation of an objective staging system for assessment of cervical vertebral maturation.

BACKGROUND: The aim of this study was to evaluate an objective method for Cervical Vertebral Maturation (CVM) staging. METHODS: An initial sample of 647 Lateral Cephalometric Radiographs (LCR) were staged according to the CVM (Baccetti et al.) by 4 examiners. The final sample (n = 394) included LCR on which the staging of the 4 investigators matched. The objective staging was performed by a single operator. The sample was divided according to the maturational stages into pre-pubertal, pubertal and post-pubertal groups. Measurements were performed on the cervical vertebrae (C2, C3 and C4). The angle between posterior and superior borders for C3 and C4 was the Superior Wall Inclination Angle (SWIA). Concavity Depth (CD) for C2, C3 and C4, and Body Shape (BS) (ratio of width to height of C3 and C4). Measurements of the 3 groups were compared. RESULTS: Reliability of subjective staging was high (intra-observer reliability, 0.948; inter-observer reliability, 0.967). Good agreement was observed for the outcomes measured. Intra-observer reliability was good (0.918, 0.885 and 0.722 for CD, BS and SWIA, respectively). The same was for the inter-observer reliability results (0.902, 0.889 and 0.728 for CD, BS and SWIA, respectively). Significant differences were observed for mean values of SWIA and BS and median values of CD within maturational stage. Similar findings were observed when the outcomes were compared at different phases (P < 0.001). CONCLUSIONS: A standardized, objective staging system using linear, angular measurements and ratios was applied for the determination of cervical vertebral maturation.

Magnetic resonance and diffusion tensor imaging of the adolescent rabbit growth plate of the knee.

PURPOSE: To assess the ability of MRI-DTI to evaluate growth plate morphology and activity compared with that of histomorphometry and micro-CT in rabbits. METHODS: The hind limbs of female rabbits aged 16, 20, and 24 wk (n = 4 per age group) were studied using a 9.4T MRI scanner with a multi-gradient echo 3D sequence and DTI in 14 directions (b-value = 984 s/mm2 ). After MRI, the right and left hind limb were processed for histological analysis and micro-CT, respectively. The Wilcoxon signed-rank test was used to evaluate the height and volume of the growth plate. Intraclass correlation and Pearson correlation coefficient were used to evaluate the association between DTI metrics and age. RESULTS: The growth plate height and volume were similar for all modalities at each time point and age. Age was correlated with all tractography and DTI metrics in both the femur and tibia. A correlation was also observed between all the metrics at both sites. Tract number and volume declined with age; however, tract length did not show any changes. The fractional anisotropy color map showed lateral diffusion centrally in the growth plate and perpendicular diffusion in the hypertrophic zone, as verified by histology and micro-CT. CONCLUSION: MRI-DTI may be useful for evaluating the growth plates.

Intra-observer reproducibility and inter-observer agreement of Fels skeletal age assessments among male tennis players 8-16 years.

BACKGROUND: Skeletal age (SA) is an estimate of biological maturity status that is commonly used in sport-related medical examinations. This study considered intra-observer reproducibility and inter-observer agreement of SA assessments among male tennis players. METHODS: SA was assessed with the Fels method in 97 male tennis players with chronological ages (CA) spanning 8.7-16.8 years. Radiographs were evaluated by two independent trained observers. Based on the difference between SA and CA, players were classified as late, average or early maturing; if a player was skeletally mature, he was noted as such as an SA is not assigned. RESULTS: The magnitude of intra-individual differences between repeated SA assessments were d = 0.008 year (observer A) and d = 0.001 year (observer B); the respective coefficients of variation were 1.11% and 1.75%. Inter-observer mean differences were negligible (t = 1.252, p = 0.210) and the intra-class correlation coefficient was nearly perfect (ICC = 0.995). Concordance of classifications of players by maturity status between observers was 90%. CONCLUSION: Fels SA assessments were highly reproducible and showed an acceptable level of inter-observer agreement between trained examiners. Classifications of players by skeletal maturity status based on assessments of the two observers were highly concordant, though not 100%. The results highlight the importance of experienced observers in skeletal maturity assessments.

Association between dental and skeletal maturation in Scandinavian children born between 2005 and 2010.

OBJECTIVE: The aim of this cross-sectional study was to analyse the association between dental and skeletal maturation in children born between 2005 and 2010. MATERIALS AND METHODS: Dental and skeletal maturation of 117 ethnic Scandinavian children born between 2005 and 2010 (70 girls, 47 boys, mean age 11.48 years) was analysed. Dental maturation (DM) was assessed on orthopantomographs (OPs) by using Demirjian's and Haavikko's methods while skeletal maturation was assessed on hand-wrist radiographs by use of Helm's method. The correlation between skeletal and DM was analysed using Spearman's rho (Rs). Additionally, the most frequent DM stage in relation to the skeletal maturation stage was analysed by logistic regression adjusted for age and sex. RESULTS: The correlation between dental and skeletal maturation was significant for all teeth (Rs = 0.071-0.562; p < .000-p = .035) except for the first incisor and the first molar. Logistic regression analysis showed that when the mandibular and maxillary canines are ¾ mineralized, this is significantly associated with the beginning of the adolescent period before peak height velocity (PHV) (PP2= p < .005-< .05). Likewise, when the mandibular second premolars are ¾ mineralized, this is significantly associated with the maturation stage PP2= or S (PP2= p < .05, S: p < .005-< .05), both of which are before PHV at the beginning of the adolescent period. LIMITATIONS: Limited sample size and the X-rays were taken before orthodontic treatment, which may have introduced a selection bias. CONCLUSIONS: When the root of the canines or second premolars is ¾ mineralized, it may indicate the beginning of the adolescent period with increased skeletal growth intensity.

Evaluation of the knee joint morphology associated with a complete discoid lateral meniscus, as a function of skeletal maturity, using magnetic resonance imaging.

INTRODUCTION: A discoid lateral meniscus (DLM) is associated with increased risk for meniscal tears and progression of knee joint osteoarthritis. Our aim was to differentiate knee joint morphology between patients with and without a DLM, as a function of skeletal maturity, using magnetic (MR) imaging. MATERIALS AND METHODS: This was a retrospective analysis of MR images of the knee for 110 patients, 6-49 years of age. Of these, 62 were in the open physis group (38 with a DLM) and 48 in the closed physis group (23 with a DLM). The following morphological parameters were measured: anterior obliquity of the lateral tibial plateau (AOLTP), posterior obliquity of the lateral tibial plateau (POLTP), the lowest point of the lateral femoral condyle (LPLFC), and the posterior lateral condylar angle (PLCA). RESULTS: Regardless of skeletal maturity, a DLM was associated with a greater inclination of the POLTP, lateralization of the LPLFC, and smaller PLCA (p < 0.001 for all compared to that of the control group). In the DLM group, the inclination of the AOLTP and the POLTP were significantly smaller (p < 0.001) and the LPLFC was more lateral (p < 0.001) in the closed physis group than in the open physis group. In the control group, the inclination of the POLTP was larger (p < 0.001) and the PLCA smaller (p = 0.019) in the open than in the closed physis group. CONCLUSIONS: We identified a characteristic knee morphology among patients with a complete DLM using MR imaging, which was observed before physeal closure and persisted after skeletal maturity was attained. We also noted lateralization of the LPLFC in the presence of a DLM, with an increase in lateralization with skeletal maturation. LEVEL OF EVIDENCE: Case-control study, III.

Validation of automated bone age analysis from hand radiographs in a North American pediatric population.

BACKGROUND: Radiographic bone age assessment by automated software is precise and instantaneous. OBJECTIVE: The aim of this study was to evaluate the accuracy of an automated tool for bone age assessment. MATERIALS AND METHODS: We compared a total of 586 bone age radiographs from 451 patients, which had been assessed by three radiologists from 2013 to 2018, with bone age analysis by BoneXpert, using the Greulich and Pyle method. We made bone age comparisons in different patient groups based on gender, diagnosis and race, and in a subset with repeated bone age studies. We calculated Spearman correlation (r) and accuracy (root mean square error, or R2). RESULTS: Bone age analyses by automated and manual assessments showed a strong correlation (r=0.98; R2=0.96; P<0.0001), with the mean bone age difference of 0.12±0.76 years. Bone age comparisons by the two methods remained strongly correlated (P<0.0001) when stratified by gender, common endocrine conditions including growth disorders and early/precocious puberty, and race. In the longitudinal analysis, we also found a strong correlation between the automated software and manual bone age over time (r=0.7852; R2=0.63; P<0.01). CONCLUSION: Automated bone age assessment was found to be reliable and accurate in a large cohort of pediatric patients in a clinical practice setting in North America.

Skeletal Maturation in Patients With Cleft Lip and/or Palate: A Systematic Review.

OBJECTIVE: The objective of this systematic review was to evaluate the evidence regarding skeletal maturation in patients with cleft lip and/or palate (CL/P) and to investigate whether the skeletal maturation is delayed in these patients. DESIGN: Systematic review. METHODS: Electronic and manual searches of scientific literature were conducted in 4 databases (MEDLINE, Embase, Cochrane Library, and Web of Science). Cohort studies that compared the skeletal maturation of patients with CL/P with that of children without CL/P were eligible for inclusion. The quality of included cohort studies was assessed using the Newcastle-Ottawa Scale. PATIENTS AND PARTICIPANTS: Patients of any sex and ethnicity with CL/P and children without CL/P were included in this systematic review. MAIN OUTCOME MEASURES: Difference in skeletal maturation between patients with CL/P and patients without CL/P. RESULTS: Thirteen retrospective cohort studies were included in this systematic review. Ten studies were considered of high quality and 3 were considered of general quality. The results of the included studies comparing skeletal maturation of patients with CL/P and children without CL/P were heterogeneous. CONCLUSION: Heterogeneity of skeletal maturation assessment methods, chronological age, sex, cleft type, and race may influence the final results of clinical studies on skeletal maturation in patients with CL/P. Overall, there is limited evidence to determine whether the skeletal maturation level of patients with CL/P is delayed compared to that of normal children. Further studies are needed to determine the skeletal maturation patterns in patients with CL/P.

Effects of Orthodontic Functional Appliances in Relation to Skeletal Maturation of Cervical Vertebrae In Class II Malocclusion.

AIM: To evaluate the effects produced by functional orthodontic appliances at dental and skeletal level in relation to the level of skeletal maturation in class II patients Study design: Longitudinal and observational study Patients selected for the study had been wearing Sander Bite Jumping Appliance (SBJA) for at least 12 months; they were first diagnosed (T1) with skeletal class II according to Ricketts' cephalometric analysis, and had had lateral cephalograms taken before and after orthopaedic treatment (T2). Variables studied at T1 and T2 were: facial convexity, inclination of the upper and lower incisors, and facial depth. Results were compared between T1 and T2 for each variable and in relation to cervical maturation stage (CVS) according to the Lamparski analysis. Statistical analysis was performed using Shapiro-Wilk, t-student, Analysis of Variance (ANOVA) and multiple comparison tests, taking as statistically significant a p-value <0.05. RESULTS: A final sample of 235 patients was obtained. Statistically significant differences were found in the inclination of the mandibular incisors between T1 and T2 and among the different cervical stages when the functional appliances were placed in CVS1 (p = 0.000), CVS2 (p = 0.04) or CVS5 (p = 0.048). For the remaining variables, significant differences were also found between T1 and T2, but these differences were similar in all cervical stages. CONCLUSIONS: A significant proclination of the mandibular incisors was found when the functional appliance was placed during CVS1, CVS2, or CVS5. Time of placement of the functional appliances was not statistically significant for the remaining variables studied.

Prediction of hand-wrist maturation stages based on cervical vertebrae images using artificial intelligence.

OBJECTIVE: To predict the hand-wrist maturation stages based on the cervical vertebrae (CV) images, and to analyse the accuracy of the proposed algorithms. SETTINGS AND POPULATION: A total of 499 pairs of hand-wrist radiographs and lateral cephalograms of 455 orthodontic patients aged 6-18 years were used for developing the prediction model for hand-wrist skeletal maturation stages. MATERIALS AND METHODS: The hand-wrist radiographs and the lateral cephalograms were collected from two university hospitals and a paediatric dental clinic. After identifying the 13 anatomic landmarks of the CV, the width-height ratio, width-perpendicular height ratio and concavity ratio of the CV were used as the morphometric features of the CV. Patients' chronological age and sex were also included as input data. The ground truth data were the Fishman SMI based on the hand-wrist radiographs. Three specialists determined the ground truth SMI. An ensemble machine learning methods were used to predict the Fishman SMI. Five-fold cross-validation was performed. The mean absolute error (MAE), round MAE and root mean square error (RMSE) values were used to assess the performance of the final ensemble model. RESULTS: The final ensemble model consisted of eight machine learning models. The MAE, round MAE and RMSE were 0.90, 0.87 and 1.20, respectively. CONCLUSION: Prediction of hand-wrist SMI based on CV images is possible using machine learning methods. Chronological age and sex increased the prediction accuracy. An automated diagnosis of the skeletal maturation may aid as a decision-supporting tool for evaluating the optimal treatment timing for growing patients.

Assessment of craniofacial maturation in preadolescents with cleft lip and/or palate using the cervical vertebral maturation method.

OBJECTIVES: Aberrant growth of the maxillomandibular complex in patients with cleft lip and/or palate (CL/P) can be managed with dentofacial orthopaedics. However, no consensus has been reached regarding timing and evolution of the maturational stages. Therefore, the aim of this study is to determine if patients with CL/P have an increased risk for delayed craniofacial maturation. MATERIALS AND METHODS: A sample of 246 cleft patients and 210 non-affected individuals was retrospectively compiled. Cephalometric radiographs taken between the ages of 10 and 14 years (girls) and 12 and 16 years (boys) were collected and assessed with the cervical vertebral maturation (CVM) method. RESULTS: In boys, no significant association between the presence of CL/P and a CVM score of CS3 or higher was observed in any age subsample. This was similar for a CVM score of CS5 or higher. Girls in the CL/P group had a significant lower probability of having a CVM score of at least CS3 in the subsample with age 11 to 12 (p = 0.001) and a borderline non-significant lower probability of having a CVM score of at least CS5 in the subsample with age 12 to 13 (p = 0.055). CONCLUSIONS: The current study demonstrated a discrete delay in skeletal maturation before the pubertal growth spurt of (pre)adolescents with CL/P, especially girls. This delay was less apparent at the end of the pubertal growth spurt. CLINICAL RELEVANCE: This research suggests that the craniofacial maturational stages relevant for dentofacial orthopaedic treatment in cleft patients, especially girls, occur at higher chronological age. Further research must quantify this delay, investigate its clinical significance, and determine its effect on the timing of dentofacial orthopaedic treatment.

Are Dental Maturation, Skeletal Maturation, and Chronological Age Associated With Complete Cleft Lip and Palate?

OBJECTIVE: The relationship between dental and skeletal development levels was determined in individuals with cleft lip and palate and a control group comprising individuals without cleft lip and palate. DESIGN: Retrospective, cross-sectional study. SETTING: A university clinic specializing in orthodontic and pedodontic care. PATIENTS: A total of 198 patients with cleft lip and palate (99 females, 11.66 ± 2.36 years; 99 males, 12.44 ± 2.33 years) and 198 patients without cleft lip and palate (99 females, 11.88 ± 2.26 years; 99 males, 12.99 ± 2.25 years). INTERVENTIONS: None. MAIN OUTCOME MEASURES: The Demirjian method and cervical vertebra maturation method were used to evaluate panoramic and lateral cephalometric radiographs, respectively. The Fishman maturation predictors were determined from hand-wrist radiographs. RESULTS: Statistically significant correlations were found between the chronological age and the dental age in both the groups (P < .05). Significant correlations between skeletal maturation indicators and dental maturation indicators were observed in both groups and sexes (P < .05), with a stronger correlation among teeth with incomplete dental maturation. Dental age was found to be significantly lower (female, P = .001; male, P = .001) in individuals with cleft lip and palate (female, 11.71 ± 2.58 years; male, 12.51 ± 2.62 years) compared to those in the control group (female, 12.95 ± 2.47 years; male, 13.64 ± 2.37 years). CONCLUSIONS: A high correlation between the results of the evaluated radiographic methods and chronological age supports their use for accurate age estimation in the patients with cleft lip and palate.

Effects of Orthodontic Functional Appliances in Relation to Skeletal Maturation of Cervical Vertebrae in Class II Malocclusion.

AIM: To evaluate the effects produced by functional orthodontic appliances at dental and skeletal level in relation to the level of skeletal maturation in class II patients. STUDY DESIGN: Longitudinal and observational study. Patients selected for the study had been wearing Sander Bite Jumping Appliance (SBJA) for at least 12 months; they were first diagnosed (T1) with skeletal class II according to Ricketts' cephalometric analysis, and had had lateral cephalograms taken before and after orthopaedic treatment (T2). Variables studied at T1 and T2 were: facial convexity, inclination of the upper and lower incisors, and facial depth. Results were compared between T1 and T2 for each variable and in relation to cervical maturation stage (CVS) according to the Lamparski analysis. Statistical analysis was performed using Shapiro-Wilk, t-student, Analysis of Variance (ANOVA) and multiple comparison tests, taking as statistically significant a p-value <0.05. RESULTS: A final sample of 235 patients was obtained. Statistically significant differences were found in the inclination of the mandibular incisors between T1 and T2 and among the different cervical stages when the functional appliances were placed in CVS1 (p = 0.000), CVS2 (p = 0.04) or CVS5 (p = 0.048). For the remaining variables, significant differences were also found between T1 and T2, but these differences were similar in all cervical stages. CONCLUSIONS: A significant proclination of the mandibular incisors was found when the functional appliance was placed during CVS1, CVS2, or CVS5. Time of placement of the functional appliances was not statistically significant for the remaining variables studied.

Physical capacity, not skeletal maturity, distinguishes competitive levels in male Norwegian U14 soccer players.

The main aim of the present study was to compare skeletal maturity level and physical capacities between male Norwegian soccer players playing at elite, sub-elite and non-elite level. Secondary, we aimed to investigate the association between skeletal maturity level and physical capacities. One hundred and two U14 soccer players (12.8-14.5 years old) recruited from four local clubs, and a regional team were tested for bone age and physical capacities. Bone age was estimated with x-ray of their left hand and used to indicate maturation of the skeleton. Players went through a comprehensive test battery to assess their physical capacities. Between-groups analysis revealed no difference in chronological age, skeletal maturity level, leg strength, body weight, or stature. However, elite players were superior to sub-elite and non-elite players on important functional characteristics as intermittent-endurance capacity (running distance: 1664 m ± 367 vs 1197 m ± 338 vs 693 m ± 235) and running speed (fastest 10 m split time: 1.27 seconds ± 0.06 vs 1.33 seconds ± 0.10 vs 1.39 seconds ± 0.11), in addition to maximal oxygen uptake ( V ˙ O 2 m a x ), standing long jump, and upper body strength (P < .05 for all comparisons). Medium-to-large correlations were found between skeletal maturity level and peak force (r = 695, P < .01), power (r = 684, P < .01), sprint (r = -.471, P<.001), and jump performance (r = .359, P < .01), but no correlation with upper body strength, V ˙ O 2 m a x , or intermittent-endurance capacity. These findings imply that skeletal maturity level does not bias the selection of players, although well-developed physical capacity clearly distinguishes competitive levels. The superior physical performance of the highest-ranked players seems related to an appropriate training environment.

Variation in the fusion sequence of primary and secondary ossification centers in the human skeleton.

OBJECTIVES: One of the biggest challenges for biological anthropologists is determining the minimum number of individuals in commingled skeletal samples in forensic or bioarcheological contexts. The fusion sequence of primary and secondary ossification centers is a promising, yet under-explored, process to improve identification of associated remains of subadults and young adults, but is limited by the lack of understanding of population variation in this aspect of human development. While prior studies show within-population variation in fusion sequence, possible geographic variation has not been systematically explored. MATERIALS AND METHODS: To explore potential variation in fusion sequence in different populations, we analyzed eight skeletal samples of East Asian, North American, African, and European ancestry. Forty-three epiphyses were cross tabulated to determine the order of beginning and completing fusion for each geographic group. Results were distilled into modal sequence (most common order) trajectories, including the variation around the modal sequence. RESULTS: Population variation occurs within and across all geographic groups, especially in later fusing sites. Some sites, such as the acromion and sacral elements, consistently exhibit greater variability. Among outliers from the modal sequence, it is more common for early-fusing sites to fuse late than for later-fusing sites to fuse early. The completing fusion trajectories vary less than the beginning fusion trajectories. DISCUSSION: Despite considerable variation within and among different geographic groups, there are shared commonalities across different samples that can facilitate differentiation of multiple individuals. With fewer outliers, the completing fusion trajectories are potentially of greater practical use in forensic and bioarcheological practice.

Bone age for chronological age determination - statement of the European Society of Paediatric Radiology musculoskeletal task force group.

Radiologists are sometimes requested to determine a person's age based on skeletal radiographs. Critical reviews demonstrate that this cannot be done with sufficient accuracy with existing methods.

Lower-extremity growth patterns and skeletal maturation in children with unilateral fibular hemimelia.

BACKGROUND: Fibular hemimelia is the most common congenital long-bone deficiency. It is usually unilateral and results in a limb-length discrepancy. The literature generally subscribes to the concept of constant inhibition, a process by which limb-length ratios between the shorter and longer extremity remain constant throughout growth, but scientific data supporting this concept are sparse. Additionally, recent literature suggests that these children have abnormal skeletal maturation. OBJECTIVE: To elucidate the lower-extremity long-bone growth patterns and skeletal maturation of children with unilateral fibular hemimelia. MATERIALS AND METHODS: We reviewed medical records of children with unilateral fibular hemimelia seen at a large pediatric hospital over a 17-year period. Inclusion criteria were: at least two scanograms prior to any shortening/lengthening procedure, and no other congenital or acquired disorders. We collected the study cohort's femoral and tibial lengths (scanogram reports), plotted them against patient chronological ages and compared them to published growth standards. When these children's bone ages (Greulich and Pyle) were available, we plotted them against the children's chronological ages. RESULTS: Twenty-three children were included (total=115 scanograms). At least 1 bone-age assessment was performed in 19 children (total=84 bone ages). All bone growth curves were within normal growth standards for the femur and tibia. Length ratios between shorter and longer limbs remained constant. Skeletal maturation was within two standard deviations of normal in 90% of bone ages. CONCLUSION: Lower-extremity long bones of children with unilateral fibular hemimelia have relatively normal growth curves, supporting and confirming the concept of constant inhibition. Most children show normal skeletal maturation.

Maturation-dependent findings in the shoulders of pediatric baseball players on magnetic resonance imaging.

PURPOSE: To compare the prevalence and characteristics of shoulder osseous and soft tissue findings on magnetic resonance imaging (MRI) with respect to skeletal maturation in symptomatic pediatric baseball players without a history of acute trauma. METHODS: The IRB-approved, HIPAA-compliant retrospective study analyzed 87 consecutive pediatric baseball players (86 boys and 1 girl; mean age, 15.4 ± 2.1 years) with shoulder MRI performed between March 1, 2012 and September 30, 2017. In consensus, two radiologists assessed the MRI studies for findings involving the humerus, the glenoid, the labrum, the rotator cuff, and the acromioclavicular joint. Exact Cochran-Armitage trend and Mantel-Haenszel Chi-square tests were used to investigate the association between these findings and skeletal maturation. RESULTS: The mean ages between players who are skeletally immature (37 shoulders), maturing (26 shoulders), and matured (24 shoulders) were significantly different (p < 0.001). Bone marrow edema (p < 0.001) and sclerosis (p < 0.001) within the proximal humeral metaphysis decreased with skeletal maturation. Glenoid remodeling (p = 0.038) was more severe in the skeletally immature players and the prevalence of Bennett lesions (p = 0.048) increased with skeletal maturation. The prevalence of labral tears, rotator cuff tendinosis, and acromioclavicular joint separation did not significantly change with skeletal maturation. CONCLUSIONS: The change in the prevalence of findings within the proximal humerus and glenoid with skeletal maturation suggest differences in the distribution of stress within the shoulders of pediatric baseball players during development.