A comparison of 3 different methods for assessment of skeletal age when treating leg-length discrepancies: an inter- and intra-observer study

Background and purpose — Skeletal maturity is a crucial parameter when calculating remaining growth in children. We compared 3 different methods, 2 manual and 1 automated, in the radiological assessment of bone age with respect to precision and systematic difference. Material and methods — 66 simultaneous examinations of the left hand and left elbow from children treated for leg-length discrepancies were randomly selected for skeletal age assessment. The radiographs were anonymized and assessed twice with at least 3 weeks’ interval according to the Greulich and Pyle (GP) and Sauvegrain (SG) methods by 5 radiologists with different levels of experience. The hand radiographs were also assessed for GP bone age by use of the automated BoneXpert (BX) method for comparison. Results — The inter-observer intraclass correlation coefficient (ICC) was 0.96 for the GP and 0.98 for the SG method. The inter- and intra-observer standard error of the measurement (SEm) was 0.41 and 0.32 years for the GP method and 0.27 and 0.21 years for the SG method with a significant difference (p < 0.001) between the methods and between the experienced and the less experienced radiologists for both methods (p = 0.003 and p < 0.001). In 25% of the assessments the discrepancy between the GP and the SG methodwas > 1 year. There was no systematic difference comparing either manual method with the automatic BX method. Interpretation — With respect to the precision of skeletal age determination, we recommend using the SG method or preferably the automated BX method based on GP assessments in the calculation of remaining growth.

Evaluation of Brace Treatment Using the Soft Brace Spinaposture: A Four-Years Follow-Up

The braces of today are constructed to correct the frontal plane deformity of idiopathic adolescent scoliosis (AIS). The Spinaposture brace© (Spinaposture Aps, Copenhagen, Denmark) is a soft-fabric brace for AIS and is designed to enhance rotational axial stability by inducing a sagittal plane kyphotic correction. This prospective observational study evaluated the brace in fifteen patients with AIS. The initial average CA was 16.8° (SD: 2.8). They were followed prospectively every 3 to 6 months during their brace usage until skeletal maturity of 25 months and at long-term follow-up of 44 months. In- and out-of-brace radiographs were performed in six subjects at inclusion. This resulted in an immediate in-brace correction of 25.3 percent in CA (14.3°→10.8°) and induced a kyphotic effect of 14.9 percent (40.8°→47.9°). The average in-brace improvement at first follow-up was 4.5° in CA, and the CA at skeletal maturity was 11° (SD: 7.4°) and long-term 12.0° (SD: 6.8°). In conclusion, the Spinaposture brace© had an immediate in-brace deformity correction and a thoracic kyphotic effect. At skeletal maturity, the deformities improved more than expected when compared to that of the natural history/observation and similar to that of other soft braces. No long-term deformity progression was seen. To substantiate these findings, stronger designed studies with additional subjects are needed.

Identifying Skeletal Maturity from X-rays using Deep Neural Networks

Skeletal maturity estimation is routinely evaluated by pediatrics and radiologists to assess growth and hormonal disorders. Methods integrated with regression techniques are incompatible with low-resolution digital samples and generate bias, when the evaluation protocols are implemented for feature assessment on coarse X-Ray hand images. This paper proposes a comparative analysis between two deep neural network architectures, with the base models such as Inception-ResNet-V2 and Xception-pre-trained networks. Based on 12,611 hand X-Ray images of RSNA Bone Age database, Inception-ResNet-V2 and Xception models have achieved R-Squared value of 0.935 and 0.942 respectively. Further, in the same order, the MAE accomplished by the two models are 12.583 and 13.299 respectively, when subjected to very few training instances with negligible chances of overfitting.

Gingival crevicular fluid alkaline phosphatase activity as growth marker: A systematic review

Background: This review synthesizes the available evidence about the individual skeletal maturity with biological maturity indicators and compares it with the levels of gingival crevicular fluid (GCF) alkaline phosphatase (ALP) activity in growing children. Aims: This systematic review aimed to clarify the question: Is GCF ALP a reliable biomarker to assess skeletal maturity during growth? Objectives: The objective of this systematic review is to collect, compile, and review the existing evidence on the levels of GCF ALP activity in growing children and comparing its reliability with contemporary growth indicators. Materials and Methods: A literature appraisal executed using Entres PubMed, www.ncbi.nim.nih.gov, Scupose, Hinary, Ebsco, Embass, Cochrane; Google Scholar Electronic database search engines were used. The MeSH term used “growth markers in gingival crevicular fluid” or “growth markers in growing children.” Studies published till October, 2020, were included in this study. Data Extraction and Quality Assessment: The data have extracted from the selected articles based on year of publication, study design, age of subjects, instruments used, and author’s conclusions. The quality assessment was executed using BIOCROSS Scale. This scale is exclusive for cross-sectional studies with biomarkers. Results: Literature search identified 731 records from electronic databases and from the partial grey literature (Google scholar) search. Finally, six articles fulfilled eligibility criteria included in the review. Conclusions: All the six studies concluded that GCF ALP activity is a reliable method in determining a skeletal maturity indicator in growing children.

General principles governing record taking in patients with cleft lip and palate

(WHO meetings on International Collaborative Research on Craniofacial Anomalies).One of the most common congenital anomaly we come across is the Cleft Lip and palate where affected children suffer from range of functional as well as aesthetic problems. Cleft lip and palate is a multifunctional disease associated with environmental factors. Management of cleft is a complex procedure and demands co-operation among experts from different fields. Clinical treatment procedure extends from beginning of birth, to achieving skeletal maturity effectively.

Relationship between Skeletal Maturity, BMI Percentile and Dental Caries Experience among Taster and Non-taster Children

Introduction: Ability of an individual to taste phenylthiocarbamide (PTC) substance divides the population in tasters and non-tasters. The objective of this study was to investigate the relationship between the taste ability for PTC substance with BMI percentile, skeletal maturity and dental caries experience within taster and non-taster children of age 8-12 years. Hypotheses: Tasting ability for PTC affects the BMI percentile, skeletal maturity and dental caries experience and emerge as a useful caries risk assessment tool. Evaluation of Hypotheses (Materials and Method): One hundred children of 8-12 years were randomly selected and their taste perception was assessed using PTC sensitivity test. Radiovisiography (RVG) of middle phalanx was obtained to determine the skeletal maturity by using Rajgopal and Kansal modification 2005. Anthropometric measurements were recorded to obtain BMI value and then BMI percentile was calculated using CDC Pediatric growth charts. For dental caries assessment, deft/DMFT scores were recorded. Results: The non-tasters had early skeletal maturation, higher caries experience and higher BMI percentile than the tasters. Conclusion and Clinical Relevance: PTC Sensitivity is a genetically controlled trait showing strong association with dental caries. From the results of this study we can conclude that the genetic ability of tasting PTC affects the BMI percentile, skeletal maturity and dental caries experience. Thus it can emerge as a useful caries risk assessment tool helping in planning the preventive measures and interceptive orthodontics in children.

Comparison of abnormalities in the sequence of growth stages in the skeletal maturity index vs cervical vertebral maturation: A retrospective study

ABSTRACT Objectives To evaluate the frequency of abnormal progression that could ultimately affect the reliability of the skeletal maturity index (SMI) and the cervical vertebral maturation (CVM) method that are most commonly used analyses for skeletal age assessment. Materials and Methods A retrospective design was used to compare 299 hand-wrist radiographs with 299 lateral skull radiographs regarding the number of abnormalities in the proposed sequence of maturation in the SMI and CVM methods. Results A significantly greater number of abnormalities occurred in the sequence of CVM progression compared with SMI (P &lt; .001). Sex and age did not have an effect. Conclusions Skeletal age assessment based on SMI is more accurate than CVM regarding the progressive sequence of stages.

Characteristics of Giant Cell Tumor of the Bone in Pediatric Patients: Our 18-Year, Single-Center Experience

A giant cell tumor (GCT) of the bone is characteristically found in skeletally mature patients. The tumor is rare in pediatric patients, and incidence reported in literature varies from 1.8% to 10.6%. We performed a retrospective study addressing symptoms, treatment, and outcome in pediatric patients who were diagnosed with GCT between March 1997 and January 2015 at our hospital. Fourteen (11.1%) of 126 surgically treated patients with histologically proven GCT were <19 years of age. We confirmed skeletal maturity using magnetic resonance imaging (MRI). Fourteen patients from 8 to 19 years old were identified. Sixteen lesions (76.2%) were found in long bones and 5 lesions (23.8%) in short bones. The most common site was around the knee in 8 patients (38%). GCTs mostly occur at the epi-metaphysis in 11 patients (52.3%). Regardless of the openness of epiphyseal plate, we observed GCT of bone in the epiphysis. Further study will be needed to prove the association between the presence of epiphyseal plate and location of tumor. Three patients (21.4%) had multicentric lesions, and four patients (28.5%) had local recurrence. Multicentric giant cell tumor and local recurrence occur more often in pediatric patients. The characteristics of GCT in pediatric patients do not differ from what is reported for GCT in adults.