An insight of how multiple skeletal maturity indices can be used for growth assessment: relationship between the simplified olecranon, simplified digital, and distal radius and ulna classifications

Abstract

This cross-sectional study aims to investigate the relationship between the simplified olecranon, simplified digital, and distal radius and ulna (DRU) classifications, and whether they can aid in more comprehensive maturity assessment together. Left hand and wrist and lateral elbow radiographs from pediatric patients were assessed using the three skeletal maturity indices. The association between maturity indices was investigated using Goodman and Kruskal’s gamma, and by mapping of individual grades based on chronological age. Specific maturity grades, at which peak height velocity (PHV) occurs as previously identified, were based upon to explore how the three systems interact. A total of 114 patients (63.2% girls) were studied. Correlations and associations between the three maturity parameters were significant (all at P < 0.001). Mapping revealed uneven spans and coverage of different periods by each index. Olecranon stage 1 coincided with R3 (for girls), R4 (for boys), U3, and SS1. Olecranon stage 5 occurred as early as R7, U6, and SS4. Upon elbow fusion, the simplified digital (SS5–SS8) and DRU (R8–R11 and U7–U9) classifications can be used for assessment until maturity. The inter-relationship of the simplified hand, wrist, and olecranon methods indicates their combined use. DRU grades can be used in growth periods which are less well covered. Prepubertal and growth acceleration phase of pubertal growth spurt can best be assessed by both the simplified olecranon (stages 1–3) and DRU classifications (R1–R5 and U1–U4). All three indices are required during PHV. For post-PHV, DRU (R8–R11 and U7–U9) and simplified digital method (SS5–SS8) complement each other for assessment until skeletal maturity.

Correlations Between Eight Comprehensive Skeletal Maturity Systems in a Modern Peripubertal Pediatric Population

“…However, one study by Canavese and colleagues compared the Dimeglio method (the predecessor to the OAOSS) and the Sanders Hand system during the pubertal growth spurt and found they were equally reliable. This study, along with several others, also suggests combining different skeletal maturity systems may improve growth prediction accuracy, particularly during different periods of growth 22,25,26 . In reality, some systems likely perform better than others due to inherent differences in calibration technique, addition of new parameters, or underlying variability in radiographic positioning 27 .…”

“…While these systems have been individually validated against the GP standard, several studies have observed intersystem discrepancies in BA estimates, especially among upper extremity systems. [19][20][21][22] A recent study comparing the GP system to the Sauvegrain method, which uses anteroposterior and lateral elbow radiographs, in children treated for limb-length discrepancy found 66% of patients had BA assessments that differed by at least 6 months. 21 Inconsistencies of this degree could have major impacts on surgical planning.…”

Curve type, flexibility, correction, and rotation are predictors of curve progression in patients with adolescent idiopathic scoliosis undergoing conservative treatment

“…it is also prudent to note that the cobb angle at brace weaning is another risk factor of progression after maturity. [49][50][51][52] Patients with cobb angle reaching 40° is a well-established cutoff for adulthood progression. 4,53 similarly, those with this benchmark at the time of brace-weaning also have the potential for post-maturity progression.…”

What’s New in Limb Lengthening and Deformity Correction

“…The use of both the simplified olecranon method and DRU classification provides adequate coverage of the prepubertal and growth acceleration phases, and the DRU and simplified digital methods provide assessment beyond peak height velocity for the decelerating growth phase until skeletal maturity. Therefore, the crucial peak height velocity can be assessed with the combination of the 3 systems complementing each other 7 .…”