Utilization of distal radius and ulna classification scheme in predicting growth peak and curve progression in idiopathic scoliosis girls undergoing bracing treatment

Li, Yang; Mao, Saihu; Shi, Bo; Liu, Zhen; Liu, Dun; Sun, Xu; Qiu, Yong; Zhu, Zezhang

doi:10.1007/s00586-020-06289-8

Cited by 5 publications

(9 citation statements)

References 27 publications

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“…One study has suggested that the LDRU is more reliable than the sTW3, and may also provide more practical indications of when to start weaning off the brace. 39 , 40 Bracing was suggested in the initial study to begin at R6 and R7 although Li et al 41 suggested earlier adoption at R5 and more frequent observations around R7 to R9 to begin brace weaning at R10. 36 If the benefits of the LDRU are true, it could provide better guidance on whether bracing is appropriate, and when to begin and end bracing for any given patient with AIS.…”

Section: Discussionmentioning

confidence: 99%

“… 36 If the benefits of the LDRU are true, it could provide better guidance on whether bracing is appropriate, and when to begin and end bracing for any given patient with AIS. 2 , 41 , 42 …”

Section: Discussionmentioning

confidence: 99%

“… 43 Few reliability analyses have been performed so far, and they are all confined to a particular geographical continent. 39 , 41 , 44 The larger reliability analysis was performed by the same unit which designed the classification, and reported both inter- and intraobserver reliability to be near perfect, leaving the study open to potential criticism for not being independent. 36 , 44 The second study gave data on interobserver disagreement which was lower than our findings.…”

Section: Discussionmentioning

confidence: 99%

“…They also found in contrast to our study that the radius was the more reliable tool for assessment, although they noted that the low reliability in their ulna classification may be due to different amounts of pronation on their radiographs. Li et al 41 have suggested that either the radius or the ulna could be assessed in isolation given there is good correlation between radial and ulna progression, however this was only applicable to older children and knowing that variations in radius and ulna maturity might exist. Their study of 40 physically immature girls in a Chinese population found near perfect reliability.…”

Section: Discussionmentioning

confidence: 99%

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Reproducibility and reliability analysis of the Luk Distal Radius and Ulna Classification for European patients with adolescent idiopathic scoliosis

Houston

Chiang

Haleem

et al. 2021

Journal of Children's Orthopaedics

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Purpose Current clinical and radiological methods of predicting a patient’s growth potential are limited in terms of practicality, accuracy and known to differ in different races. This information influences optimal timing of bracing and surgical intervention in adolescent idiopathic scoliosis (AIS). The Luk classification was developed to mitigate limitations of existing tools. Few reliability studies are available and are limited to certain geographical regions with varying results. This study was performed to analyze reproducibility and reliability of the Luk Distal Radius and Ulna Classification in European patients. Methods This is a radiological study of 50 randomly selected left hand and wrist radiographs of patients with AIS referred to a tertiary referral centre. They were assessed for bone maturity using the Luk Distal Radius and Ulna Classification. Assessment was performed twice by four examiners at an interval of one month. Statistical analysis was performed using the intraclass correlation (ICC) method to determine the reliabilities within and between the examiners. Results In total, 50 radiographs (M:F = 13:37) with a mean age of 13.7 years (10 to 18) were assessed for reliability. The inter-rater ICC value was 0.918 for radius assessment and 0.939 for ulna assessment. The intra-rater ICC values for radius assessment ranged between 0.897 and 0.769 and between 0.948 and 0.786 for ulna assessment. There was near perfect correlation for both assessments. Conclusion This study provides independent evidence that the Luk Distal Radius and Ulna Classification is a reliable tool for assessment of skeletal maturity for European patients. Minimal clinical experience is required to reliably utilize it. Level of evidence IV

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Reproducibility and reliability analysis of the Luk Distal Radius and Ulna Classification for European patients with adolescent idiopathic scoliosis

Houston

Chiang

Haleem

et al. 2021

Journal of Children's Orthopaedics

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“…The combination of the proximal humeral ossification system and Sanders Hand System was capable of predicting PHV more accurately, compared to a combination of Risser and triradiate closure. In 2020, Li et al [24] presented the DRU scoring system analysing ossification. They demonstrated a significant correlation combining radius and ulna scores in 40 patients, predicting PHV with an intra-observer score of 0.94 and inter-observer reliability of 0.93.…”

Section: Skeletal Maturitymentioning

confidence: 99%

Scoliosis and Prognosis—a systematic review regarding patient-specific and radiological predictive factors for curve progression

et al. 2021

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Introduction Idiopathic scoliosis, defined as a > 10° curvature of the spine in the frontal plane, is one of the most common spinal deformities. Age, initial curve magnitude and other parameters define whether a scoliotic deformity will progress or not. Still, their interactions and amounts of individual contribution are not fully elaborated and were the aim of this systematic review. Methods A systematic literature search was conducted in the common databases using MESH terms, searching for predictive factors of curve progression in adolescent idiopathic scoliosis (“adolescent idiopathic scoliosis” OR “ais” OR “idiopathic scoliosis”) AND (“predictive factors” OR “progression” OR “curve progression” OR “prediction” OR “prognosis”). The identified and analysed factors of each study were rated to design a top five scale of the most relevant factors. Results Twenty-eight investigations with 8255 patients were identified by literature search. Patient-specific risk factors for curve progression from initial curve were age (at diagnosis < 13 years), family history, bone mineral status (< 110 mg/cm3 in quantitative CT) and height velocity (7–8 cm/year, peak 11.6 ± 1.4 years). Relevant radiological criteria indicating curve progression included skeletal maturity, marked by Risser stages (Risser < 1) or Sanders Maturity Scale (SMS < 5), the initial extent of the Cobb angle (> 25° progression) and curve location (thoracic single or double curve). Discussion This systematic review summarised the current state of knowledge as the basis for creation of patient-specific algorithms regarding a risk calculation for a progressive scoliotic deformity. Curve magnitude is the most relevant predictive factor, followed by status of skeletal maturity and curve location.

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Forearm Fractures in Older Children and Adolescents: ORIF is Safer Than IMN With Equivalent Outcomes

Chen,

LaBarge,

Henry

et al. 2024

Journal of Pediatric Orthopaedics

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Background: Greater understanding of the impact of skeletal maturity on outcomes is needed to guide operative treatment of diaphyseal forearm fractures in children and adolescents. The purpose of this study was to compare the complications and outcomes of pediatric diaphyseal forearm fractures treated with intramedullary nailing (IMN) or open reduction internal fixation (ORIF) and to identify a radiographic marker of skeletal maturity that will aid in selecting between treatment options. Methods: A retrospective review of patients aged 10 to 16 years treated operatively for diaphyseal forearm fractures was performed. Markers of skeletal maturity including the olecranon apophysis score, the presence of the thumb adductor sesamoid, and radial epiphyseal capping. Complications were graded with the modified Clavien-Dindo system. Outcomes were scored based on final postoperative range of motion combined with complication grade. Results: A total of 260 patients were included: 163 treated with IMN, 97 treated with ORIF, mean age 12.7 years, 72% male. Among closed forearm fractures treated with IMN, open reduction was required in 45% (53/118). Patients treated with IMN had a higher complication rate than ORIF (27.0% vs. 9.3%, P<0.05), including when stratified by age. Complication rates were not impacted by greater skeletal maturity as indicated by the presence of thumb sesamoid or radial epiphyseal capping. There was no significant difference in outcomes between the ORIF and IMN groups. More skeletally immature patients, as identified by a lack of either the thumb adductor sesamoid or radial epiphyseal capping, had significantly better outcomes with ORIF than patients with greater maturity. Conclusions: Across all age groups and levels of skeletal maturity, ORIF had a significantly lower rates of complications compared with IMN with equivalent outcomes. More skeletally immature patients had significantly better outcomes with ORIF treatment when compared with older patients. The thumb adductor sesamoid, radial epiphyseal capping, and the olecranon apophysis score did not provide useful information to select between ORIF over IMN in this population. Level of Evidence: Level III—retrospective comparative study.

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Utilization of distal radius and ulna classification scheme in predicting growth peak and curve progression in idiopathic scoliosis girls undergoing bracing treatment

Cited by 5 publications

References 27 publications

Reproducibility and reliability analysis of the Luk Distal Radius and Ulna Classification for European patients with adolescent idiopathic scoliosis

Reproducibility and reliability analysis of the Luk Distal Radius and Ulna Classification for European patients with adolescent idiopathic scoliosis

Scoliosis and Prognosis—a systematic review regarding patient-specific and radiological predictive factors for curve progression

Forearm Fractures in Older Children and Adolescents: ORIF is Safer Than IMN With Equivalent Outcomes

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