Concordant Evaluation of Skeletal Age Assessment

SummaryA 2‐day‐oldWarmblood filly was presented for examination of an angular limb deformity of the left front limb and an upright conformation of both metacarpophalangeal joints. Radiological examination revealed bilateral absence of the metacarpophalangeal joint space with fusion of the third metacarpal bone and first phalanx (synostosis). No treatment was undertaken. The filly was readmitted to the clinic 10 weeks later for bilateral front limb lameness. On radiological examination, the synostosis of the front metacarpophalangeal joints was still present. Physitis of the distal growth plate of the right third metacarpal bone and proximal growth plate of the right proximal phalanx, and an avulsion fracture of the palmaromedial and proximal aspect of the left middle phalanx, with a cystic like lesion on the medial aspect of distal first phalanx and proximal middle phalanx were diagnosed. Given the poor prognosis, the foal was subjected to euthanasia.Post mortemexamination confirmed the absence of the metacarpophalangeal joint space with a trabecular bony union between the third metacarpal bone and the first phalanx. A rudimentary joint capsule was present at the level of the absent joints as well as a small zone of articular cartilage, which invaginated over a short distance into the dorsal trabecular bone on the right front limb. On the medial aspect of the left proximal interphalangeal joint, a focal defect of articular cartilage with exposure of subchondral bone was observed. This is the first case report of a foal born with congenital aplasia of both metacarpophalangeal joints. Congenital malformations should be considered as differential diagnosis in lame foals or foals born with angular or flexural limb deformities.

Objective To report the micro-hardness of human metacarpal bones, compare and analyze the hardness values between different anatomical parts, and explore the distribution characteristics of micro-hardness of human metacarpal bones. Methods The metacarpal bones were collected from three fresh healthy frozen specimens. The soft tissue of the right metacarpal bone was dissected. These metacarpal bones were cut into 3 mm-thick slices perpendicular to the long axis with a low-speed saw in metacarpal base, shaft and head. The Vickers method was used to measure the hardness of different areas of the palmar, dorsal, medial and lateral site of bone slices, and the standard operation method with 50 g force loading for 50 s and maintenance for 12 s was used to determine the hardness. The hardness value was compared by one-way ANOVA, and P<0.05 was statistically significant. Results Totally, 45 specimens and 900 indentations at different bones and anatomic sites were involved. The overall hardness of metacarpal bone was (38.23±7.15) HV. The third metacarpal bone had the highest hardness (41.04±6.75) HV, followed by the second metacarpal bone (39.62±7.64) HV, the first metacarpal bone (37.83±6.52) HV, the fifth metacarpal bone (36.69±7.30) HV, and the fourth metacarpal bone (35.97±6.28) HV. The metacarpal shaft hardness (43.45±6.35) HV was higher than metacarpal basal (35.82±6.17) HV and metacarpal head (35.43±5.85) HV (F=16.415, P<0.01). There was no significant difference in palmar (37.58±7.35) HV, dorsal (38.93±7.08) HV, medial (38.26±7.00) HV and lateral site (38.15±7.14) HV in hardness (F=1.352, P=0.256). Conclusion The results of this study have deepened the understanding of metacarpal micro-biomechanical properties, and can guide the placement, direction and number of internal fixators in metacarpal fracture surgery, and provide data support for 3D printing of artificial metacarpophalangeal joint for the treatment of comminuted metacarpal fracture or defect. Key words: Metacarpal bones; Biomechanics; Vickers hardness; Micro-hardness

Objective To provide more references for the thumb revascularization and improve success rate of thumb replantation through retrospecting and summrizing various revascularization methods in thumb replantation. Methods From August 2013 to October 2015, 20 cases of complete or incomplete thumb severance were replanted. There were complete thumb severance in 17 cases and incomplete one in 3 cases. Severance level at distal phalanx was in 4 cases, at interphalangeal joint in 3 cases, at proximal phalanx in 8 cases, at metacarpophalangeal joint in 2 cases, at first metacarpal bone in 3 cases. There were 12 male and 8 female patients, with a mean age of 37.25 years (range, 12 to 64 years). It depended on the injury mechanism and vascular injury condition to choose the revascularization methods. Results Postoperatively all 20 cases completely survived. All the patients were follow-up for 8 to 36 months, with an average of 16 months. The blood supply and appearance of replantation thumb were satisfactory. The finger pulp was full. The function of opposition and pinch were good. According to the functional evaluation criteria of the finger replantation issued by the Hand Surgery Society of the Chinese Medical Association, the results of replantation thumb were excellent in 12 fingers, good in 6 fingers and fair in 2 fingers. Conclusion Fully familiar with the anatomy and variation of thumb blood supply, preoperative complete evaluation of injury mechanism and severance level, and classification can provide more choice for the reconstruction of thumb function. Key words: Replantation; Thumb; Revascularization; Transplantation

An improved AlexNet model for automated skeletal maturity assessment using hand X-ray images

Fizjologiczne, żywieniowe i genetyczne uwarunkowania właściwości kości rosnących świń

Objective To study the first metacarpal dorsal artery anatomy, and explore the flap based on the branch chain of the first metacarpal dorsal artery. To provide anatomical basis for clinical application of the flap. Methods The origin, courses and distribution of the branch chain of the first metacarpal dorsal artery from 8 fresh hand specimens perfused by red latex were explored from January, 2015 to December, 2016. Results There was a dorsal artery network in the dorsal side of the first metacarpal. The radial and ulnar dorsal artery of the first metacarpal originated from the radial artery and along the first metacarpal lateral margin to go down. The initial diam-eter of the radial dorsal artery was (0.82±0.06) mm. The initial diameter of the ulnar dorsal artery was (0.74±0.05) mm. And anastomosed with the dorsal branches of the thumb inherent arteries. The both inherent arteries of thumb give off dorsal branches count (2.62±0.34). The initial diameter of proximal dorsal branch was (0.32±0.03) mm. The initial diameter of distal dorsal branch was (0.24±0.08) mm. Conclusion The radial and ulnar dorsal vascular chain of the first metacarpal were constant. The anastomosed branches with the dorsal branches of the thumb inherent arteries were abundant. The free flap or retrograde flap based on the vsscular chain has reliable blood supply. And without de-stroyed the main artery of thumb. Key words: Thumb; Thumb inherent artery; First metacarpal dorsal artery; Surgical flaps; Applied anatomy

Bone age can reflect the true growth and development status of a child; thus, it plays a critical role in evaluating growth and endocrine disorders. This study established and validated an optimized Tanner-Whitehouse 3 artificial intelligence (TW3-AI) bone age assessment (BAA) system based on a convolutional neural network (CNN). A data set of 9,059 clinical radiographs of the left hand was obtained from the picture archives and communication systems (PACS) between January 2012 and December 2016. Among these, 8,005/9,059 (88%) samples were treated as the training set for model implementation, 804/9,059 (9%) samples as the validation set for parameters optimization, and the remaining 250/9,059 (3%) samples were used to verify the accuracy and reliability of the model compared to that of 4 experienced endocrinologists and 2 experienced radiologists. The overall variation of TW3-metacarpophalangeal, radius, ulna and short bones (RUS) and TW3-Carpal bone score, as well as each bone (13 RUS + 7 Carpal) between reviewers and the AI, were compared by Bland-Altman (BA) chart and Kappa test, respectively. Furthermore, the time consumption between the model and reviewers was also compared. The performance of TW3-AI model was highly consistent with the reviewers' overall estimation, and the root mean square (RMS) was 0.50 years. The accuracy of the BAA of the TW3-AI model was better than the estimate of the reviewers. Further analysis revealed that human interpretations of the male capitate, hamate, the first distal and fifth middle phalanx and female capitate, the trapezoid, and the third and fifth middle phalanx, were most inconsistent. The average image processing time was 1.5±0.2 s in the TW3-AI model, which was significantly shorter than manual interpretation. The diagnostic performance of CNN-based TW3 BAA was accurate and timesaving, and possesses better stability compared to diagnostics made by experienced experts.

The present study aimed to document the relationship between biometric foot measurements and different radiographic lesions in a group of donkeys' feet with long toe under-run heel. The common radiographic foot lesions were pedal osteitis complex in 26 (86.6%) and navicular bone reaction in 8 (26.7%). Osteophyte reaction was identified at proximal phalanx in 8 (26.7%) and middle phalanx in 10 (33.3%). Pastern and coffin joints osteoarthritis were found in 4 (13.3%) and 9 (30%) respectively. Palmar soft tissue calcification and eminence of 2nd phalanx were reported in 5 (16.6%) and 1 (3.3%) respectively. The dorsal hoof wall angle (DHWA) was positive significantly correlated with the axis of the distal phalanx, distal phalanx and proximal palmar cortex angles, the heel angle, and distal phalanx solar border angle. The increased dorsal hoof wall length (DHWL) was positive strongly correlated with dorsal coronary band height, medial wall length, lateral wall length, lateral coronary band distance, medial coronary band distance, lateral distal phalanx to bottom distance, and medial distal phalanx to bottom distance. The dorsal hoof wall and heel angles reflected increased stress on the hoof capsule, distal interphalangeal joint, navicular bone, and palmar soft tissue structures. The low heel, the distal phalanx solar border angle and under development of the palmar section of the hoof indicated distal phalanx was slightly slippage dorsally, increased tension on the DDFT, navicular bone, and pedal osteitis complex in long toe under-run heels. This study demonstrated a relationship between biometric foot measurements and the presence of radiographic foot lesions detected in long toe under-run heel in donkeys.

Age and menopause-related changes in phalangeal bone density of Japanese women, measured by a digital image processing method

In recent days, skeletal bone age assessment gained more attention from researchers for auxiliary diagnosis and prediction in medical issues. Hence, it is essential to undertake more than a few complications existing in the traditional techniques in order to enhance the age assessment efficiency. So, this research work presented an intellectual skeletal bone age estimation method with neural network learning. At first, the needed images are gathered as of the available online source. Further, from gathered images, three sets of features are extracted from Vision Transformer (ViT) features as F1, Local Weber Pattern (LWP) image as F2, and raw image as F3. Subsequently, the resultant features are fed into the Vision Transformer-based Multi-scale MobileNet (ViT-MMNet) designed for assessing a skeletal bone age. In this network, multi-scale MobileNet is considered to execute the prediction process, where the ViT-based features are given to the first convolution layer, LWP-based features are given to the second convolution layer, and finally, in third convolution layer, the original images collected from the datasets are directly given. Finally, detailed experimental validations are conducted for the designed skeletal bone age assessment framework through traditional methods to assure the efficacy of the method.

Introduction: Fifth metacarpal neck fractures are common fractures affecting the pediatric population. However, no true standardization exists regarding their treatment. The purpose of this study was to determine if variation exists amongst orthopedic surgeons in treating pediatric fifth metacarpal neck fractures and determine the factors regarding this variation. Materials and Methods: Twenty-five sets of images of pediatric fifth metacarpal …

Objective To analyze the morphologic characteristics of the first web space in thumb duplication based on Wassel classifications, and propose corresponding treatment strategies. Methods Sixty thumb duplication patients (68 thumbs) were operated on between February and June of 2016. The special vernier caliper and goniometer used for hand function assessment were used to measure the first web space distance, the intermetacarpal distance (IMD) and intermetacarpal angle (DIMA) between the first and second metacarpal. Paired t test was used to compare the differences of these parameters between thumb duplication and the normal side. Emphasis was given to analyzing the first web space in Wassel type Ⅳ with the first metacarpal head ulnar deviation and Wassel typeⅤ, Ⅵ, Ⅶ. Results There were 23 thumbs in total in Wassel typeⅠ, Ⅱ, Ⅲ and type Ⅳ without ulnar deviation of the first metacarpal. The first web space distance were (2.56±0.46) cm and (2.32±0.39) cm for the normal and abnormal sides, respectively, with a statistically significant difference (t=3.115, P=0.006). The IMD were (3.32±0.27) cm and (3.24±0.28) cm, and the DIMA were (41.84±3.22)° and (41.79±3.39)° for the normal and abnormal sides, respectively. There were no statistically significant differences in IMD (t=1.529, P=0.144) and DIMA (t=0.224, P=0.826). There were 45 thumbs in Wassel type Ⅳ and Wassel typeⅤ, Ⅵ, Ⅶ with ulnar deviation of the first metacarpal head. The first web space distance were (2.62±0.34) cm, (2.21±0.44) cm for the normal and abnormal sides, respectively, with a statistically significant difference (t=5.238, P=0.000). The IMD were (3.38±0.36) cm and (3.03±0.53) cm, the DIMA were (43.32±3.87)°and (35.35±6.73)° respectively. There were statistically significant differences in IMD (t=4.585, P=0.000) and DIMA (t=7.730, P=0.000). Conclusion The first web space narrowing in thumb duplication was mainly seen in Wassel type Ⅳ with ulnar deviation of the first metacarpal head and Wassel typeⅤ, Ⅵ, Ⅶ. We recommended metacarpal osteotomy to realign the skeleton when the soft tissue is relaxed. If the soft tissue is tight, we prefer to perform Z-plasty or index finger dorsal flap transfer to open the first web space. Key words: Hand deformities, congenital; Thumb; The first web space; Treatment strategy

Although many studies of the hand bone growth have done, there were few reports on their longitudinal study. In this article, the hand bone growth of longitudinal materials was studied from the standpoint of the relative growth.Radiographs of the hand bone of 16 boys and 21 girls were taken from 9 to 15 years of age at 6 month intervals. Lengths and widths of 5 metacarpal and 14 phalangeal bones were measured on the serial radiographs. The relative growth coefficients of length against width were calculated by means of least squares. The allometry formula y=bxa was valid to 19 hand bones for each individual. Each individual relative growth of 19 hand bones was suitable to simple allometry.Mean values and coefficients of variation of relative growth coefficients in the girls were almost larger than those in the boys. On the digit bones the marginal group grew wider than axial group. The growth gradients of the digit and the metacarpal bones within rows was reverse.The rank order correlation analysis of individual numerical order of 19 relative growth coefficients (growth gradient) showed that there are many variations from the person who have many significant correlative pairs to the person who have none. On the individual growth the growth gradient showed a tendency to be more similar in girls than in boys. The growth gradient on the average growth had only a few significant correlation with each individual growth gradient. It was suggested that the growth gradient of a paticular person is better representative of this group than that of average growth.Principal component analysis was accomplished to make individual variations clear. Four principal components whose eigenvalues exceeded unity were obtained from principal component analysis of the correlation matrix. Those were interpreted as the relative growth factors of the hand bone by the highest loadings as follow: F1, a size factor of relative growth coefficient. F2, a factor concerning distal and metacarpal phalanx opposition to middle and proximal phalanx. F3, a factor on marginal bones.From the scatter diagram plotting the 2nd component scores against the 1st component scores, on the 1st component girls' scores were higher than boys. On the contrary boys' component score were higher on the 2nd component. Girls' scores on the both components were more variable. The hand bone growth in girls was more variable in size but less variable in growth gradient than in boys.

Objective To investigate the method and clinical outcomes of minimally invasive internal fixation combined with external fixator for treatment of intra-articular fracture of the first metacarpal base. Methods From September 2014 to April 2016, eleven patients with intra-articular fractures of the base of the first metacarpal were treated. All the fractures were preliminarily fixed with Kirschner wire using minimally invasive technique to avoid open reduction. Small incision was made for these that could not be fixed with closed reduction. Then an external fixator was applied to distract the first carpometacarpal joint for 2 to 3 mm and maintain the reduction. The forearm was immobilized with a plaster cast. Results The time of fracture healing was 7 to 9 weeks, the average being 7.6 weeks. The external fixator was removed at 5 to 6 weeks postoperatively when functional exercise was resumed. Postoperative follow-up ranged from 4 to 18 months with an average of 10.5 months. Functions of the involved thumb were evaluated by the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association at final follow-up, which revealed excellent results in 8 cases, good in 2 cases, and fair in 1 case. Conclusion For intra-articular especially comminuted fractures of the base of the first metacarpal, application of external fixator combined with Kirschner wire to fix the fracture and distract the MP joint gives rise to satisfactory results. Key words: Metacarpal bones; External fixators; Intra-articular fracture; Comminuted fracture

Method The study includes 80 patients identified from an endocrine clinic, two males and two females from each of 5 age groups (<5, 5 to 7, 8 to 10, 11 to 13, and 14 to 16 years). Skeletal age as determined from an open MRI scanner and radiographs performed on the same day was compared for each child. Two observers assess the skeletal age from radiographs and MRI images independently. After a period of at least three weeks, observers determined the skeletal age of all patients independently. All of the images were in different and random orders, on both of the assessment occasions. The agreement was assessed using the interclass correlation coefficient and Bland Altman plots. Problem Statement. The recurrent use of left-hand radiography in children with chronic conditions might result in the patient being exposed to the same image several times throughout the course of their lives. Use of radiation-free methods such as magnetic resonance imaging (MRI) may be able to assist in reducing the risks associated with radiation exposure, if done properly. Results Patients' age ranged from 3 to 16 years, in which the mean of the chronological age was 9.3 years (±2.9) and 9.8 years (±2.7) in girls and boys, respectively. The interrater agreement for skeletal age determination was 0.984 for radiographs and 0.976 for MRI scans. Using the G&P technique, for Observer 1, intraobserver agreement for radiographs and DXA was 0.993 and 0.983, respectively, and 0.995 and 0.994, respectively, for Observer 2. Plotting the rater readings against the line of equality shows no significant differences between readings acquired from radiographs and MRI scans. Conclusion For the study contribution, it is possible to employ open compact MRI to determine the skeletal age of a person. Our results showed that left-hand MRI scans were of better quality than the radiographs.