Study of age dependence of epiphyseal ossification of the hand skeleton

Radiological analysis of the hand skeleton is a key pillar of forensic age diagnostics in living subjects undergoing criminal proceedings. The present study investigated whether ossification stage classification of selected epiphyses of the hand could provide added value to hand radiograph analysis. Hand radiographs from 265 male and 164 female subjects aged 10–18years old who had been X-rayed due to traumatological indications were therefore assessed. Epiphyseal ossification of selected elements of the hand skeleton (ulna, radius and third metacarpal, basal phalanx, mesophalanx and telephalanx) was graded based on the criteria of the five-stage classification system of Schmeling et al. (Int J Legal Med, 118:5–8, 2004) for clavicular epiphyseal cartilage. Stage 5 (absence of the epiphyseal scar) does not occur in the radius of men before the age of 18. Stage 5 can therefore be regarded as a potential parameter for valid determination of a minimum age of 18 years for forensic age estimation in criminal proceedings.     

The distal femoral epiphyseal ossification center in the assessment of third-trimester menstrual age: sonographic identification and measurement

The distal femoral epiphyseal secondary ossification center (DFE), which can be reliably identified and measured sonographically, may assist the sonologist in predicting third-trimester menstrual age. Between 28 and 35 menstrual weeks, the percentage of fetuses with a DFE progressively increases. Although the mean age at DFE appearance is approximately 32-33 menstrual weeks, the DFE may be seen as early as 29 menstrual weeks. Nevertheless, the age of a fetus without an identifiable DFE is most likely less than or equal to 34 menstrual weeks. Measurements of the DFE show that its size increases linearly: the menstrual age of a fetus whose DFE measures greater than or equal to 7mm is most likely greater than or equal to 37 weeks.     

桡骨远端骨折的诊治进展

桡骨远端骨折是全身最常见的骨折之一，但近些年随着对于桡骨远端骨折研究的深入，伴随固定材料的不断改进，治疗方法也不断进步。根据个体情况选择合适的治疗方案，预防和减少并发症，提高患者生活质量仍是医生面临的重要问题。     

影像学在桡骨远端骨折中的应用进展

桡骨远端骨折是各种上肢骨折类型中最为常见的一种,由于日常生活中腕关节的活动频率非常高,所以对于其损伤的明确诊断、治疗方式的选择及后续功能的恢复具有很高的要求,而影像学检查是桡骨远端骨折临床诊断和观察疗效的主要手段。本文就影像学在桡骨远端骨折诊断、治疗方式选择及观察疗效中的应用进展进行综述。     

Stress fractures of the distal radius in adolescent gymnasts

Adolescent girl gymnasts sustained stress fractures of the distal end of the radius in the wrist on which a rotational vault was performed. The history and clinical progress were typical of stress fractures.     

桡骨远端骨折超声治疗效果的定量CT评价

目的 观察定量CT评价低强度超声仪(LIUS)促进桡骨远端骨折愈合效果和应用价值.方法 选取20例闭合性桡骨远端A型骨折患者为研究对象,随机分为超声组(10例,骨折手法复位、石膏外固定后给予超声治疗)和对照组(10例,单纯骨折手法复位、石膏外固定).超声组每天治疗1次,每次20 min,超声平均强度为30 mW/cm2;所有患者均在第14,42,70天采用TOSHIBA CT机[Aquilion、TSX-101A,标准骨密度(BMD)体模及扫描条件为120 kV,75 mAs,0.5 s,层厚5 mm)扫描骨折端远近3 cm骨段和体模,测量两侧骨骼的皮质横截面积(CSA)和皮质骨骨密度(cBMD),观察及计算两组以骨折端为中心远近1 cm(共计5个层面)骨段的力学强度指数(BSICSA=CSA×cBMD)、骨折端X线表现、骨折愈合时间等相关指标并予统计学分析.结果 超声组与对照组相比,骨折端BSI F组别值为18.823,BMD F组别值为3.085.差异均有统计学意义(P<0.05或0.01).定量CT所获取数值显示超声干预和时间因素的交互作用最有效,超声干预作用次之(Eta组别*时阃>Eta组别>Eta时间).结论 LIUS可促进桡骨远端骨折愈合,其中定量CT所提供的CSA和cBMD能够作为桡骨远端骨折愈合的定量评价依据,且比传统方法更精确、更具体、更灵敏.     

Post-traumatic osseous cyst of the distal radius in a child

Post-traumatic osseous cysts are an uncommon complication of pediatric appendicular trauma which develop in the first few weeks following the injury. Due to their infrequent occurrence, their appearance may be mistaken for other, more sinister entities. We present a case of a post-traumatic osseous cyst in a 6-year old child with radiographic and magnetic resonance imaging findings which we hope will reassure clinicians as to their benign nature and prevent over-investigation.     

Studies on the time frame for ossification of the medial clavicular epiphyseal cartilage in conventional radiography

Radiological assessment of the degree of ossification of the medial clavicular epiphyseal cartilage plays a vital part in forensic age diagnosis of living adolescents and young adults. A total of 873 plain chest radiographs requested by the staff medical officer for members of staff aged 16–30 at the University Hospital Charité were evaluated retrospectively. Of these X-rays 699 permitted an assessment of ossification of at least 1 side of the clavicle. In addition to the customary stages (1: non-ossified epiphysis, 2: discernible ossification centre, 3: partial fusion, 4: total fusion) a stage 5 was also defined, characterised by the disappearance of the epiphyseal scar following total fusion. The earliest age at which stage 3 was detected in either gender was 16 years. Stage 4 was first observed in women at 20 years and in men at 21 years. In both genders, the earliest observation of stage 5 was at 26 years. It was concluded that plain chest radiographs can essentially be used to assess clavicular ossification. In practice, if overlap in posterior-anterior views impedes evaluation, a lateral view should also be taken to facilitate age estimation. In forensic practice the reference values of the present paper should be applied.     

The ossification of the ischial tuberosity for forensic age diagnostics in conventional radiography

Age estimation in living individuals is an area of increasing importance for both radiology and forensic medicine. Owing to a relatively late completion of maturation, the ischial tuberosity can offer a valuable alternative for assessing 18?years of age. However, the ossification of the ischial tuberosity has rarely been investigated with respect to forensic requirements. The aim of the study was to clarify how strong the chronological age relates to the ossification of the ischial tuberosity in the West China Han group. Our results indicated that the ischial tuberosity ossification appears to begin from 15.34 to 16.17?years for males, and from 14.39 to 15.64?years for females. The apophyseal cartilage begins to ossify from 18.50 to 19.17?years for males, and 18.73 to 19.44?years for females, and has fully ossified from 22.93 to 23.30?years for males, and 23.62 to 24.07?years for females. The present study offers a valuable alternative for age estimation.     

桡骨远端关节内骨折的手术治疗与早期康复

目的探讨桡骨远端关节内骨折的手术治疗与早期康复的临床疗效。方法2001~2005年我科应用π型钢板对18例桡骨远端关节内骨折行切开复位内固定,并行早期功能康复,术后按L idstrom评分标准评定。结果18例经8~12个月随访,平均10个月。优:无功能损害,无主观症状,无畸形,背伸掌屈失位<15°15例;良:无功能损害,无主观症状,轻度畸形2例;可:关节功能恢复不理想,关节活动度差1例;差:工作能力减弱,日常生活受影响,伴活动性疼痛0例。本组优良率94.4%。结论对桡骨远端关节内骨折应用π型钢板内固定,术中解剖复位,术后早期进行功能康复,可得到较满意的治疗效果。     

手术治疗复杂桡骨远端骨折

目的 探讨治疗复杂桡骨远端骨折(AO分型的B型和C型)的方法. 方法 2005年6月-2007年6月手术治疗78例(83侧)复杂桡骨远端骨折,男51例,女27例;平均年龄34.6岁.按AO分型:B1型12侧,B2、B3型22侧,C1型21侧,C2型16侧,C3型12侧.手术采用切开直视下关节面复位、撬拨复位植骨支撑矫止桡骨远端掌倾角和尺偏角、应用外固定支架固定等方法. 结果 全部患者得到随访,平均随访时间10.5个月.术后关节面塌陷、移位均＜2 mm,掌倾角平均10.6°,尺偏角学均20.3°全部骨性愈合,以Garland and Werley评分方法评定腕关节功能:优33侧,良41侧,可7侧,差2侧,优良率89%. 结论 手术治疗可使关节而复位、可矫止掌倾角和尺偏角,应用外固定支架消除了前臂的轴向短缩应力,足治疗桡骨远端复杂骨折的有效疗法.     

老年桡骨远端骨折治疗方法的探讨

目的对比分析手法复位石膏外固定和掌侧斜"T"形钢板内固定治疗老年桡骨远端骨折的疗效。方法 2010年10月—2011年6月分别采用手法复位加石膏托外固定及切开复位"T"形锁定钢板内固定治疗老年桡骨远端骨折146例,采用Gartland等腕关节评分进行功能评定,比较两种不同治疗方法的疗效。结果所有患者均获得随访,随访时间6～15个月,平均11.3个月。X线显示骨折全部愈合。Gartland腕关节评分手法复位石膏外固定组优良率为72.2%,掌侧斜"T"形钢板内固定组优良率为87.8%,差异有统计学意义(P<0.01)。结论尽管钢板内固定的优良率较高,但除少数经关节面且有明显关节面移位,非手术治疗失败的老年桡骨远端骨折可采用手术治疗外,大多数老年桡骨远端骨折经手法复位石膏外固定非手术治疗即可取得较为满意的临床效果,手术的选择应慎重,应尊重患者的要求。     

桡骨远端不稳定骨折的手术治疗

目的 探讨桡骨远端不稳定骨折的手术治疗方法及临床效果评价.方法 回顾性分析2001年5月-2008年7月手术治疗桡骨远端不稳定性骨折87例,根据AO分型的不同类型骨折及其粉碎程度分别采用钢板内固定、外固定支架辅以克氏针固定以及钢板内固定联合外固定毒架等三种不同的治疗方法.结果 对78例患者平均随访18个月.根据Cooney腕关节功能评价:优44例,良21例,可11例,差2例,优良率为83%.结论 对不同类型桡骨远端不稳定骨折采用不同的手术方法,最大限度恢复桡骨与尺骨的相对长度、关节面的平整、掌倾角及尺偏角,术后配合合理的康复锻炼,能使腕关节功能得到最大恢复.     

Angle of inclination of the articular surface of the distal radius

Measurements on 57 normal radiographs of the wrist were performed twice by the same observer in order to determine the intra-observer variance. Measurements of the volar tilt (average 12 degrees), the radial angulation (average 23 degrees) and the length of the radial styloid (average 12 mm) had a reproducibility of 21%, 9% and 6% respectively. It was concluded that a good lateral radiograph, clearly outlining the articular surface, is important for the reproducibility of the measurements. In the AP plane the length of the radial styloid should be used as a measure of dislocation when evaluating fractured wrists, since the latter is easier to determine and gives the same information as the radial angulation.     

Transphyseal linear ossific striations of the distal radius and ulna

Radiologic and histologic analysis of transphyseal linear ossific striations of the distal ulna and radius showed that these striations consist of trabecular bone extending from the metaphysis across all zones of the physis into a small focus of fibrous and necrotic tissue within the epiphyseal cartilage. The focus appears to be a discrete area of epiphyseal ischemia with subsequent necrosis within and around the vasculature of a cartilage canal and probably represents a microscopic response to antecedent trauma that was insufficient to cause macrofailure (fracture) of the physis. The striations did not continue into the epiphyseal ossification center. The consequence is partial osseous bridging across the physis. This bridging is unlikely to cause significant growth damage, since in most cases it does not appear to extend farther into the secondary ossification center.