A roentgenologic study of cortical bone resorption in chronic renal failure

Periosteal, intracortical, and endosteal resorptive changes were evaluated in both hands and the proximal radius in 161 chronic renal-failure patients by microradioscopy, radiographic morphometry, and photodensitometry. These changes were compared to abnormalities found in skeletal surveys. A combination of microradioscopy and morphometry of hand bones was sufficiently sensitive for early detection of bone loss in renal osteodystrophy in 61% of the patients. Intracortical resorption in metacarpals appeared to be a sign of more advanced renal osteodystrophy than subperiosteal resorption in phalanges. Photodensitometric findings in the radius generally agreed with microradioscopic and morphometric findings in hand bones.     

Improved roentgenologic diagnosis of osteomalacia by microradioscopy of hand bones.

Microradioscopic study of metacarpals in 24 osteomalacic and 34 osteoporotic patients revealed excessive intracortical resorption (striations) in approximately 60 percent of patients suffering from osteomalacia, but in none of the osteoporotics. Phalangeal periosteal resorption was found less frequently in osteomalacia than metacarpal striations, and was absent in osteoporotics. On the other hand, quantitative evaluation of cortical thickness, percent cortical area, bone mineral mass, and density did not show any clear differences between the two study groups. It is concluded that the differential diagnosis between osteomalacia and osteoporosis may be considerably improved by microradioscopy of hand bones.     

假性甲状旁腺机能减退综合征5例报道及文献复习

目的 探讨假性甲状旁腺机能减退综合征的X线表现和诊断方法。资料与方法 回顾分析5例经临床和实验室证实的典型病例的手、足、颅骨X线表现并文献复习。结果 掌（跖）指（趾）骨对称性不成比例短缩畸形5例，颅内基底节和脑实质钙化3例，骨质疏松，颅板增厚、板障变窄，下颌角变浅各2例。结论 掌（跖）指（趾）骨对称性不成比例短缩畸形，尤其是第415掌骨和拇指末节指骨变短是该病特征性X线表现，结合临床表现和实验室检查发现低血钙、高血磷，甲状旁腺激素（PTH）含量正常或升高，且应用PTH治疗无效可确诊。     

The mode of progression of subperiosteal resorption in the hyperparathyroidism of chronic renal failure

Subperiosteal resorption in finger phalanges is usually thought to be the result of osteoclastic bone resorption on the periosteal surface of bone, progressive centripetally, with creation of the serrated appearances and “lace-like” patterns in periosteal cortical bone. Our longitudinal microradioscopic observations in patients with secondary hyperparathyroidism of chronic renal failure have revealed evidence of another pathogenetic mechanism: by the enlargement of intracortical juxtaperiosteal resorption spaces, the remaining thin layer of bone is broken down from inside the bone, i.e., a centrifugal rather than centripetal process.     

Sex determination by the length of metacarpals and phalanges: X-ray study on Egyptian population

Measurements of hand bones length have been shown to be sexually dimorphic in many nationalities. The aim of this study is to assess the accuracy of sex determination from the length of all metacarpals and phalanges of right and left hands using X-ray radiographs and to develop a discriminant formula that can be used in the Egyptians. One hundred Egyptians are included in the study (50 adult males and 50 adult females) in the period from December 2009 to January 2011 with mean age 31.60 ± 9.44. Each is subjected to X-ray radiographs on both hands. The results reveal that males have significantly greater mean values than females for all metacarpals and phalanges of both hands and the Egyptian population has greater measurements in comparison to the other ones (e.g. Turkish and European Americans). In addition there is no significant difference between the right and the left hands in either males or females. The correct classification reached an accuracy of 88%–94% by using both hands, while that for right hand only is 88% and 88%–90% for the left hand only. Regarding the accuracy of each bone, the present results revealed that 1st DP & PP and 3rd and 4th MC in the right and left hands are the best bones that can be used in correct sex determination. It is concluded that the length of metacarpals and phalanges (especially the 1st DP & PP and 3rd and 4th MC) could be used for sex determination. The right hand could be used as the left hand in determination of sex. Also the X-ray radiographs are good non invasive and simple tool in the determination of sex from the hand bones. Furthermore the regression equation for both hands and each hand separately is specific to Egyptian population and should be used after validation of the results in other ones.     

Measuring radiographic bone density and irregularity in normal hands

This paper describes a method of measuring the radiographic density of the proximal phalanges and metacarpals using a television image analyser. The site for measurement is highly definable and covers the majority of the middle 2/4ths of these bones. Measurements yield two figures; one for mean bone density and one for the density distribution factor (irregularity). Thirty pairs of normal female hands were radiographed and measured. Variations of density and irregularity bone by bone, with age and with dominance are described.     

Gender determination from hand bones length and volume using multidetector computed tomography: a study in Egyptian people

Determination of sex from incomplete skeletal and decomposing human remains is particularly important in personal identification. Measurements of hand bones length have been shown to be sexually dimorphic in many nationalities. Since the validity of discriminant function equation in sex determination is population specific; the purpose of this study is to assess sex from the hand bones length in a contemporary Egyptian population using data derived from both multiplanar (two-dimensional) and volumetric (three-dimensional) reformatted images of multidetector CT to derive special equations for sex determination in Egyptians. One hundred and twenty two Egyptians (60 males and 62 females) with mean age of 24.1?±?4.4 were included. An independent samples student's t-test and discriminant function analysis were done. Results indicate existence of length differences between the sexes. Males presented with significantly greater mean values than females for distal phalanges of all fingers, 1st and 3rd proximal phalanges and all metacarpal bones measured by 2D images. Metacarpals, proximal phalanges and distal phalanges are sexually dimorphic with accuracies of 80%, 76.6% and 80% respectively. Three-dimensional volume-rendered reconstructed images of metacarpals give more accurate results (92.9%) in correct sex determination when compared with 2D images. From the forensic standpoint, the usefulness of this study rests on the identification of sex among Egyptian based on length and volume differences observed on MDCT examination.     

Behavior and significance of phalangeal bone changes in uremic patients under periodic hemodialysis treatment

Bone damage in hand phalanges has been evaluated with reference to age and duration of hemodialysis (on the basis of 248 radiological observations), in 93 cases with chronic renal failure (age: 20-59 years). These patients were on regular dialytic treatment (RDT) from 1 to 138 months. 72% of the patients underwent several periodic (annual) controls using the mammographic technique. The radiologic evaluations have been arranged into groups according to age. Skeletal damage was more evident when RDT was prolonged. Bone damage increases with age in the first 48 months; afterwards, on the contrary, bone changes were more evident in middle aged patients. At the beginning of RDT, acroosteolysis was the most important change always present. Both subperiosteal and intracortical resorption are more evident increasing age and duration of RDT. Radiological changes give a clear picture of the possible histo-morphologic pattern that characterizes uremic osteodystrophy.     

The hand of the patient under periodic hemodialysis treatment. Comparative radiographic and xeroradiographic aspects

Renal osteodystrophy is the skeletal response to long-standing chronic renal disease. The radiographic features include hyperparathyroidism (osteitis fibrosa cystica), rickets or osteomalacia, osteoporosis, osteosclerosis and soft tissue and vascular calcifications. Many investigators have verified that changes in the phalanges of the hand are the most sensitive indicator of renal osteodystrophy, especially subperiosteal bone resorption. The hands of 50 chronic dialysis patients were evaluated for at least one year for tuftal resorption (acro-osteolysis), subperiosteal and intracortical bone resorption, and periosteal new bone formation (periosteal neostosis), using fine detail radiography and optical magnification. At last control, only in a group of 17 subjects (34%), xeroradiography of the hand was also performed. Results indicate the importance of the use of fine detail radiography in the early diagnosis of renal osteodystrophy and that serial radiography of the hand is a proper method of evaluating progressive bone resorption. In addition, a significant difference (p less than 0.05) is demonstrated between xeroradiography and radiography to evaluate periosteal neostosis.     

99mTc-pyrophosphate scan and radiographic correlation in thyroid acropachy: case report.

A case of thyroid acropachy secondary to Graves' disease is described. Radiographic abnormalities were found to correlate with those in a 99mTc-pyrophosphate bone scan. Abnormal tracer concentrations were observed in the diaphyses of the metacarpals and phalanges of both hands and also in regions of pretibial myxedema. The differential diagnosis of the scan abnormalities is discussed.     

Growth disturbances in the hands following thermal injuries in children. 2. Frostbite

Nine children who had growth abnormalities of their hands following frostbite were studied. In all nine there was shortening of distal phalanges and some adjacent middle phalanges. Proximal phalanges and metacarpals were rarely involved. Epiphyseal abnormalities included destruction, premature fusion, and fragmentation. Other findings included irregularity of the distal ends of phalanges, abnormal alignment, joint abnormalities, and soft tissue swelling.     

Hand injuries in boxing

Investigations of 100 consecutive hand injuries in boxing have shown that 39% occurred in the area of the thumb, including the radial carpals, metacarpals and phalanges and their joints. These injuries were mostly caused by forced abduction of the thumb. Thirty-five percent of the injuries occurred at the base of Metacarpals 2 to 5, including the wrist joint, and arose from forced flexion of the wrist. Twenty-six percent occurred in the phalanges and the rest of the metacarpals, excluding the bases.     

Quantitative microfocal radiography of children with renal osteodystrophy; comparison with laboratory and histological findings

High definition microfocal radiography permitted the quantitative assessment of the radiographic features of renal osteodystrophy in the phalanges of 11 children in stable chronic renal failure, treated with phosphate binders for 1 year. The most consistent feature was subperiosteal cortical resorption, expressed as a ratio total length of resorbed subperiosteal bone/total length subperiosteal bone x 100. It was found that the extent of resorbed bone was significantly greater in the middle phalanx and on the ulnar surface of the phalanges. The radiological findings over the duration of the disease were compared with laboratory assessments and bone histomorphometry. The extent of the percentage of subperiosteal resorption at base line and its change during the study period correlated significantly with the level of serum parathyroid hormone levels and its change over the same period. No other significant correlations were found between radiographic features and laboratory assessments or with bone histomorphometry.     

假性甲状旁腺机能减退症(附一家系六例报告)

目的 提高对假性甲状旁腺机能减退症（PHP）的认识和诊断。方法 发现PHP先证者后,对其家族进行了调查。该家族共4代6例患者,男4例（死亡2例）,女2例。现存4例年龄最大者55岁,最小者8岁。6例均经生化证实,选择2例摄取手平片和头颅CT片。结果 6例均有典型的Albright遗传性骨营养不良症体型、短指（趾）畸形。2例行X线检查者表现为掌、指骨粗短,骨增厚、基底节区呈对称性钙化。结论 影像学表现与临床特点相结合,可对PHP做出明显诊断。     

Hyperparathyroidism

Since the introduction of routine automated measurements of serum calcium levels in the 1970s, the detection of primary hyperparathyroidism has risen considerably. Nevertheless, the severe bone changes described by von Recklinghausen are still quite rare. The apparent rise in incidence is accounted for by the discovery of a large group of predominantly asymptomatic elderly patients who have mild primary hyperparathyroidism. Because the diagnosis is most often confirmed through laboratory tests, radiologic studies are now most useful in assessing the severity of the disease. The presence of bone changes is an accepted indication for parathyroid surgery in primary hyperparathyroidism. For patients with asymptomatic disease in whom nonsurgical treatment may be considered, radiographic evaluation is one of several techniques that may be used to assess progression. High resolution radiographs of the hands are most valuable in this regard. Accelerated bone mineral loss, as measured by quantitative techniques, will probably play a significant role in the future. Radiographic follow-up of patients with renal disease and secondary hyperparathyroidism is equally important, as increased bone or soft tissue changes may indicate a need for therapeutic change. Radiographically identifiable changes of hyperparathyroidism consist mainly of various types of accelerated bone resorption. Multifocal subperiosteal resorption is generally considered to be pathognomonic of hyperparathyroidism. Subligamentous, subchondral, endosteal, and intracortical resorption are also important manifestations of accelerated bone turnover. The earliest bone changes are visible in the hands and should be searched for especially carefully in the phalanges and terminal tufts. Only occasionally will changes be found elsewhere in the skeleton when hand changes are not present.     

Nutrient foramina in the phalanges of the hands

The normal distribution and size of nutrient foramina in the terminal and middle phalanges of the fingers, which appear as radiolucencies on hand radiographs, is described. In a study based on the antero-posterior (AP) hand films of 218 patients, we found no evidence that the foramina were more frequently seen in childhood. When age is disregarded in statistical analysis, the foramina are more frequently observed in women than in men. In both sexes foramina are seen most often in the middle phalanges. We have found that the upper limit of normal of foraminal diameters is 1 mm (uncorrected for enlargement) and this permits recognition of enlargement of the foramina which can occur in disorders such as Gaucher's disease, sickle cell anemia and thalassemia.     

微型加压螺钉在不稳定掌、指骨骨折中的应用

目的 对不稳定掌、指骨骨折用微型加压螺钉切开复位内固定的方法及效果进行评价和分析。方法 闭合掌骨骨折以骨折断端为中心做掌背侧纵形切口；指骨做背外侧切口，开放骨折按照伤口情况另做切口或就原伤口入路，复位后在垂直骨折面打入2枚（或1枚）微型加压螺钉，术后不用石膏外固定，3天后即开始被动活动，10天后开始主动活动，6周内 禁用手持重。有肌腱损伤者及1枚螺钉固定者，术后石膏外固定3周开始功能锻炼。结果 骨折愈合时间平均8周，掌指及指间关节功能恢复满意；无畸形愈合、延迟愈合和骨不连。随访时间3个月－1年半，平均7个半月。2例发生创伤性关节炎，2例取钉困难。结论 微型加压螺钉是治疗不稳定掌、指骨骨折的比较好的内固定方式。     

Radiogrammetry of the metacarpal: A critical reappraisal

The precise estimation of osteoporosis is hampered by the lack of a generally accepted method of evaluation. Measurement of the combined cortical thickness (CCT) of the centre point of the second metacarpal has been widely used for this purpose, but the wide normal variation found in population studies has reduced its value in the diagnosis of this condition in the individual. The factors leading to this normal variability are discussed and the three centre metacarpals are compared with each other. It is concluded that simple CCT measurement is preferable to any of the indices so far devised, but that a single measurement of a given metacarpal is too imprecise to be of real value. If a single metacarpal is to be chosen, three measurements of the third metacarpal gives a coefficient of variation lower than those of the second or fourth, and an average of nine measurements of the three centre metacarpals produces a further useful reduction in variability.     

Unusual findings of benign enchondroma in the ulna on 3-phase bone scintigraphy

Enchondroma is a common benign cartilaginous tumor arising from the medullary cavity, most commonly in the phalanges and metacarpals of the hand. Enchondroma involving the ulna is very rare. Typically, benign enchondroma shows normal or only slightly increased uptake of a bone-seeking agent on delayed bone scintigraphy. Markedly increased activity of enchondroma with pain is most often associated with pathologic fracture or malignant degeneration. The authors present the 3-phase bone scintigraphic findings of a benign enchondroma associated with pain, which showed focal hyperperfusion, hyperemia, and intense bone uptake in the distal right ulna.     

Metacarpophalangeal pattern profile analysis as a tool for early diagnosis of Turner syndrome

PURPOSE: To analyze the metacarpophalangeal pattern profile (MCPP) in a cohort of individuals with Turner syndrome (TS), and to assess its value as a tool for early diagnosis of TS. MATERIAL AND METHODS: Medical records and radiological material were collected of 71 patients with TS aged between 3 and 21 years. Forty-six patients received growth hormone therapy (33-66 microg kg(-1) day(-1)) and 14 of these were also treated with the anabolic steroid oxandrolone (1.25-3.75 mg day(-1)). A total of 233 frontal hand radiographs were studied and pattern profiles were calculated. Profiles of the TS patients were compared with those of 70 normal females. Mean pattern profiles were calculated for different age groups and extrapolated profiles for newborns and infants were developed. RESULTS: Our results confirm that patients with TS have a distinct MCPP which differs significantly from that of normal individuals. A bone-shortening gradient with increasing shortening from distal phalanges to metacarpals was demonstrated. We also showed that the MCPP in TS is a remarkably constant feature from 3 to 18 years. Pattern profiles did not differ significantly between the patients with 45,X and non-45,X karyotype. MCPP was not affected by treatment with growth hormone of growth hormone plus oxandrolone. Discriminant analysis yielded correct classification in 88%, of analyzed cases. CONCLUSION: TS individuals have a distinct hand pattern profile that is not age-related. MCPP analysis can be applied at any age and may facilitate early diagnosis of TS. Our study showed that MCPP analysis is a specific and sensitive method that should be considered as a routinely used tool for early diagnosis of TS in girls with unexplained short stature.