The purpose of this study was to assess the Interobserver Reliability of the Sauvegrain Skeletal Age Assessment. Elbow radiographs requested to exclude injury were anonymised. Sixteen examinations were assessed by ten independent orthopaedic specialist registrars or consultants. The Sauvegrain method as modified by Dimeglio was used to score the radiographs. The observations made were then assessed for interobserver reliability by means of a multiple observer Kappa score and the total scores by intra-class correlation coefficient. Kappa scores for the components of the score were 0.403 for the lateral condyle; 0.492 for the trochlea; 0.354 for the proximal radius and 0.508 for the olecranon. Adding item scores to produce a modified Sauvegrain score had an intraclass reliability of 0.858 (95% CI 0.758 to 0.935). Methods of identifying skeletal maturation and predicting future growth generally depend on the use of an atlas of hand radiographs. Difficulties with poor interobserver reliability associated with these methods has led to a move towards assessments that do not depend upon bone age estimations. Unfortunately plans based on ratios of growth or average patterns produce errors when unusual types of growth disturbance are present. We conclude that use of a scoring system for maturation assessed by elbow radiographs offers a significant advantage when substituted into the straight line method of growth prediction. The Sauvegrain method as modified by Dimeglio1 has demonstrated an excellent level of inter observer reliability. We have used Sauvegrain scores to improve the accuracy of timing when using the Mosely straight line method

Aim: To assess the Interobserver Reliability of the Sauvegrain Skeletal Age Assessment. Methods and Results: Elbow radiographs requested to exclude injury were anonymised. Sixteen examinations were assessed by ten independent orthopaedic specialist registrars or consultants. The Sauvegrain method as modified by Dimeglio was used to score the radiographs. The observations made were then assessed for interobserver reliability by means of a multiple observer Kappa score and the total scores by intra-class correlation coefficient. Kappa scores for the components of the score were 0.403 for the lateral condyle; 0.492 for the trochlea; 0.354 for the proximal radius and 0.508 for the olecranon. Adding item scores to produce a modified Sauvegrain score had an intra-class reliability of 0.858 (95% CI 0.758 to 0.935). Conclusions: Methods of identifying skeletal maturation and predicting future growth generally depend on the use of an atlas of hand radiographs. Difficulties with poor interobserver reliability associated with these methods have led to a move towards assessments that do not depend upon bone age estimations. Unfortunately plans based on ratios of growth or average patterns produce errors when unusual types of growth disturbance are present. We conclude that use of a scoring system for maturation assessed by elbow radiographs offers a significant advantage when substituted into the straight-line method of growth prediction. The Sauvegrain method as modified by Dimeglio. 1. has demonstrated an excellent level of interobserver reliability. We have used Sauvegrain scores to improve the accuracy of timing when using the Mosely straight-line method. 3.

Aims. Accurate skeletal age and final adult height prediction methods in paediatric orthopaedics are crucial for determining optimal timing of growth-guiding interventions and minimizing complications in treatments of various conditions. This study aimed to evaluate the accuracy of final adult height predictions using the central peak height (CPH) method with long leg X-rays and four different multiplier tables. Methods. This study included 31 patients who underwent temporary hemiepiphysiodesis for varus or valgus deformity of the leg between 2014 and 2020. The skeletal age at surgical intervention was evaluated using the CPH method with long leg radiographs. The true final adult height (FH. TRUE. ) was determined when the growth plates were closed. The final height prediction accuracy of four different multiplier tables (1. Bayley and Pinneau; 2. Paley et al; 3. Sanders – Greulich and Pyle (SGP); and 4. Sanders – peak height velocity (PHV)) was then compared using either skeletal age or chronological age. Results. All final adult height predictions overestimated the FH. TRUE. , with the SGP multiplier table having the lowest overestimation and lowest absolute deviation when using both chronological age and skeletal age. There were no significant differences in final height prediction accuracy between using skeletal age and chronological age with PHV (p = 0.652) or SGP multiplier tables (p = 0.969). Adult height predictions with chronological age and SGP (r = 0.769; p ≤ 0.001), as well as chronological age and PHV (r = 0.822; p ≤ 0.001), showed higher correlations with FH. TRUE. than predictions with skeletal age and SGP (r = 0.657; p ≤ 0.001) or skeletal age and PHV (r = 0.707; p ≤ 0.001). Conclusion. There was no significant improvement in adult height prediction accuracy when using the CPH method compared to chronological age alone. The study concludes that there is no advantage in routinely using the CPH method for skeletal age determination over the simple use of chronological age. The findings highlight the need for more accurate methods to predict final adult height in contemporary patient populations. Cite this article: Bone Jt Open 2023;4(10):750–757

Introduction: Percutaneous epiphyseodesis is a simple method of achieving leg length equality in cases of minor leg length discrepancy, however few studies document its effectiveness. A retrospective study was undertaken to assess this. Materials and methods: Patient notes and radiographs were reviewed. The growth remaining method was used to estimate timing. Percutaneous epiphyseodesis was performed with a drill and curette under radiological guidance. Results: A total of 24 skeletally mature patients with a mean preoperative leg length discrepancy (LLD) of 2.8cm were identified. Skeletal age was significantly different from chronological age in 5 of 11 cases where it had been performed. In all patients, there was radiographic evidence of physeal closure soon after epiphyseodesis. At skeletal maturity, 14 patients have a LLD of 0–1cm and are considered to have a satisfactory outcome. 10 patients have a LLD> 2cms. In 6 of these, either presentation was too late or the amount of discrepancy too large for complete correction to be expected. In the other 4, skeletal age assessment may have been useful in 3, and in one additional case of overgrowth of the short limb prior to maturity. A successful outome was more likely when skeletal age assessment had been used (82% versus 57%). Of the 18 cases where there was sufficient time for a full correction to be achieved, the overall success rate was 72%. There were no significant clinical or radiological complications. Conclusions:. Percutaneous drill epiphyseodesis is an effective method of achieving physeal ablation with no significant complications. While the growth remaining method is a crude estimate of the timing of epiphyseodesis, it was accurate in the majority of cases in this small series. The determination of skeletal age was found to be a useful adjunct to management in a small proportion of cases

Purpose: In pediatric orthopedics, Risser sign is used to assess skeletal maturity. Two grading system exist for the Risser sign, one US and one European. In adolescent idiopathic scoliosis (AIS) the curve acceleration phase begin at a digital skeletal age (DSA) score between 400 – 425. The objective was to asses the disagreement between both grading system and evaluate the best estimator of the curve acceleration phase. Method: One hundred twenty-one AIS patients had a PA and lateral X-rays of the spine and a left hand and wrist X-ray. Risser sign was measured according to both grading system and bone age was calculated according to Tanner-Whitehouse III method. Kappa statistics were done to evaluate concordance between US and Euro-pean grading system and 2 multiple linear regression models were performed to find which stage best predicts the beginning of the rapid acceleration phase. Results: Kappa statistic between the US and European system was 0.517 (moderate agreement). US Risser 1 was the best predictor of the curve acceleration phase. DSA scores predicted with Risser 1 were 425 and 445 for US and European system respectively. Conclusion: American and European Risser grading system use different criteria to define 6 stages of a same sign. This is reflected in our study with a moderate agreement between both grading systems. US Risser 1 is the stage that best predicts the beginning of the rapid acceleration phase and a close follow up should be made at the beginning of the iliac apophysis ossification

Introduction. The aim of this study was to retrospectively evaluate the efficacy of the SpineCor bracing treatment in all forms of scoliosis, between 2000–2006. Methods. Over the past 6 years 56 skeletally immature and 1 skeletally mature patients with progressive scoliosis have been treated with the Spine-Cor bracing system. They were divided into the following groups; infantile 3; juvenile 19; adolescent 29; adult 1; “other” 5. Results. 20 were deemed to have achieved a correc-tion, 24 stabilised 3 worsened and the progression of 4 patients was not recorded. To date 11 patients have gone on to surgery. Discussion. Various bracing systems utilised in the past have shown what appeared to be a lasting degree of protection for scoliosis but subsequent long term follow ups have demonstrated progression of curves. The newer SpineCor system may offer a good short term outcome. Conclusion. Early diagnosis and rapid treatment at a young skeletal age may offer an alternative to surgery with this relatively new bracing system. A further prospective study continues at S.C.H. and will be ready to present in 2011. Far longer term follow up will be required to validate apparent successes in the short term

Aims

The aim of this study was to assess the ability of morphological spinal parameters to predict the outcome of bracing in patients with adolescent idiopathic scoliosis (AIS) and to establish a novel supine correction index (SCI) for guiding bracing treatment.

Purpose. 1. To evaluate how radiological parameters change during the first 3 years following anterior endoscopic surgery. 2. To report complications encountered in this period. Methods. Between April 2000 and June 2006,106 patients underwent an anterior endoscopic instrumented fusion. There were 95 females and 11 males. Average age was 16.1 years (range 10-46). 103 (97%) had right-sided idiopathic curves. The majority were Lenke type 1 (79%). Patients were assessed at 3, 6, 12, 24, and 36 months. 83 patients had 1 year follow-up, 69 had 2 years or more. The following were investigated; the structural curve, instrumented curve, non-structural curves, skeletal age at operation and sagittal profile (T5-T12). Results. The mean Cobb angle of the structural curve was 52.3 degrees. 2 months following surgery, it was 21.4 degrees, with a correction rate was 59%. There was a partial loss of correction thereafter (29.3 degrees at 3 years, P=<0.001). The instrumented curve did not change significantly. The mean post-operative Cobb angles of the proximal and distal non-structural curves (when present) at 2months were 19.6 and 19.7 degrees respectively. At 3 years they were 18.8 and 24.4. The change in the distal curve was significant (p=<0.05). The pre-operative sagittal profile was 19 degrees. At 2 months it was 28 degrees and 31 degrees at 3 years. Skeletal maturity at time of surgery was not found to influence the structural curve. There were 12 fractured rods. All were 4.5mm rods and all but 2 were using rib autograft. There were 8 cases of proximal screw pullout. Conclusion. Anterior endoscopic surgery is effective in restoring both sagittal and coronal balance. However, there is small loss of coronal correction in the structural curve. 11% of rods fractured, though none occurred in the 94 patients where a larger rod (5.5mm) and femoral allograft was used

Introduction: This study examines the proximal tibial metaphyseal fractures in children and specifically the valgus deformity and leg overgrowth of the tibia. Methods: We examined 27 children with proximal tibial metaphyseal fractures. Among them, 11 presented with greenstick fractures, 6 with complete, 5 with hairline, 3 with torus and 2 with stress fractures. The mean age was 7 years old (1–14). The average follow up period was 9.5 years. Fifteen children were below the age of 7 while 12 were between 8–14 years old. Twenty five patients were treated conservatively and 2 surgically. Results: Valgus deformity occurred during the follow up period in 73% of the children aged below 7 y.o. and 17% of the older children. The higher values of valgus deformity ranged between 8–18 degrees and were observed at 10–18 months post-traumatically, especially in younger ages and after inadequate reductions. At the time of the final follow up examination, satisfactory spontaneous correction of the deformity, inversely proportional to age was observed in all cases. The degree of final valgus deformity ranged between 1–9 degrees. Overgrowth of the affected extremity was observed in 74% of the cases and ranged between 0, 4 and 1, 5 cm. Tibial overgrowth is not dependent to skeletal age. None of torus and stress fractures developed valgus deformity or longitudinal overgrowth. Compartment syndrome occurred in one case. Conclusion: A high tendency to valgus deformity, especially in younger ages, was observed in proximal tibial metaphyseal fractures, even among undisplaced or surgically treated ones. Approximately two years post-traumatically, the beginning of a progressive spontaneous satisfactory correction of the deformity – inversely proportional to age – was noticed. It is worth mentioning that valgus deformity up to 10 degrees and tibial overgrowth up to 1, 5 cm cause no functional or cosmetic problems. The above observations prevent us from unnecessary surgical correction. Conservative treatment is preferred for the proximal tibial metaphyseal fractures. Operative treatment is indicated after inadequate reduction, especially in older children and after open fractures

Purpose. Internal fixation of fractures in the presence of osteopenia has been associated with a failure rate as high as 25%. Enhancing bone formation and osseointegration of orthopaedic hardware is a priority when treating patients with impaired bone regenerative capacity. Fibroblast Growth Factor (FGF) 18 regulates skeletal development and could therefore have applications in implant integration. This study was designed to determine if FGF 18 promotes bone formation and osseointegration in the osteopenic FGFR3−/− mouse and to examine its effect on bone marrow derived mesenchymal stem cells (MSCs). Method. In Vivo: Intramedullary implants were fabricated from 0.4 × 10mm nylon rods coated with 300nm of titanium by physical vapour deposition. Skeletally mature, age matched female FGFR3−/− and wild type mice received bilateral intramedullary femoral implants. Left femurs received an intramedullary injection of 0.1μg of FGF 18 (Merck Serono), and right femurs received saline only. Six weeks later, femurs were harvested, radiographed, scanned by micro CT, and processed for undecalcified for histology. In Vitro: MSCs were harvested from femurs and tibiae of skeletally mature age matched FGFR3−/− and wild type mice. Cells were cultured in Alpha Modified Eagles Medium (αMEM) to monitor proliferation or αMEM supplemented with ascorbic acid and sodium beta-glycerophosphate to monitor differentiation. Proliferation was assessed through cell counts and metabolic activity at days 3, 6 and 9. Differentiation was assessed through staining for osteoblasts and mineral deposition at days 6, 9 and 12. Results. Wild type mice exhibited more peri-implant bone formation compared to FGFR3−/− mice. Peri-implant bone formation at the proximal metaphyseal-diaphyseal junction was increased in FGF18 treated femurs compared with contralateral control femurs in wild type (p = NS) and FGFR3−/− (p = 0.04) mice. Histological analysis corroborated micro CT findings, with FGF 18 treated FGFR3−/− femurs forming peri-implant bone instead of the fibrous response seen in controls. In vitro studies showed that FGF18 significantly increased MSC proliferation and metabolism in a dose dependent manner in wild type and FGFR3−/− mice. Osteoblast differentiation was inhibited by FGF18 in wild type MSCs, but was increased at physiological concentrations in cells harvested from FGFR3−/− mice. Conclusion. FGF 18 increases bone formation and osseointegration of intramedullary implants in osteopenic mice and increases MSC proliferation in both the presence and absence of FGFR3. FGF18 also promoted osteoblast differentiation in the absence of FGFR3 signalling, most likely via FGFR1 or 2. Additional work is needed to confirm the identity of the alternate FGFR and to evaluate its capacity to improve osseous healing in unfavourable in-vivo environments

Objectives

Distraction osteogenesis (DO) mobilises bone regenerative potential and avoids the complications of other treatments such as bone graft. The major disadvantage of DO is the length of time required for bone consolidation. Mesenchymal stem cells (MSCs) have been used to promote bone formation with some good results.