Research Developments in Medicine and Medical Science Vol. 5

What is it about?

Abstract In this article, the authors detail the necessary instructions to proceed correctly to interpret the computer program to calculate the bone age and prognosis of adult size of the child under study. This program is free download from the website of the Illustrious College of Medical of Zaragoza (Spain) https://www.comz.org/maduracion-osea Once downloaded on the computer, the practical doctor: radiologist, pediatrician, endocrine or researcher, from the hospital intranet, he will be able to perform the appropriate radiological measures of left hand and Tarsus, as detailed in the attached schemes and figures. When introducing them to the program's computer window, together with the size of the child and parents, the diagnosis of the child's bone age and the prognosis of their adult size can be obtained. Thus, it will be possible to know if the bone age is normal, advanced or delayed, and can be required in these cases to expand the study by other procedures as analytics. The database of children who have served to prepare this program has been obtained from the Spanish Longitudinal Series of the Andrea Prader Center. Keywords: • Computer program • bone age • radiography measurement • hospital intranet

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Why is it important?

After a comprehensive bibliographic review of Skeletal Maturity and Growth in its physiological and pathological aspects, the main existing methods of bone age calculation and size prediction are described. In this sense, we provide in this thesis a new numerical method for bone age calculation based on the carpal (IC), meta-carpal-phalangeal index (IMF), and carpal-meta-carpal-phalangeal (ICMF) indexes, as well as on the Ossified Value Index IVO (Indice de Valoración Osificativo) of the three above mentioned indexes, which simplifies the diagnosis of the child’s bone age through a computing program using the radiological measurements of the ossification cores. The casuistry length of our study covers 160 children form Aragon, 73 male and 87 female, from the child longitudinal study developed at the CAP (Centro Andrea Prader), who are divided by genre and age from their birth until the age of 21, excluded. The radiological study was carried out at Miguel Servet Children´s Hospital in Zaragoza, calling every child annually on his birthday. The “Statistix” statistical package has been used for the statistical work, and the Excel program for the elaboration of the tables and the Graphics study that we present. Numerical tables and descriptive graphics of mean values, standard deviations, percentiles (from 3 to 97) of all the parameters studied, including the bone ages obtained by our indexes and the Greulich- Pyle and TW2 bone ages, children’s sizes, and the carpal and meta-carpal-phalanges core diameters, are presented in this thesis for practical use. Moreover, non- descriptive statistical results such as correlation coefficients, multi-regression equations of adult size prediction, are presented in tables and graphics. We have compared the results of our series with others like the Spanish transversal series and the longitudinal series of the Swiss child, as well as the original CAP series. We have also carried out a study of the chronology of appearance of ossification cores and the finding of accessory bones of the hand, contrasting them with the ones found by other authors. We have ascertained that our indexes are closely co-related with the chronological age, with a statistical significance p<0.001, being the bone ages IC, IMF, ICMF statistically different from the bone ages GP and TW2 (p<0.001). Therefore, the average differences between the EO (bone age) and the EO (chronological age) that we have found must be corrected between them when want to pass from our ages to those of GP or TW2, or vice versa, that is, when we want to transform one group of ages to others. However, it is not recommended to do so if they are referred to the Spanish child calculated with using our bone age methods. This methodology allows the adaptation to different populations, creating bone age standards of different racial groups. This is one of the most remarkable aspects of this contribution, as it does not require extrapolations of foreign methods in native populations, avoiding subsequent corrections of the bone age, as racial and social-cultural characteristics of the studied populations are respected. The average PTA for the different bone ages have not statistically differed from the adult size reached. To this current revision of our method, it has been incorporated into the general computer program (children up to the age of 20 years),which allows the calculation of the bone size and prediction of the child´s adult height, another computer program, with equations that allow the calculation of Bone age children through the hand, up to four years. Likewise, another computer program has been incorporated, with equations that allow the calculation of Bone age in Tarsus, of children up to four years, from the Casuistry of Doctoral Thesis of the author (1977). The software can be downloaded directly from the address indicated in the book

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