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Topic:

​

Issue:

Wrist

Category:

Research

Title:

The Addition of Hand-specific Skeletal Maturity Parameters Does Not Improve Skeletal Maturity Estimation Accuracy of the Modified Fels Wrist System

Author:

Sinkler, Margaret A. MD; Furdock, Ryan J. MD; Halloran, Sean BS; Liu, Raymond W. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

April 2024

Reference:

44(4):p 281-285, DOI: 10.1097/BPO.0000000000002621

Level Of Evidence:

​

# of Patients:

372 radiographs from 80 participants

Study Type:

Retrospective comparative study

Location:

Single-center, specific study population

Summary:

The study aimed to optimize the Modified Fels Wrist system for skeletal maturity estimation by including hand-specific radiographic parameters. 31 new hand parameters were assessed alongside existing Modified Fels Wrist parameters.

Methods:

Evaluated 43 AP hand radiographic parameters for correlation with skeletal maturity, reliability, and relevance. Compared the new Hand-Wrist system's performance to other skeletal maturity systems (GP, SH, and Modified Fels Wrist). Assessed estimation accuracy and rate of outlier predictions.

Exclusions:

12 hand parameters were excluded due to poor correlation or reliability.

Results:

Modified Fels Hand-Wrist system performed similarly to the Modified Fels Wrist system in accuracy (0.36±0.32 vs. 0.34±0.26, P=0.59). Hand-Wrist system had a higher rate of outlier predictions (>1 year discrepancy) compared to the Wrist system (4.9% vs. 1.9%, P=0.01). Existing Modified Fels Wrist system outperformed GP and SH systems.

Conclusions:

Adding hand-specific parameters did not improve accuracy and increased the rate of outlier predictions. The Modified Fels Wrist system remains the most accurate method for skeletal maturity estimation when an AP hand-wrist radiograph is available.

Relevance:

Limitations:

Perspective:

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