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Skeletal maturation in children with quadriplegic cerebral palsy
Shawn R Gilbert1, Adam C Gilbert, Richard C Henderson
1University of North Carolina, Chapel Hill, North Carolina 27599, USA.
Insights
Children with severe cerebral palsy (CP) show varied skeletal bone age, with no average difference from chronological age but wide individual variations in maturation. This study assessed bone age in CP using hand-wrist and pelvis radiographs.
Area of Science:
- Pediatric Endocrinology
- Orthopedics
- Radiology
Background:
- Severe cerebral palsy (CP) is associated with skeletal growth issues like diminished linear growth and osteoporosis.
- Skeletal maturation, specifically bone age, is another critical aspect of growth in children with CP.
- Understanding bone age variations is crucial for comprehensive care of children with severe CP.
Purpose of the Study:
- To investigate skeletal bone age in children with severe cerebral palsy (CP).
- To assess skeletal maturation using both hand-wrist and pelvis radiography methods.
- To compare skeletal maturity in CP cohorts with contemporary controls.
Main Methods:
- Two cohorts of children with CP were assessed: 133 using hand-wrist radiographs (Fels method) and 241 using pelvis radiographs (Oxford method).
- Pelvis radiographs from 114 trauma-evaluated children served as contemporary controls for the Oxford method validation.
- Chronological age and skeletal age (bone age) were compared between groups.
Main Results:
- Average skeletal age did not significantly differ from chronological age in the CP cohort using hand-wrist radiographs.
- Average pelvic skeletal maturity scores in CP children were comparable to age-matched controls.
- Significant individual variations in skeletal maturity (both delayed and advanced) were observed within the CP groups.
Conclusions:
- While average bone age is not significantly different, severe cerebral palsy is linked to wide individual variations in skeletal maturation.
- Pelvic maturity scores in contemporary controls differed from historical data, indicating potential secular trends.
- Further research into the clinical implications of these bone age variations in CP is warranted.
Abstract:
Skeletal growth abnormalities, including diminished linear growth and osteoporosis, are well recognized in children with severe cerebral palsy (CP). The purpose of this study was to examine skeletal bone age, another aspect of skeletal growth, in this severely handicapped population. The study consisted of two parts, each assessing skeletal maturation but using different methods on different cohorts of children with CP: 133 hand-wrist radiographs were scored using the Fels method and 241 pelvis radiographs were scored using the Oxford method. The Oxford method has not been validated against contemporary normal children; therefore, 114 recently obtained pelvis radiographs of otherwise normal children being evaluated for trauma were included as controls. On average, there was not a statistically significant difference between the chronological age of the child with CP and the skeletal age based on hand-wrist x-rays. Similarly, average pelvic skeletal maturity scores did not differ between the CP children and age-matched contemporary controls. While averages did not differ, wide individual variation was noted in the CP cohorts, with a high prevalence of both delayed and advanced skeletal maturity. Of note, pelvic maturity scores in the contemporary controls significantly differed from those reported in the original Oxford series from over 50 years ago.
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