The Metacarpophalangeal Pattern Profile: An Old Method With New Insights Into the Evaluation of Short Stature

To characterize the metacarpophalangeal pattern profile (MCPP) of healthy children and adolescents from São Paulo, Brazil, and to establish percentile curves by chronological age (CA), bone age (BA), and sex using the LMS method. Additionally, to compare these findings with previous population-based data and to apply the derived standards to patients with skeletal dysplasias.

Left hand and wrist radiographs were obtained from healthy individuals and age-matched patients with confirmed skeletal dysplasias. Tubular bone lengths were compared across CA and BA, against prior normative studies, and with dysplastic cohorts using Student's t-test. Patient Z-scores were calculated from LMS parameters generated from the healthy population.

We analyzed 974 radiographs from healthy subjects and 83 from patients (18 hypochondroplasia, 27 achondroplasia, 14 osteogenesis imperfecta, 24 Turner syndrome). In healthy participants, hand bone lengths correlated significantly with CA and BA. Compared with international reference data, differences in mean metacarpal and phalangeal lengths were noted. Patients with achondroplasia and hypochondroplasia exhibited markedly reduced Z-scores relative to controls, whereas those with Turner syndrome showed reductions of up to 1.8 SD in the fourth metacarpal. Patients with osteogenesis imperfecta demonstrated no significant deviations.

This study established MCPP reference percentiles for Brazilian children and adolescents using the LMS method. Bone measurements showed consistent associations with CA and BA. Although differences were observed relative to international cohorts, the generated standards effectively discriminated dysplastic phenotypes, particularly achondroplasia and hypochondroplasia, supporting the use of MCPP analysis as an adjunct tool for evaluating short stature and suspected skeletal dysplasias.