Morphometric study of the two fused primary ossification centers of the clavicle in the human fetus

The Ratio of Clavicle Length to Head Circumference: A Novel Date-Independent Clavicle Index

ABSTRACT

We aimed to plot the growth curve of the fetal clavicle, identify gestational date-independent parameters. Using 2-dimensional ultrasonography, we obtained the clavicle lengths (CLs) from 601 normal fetuses between 12 and 40 gestational age (GA). The CL/fetal growth parameters ratio was calculated. Moreover, 27 cases of fetal growth restriction (FGR) and 9 cases of small for GA (SGA) were detected. In normal fetuses, the mean CL (mm) = -68.2 + 29.80 × ln(GA) ± Z × (1.07 + 0.02 × GA). A linear relationship was detected between CL and head circumference (HC), biparietal diameter, abdominal circumference and femoral length with R2 values of 0.973, 0.970, 0.962, and 0.972, respectively. The CL/HC ratio (mean value 0.130) showed no significant correlation with GA. Clavicle lengths in the FGR group significantly decreased compared with the SGA group ( P < 0.01). This study determined a reference range of fetal CL in a Chinese population. Furthermore, the CL/HC ratio, which is independent of GA, is a novel parameter for the evaluation of the fetal clavicle.

[Clavicle shaft fractures in childhood and adolescence : Consensus report of the Pediatric Traumatology Section of the German Society for Trauma Surgery]

INTRODUCTION

Clavicle shaft fractures are among the most common fractures in childhood and adolescence. In the past they were almost exclusively treated conservatively but in recent years there has been an increase in surgical treatment. Nevertheless, exact recommendations for the choice of diagnostics and for the treatment regimen do not yet exist.

MATERIAL AND METHODS

Therefore, our aim was to develop a consensus within the 7th scientific working meeting of the section for pediatric traumatology in the German Society for Trauma Surgery based on expert opinion.

RESULTS

Single-plane radiographic imaging is considered the gold standard diagnostic tool. Children younger than 10 years are primarily treated conservatively, and the type of immobilization is secondary. In girls older than 12 years and boys older than 14 years, fractures dislocated by more than the shaft width and shortened by > 2 cm should be treated by open reduction and stabilized by osteosynthesis, followed by free-functional follow-up treatment.

CONCLUSION

In addition to X‑rays, diagnostics using ultrasound must be further established. Treatment continues to be primarily conservative, but surgical treatment is also important, especially in adolescents. If the indications are correct, a good outcome can be expected regardless of the choice of treatment.

Contemporary imaging of the pediatric shoulder: pearls and pitfalls

In skeletally immature patients, the presence of growth plates and articular cartilage of the shoulder can create a predisposition for unique injuries not observed in adults. Furthermore, increasing participation in sports by children and adolescents appears to be leading to a corresponding increase in the number of sports-related injuries. The importance of radiologists being familiar with pediatric shoulder imaging and its associated injuries is therefore growing. In this article, we review the normal development and maturation pattern of ossification centers of the shoulder from the early gestational period through adolescence. Brachial plexus birth palsy, physeal injuries, shoulder dislocation, and internal impingement are discussed within the context of the child's age and the mechanism of injury to guide radiologists to a correct diagnosis.

Spontaneous union of bilateral congenital pseudoarthrosis of the clavicle, in a baby

Congenital bilateral pseudoarthrosis is an extremely rare condition. We report a neonate with bilateral congenital clavicle pseudoarthrosis. The neonate had a palpable gap bilaterally. Radiological examination confirmed the diagnosis. The baby had a complete spontaneous healing in a year. We review the recent literature.

Quantitative anatomy of the primary ossification center of the radial shaft in human fetuses

Purpose

The medical literature still lacks studies on the size of the radial shaft primary ossification center, thus preventing us from potentially relevant data in diagnosing skeletal dysplasias, i.e., TAR syndrome, VATER syndrome, Holt–Oram syndrome, Fanconi anemia and Edwards syndrome, frequently characterized by disrupted or retarded fetal growth.

Materials and methods

The size of the radial shaft primary ossification center in 47 (25 males and 22 females) spontaneously aborted human fetuses aged 17–30 weeks was studied by means of CT, digital image analysis and statistics.

Results

With neither sex nor laterality differences, the best-fit growth dynamics for the radial shaft primary ossification center was modeled by the following functions: y = − 10.988 + 1.565 × age ± 0.018 for its length, y = − 2.969 + 0.266 × age ± 0.01 for its proximal transverse diameter, y = − 0.702 + 0.109 × age ± 0.018 for its middle transverse diameter, y = − 2.358 + 0.203 × age ± 0.018 for its distal transverse diameter, y = –189.992 + 11.788 × (age)² ± 0.018 for its projection surface area, and y = − 798.174 + 51.152 × age ± 0.018 for its volume.

Conclusions

The morphometric characteristics of the radial shaft primary ossification center show neither sex nor bilateral differences. The radial shaft primary ossification center grows proportionately in length, transverse dimensions and volume, and quadratically in its projection surface area. The obtained numerical findings of the radial shaft ossification center are considered age-specific reference of relevance in both the estimation of fetal ages and the diagnostic process of congenital defects.

Quantitative anatomy of the ulna's shaft primary ossification center in the human fetus

PURPOSE

There has been little information in the medical literature regarding the growing ulna in the human fetus, though such knowledge appears to be potentially useful in diagnosing skeletal dysplasias, characterized by a disrupted or completely halted growth of the fetus. Therefore, longitudinal measurements of long bones are extremely conducive in assessing both pregnancy and fetal anatomy.

MATERIALS AND METHODS

Using methods of CT, digital-image analysis and statistics, the size of the ulna's shaft primary ossification center in 48 (26 males and 22 females) spontaneously aborted human fetuses aged 17-30 weeks was studied.

RESULTS

With no sex differences, the best fit growth dynamics for the ulna's shaft primary ossification center was modeled by the following functions: y = - 8.476 + 1.561 × age ± 0.019 for its length, y = - 2.961 + 0.278 × age ± 0.016 for its proximal transverse diameter, y = - 0.587 + 0.107 × age ± 0.027 for its middle transverse diameter, y = - 2.865 + 0.226 × age ± 0.295 for its distal transverse diameter, y = - 50.758 + 0.251 × (age)2 ± 0.016 for its projection surface area, and y = - 821.707 + 52.578 × age ± 0.018 ± 102.944 for its volume.

CONCLUSIONS

The morphometric characteristics of the ulna's shaft primary ossification center show neither sex nor bilateral differences. The ulna's shaft primary ossification center grows linearly with respect to its length, transverse dimensions and volume, and follows a quadratic function with respect to its projection surface area. The obtained morphometric data of the ulna's shaft primary ossification center is considered normative for respective prenatal weeks and may be of relevance in both the estimation of fetal ages and the diagnostic process of congenital defects.

Quantitative anatomy of the ilium's primary ossification center in the human fetus

Purpose

An understanding of the development of the ilium’s primary ossification center may be useful in both determining the fetal stage and maturity, and for detecting congenital disorders. This study was performed to quantitatively examine the ilium’s primary ossification center with respect to its linear, planar and volumetric parameters.

Materials and methods

Using methods of CT, digital-image analysis and statistics, the size of the ilium’s primary ossification center in 42 spontaneously aborted human fetuses of crown–rump length (CRL) ranged from 130 to 265 mm (aged 18–30 weeks) was studied.

Results

With no sex and laterality differences, the best fit growth dynamics for the ilium’s primary ossification center was modelled by the following functions: y = − 63.138 + 33.413 × ln(CRL) ± 1.609 for its vertical diameter, y = − 59.220 + 31.353 × ln(CRL) ± 1.736 for its transverse diameter, y = − 105.681 + 1.137 × CRL ± 16.035 for its projection surface area, and y = 478.588 + 4.035 × CRL ± 14.332 for its volume. The shape of the ilium’s primary ossification center did not change over the study period, because its transverse -to- vertical diameter ratio was stable at the level of 0.94 ± 0.07.

Conclusions

The size of the ilium’s primary ossification center displays neither sex nor laterality differences. The ilium’s primary ossification center grows logarithmically with respect to its vertical and transverse diameters, and linearly with respect to its projection surface area and volume. The shape of the ilium’s primary ossification center does not change throughout the examined period. The obtained quantitative data of the ilium’s primary ossification center is considered normative for respective prenatal weeks and may contribute to the prenatal ultrasound diagnostics of congenital defects.

Quantitative anatomy of the primary ossification center of the femoral shaft in human fetuses

Purpose

Early clinical distinction of congenital defects in the femur is extremely important, as it determines the prognosis of the development of the lower limb. This study was performed to quantitatively examine the primary center of ossification in the femoral shaft with respect to its linear, planar, and volumetric parameters.

Materials and methods

Using methods of CT, digital-image analysis, and statistics, the size of the primary ossification center of the femoral shaft in 47 spontaneously aborted human fetuses aged 17–30 weeks was studied.

Results

With no sex and laterality differences, the best fit growth dynamics for femoral shaft ossification center was modelled by the following functions: y = 5.717 + 0.040 × (age)² ± 2.905 (R² = 0.86) for its length, y = −3.579 + 0.368 × age ± 0.529 (R² = 0.88) for its proximal transverse diameter, y = −1.105 + 0.187 × age ± 0.309 (R² = 0.84) for its middle transverse diameter, y = −2.321 + 0.323 × age ± 0.558 (R² = 0.83) for its distal transverse diameter, y = −50.306 + 0.308 × (age)² ± 18.289 (R² = 0.90) for its projection surface area, and y = −91.458 + 0.390 × (age)³ ± 92.146 (R² = 0.88) for its volume.

Conclusions

The size of the femoral shaft ossification center displays neither sex nor laterality differences. The ossification center in the femoral shaft follows quadratic functions with respect to its length and projection surface area, linear functions with respect to its proximal, middle, and distal transverse diameters, and a cubic function with respect to its volume. The obtained morphometric data of the femoral shaft ossification center are considered normative for respective prenatal weeks and may be of relevance in both the estimation of fetal ages and the ultrasound diagnostics of congenital defects.

Ossification center of the humeral shaft in the human fetus: a CT, digital, and statistical study

Purpose

The knowledge of the development of the humeral shaft ossification center may be useful both in determining the fetal stage and maturity and for detecting congenital disorders, as well. This study was performed to quantitatively examine the humeral shaft ossification center with respect to its linear, planar, and volumetric parameters.

Materials and method

Using methods of CT, digital image analysis, and statistics, the size of the humeral shaft ossification center in 48 spontaneously aborted human fetuses aged 17–30 weeks was studied.

Results

With no sex differences, the best-fit growth dynamics for the humeral shaft ossification center was modeled by the following functions: y = −78.568 + 34.114 × ln (age) ± 2.160 for its length, y = −12.733 + 5.654 × ln(age) ± 0.515 for its proximal transverse diameter, y = −4.750 + 2.609 × ln (age) ± 0.294 for its middle transverse diameter, y = −10.037 + 4.648 × ln (age) ± 0.560 for its distal transverse diameter, y = −146.601 + 11.237 × age ± 19.907 for its projection surface area, and y = 121.159 + 0.001 × (age)⁴ ± 102.944 for its volume.

Conclusions

With no sex differences, the ossification center of the humeral shaft grows logarithmically with respect to its length and transverse diameters, linearly with respect to its projection surface area, and fourth-degree polynomially with respect to its volume. The obtained morphometric data of the humeral shaft ossification center are considered normative for respective prenatal weeks and may be of relevance in both the estimation of fetal ages and the ultrasonic diagnostics of congenital defects.

Quantitative anatomy of the growing clavicle in the human fetus: CT, digital image analysis, and statistical study

Purposes

Knowledge of dimensions of fetal long bones is useful in both the assessment of fetal growth and early detection of inherited defects. Measurements of the fetal clavicle may facilitate detection of numerous defects, e.g., cleidocranial dysplasia, Holt–Oram syndrome, Goltz syndrome, and Melnick–Needles syndrome.

Methods

Using the methods of CT, digital image analysis, and statistics, the size of the growing clavicle in 42 spontaneously aborted human fetuses (21 males and 21 females) at ages of 18–30 weeks was studied.

Results

Without any male–female and right–left significant differences, the best fit growth models for the growing clavicle with relation to age in weeks were as follows: y = −54.439 + 24.673 × ln(age) ± 0.237 (R² = 0.86) for length, y = −12.042 + 4.906 × ln(age) ± 0.362 (R² = 0.82) for width of acromial end, y = −4.210 + 2.028 × ln(age) ± 0.177 (R² = 0.77) for width of central part, y = −4.687 + 2.364 × ln(age) ± 0.242 (R² = 0.70) for width of sternal end, y = −51.078 + 4.174 × ln(age) ± 6.943 (R² = 0.82) for cross-sectional area, and y = −766.948 + 281.774 × ln(age) ± 19.610 (R² = 0.84) for volume.

Conclusions

With no sex and laterality differences, the clavicle grows logarithmically with respect to its length, width, and volume, and linearly with respect to its projection surface area. The obtained morphometric data of the growing clavicle are considered normative for their respective weeks of gestation and may be of relevance in the diagnosis of congenital defects.