To investigate the geometric development of the wrist in relation to the changes in its ossification pattern; the study will help the treating surgeon to identify early deviations from normal in children with musculoskeletal disorders and provide a template for anatomic reduction after trauma scenarios.

1. Normal Wrist Development in
Children and Adolescents
Prof. Mohamed A. Imam
MD, MSc (Orth)(Hons), D.SportMed, Ph.D., FRCS (Tr. and Orth.)
Consultant Trauma and Orthopaedic Surgeon, Rowley Bristow Orthopaedic Centre, Chertsey, UK
Email: Info@theArmDoc.co.uk
www.TheArmDoc.co.uk
www.OrthoGlobe.Org
@MoAImam

3. Background
To investigate the geometric development of the wrist in relation
to the changes in its ossification pattern.
This study aim to help the treating surgeon to identify early
deviations from normal in children with musculoskeletal disorders
and provide a template for anatomic reduction after trauma
scenarios.

4. Methods
A retrospective multicenter analysis was carried out of radiographs of 896
children (896 posteroanterior and 896 lateral views) with normal wrists
from January 1996 till April 2016.
We stratified patients into different yearly age groups; these included 16
age groups from 1 to 16 years, and 2 sex groups: males and females. We
evaluated, depending on the wrist ossification pattern, the ulnar variance,
radial and carpal heights, carpal height ratio, radial inclination, volar tilt,
together with radiocarpal, scapholunate, and capitate-lunate angles and
scapholunate distance.

5. Results
Our analysis showed that the ulna minus variance predominates in
children.
Radial height, radial inclination, and radiocarpal angle increase steadily
during growth and reach their respective expected values at the beginning
of the pubertal growth spurt.

6. Results
The scapholunate and capitolunate angles showed a downward trend with
growth till reaching the adult values at puberty. Carpal height increased
constantly, whereas the carpal height ratio was similar to that in adults.

7. Results
Volar tilt was not developed until the age of 12 years, when it started to
increase gradually to reach the adult values by puberty. Both sexes have
similar measurements.

8. Measurement technique of different radiologic parameters

9. Means of ulna variance per age among (A) boys (solid lines) and (B) girls (dashed lines). Error bars
represent SEM.

21. Questions?!
Thank you!!
Email: Info@TheArmDoc.co.uk