A VALIDITY OF ULTRASOUND SUBDIVISION OF RISSER GRADE 4 IN ASSESSMENT OF SKELETAL MATURITY

Hrvoje Pitlovic, Savo Jovanovic, Vlatka Pitlovic, Gordan Saric, Tomislav Crnkovic

Abstract


In the treatment of an adolescent idiopathic scoliosis, one of the most frequently used technique to determine skeletal maturity is method described by. Risser. The ossification of iliac apophysis progresses from ventral to caudal through the four zones and fusion of the iliac apophysis to the iliac crest (Risser grade 5) indicated vertebral growth completion, therefore the termination of scoliotic deformity progression. The main disadvantages of Risser method are exposure to radiation and the questionable reliability, so there are efforts to examine iliac apophysis by ultrasound. There is also no resolute recommandation when to discontinue brace treatment of scolisis. Using ultrasound, in this study, we subdevided Risser grade 4 to grade 4a and 4b, according to the amount of cartilage left unossified, in order to make clear when is safe to end brace treatment. We measured increase in height, during six month period, for 92 healthy children who were classified by ultrasound in Risser 4a and 4b group. There was significantly larger increase in height for group 4a. For girls, we also noted time past from menarche as sign of biological maturity. Girls from group Risser 4b got menarche 2.74 years before they were examined while group 4a got menarcheonly 1.57 years before. Subdivision of Risser grade 4 by ultrasound is promising method in determining end of brace treatment of scoliosis.

Keywords*


iliac crest apophysis; Risser grade; skeletal maturity; ultrasound assessment

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