Dysharmonic maturation of the hand in the congenital malformation syndromes

In many congenital malformation syndromes the pattern of hand‐wrist development does not fit the sequence pictured in the Greulich‐Pyle atlas. Not infrequently, there is a difference in maturation level of carpal and phalangeal centers in excess of that found in clinically normal children. Usually, the carpal centers are less developed than the phalangeal centers, whereas overall skeletal maturation is retarded (as in trisomy 18) or advanced (as in cerebral gigantism). In still other conditions, specific carpal centers are disproportionately delayed. By way of example, the capitate is differentially delayed in epiphyseal dysplasia, the lunate in homocystinuria, and the scaphoid in Fanconi's anemia and other radial hypoplasia syndromes. Side to side (i.e., bilateral) asymmetries may also occur in the developing hand, as in paralysis, in conditions involving increased local vascularity (as in hemangioma and rheumatoid arthritis) or in conditions associated with decreased vascularity. In the presence of excessive dysharmonic development or major bilateral asymmetry, with or without agenesis of one or more hand bones, assigning meaningful bone ages in congenital malformation syndromes becomes difficult. On the other hand, the degree and pattern of dysharmonic maturation may be helpful in diagnosis

Achondroplasia · Agenesis · Carpal bones · Dysplasia · Hypoplasia · Lunate · Ulnar deviation · Vascularity · Wrist · Anatomy · Cleft Lip and Palate Research · Congenital limb and hand anomalies · Forensic Anthropology and Bioarchaeology Studies · Internal Medicine · Medicine · Surgery

• Developmental implications of dichotomous ossification sequences in the wrist region

  Open Access•Stanley M Garn, Sam T Sandusky et al.•American Journal of Physical…•1972

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• Magnitude of sex differences in dichotomous ossification sequences of the hand and wrist

  Open Access•Stanley M Garn, Andrew K Poznanski et al.•American Journal of Physical…•1975

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• Radiographic Atlas of Skeletal Development of the Hand and Wrist

  William Walter Greulich, William Greulich et al.•The American Journal of the…•1959

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• Ossification sequence polymorphism and sexual dimorphism in skeletal development

  Open Access•Stanley M Garn, Christabel G Rohmann et al.•American Journal of Physical…•1966

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• Genetics of hand‐wrist ossification

  Open Access•Stanley M Garn, Christabel G Rohmann et al.•American Journal of Physical…•1963

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• The number of hand‐wrist centers

  Open Access•Stanley M Garn, Christabel G Rohmann•American Journal of Physical…•1960

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• Bilateral asymmetry in skeletal maturation of the hand and wrist

  Open Access•Melvyn J Baer, Josephine Durkatz•American Journal of Physical…•1957

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• Variability in the order of ossification of the bony centers of the hand and wrist

  Open Access•Stanley M Garn, Christabel G Rohmann•American Journal of Physical…•1960

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