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Title Hand-wrist Analysis is Slightly More Effective in Predicting Peak Growth Velocity Than Cervical Vertebral Maturation
Clinical Question In adolescents, is the Fishman hand-wrist analysis (HWM) more effective than the cervical vertebral maturation (CVM) index in predicting peak growth velocity?
Clinical Bottom Line Systematic Reviews have shown that hand-wrist analysis is significantly correlated to peak growth velocity and that while a positive correlation exists between CVM and HWM, the strength of this evidence is weak. A recent study indicates that HWM is more effective than CVM in prediction of peak growth velocity, however chronological age and Statural growth are nearly as accurate and should be used due to their ease of use and decreased number of radiographs necessary for the patient.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22417653Santiago/2012Adolescents nearing pubertal growthSystematic review of non-randomized trials
Key resultsSome studies show good correlation between CVM and HWM, however it is indicated that the vast majority of studies suffer from poor methodologies and the number of studies considered to be of moderate to high methodological quality is small enough that the correlation between CVM and HWM should be considered a “low level of evidence.”
#2) 15038500Flores-Mir/2004Adolescents nearing pubertal growthSystematic review of non-randomized trials
Key resultsBoth horizontal and vertical facial growth velocity is significantly correlated to skeletal maturity as determined by hand-wrist analysis. Analysis of skeletal maturity by hand-wrist analysis should include bone staging and ossification events.
#3) 23726335Mellion/2013100 children (50M, 50F) chosen from files of the Bolton-Brush Growth Study CenterOther
Key resultsHand wrist staging had the lowest root mean squared error (was the best indication) in predicting peak growth velocity. CVM consistently performed worse in predicting peak growth velocity. Chronological age and statural growth proved to be nearly as accurate as HWM.
Evidence Search ("neck"[MeSH Terms] OR "neck"[All Fields] OR "cervical"[All Fields]) AND ("spine"[MeSH Terms] OR "spine"[All Fields] OR "vertebral"[All Fields]) AND maturation[All Fields] AND hand-wrist[All Fields] AND ("analysis"[Subheading] OR "analysis"[All Fields])skeletal[All Fields] AND maturation[All Fields] AND hand-wrist[All Fields] AND ("face"[MeSH Terms] OR "face"[All Fields] OR "facial"[All Fields]) AND ("growth and development"[Subheading] OR ("growth"[All Fields] AND "development"[All Fields]) OR "growth and development"[All Fields] OR "growth"[All Fields] OR "growth"[MeSH Terms])
Comments on
The Evidence
Validity: The systematic review articles are not reviews of RCTs, but do provide comprehensive, detailed search for relevant trials and assess individual studies for validity. Santiago’s review of CVM included 6 studies that had a combined total of 3959 subjects and Flores-Mir’s review of HWM included 11 studies with a total of 2227 subjects (3 of the 11 studies had less than 30 participants).
Applicability A hand-wrist analysis requires an additional radiograph where as the information for cervical vertebral maturation can be found in the lateral cephalometric radiograph taken in the course of normal orthodontic treatment planning. The decision to radiograph the hand and wrist should be accompanied by evidence that new, clinically useful information will be acquired that could not be more easily obtained through other means. The Mellion study found that using chronological age and changes in statural growth, measures easily gathered by observing the patient and talking with the parents, is nearly as accurate as HWM in predicting peak growth velocity. Therefore, HWM may not need to be used clinically despite its superiority to CVM.
Specialty/Discipline (Orthodontics)
Keywords Cervical Vertebral Maturation, Hand-wrist radiographs Fishman analysis and Peak growth velocity
ID# 2649
Date of submission: 03/09/2014spacer
E-mail tardyc@livemail.uthscsa.edu
Author Calvin Tardy
Co-author(s) e-mail
Faculty mentor/Co-author Clarence C. Bryk, DDS, MS
Faculty mentor/Co-author e-mail brykc@uthscsa.edu
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