Predicting peak growth spurt and cessation of growth with the distal radius and ulna classification

Abstract

SUMMARY: Prediction of a patient′s remaining growth potential is important in management of adolescent idiopathic scoliosis for timing of brace treatment and weaning. The distal radius and ulna (DRU) classification has been developed to address this issue. The DRU classification is shown to be able to predict both peak growth and growth cessation and is superior to commonly used maturity assessments. HYPOTHESIS: The distal radius and ulna (DRU) classification can accurately predict peak growth and growth cessation. DESIGN: Retrospective assessment of prospectively collected data. INTRODUCTION: The prediction of a patient′s growth potential in scoliosis management is important for determining the optimal timing of brace treatment. Previous methods such as the Risser sign, onset of menarche and skeletal bone age assessment have been inaccurate, retrospective and difficult to use, respectively. To address such limitations, the distal radius and ulna (DRU) classification was developed. However, its clinical utility in comparison to previous methods remains unknown. As such, this study aimed to compare the DRU classification with other growth parameters in predicting peak growth (PG) and growth cessation (GC). METHODS: This was a retrospective assessment of prospectively collected data of idiopathic scoliosis patients. The chronological age, body height (BH), arm span (AS), date of menarche, Risser sign, DRU grade and status of the phalangeal/metacarpal physis were extracted. Mean growth rates were charted according to each maturity parameter. PG was defined as the summit and GC was defined as a plateau in growth deceleration. The growth rates at PG and GC were used for receiver operating characteristic (ROC) curve analyses to determine the strength and cut-off values of the growth parameters. RESULTS: This study consisted of This study consisted of 777 patients (585 females, 192 males). Mean length of follow-up was 3.5 years for females and 3.2 years for males. Only the DRU could identify both a peak in growth rate and plateau in growth deceleration for GC. ROC analysis suggested that radius grade 6 and ulna grade 5, and radius grade 9 and ulna grade 7 had the best sensitivity and specificity for predicting PG and GC, respectively. CONCLUSION: This is the first study to note that the DRU classification can predict both PG and GC, and is superior to other commonly used growth parameters. Our large-scale study provides solid evidence that the DRU classification has tremendous clinical utility and application for managing idiopathic scoliosis.