title: Radiographical study showing asymmetry in the surface area of carpal bones in malnourished children.
abstract: BACKGROUND
  Protein energy malnutrition, a major health and nutritional problem in India, leads to retardation in bone maturity and eventually physical growth. Many studies have been done on ossification centers of hand bones for estimation of skeletal maturation and to diagnose malnutrition but very few studies have been done so far to see effect of protein energy malnutrition on surface area of carpal bones.
  
  
  OBJECTIVE
  The surface areas of carpal bones on radiographs on both sides were calculated, analysed and compared in protein energy malnutrition (PEM) cases and healthy controls upto five years of age to see the variability among study groups.
  
  
  METHODS
  The study was conducted in Department of Paediatrics, Radiodiagnosis and Anatomy of S.N. Medical College, Agra, India consisting of 68 PEM cases and 68 controls of either sex upto five years of age. Radiography of wrist done and surface areas of carpal bones were calculated by using millimeter Graph Transparency paper by Hit method and data were evaluated for significance by using t-test.
  
  
  RESULTS
  The surface areas of capitate, hamate and triquetral bones of both hands were reduced in PEM children of all grades as compared to healthy controls. The surface areas of these carpal bones were much reduced in grade 2 and grade 3 PEM cases as compared to healthy controls and grade 1 PEM cases. Asymmetry in surface areas of capitate and hamate bones were ascertained in healthy controls and grade 1 PEM cases but due to delay in appearance of ossification centers and reduced surface areas of these bones, asymmetry could not be ascertained in grade 2 and grade 3 malnutrition children.
  
  
  CONCLUSIONS
  The surface areas of capitate, hamate and triquetral bones on both sides were reduced in grade 2 and grade 3 PEM cases as compared to controls. Asymmetry in surface area of carpal bones was ascertained in healthy controls and grade 1 PEM cases.
authors.affiliation: Assistant Professor, Department of Anatomy, Mahatma Gandhi Medical College and Hospital , Jaipur, Rajasthan, India .
authors.forename: Shelja
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Assistant Professor, Department of Anatomy, AIIMS , Rishikesh, Uttarakhand, India .
authors.forename: Vivek
authors.initials: V
authors.lastname: Mishra
authors.affiliation: Professor and HOD, Department of Anatomy, S.N. Medical College , Agra, UP, India .
authors.forename: Vasundhra
authors.initials: V
authors.lastname: Kulshreshtha
keywords: Asymmetry; Carpal bone; PEM; Surface area