title: The use of the distal radius and ulna classification for the prediction of growth: peak growth spurt and growth cessation.
abstract: OBJECTIVE
  We report the use of the distal radius and ulna (DRU) classification for the prediction of peak growth (PG) and growth cessation (GC) in 777 patients with idiopathic scoliosis. We compare this classification with other commonly used parameters of maturity.
  
  
  METHODS
  The following data were extracted from the patients' records and radiographs: chronological age, body height (BH), arm span (AS), date of menarche, Risser sign, DRU grade and status of the phalangeal and metacarpal physes. The mean rates of growth were recorded according to each parameter of maturity. PG was defined as the summit of the curve and GC as the plateau in deceleration of growth. The rates of growth at PG and GC were used for analysis using receiver operating characteristic (ROC) curves to determine the strength and cutoff values of the parameters of growth.
  
  
  RESULTS
  The most specific grades for PG using the DRU classification were radial grade 6 and ulnar grade 5, and for GC were radial grade 9 and ulnar grade 7. The DRU classification spanned both PG and GC, enabling better prediction of these clinically relevant stages than other methods. The rate of PG (≥ 0.7 cm/month) and GC (≤ 0.15 cm/month) was the same for girls and boys, in BH and AS measurements.
  
  
  CONCLUSIONS
  This is the first study to note that the DRU classification can predict both PG and GC, providing evidence that it may aid the management of patients with idiopathic scoliosis. Cite this article: Bone Joint J 2016;98-B:1689-96.
authors.affiliation: The University of Hong Kong, 5th Floor Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, China.
authors.forename: J P Y
authors.initials: JP
authors.lastname: Cheung
authors.affiliation: The University of Hong Kong, 5th Floor Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, China.
authors.forename: P W H
authors.initials: PW
authors.lastname: Cheung
authors.affiliation: The University of Hong Kong, 5th Floor Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, China.
authors.forename: D
authors.initials: D
authors.lastname: Samartzis
authors.affiliation: The University of Hong Kong, 5th Floor Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, China.
authors.forename: K M C
authors.initials: KM
authors.lastname: Cheung
authors.affiliation: The University of Hong Kong, 5th Floor Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, China.
authors.forename: K D K
authors.initials: KD
authors.lastname: Luk
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D001132:Arm / Q000473:pathology; D001827:Body Height / Q000502:physiology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006128:Growth / Q000502:physiology; D057238:Growth Charts; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012372:ROC Curve; D011884:Radius / Q000000981:diagnostic imaging / Q000254:growth & development*; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D012680:Sensitivity and Specificity; D014457:Ulna / Q000000981:diagnostic imaging / Q000254:growth & development*
keywords: Age; Distal radius and ulna classification; Growth cessation; Peak growth; Scoliosis