Professional Documents
Culture Documents
William
Robinow,
Cameron
M.D.
Chumlea,
Ph.D.
Standards
Norms
have been developed
for the following
limb bone length
ratios:
middleto-proximal
segments
(radius/humerus
and tibia/femur)
and upper-to-lower
limb segments
(humerus/femur
and radius/tibia)
in individuals
aged 2 months
to maturity.
These
norms
were calculated
from serial
measurements
of limb radiographs
of 350 participants
in the Child
Research
Council
Study,
Denver,
Cobrado. The norms
provide
an objective
measure for assessing
disproportionate
growth
of the extremities.
Index
Bones,
normal
Radiology
terms:
Bones,
growth
measurement,
4(0)123
variants,
4[0.130)
143: 433-436,
May
and
development.
(Skeletal
system,
#{149}
EVERAL
Brachyme!ia
1982
MATERIALS
AND
METHODS
Radiographs
of the extremities
were obtained
at regular
intervals
from 2 months
to 18 years of age on all children
enrolled
in the Child
Research
Council
Study,
Denver,
Colorado,
between
1935 and 1967.
The children
were
middle
and upper
middle
class, white,
and the
majority
were
of
northern
lengths
lengths
were
measured
(diaphysis
plus
of bone
length
(1): from
measurement
age 0-2
most
distal
proximal
edge
has
to 12 years
the most
European
edge
of the
ancestry.
Diaphyseal
bone
length
described
was
edge
to the
adolescence,
most
length
of the epiphysis
epiphysis
at the
in detail
measured
parallel
by
Maresh
to the
long
distal
edge
of the diaphysis.
measurements
were
from
at one
opposite
end
end
of the bone
of the
bone,
to the
care
being
taken
to keep the ruler parallel
to the long axis of the bone
(Fig. 1). From
10 through
12 years there are therefore
2 sets of measurements.
No correction
has been
made
for magnification
or
.
1 From
the Department
of Pediatrics,
Wright
State
University,
Dayton,
OH. Received
July 9, 1981; accepted and revision
requested
Oct. 6, 1981; revision
received
Dec. 11, 1981.
This study
was supported
by Grant
HD-AM-l2252,
National
Institutes
of Health
and a Biomedical
support
grant,
Wright
State University
School
of Medicine,
Dayton,
OH.
ht
distortion.
The Child
Research
Council
Study
measurement
data were computerized
this tape, as well as most of the original
to Dr.
Wright
Alex
Roche,
Fels
State
University
to the
authors.
433
Research
School
was terminated
in 1967. All
and stored
on tape. A copy of
radiographs,
are now on loan
Institute,
of Medicine,
Department
and were
of Pediatrics,
made
available
RESULTS
In
a preliminary
study
the
diaphyseal
and total limb
bone
length
ratios were
calculated
separately
for both
sexes
and
for a large
number
of age
groups.
The
results
indicated
the following:
1. There
were
no significant
sex
differences
in the ratios;
2. Middle-to-proximal
length
ratios in upper
and
lower
extremities change
during
the first
two
years
of life
but
remain
almost
constant
thereafter;
3. The
upper-to-lower
extremity
ratios
growth
tremities
upper
decrease
throughout
the
period,
i.e. , the lower
exgrow
faster
than
the
ones;
and
4. After
10 years
of age
there
was
little
difference
in
the
ratios,
whether
computed
from
diaphyseal
or total
bone
lengths.
It was therefore
decided
to combine
the
data
on boys
and girls
and to increase
the number
of groupings
before
2 years
of age while
reducing
the number
of
age groupings
thereafter.
Means
and
standard
deviations
for each
ratio
and
the
respective
percentiles
are presented
in TABLES
I and II. The distribution
of
the
ratios
showed
no significant
deviations
from
normality.
For the radius/humerus,
humerus/femur,
and
radius/tibia
ratios,
the highest
values
occurred
in the youngest
age
group
and
declined
with
age.
The
radius/
humerus
ratio was stable
after
1.0 years
of age,
but
the
humerus/femur
and
radius/tibia
ratios
decreased
throughout the ages
studied.
The tibia/femur
ratio
showed
little
or no change
from
birth
to 15 years
of age.
CLINICAL
AND
Guide
lines
for measuring
(a) and radius
(b).
total
bone
lengths
(see
text)
in humerus
APPLICATION
DISCUSSION
The limb
length
ratios
give
numericab expression
to the terms
rhizomelic
and
mesomelic
dwarfism
and
to the
disproportion
between
the lengths
of
upper
and lower
extremities
(encountered
so often
meningocele
in patients
or spastic
with
diplegia).
myelo-
The
limb
length
ratios
can also
be
included
in construction
of disproportion
profiles.
A comprehensive
profile
would
include:
stature,
length
of limb
bones,
relative
length
of limb
bones
([bone
length
X 100]/stature),
limb
bone
length
ratios,
and length
of
metacarpals
surements
with
the
434
May1982
Volume
143,Numher2
and
phalanges.
and
ratios
appropriate
Robinow
All
are
norms
and
mea-
compared
(1, 3, 4),
Chumlea
TABLE
I:
Diaphyseal
Bone
Length
Ratios
Percentile
Age (years)
No.
Mean
SD
10
50
90
95
Radius
0.2-0.49
134
0.82
0.04
0.77
0.78
0.82
0.87
0.89
Humerus
0.5-0.99
132
0.79
0.03
0.74
0.75
45
0.77
0.03
0.73
0.74
1.5-1.99
2.0-9.99
123
218
0.76
0.75
0.02
0.02
0.72
0.71
0.73
0.72
0.78
0.77
0.76
0.74
0.83
0.81
0.79
0.77
0.85
0.82
0.80
0.78
10.0-15.0
170
0.75
0.02
0.71
0.72
0.75
0.78
0.78
Tibia
0.2-0.49
133
0.81
0.04
0.75
0.77
0.82
0.86
0.87
Femur
0.5-0.99
132
0.81
0.03
0.76
0.77
0.81
0.84
0.85
1.0-1.49
1.5-1.99
45
124
0.81
0.81
0.02
0.02
0.78
0.78
0.78
0.78
0.81
0.81
0.83
0.84
0.83
0.84
Bone
Ratio
1.0-1.49
Humerus
Femur
Radius
Tibia
2.0-9.99
218
0.81
0.02
0.78
0.78
0.81
0.84
0.85
10.0-15.0
170
0.82
0.02
0.78
0.79
0.82
0.85
0.86
0.2-0.49
133
0.83
0.05
0.75
0.76
0.83
0.90
0.92
0.5-0.99
1.0-1.49
1.5-1.99
2.0-9.99
10.0-15.0
132
45
124
218
170
0.79
0.77
0.76
0.71
0.69
0.03
0.02
0.02
0.03
0.02
0.73
0.73
0.73
0.67
0.65
0.74
0.74
0.73
0.68
0.66
0.79
0.77
0.76
0.71
0.69
0.82
0.80
0.79
0.75
0.71
0.83
0.80
0.80
0.75
0.72
0.2-0.49
134
0.84
0.05
0.77
0.78
0.83
0.90
0.94
0.5-0.99
1.0-1.49
1.5-1.99
2.0-9.99
10.0-15.0
132
45
123
218
170
0.77
0.74
0.71
0.65
0.63
0.03
0.02
0.03
0.03
0.02
0.72
0.69
0.67
0.61
0.59
0.73
0.70
0.68
0.62
0.60
0.77
0.74
0.71
0.65
0.62
0.81
0.77
0.75
0.69
0.65
0.82
0.78
0.76
0.70
0.66
converted
into standard
tion
from
mean/standard
and presented
graphically.
An
extensive
scores
(deviadeviation)
study
of
profiles
prove
helpful
in precise
the disproportion
and,
the specific
diagnosis.
epiphyseal
so characteristic
References
are
are
unnecessary
for diagnosis,
but in many
other
dysplasias
a diagnosis
cannot
readily
be made
by inspection
of the
patient
or the radiographs.
In such
cases the norms
presented
here should
II:
Total
Bone
Length
3.
4.
Acknowledgment:
TABLE
of
in
of
various
skeletal
dysplasias
and other
dwarfing
conditions
will be the subject
of a future
report.
At this time profiles
for only one rare skeletal
dysplasia
are
presented
(Fig. 2).
In many
dwarfing
syndromes
the
or diaphyseal
changes
that measurements
description
at times,
aid
We are indebted
to R. W.
McCammon,
M.D., former
Director
of the Child
Research Council Study, for making
the data and
radiographs
available.
5.
6.
1.
2.
Maresh
MM.
Measurements
from
roentgenograms.
In: McCammon
RW, ed. Human
growth
and development.
Springfield,
IL,
Charles
C Thomas,
1970:187-200.
Maresh
MM, Deming
J. The growth
of the
long bones
in 80 infants.
Child Development
1939; 10:91-100.
Cam
SM, Hertzog
KP, Poznanski
AK, Nagy
JM.
Metacarpophabangeal
length
in the
evaluation
of skeletal
malformation.
Radiology 1972; 105:375-381.
Poznanski
AK, Garn SM, Nagy JM, Gall JC.
Metacarpophalangeal
pattern
profiles
in the
evaluation
of skeletal
malformations.
Radiobogy 1972; 104:1-11.
International
nomenclature
of constitutional
diseases of bone. Revision
May 1977. Amer
J Med Genet 1979; 3:21 -26.
Robinow
M, Silverman
FN, Smith
HD.
A
newly
recognized
dwarfing
syndrome.
Amer
J Dis Child 1969; 1 17:645-651.
Childrens
Medical
Center
One Childrens
Plaza
Dayton,
OH 45424
Ratios
Percentile
Bone
Ratio
50
90
95
10.0-15.0
174
0.75
0.02
0.72
0.72
0.74
0.77
0.78
10.0-15.0
174
0.84
0.02
0.80
0.81
0.84
0.87
0.88
10.0-15.0
174
0.67
0.02
0.64
0.65
0.67
0.69
0.70
10.0-15.0
174
0.59
0.02
0.57
0.57
0.60
0.62
0.62
Age
Radius
(years)
No.
Mean
SD
10
Humerus
Tibia
Femur
Humerus
Femur
Radius
Tibia
Bone
Length
Ratios
PEDIATRIC
RADIOLOGY
435
Figure
Bone Length
Height
HRFT
Relative
none Length
HRFT
Limb Bone
Proportions
RI
HFFT
HR
mear
-1
-2
0
-3
-4
-5
-6
1234512345123412345
Disproportion
profile.
The profiles
represent
Robinow
(5). These
patients
have been described
They
demonstrate
that both
patients
have
short
The brachymelia
is predominantly
mesomebic
mesomelic
shortening
profile,
indicates
that
metacarpophalangeab
T = tibia; S.D.
436
May
1982
Volume
standard
143, Number
two brothers
with
Mesomebic
dysplasia,
type
before
(6). The patterns
are remarkably
similar.
stature
and absolute
and relative
brachymelia.
and
the upper
extremities
show
far greater
deviation.
Robinow
and
Chumlea