Radiological Assessment of Hand Skeleton Ossification in Children under Protein Energy Malnutrition (PEM)

Abstract

Introduction: Protein energy malnutrition (PEM) in childhood leads to a skeletal undergrowth that cannot be rectified during later stages of life, therefore it may lead to an increase risk of osteoporotic fractures. Aim: This study designed to assess the radiological assessment of skeletal changes in children with malnutrition. Materials and Methods: A total one hundred cases between age group 0-12 years reporting to paediatric department were recruited and cases with skeletal and ossification anomalies were excluded. The grading for the malnutrition cases was done according to the recommendation of the Indian Academy of Paediatrics Nutrition sub-committee. The plain skiagrams of the wrist, with hand (AP view) and knees (AP view) were taken. Results: The capitate and hamate were having least affected centres in the hand skeleton. The most severely affected centres were the epiphysis of the metacarpals. In group 1 & 2, the skeletal age was highly lagged behind the chronological age at 6-7 years in low income (24 months) and middle income (27 months) groups. Whereas in Grade 3 and 4, it was seen in 33.3% cases of both sexes and in 100% cases at the age of three years. Conclusion: Malnutrition plays a crucial role in determination of mortality rate in <5 year children. There is a variation between skeletal age and chronological age in children with malnutrition. Ossification centres appear earlier in females compared to that of the males. Adequate supply of calories, protein, mineral and vitamin D is a prerequisite for the attainment of peak bone mass.

Keywords

• carpal bones
• marasmus
• metacarpal bones
• ossification