Sex Determination by the Machine Learning Algorithms Through Using Morphometric Measurements of the Carpal, Metacarpal, and Phalangeal Bones / Determinación del Sexo Mediante Algoritmos de Aprendizaje Automático Mediante el Uso de Mediciones Morfométricas de los Huesos del Carpo, el Metacarpo y las Falanges

SUMMARY: In the study, it was aimed to predict sex from hand measurements using machine learning algorithms (MLA). Measurements were made on MR images of 60 men and 60 women. Determined parameters; hand length (HL), palm length (PL), hand width (HW), wrist width (EBG), metacarpal I length (MIL), metacarpal I width (MIW), metacarpal II length (MIIL), metacarpal II width (MIIW), metacarpal III length (MIIL), metacarpal III width (MIIIW), metacarpal IV length (MIVL), metacarpal IV width (MIVW), metacarpal V length (MVL), metacarpal V width (MVW), phalanx I length (PILL), measured as phalanx II length (PIIL), phalanx III length (PIIL), phalanx IV length (PIVL), phalanx V length (PVL). In addition, the hand index (HI) was calculated. Logistic Regression (LR), Random Forest (RF), Linear Discriminant Analysis (LDA), K-nearest neighbour (KNN) and Naive Bayes (NB) were used as MLAs. In the study, the KNN algorithm's Accuracy, SEN, F1 and Specificity ratios were determined as 88 %. In this study using MLA, it is understood that the highest accuracy belongs to the KNN algorithm. Except for the hand's MIIW, MIIIW, MIVW, MVW, HI variables, other variables were statistically significant in terms of sex difference.

En el estudio, el objetivo era predecir el sexo a partir de mediciones manuales utilizando algoritmos de aprendizaje automático (MLA). Las mediciones se realizaron en imágenes de RM de 60 hombres y 60 mujeres. Parámetros determinados; longitud de la mano (HL), longitud de la palma (PL), ancho de la mano (HW), ancho de la muñeca (EBG), longitud del metacarpiano I (MIL), ancho del metacarpiano I (MIW), longitud del metacarpiano II (MIIL), ancho del metacarpiano II (MIIW), longitud del metacarpiano III (MIIL), ancho del metacarpiano III (MIIIW), longitud del metacarpiano IV (MIVL), ancho del metacarpiano IV (MIVW), longitud del metacarpiano V (MVL), ancho del metacarpiano V (MVW), longitud de la falange I (PILL), medido como longitud de la falange II (PIIL), longitud de la falange III (PIIL), longitud de la falange IV (PIVL), longitud de la falange V (PVL). Además, se calculó el índice de la mano (HI). Regresión logística (LR), Random Forest (RF), Análisis discriminante lineal (LDA), K-vecino más cercano (KNN) y Naive Bayes (NB) se utilizaron como MLA. En el estudio, las proporciones de precisión, SEN, F1 y especificidad del algoritmo KNN se determinaron en un 88 %. En este estudio que utiliza MLA, se entiende que la mayor precisión pertenece al algoritmo KNN. Excepto por las variables MIIW, MIIIW, MIVW, MVW, HI de la mano, otras variables fueron estadísticamente significativas en términos de diferencia de sexo.

Morphometric evaluation of second to fifth metacarpals for retrograde intramedullary headless screw fixation / Evaluación morfométrica del segundo al quinto metacarpianos para la fijación retrógrada con tornillos intramedulares sin cabeza

SUMMARY: Intramedullary headless screw fixation has come to the fore in the treatment of metacarpal fractures in recent years with its advantages. Our aim was to evaluate the metacarpal morphometry for retrograde intramedullary entrance and to determine the optimal entry point. Computed tomography images of 105 patients including 64 men and 41 women, were examined. Distal and proximal metacarpal widths, medullary cavity width, cortex thickness and the measurements of the optimal entry site in volar-dorsal and radio-ulnar directions were measured in both coronal and sagittal planes. In the sagittal plane, the second metacarpal had the widest proximal width (16.29 mm), distal width was greatest in the third metacarpal (14.34 mm) which was significantly different between the sexes (p<0.001). Third metacarpal had the widest medullary cavity width in the sagittal plane (4.12 mm). In the coronal plane, it was the second metarcarpal with the widest proximal (16.14 mm) and distal width (13.92 mm) and was also the longest (66.32 mm). Unlike the sagittal plane, the medullary cavity width in the coronal plane was at the widest (4.06 mm) in fifth metacarpal. The points determined for optimal entry were respectively (4.60 mm; 4.97 mm; 4.55 mm; 4.36 mm) in the dorsal-volar plane, close to the dorsal side. There was no significant difference between the sexes for optimal insertion point in the sagittal planes in all the measured metacarpals. Considering its three dimensional structure, metacarpal bones have irregular morphometric properties and these features differ in sagittal and coronal planes. The optimal entry site is located in the midline in the coronal plane, while it is located in the sagittal plane close to the dorsal part. Knowing these properties can reduce the complication rate by reducing entry attempts and help select the correct material.

RESUMEN: En los últimos años, debido a sus ventajas la fijación intramedular con tornillos sin cabeza ha pasado a primer plano en el tratamiento de las fracturas de los huesos metacarpianos. Nuestro objetivo fue evaluar la morfometría del hueso metacarpiano para la entrada intramedular retrógrada y determinar el punto de entrada óptimo. Se examinaron imágenes de tomografía computarizada de 105 pacientes, incluidos 64 hombres y 41 mujeres. Los anchos de los huesos metacarpianos distal y proximal, el ancho de la cavidad medular, el grosor de la cortical y las medidas del sitio de entrada óptimo en las direcciones palmar-dorsal y radioulnar se midieron en los planos coronal y sagital. En el plano sagital, el segundo hueso metacarpiano presentó el mayor ancho proximal (16,29 mm), el ancho distal fue mayor en el tercer hueso metacarpiano (14,34 mm), lo que fue significativamente diferente entre individuos de ambos sexos (p<0,001). El tercer metacarpiano tenía la cavidad medular más ancha en el plano sagital (4,12 mm). En el plano coronal, era el segundo hueso metarcarpiano con mayor ancho proximal (16,14 mm) y distal (13,92 mm) y también era el más largo (66,32 mm). A diferencia del plano sagital, el ancho de la cavidad medular en el plano coronal era más ancho (4,06 mm) en el quinto hueso metacarpiano. Los puntos determinados para la entrada óptima fueron respectivamente (4,60 mm; 4,97 mm; 4,55 mm; 4,36 mm) en el plano dorsal-volar, próximo del lado dorsal. No hubo diferencia significativa entre ambos sexos para el punto de inserción óptimo en los planos sagitales en todos los huesos metacarpianos medidos. Teniendo en consideración su estructura tridimensional, los huesos metacarpianos tienen propiedades morfométricas irregulares, y estas características difieren en los planos sagital y coronal. El sitio de entrada óptimo se encuentra en la línea mediana en el plano coronal, mientras que se ubica en el plano sagital cerca de la parte dorsal. Conocer estas propiedades puede reducir la tasa de complicaciones al disminuir los intentos de entrada y ayudar a seleccionar el material correcto.

Manejo quirúrgico de tumor pardo en metacarpo. Reporte de caso / Surgical management of Metacarpal brown tumor. A case report

El tumor pardo, también conocido como osteoclastoma ó como osteítis fibrosa quística, es un tumor lítico, que se presenta en hiperparatiroidismo (primario, secundario y terciario), aunque su presentación habitual es altamente invasiva, no tiene potencial de malignidad. Los tumores pardos en la mano son muy poco frecuentes y existen solo algunos reportes de casos. Presentamos un paciente masculino de 18 años con una tumoración dura, no móvil, adherida a planos profundos en región dorsal de la mano derecha sobre el cuarto metacarpiano, que además limita la flexión y extensión del cuarto dedo sin alterar su función neurovascular. El paciente fue sometido a resección de la tumoración que involucraba por completo al cuarto metacarpiano derecho, además se realizó un abordaje lateral directo en miembro pelvico izquierdo para tomar un injerto autólogo de peroné no vascularizado. Es importante la detección temprana de este tipo de tumores y se debe dar un adecuado seguimiento, ya que, al progresar, generan una destrucción ósea importante y el tratamiento se vuelve de mayor complejidad. En etapas tempranas, el manejo agresivo con resección y aporte óseo puede evitar secuelas funcionales. El uso de injerto no vascularizado de peroné de seis centímetros para la sustitución del cuarto metacarpiano por osteolísis secundaria a un tumor pardo es una alternativa adecuada de tratamiento que permite la preservación estético funcional de la mano.

The brown tumour, also known as osteoclastoma, or as osteitis fibrosa cystica, is a lytic tumour, which occurs in hyperparathyroidism (primary, secondary, and tertiary), although its usual presentation is highly invasive, has no potential for malignancy. Brown tumours of the hand are sporadic, and there are only few case reports. The case is presented of an 18-year-old male patient with a solid, non-mobile tumour, adhered to deep planes, in the dorsal region of the right hand over the fourth metacarpal. This also limited the flexion and extension of the fourth finger, but did not show alterations in the neurovascular function of the finger. The patient underwent a tumour resection that completely involved the right fourth metacarpal. A direct lateral approach was made in the left pelvic limb to perform a non-vascularised autologous fibular graft. Early detection of this type of tumour is important, and an adequate follow-up must be carried out, since when they progress, they generate significant bone destruction and the treatment becomes more complex. In early stages, aggressive management of resection and bone support can prevent functional sequelae.

Colgajo toracoabdominal para la cobertura de lesión traumática de mano / Thoracoabdominal flap for hand traumatic injury coverage

Es de gran importancia conocer las técnicas apropiadas para la restauración de las unidades funcionales de la mano a consecuencia de lesiones traumáticas, resguardando en lo posible su configuración y funcionalidad, puesto que desempeña múltiples tareas en distintos ámbitos de la vida. A continuación, se expone el caso de un paciente con lesión traumática por aplastamiento en mano derecha, cuyo tratamiento de consideración fue el colgajo toracoabdominal que fue llevado a cabo en tres tiempos, el paciente evolucionó de forma favorable sin complicaciones de infección, dehiscencia o necrosis del colgajo. A pesar de la introducción microquirúrgia para la reconstrucción de estas lesiones, los colgajos pediculados continúan siendo factibles con resultados óptimos en situaciones en las que la microcirugía no puede ser considerada. Si bien existen múltiples técnicas para la corrección de los defectos en mano, la habilidad y creatividad del cirujano siguiendo los principios básicos de la reconstrucción serán concluyentes para un resultado óptimo.

It is very important to know the appropriate techniques for the restoration of hand injuries, protecting as much as possible their configuration and functionality, since it performs multiple tasks in different areas of life. Hence, we present the case of a patient with traumatic injury due to crushing in the right hand, which treatment was considered the thoracoabdominal flap that was carried out in three times, the patient evolved favorably without complications of infection, dehiscence or necrosis of the flap. Despite the introduction of microsurgery for the reconstruction of these lesions, pedicle flaps continue to be feasible with optiomal results in situations in which microsurgery cannot be considered. Although there are multiple techniques for the correction of defects in hand, the skill and creativity of the surgeon following the basic principles of reconstruction will be conclusive for an optimal result.

Trend of bone development of adolescent at 14 years old / 法医学杂志

OBJECTIVE@#To describe characteristic of hand-wrist bone development in adolescents of 14 years old in China, and to estimate trend of bone development of them.@*METHODS@#A total of 109 adolescents of 14 years was selected as subjects (males: 53, females: 56). X-rays examination of their left hand-wrist bone were performed and analyzed. The development characteristics of each position in accordance with Gu's mapping of skeletal age were compared with Gu's results and ours.@*RESULTS@#Compared with Gu's, osteoepiphysis of distal radius, the first metacarpal bone, the fourth proximal phalanx were more advanced in boys, osteoepiphysis of distal radius, the second-fifth metacarpal bones, the first-fifth proximal phalanxs, and the second-fifth middle phalanxs were more advanced in girls.@*CONCLUSION@#The results suggested that a forward trend of 14 years old adolescents bone development currently exists in our country, especially in girls. As an important age of criminal responsibility, this forward trend of development of bones among adolescents currently should be kept in mind when estimating bone age of criminals.

Accuracy of age estimation in 14-year-old females by two skeletal age standards / 法医学杂志

OBJECTIVE@#To study the accurate of Li Guozhen's Percent Numeration and the Development Standard of Chinese Wrist Bone CHN Numeration of age estimation in 14-year-old females.@*METHODS@#Fifty-one 14-year-old females from three middle schools in Loudi City in Hunan were selected randomly, whose left wrists were photographed with X-rays under the same condition. Skeletal age was estimated following the two numerations. The two skeletal ages were compared with each other and with chronological age.@*RESULTS@#The skeletal age from Percent Numeration and CHN Numeration have no significance difference, P > 0.05. And the skeletal ages of the two Numerations have no significance difference either, P > 0.05.@*CONCLUSION@#The Percent Numeration and the CHN Numeration are still suited for age estimation in 14-year-old females.

Preliminary study on the applying value of two measurements for bone age in the cases of minors / 法医学杂志

OBJECTIVE@#To research the connection of the minor's bone age and chronological age and age for penal responsibility, to discuss the application of Gu's Atlas and Li Guozhen's Percent Numeration to measure the bone age in the cases of immature criminals and the applying value.@*METHODS@#33 healthy youths, 12-19 years old, were selected, whose left wrists were photographed with X-rays. According to the radiographic appearance of the maturity indicators, the bone age of every person was determined respectively by the Gu's Atlas and Li Guozhen's Percent Numeration, and then compared with his/her chronological age. CMH test and Pearson test were used to evaluate precision and accuracy on concluding the immature age for penal responsibility.@*RESULTS@#Li Guozhen's Percent Numeration was more precise than Gu's Atlas on extrapolating the chronological age of the youth, P<0.005. On extrapolating the age for penal responsibility, the accuracy of the former was 90.91%, and the latter was 78.79%, but the statistic result did not show significant difference (P>0.1).@*CONCLUSION@#Both measurements can apply in determining the criminal cases of immature youths.