Assessment of correlation between hand-wrist maturation and cervical vertebral maturation: a fractal analysis study

Background To investigate whether fractal dimension (FD) measurements from hand-wrist radiographs and lateral cephalometric radiographs are correlated with each other and with skeletal maturation stages. Methods In this retrospective study conducted on hand-wrist and lateral cephalometric radiographs obtained from patients between 2017 and 2023, hand-wrist maturation stages (HWMS) and cervical vertebral maturation stages (CVMS) of 144 subjects (6 to 17 years of age) were assessed radiographically. The participants were divided into nine groups (n = 16 each) based on HWMS. Fractal analysis was performed on the radiographs of the radius, the middle finger phalanges (proximal, medial and distal), and the cervical vertebral bodies (C2, C3, C4). Mean and standard deviation values, Spearman’s and Pearson correlation analyses, one-way ANOVA, Kruskal-Wallis H tests and Mann- Whitney-U test were used to evaluate the data. Results Positive correlations were found between the FD values of the radius and HWMS or CVMS (r = .559, P = .001, r = .528 P = .001 respectively). The FD values of the radius were positively correlated with those of all cervical vertebrae (C2, C3, C4), proximal and medial phalanges as well as age. FD values measured from the proximal phalanx, medial phalanx and radius showed significant differences among both HWMS and CVMS (P < .05). HWMS was strongly correlated with CVMS (r = .929, P = .001). Age was strongly correlated with HWMS (r = .795, P = .001) and CVMS (r = .756, P = .001). There was a significant difference in terms of age distribution among HWMS and CVMS (P < .05). Conclusions FD measurements on hand-wrist radiographs can provide useful information for the assessment of skeletal maturation stage. Especially, FD measurements from the radius are important and more reliable to predict skeletal maturation stage.