M

27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 Gestational age (weeks)

Figure 9.15 Torso length, both sexes, at birth. From Sivan et al. (1983), by permission.

Chapter 9 Chest and Trunk Biacromial Distance

Definition Maximum distance between the right and left acromion (shoulder width).

Landmarks The spine of the scapula projects laterally and superiorly over the shoulder joint to form the acromion. The acromion articulates anteriorly with the clavicle. The acromion is the most lateral bony projection of the shoulder girdle and should be easily palpable. Measure between the right and left acromion across the back (Fig. 9.16).

Instruments Tape-measure, or calipers.

Position The patient should stand upright, hands at the sides, with the shoulders in a neutral position. The measurement is taken from behind. The infant can be seated, or lying face down, for measurement.

Alternative The patient can sit or lie face down.

Remarks The biacromial distance, like the bi-iliac distance, is a useful measurement of trunk width. However, there is greater variation in biacrominal distance than in bi-iliac distance between the sexes. Values for males and females to age 19 years are presented in Figs. 9.17 and 9.18.

Pitfalls Abnormalities of the serratus anterior muscle causing a "winged scapula", or neuromuscular disease, may "round" the shoulders, increasing the biacromial distance. If the shoulders cannot be drawn back into a reasonable posture, the measurement should be made using calipers instead of a tape-measure.

Figure 9.16 Measuring biacromial distance.

Figure 9.16 Measuring biacromial distance.

Biacromial Width

121———— 12 ——————-—————-——L-

0 1 2 3 4 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Figure 9.17 (a) Biacromial distance, males, birth to 4 years. From Maaser (1977), Demirjian and Jenickek (1983), Roche and Malina (1983), and Feingold and Bossert (1974), by permission. (b) Biacromial distance, males, 4 to 19 years. From Maaser (1977), Demirjian and Jenickek (1983), Roche and Malina (1983), and Feingold and Bossert (1974), by permission.

121———— 12 ——————-—————-——L-

0 1 2 3 4 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Figure 9.17 (a) Biacromial distance, males, birth to 4 years. From Maaser (1977), Demirjian and Jenickek (1983), Roche and Malina (1983), and Feingold and Bossert (1974), by permission. (b) Biacromial distance, males, 4 to 19 years. From Maaser (1977), Demirjian and Jenickek (1983), Roche and Malina (1983), and Feingold and Bossert (1974), by permission.

Figure 9.18 (a) Biacromial distance, females, birth to 4 years. From Maaser (1977), Demirjian and Jenickek (1983), Roche and Malina (1983), and Feingold and Bossert (1974), by permission. (b) Biacromial distance, females, 4 to 19 years. From Maaser (1977), Demirjian and Jenickek (1983), Roche and Malina (1983), and Feingold and Bossert (1974), by permission.

Figure 9.18 (a) Biacromial distance, females, birth to 4 years. From Maaser (1977), Demirjian and Jenickek (1983), Roche and Malina (1983), and Feingold and Bossert (1974), by permission. (b) Biacromial distance, females, 4 to 19 years. From Maaser (1977), Demirjian and Jenickek (1983), Roche and Malina (1983), and Feingold and Bossert (1974), by permission.

Chapter 9 Chest and Trunk Bi-Iliac Distance

Definition Distance between the most prominent lateral points of the iliac crest.

Landmarks Palpate the iliac crest to define its widest flare. Measure between the right and left points, from the front, using firm pressure to get as near as possible to a skeletal measurement (Fig. 9.19).

Instruments Calipers. A tape-measure may be used if calipers are unavailable, but the measurement is less accurate.

Position The patient should be standing upright. The infant should be lying supine with legs extended.

Alternative The patient may be lying supine with legs extended.

Remarks Normal values are presented in Figs. 9.20 and 9.21. In the patient with a skeletal dysplasis, pelvic anatomy may be distorted, and comparison with normal curves is less meaningful. The bi-iliac distance is considered the most important of the transverse distances because it is the best indicator of the width of the trunk, it is not variable with posture or respiration, and the land-marks are very definite. The bi-iliac distance is similar in males and females at any given age. Variation in hip width reflects soft tissue, not bony, differences between the sexes.

Pitfalls The most prominent lateral point of the iliac crest must be located precisely. If a tape-measure is used, the measurement may be distorted by abdominal protrusion.

Figure 9.19 Measuring bi-iliac distance.

Figure 9.19 Measuring bi-iliac distance.

Figure 9.20 Bi-iliac distance, males, birth to 16 years. From Thelander (1966), by permission.

Figure 9.21 Bi-iliac distance, females, birth to 16 years. From Thelander (1966), by permission.

Figure 9.21 Bi-iliac distance, females, birth to 16 years. From Thelander (1966), by permission.

Chapter 9 Chest and Trunk Umbilical Cord Length

Definition Length of the umbilical cord.

Landmarks The umbilical cord should be measured from its attachment to the placenta to the trunk of the newborn infant.

Instruments Tape-measure.

Remarks The segments attached to the baby and placenta are measured and results added. Any part that has been cut out is also measured and added to give the total cord length.

The normal anatomy of the umbilicus is shown in Fig. 9.22. Normal values for umbilical cord length are shown in Fig. 9.23.

Pitfalls In the presence of a supercoiled cord, once the cord is cut it should assume its true configuration, and stretching the cord will not be necessary.

20 ——1—1——1—1—1—1——1—1— 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41

Gestational age (weeks)

Figure 9.23 Umbilical cord length, both sexes, at birth. From Naeye (1985), by permission.

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