{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T09:00:43Z","timestamp":1781254843201,"version":"3.54.1"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["RC 16\/24"],"award-info":[{"award-number":["RC 16\/24"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Turner syndrome (TS) often presents with subtle or overlooked clinical signs, contributing to frequent diagnostic delays. We describe the case of a 13\u2010year\u2010old girl referred for short stature whose only remarkable physical findings were the absence of the fourth and fifth knuckles on both hands\u2014known as Archibald's metacarpal sign\u2014and a short fourth metatarsal. Growth had decelerated after spontaneous menarche, and previous examinations had not recognized these skeletal clues. Radiographs confirmed short fourth and fifth metacarpals. Karyotype analysis identified a complete deletion of the short arm of one X chromosome (Xp), consistent with TS. Further evaluation revealed a bicuspid aortic valve, autoimmune thyroiditis with subclinical hypothyroidism, and reduced ovarian reserve. Archibald's sign, caused by SHOX haploinsufficiency, is present in about one\u2010third of individuals with TS but may also appear in other disorders or even healthy individuals. This case highlights the diagnostic value of careful physical examination in girls with short stature. Recognizing seemingly minor skeletal findings can prompt timely karyotyping, allowing earlier detection of TS and appropriate long\u2010term management.<\/jats:p>","DOI":"10.1002\/ccr3.72209","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T07:11:34Z","timestamp":1775545894000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Knuckle, Knuckle, Dimple, Dimple: Do Not Miss A Diagnostic Opportunity"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0801-3645","authenticated-orcid":false,"given":"Maria Chiara","family":"Pellegrin","sequence":"first","affiliation":[{"name":"Institute for Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d  Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1635-9141","authenticated-orcid":false,"given":"Gianluca","family":"Tamaro","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d  Trieste Italy"},{"name":"Department of Medicine, Surgery and Health Sciences University of Trieste  Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8163-1247","authenticated-orcid":false,"given":"Alice","family":"Fachin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences University of Trieste  Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6343-846X","authenticated-orcid":false,"given":"Egidio","family":"Barbi","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d  Trieste Italy"},{"name":"Department of Medicine, Surgery and Health Sciences University of Trieste  Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4395-3915","authenticated-orcid":false,"given":"Gianluca","family":"Tornese","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d  Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.17925\/EE.2022.18.1.49"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1530\/EC-20-0585"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1159\/000236082"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmg.2019.01.004"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejendo\/lvae050"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-019-0224-4"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2006-1374"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.86.11.8058"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00439-005-0081-1"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-19-10-1312"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1259\/0007-1285-43-506-133"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.46.3.468"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.1330460312"},{"issue":"12","key":"e_1_2_14_15_1","first-page":"1234","article-title":"Images in Endocrinology: Archibald's Metacarpal Sign","volume":"61","author":"Ahmad Z.","year":"2011","journal-title":"Journal of the Pakistan Medical Association"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1148\/123.3.707"},{"issue":"10","key":"e_1_2_14_17_1","first-page":"2629","article-title":"Brachydactyly Type E: Isolated or as a Feature of a Syndrome","volume":"161","author":"M\u00e4kitie O.","year":"2013","journal-title":"American Journal of Medical Genetics, Part A"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/jmedgenet-2013-101720"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpem-2019-0067"},{"issue":"1","key":"e_1_2_14_20_1","first-page":"32","article-title":"The Impact of Karyotype on Congenital Heart Disease in Turner Syndrome: A Systematic Review and Meta\u2010Analysis","volume":"184","author":"Corbitt H.","year":"2020","journal-title":"American Journal of Medical Genetics. 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