{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:50:06Z","timestamp":1768207806153,"version":"3.49.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Skeletal abnormalities are common in Turner Syndrome (TS), yet data on objective radiographic markers are limited. We aimed to establish normative reference ranges for phalangeal length ratios and assess their utility in detecting skeletal abnormalities in TS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We analyzed 4,082 female bone age X-rays (&amp;lt;18 years) from the Radiological Society of North America (RSNA) database after quality screening and outlier exclusion as a reference cohort. Phalangeal length ratios\u20144th to 3rd metacarpal (4:3 MC), 5th to 3rd metacarpal (5:3 MC), and 5th to 3rd middle phalanx (5:3 MP)\u2014were measured and compared in 81 TS patients seen at a single center. Additional skeletal features such as\n                      <jats:italic>SHOX<\/jats:italic>\n                      deficiency-related signs and brachydactyly type A3 (BDA3) were assessed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In reference subjects, 4:3 MC and 5:3 MC ratios remained stable across most age groups, while the 5:3 MP ratio increased with age. TS patients showed a significantly lower 4:3 MC and 5:3 MP ratios (P &amp;lt; 0.001, P = 0.002, respectively) compared to ones from reference subjects. A low 4:3 MC ratio (&amp;lt;\u20132 SD) was seen in 27.2% of TS patients. The 4:3 MC ratio correlated with height percentile (r = 0.27, P = 0.02). BDA3 was more prevalent in TS compared to reference subjects (13.6% vs. 2.1%, P &amp;lt; 0.001) and associated with low MC ratios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Normative reference ranges for phalangeal length ratios were established and differences in 4:3 and 5:3 MP ratios in patients with TS were identified compared to the reference group. Further studies with larger TS cohorts are needed to confirm the clinical utility of these radiographic biomarkers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1735962","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T05:45:44Z","timestamp":1768196744000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Phalangeal bone growth and implications in Turner syndrome"],"prefix":"10.3389","volume":"16","author":[{"given":"Min Jae","family":"Kang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roopa","family":"Kanakatti Shankar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youn 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