New paradigms for identifying predisposition to bone injuries in young athletes: Significant keys for rapid diagnostics

Table 1 Number and sex-age structure of young people involved in groups, n (%)/median (interquartile range)

Variables	Persons with repeated bone injuries (main group)	Persons without repeated bone injuries (control group)	P value
Total number	36	502
Female number	26 (72.2)	362 (72.1)	Р = 0.946
Male number	10 (27.8)	140 (27.9)
Age	24.50 (19.00-27.25)	23.50 (19.25-27.00)	Р = 0.523

Table 2 Prevalence of dysplastic signs in the total sample, 95%CI

Variables	Osteoarticular signs	Skin-muscle and ophthalmological signs	Visceral dysplastic signs
	External dysplastic signs
Prevalence (%)	99.8 (99.61-99.99)a	95.2 (93.39-97.10)	17.50 (14.29-20.71)
	99.8% (99.61-99.99)a

^aP < 0.001.

Table 3 Dysplastic characteristics in athletes predisposed to recurrent bone injury, 95%CI/median (interquartile range)

Variables	Control group (n = 502)	Main group (n = 36)
Prevalence of CTD syndrome (%)	66.2 (61.4-70.9)	100.0 (90.3-100.0)a
Number of dysplastic signs (%)	7.00 (5.00-9.00)	10.00 (8.00-12.00)
Dysplastic severity, CTD scores	22.90 (14.46-32.73)	44.77 (30.25-53.40)

^aP < 0.001. CTD: Connective tissue dysplasia.

Table 4 Analyzing the discriminatory connective tissue dysplasia score power in identifying predisposition to bone injury

Threshold	Sensitivity (%)	Specificity (%)	Positive predictive value	Negative predictive value
44.62	88.2	52.8	96.3	24.4
44.43	87.3	52.8	96.3	22.9
44.20	87.3	55.6	96.5	23.8
44.10	87.1	55.6	96.5	23.5
43.75	86.7	55.6	96.5	23.0
37.53	76.3	55.6	96.0	14.4
37.50	76.3	58.3	96.2	15.0
36.42	74.5	58.3	96.1	14.1
36.00	74.1	58.3	96.1	13.9
35.68	73.3	58.3	96.1	13.5
35.66	72.9	58.3	96.1	13.4
35.46	72.5	58.3	96.0	13.2
35.40	72.5	61.1	96.3	13.8
34.38	70.1	61.1	96.2	12.8
34.37	70.1	63.9	96.4	13.3
34.16	69.9	63.9	96.4	13.2
33.91	69.9	66.7	96.7	13.7
33.64	69.5	66.7	96.7	13.6
32.73	66.7	66.7	96.5	12.6
32.63	66.3	66.7	96.5	12.4
31.42	63.3	66.7	96.4	11.5
31.41	63.3	69.4	96.7	12.0
31.34	63.1	69.4	96.6	11.9
31.25	63.1	72.2	96.9	12.3
31.20	62.9	72.2	96.9	12.3
30.96	62.9	75.0	97.2	12.7
28.14	57.0	75.0	96.9	11.1
28.11	56.6	77.8	97.3	11.4
27.91	56.0	77.8	97.2	11.2
27.87	56.0	80.6	97.6	11.6
26.15	50.8	80.6	97.3	10.5
26.10	50.4	80.6	97.3	10.4

Table 5 Somatometric and osteoarticular dysplastic sign distribution, 95%CI/median (interquartile range)

Somatometric and osteoarticular dysplastic signs	Persons with repeated bone injuries (main group, n = 36) (%)	Persons without repeated bone injuries (control group, n = 502) (%)
Asthenic body type	52.8 (35.5-69.6)a	26.4 (22.2-31.1)
Underweight	5.6 (0.7-18.7)	14.1 (10.8-17.9)
Severe underweight	5.6 (0.7-18.7)	8.3 (5.8-11.5)
Dolichostenomelia	47.2 (30.4-64.5)b	16.4 (12.9-20.4)
Arachnodactyly	66.7 (49.0-81.4)b	30.2 (25.7-35.0)
Shoulder blade asymmetry	30.6 (16.3-48.1)	35.8 (31.0-40.7)
Pelvic bone asymmetry	19.4 (8.2-36.0)	9.6 (6.9-12.9)
Pterygoid shoulder blades	19.4 (8.2-36.0)	14.1 (10.8-17.9)
Scoliosis	36.1 (20.8-53.8)	27.2 (22.9-31.9)
Kyphotic spine deformity	8.3 (1.8-22.5)	6.3 (4.1-9.2)
Kyphoscoliosis	8.3 (1.8-22.5)	1.3 (0.4-2.9)
Flat spine	0.0 (0.0)	0.3 (0.0-1.4)
Hyperlordosis	2.8 (0.1-14.5)	2.3 (1.0-4.3)
Infundibular chest	25.0 (12.1-42.2)b	2.5 (1.2-4.6)
Keel-shaped chest	16.7 (6.4-32.8)b	2.0 (0.9-3.9)
Acetabular protrusion	2.8 (0.1-14.5)	1.3 (0.4-2.9)
O-shaped legs	16.7 (6.4-32.8)	11.8 (8.8-15.4)
X-shaped legs	11.1 (3.1-26.1)	8.6 (6.0-11.8)
Valgus foot position	16.7 (6.4-32.8)	6.3 (4.1-9.2)
Flatfoot	50.0 (32.9-67.1)	47.6 (42.6-52.6)
First toe macrodactyly	2.8 (0.1-14.5)	0.0 (0.0)
Narrow facial skeleton	86.1 (70.5-95.3)a	57.7 (52.7-62.6)
Gothic palate	41.7 (25.5-59.2)b	8.6 (6.0-11.8)
Malocclusion	41.7 (25.5-59.2)	46.6 (41.6-51.6)
Deviated nasal septum	22.2 (10.1-39.2)	28.0 (23.6-32.7)
Joint hypermobility	47.2 (30.4-64.5)	56.9 (51.9-61.9)
Joint hypermobility degree (score)	3.00 (2.00-4.25)a	4.00 (2.00-6.00)
Joint crunching	63.9 (46.2-79.2)	68.0 (63.2-72.6)
Temporomandibular joint crunching	33.3 (18.6-51.0)	35.5 (30.8-40.4)

^aP < 0.05 vs the control group.

^bP < 0.01 vs the control group.

Table 6 Skin-muscle and ophthalmological dysplastic sign distribution, 95%CI/median (interquartile range)

Skin-muscle and ophthalmological dysplastic signs	Persons with repeated bone injuries (main group, n = 36) (%)	Persons without repeated bone injuries (control group, n = 502) (%)
Thin skin	25.0 (12.1-42.2)	33.5 (28.9-38.4)
Skin hyperextensibility	11.1 (3.1-26.1)	3.3 (1.8-5.5)
Hyperelastic auricles	16.7 (6.4-32.8)	10.6 (7.7-14.0)
Atrophic striae	36.1 (20.8-53.8)	30.7 (26.2-35.5)
Keloid scars	47.2 (30.4-64.5)a	25.7 (21.5-30.3)
Recurrent hernia	5.6 (0.7-18.7)	2.5 (1.2-4.6)
Abdominal muscle diastasis	2.8 (0.1-14.5)	2.3 (1.0-4.3)
Nails (exfoliated/fragile)	41.7 (25.5-59.2)	32.0 (27.4-36.8)
Hair (brittle/excessive hair loss)	19.4 (8.2-36.0)	24.9 (20.8-29.5)
Lower extremity varicose veins	5.6 (0.7-18.7)	4.8 (2.9-7.4)
Petechia	25.0 (12.1-42.2)	29.2 (24.8-34.0)
Myopia	30.6 (16.3-48.1)	25.4 (21.2-30.0)
Myopia degree, diopters	-3.25 (-2.88 to -6.88)	-4.00 (-2.00 to -6.00)
Retinal detachment in anamnesis	5.6 (0.7-18.7)	2.5 (1.2-4.6)
Blue sclera	19.4 (8.2-36.0)	10.8 (8.0-14.3)
Muscle pain	69.4 (51.9-83.7)	64.2 (59.3-69.0)
Нand and foot coldness	61.1 (43.5-76.9)	55.9 (50.9-60.9)
Paresthesia	72.2 (54.8-85.8)a	43.6 (38.6-48.6)
Muscle spasms/сramps	88.9 (73.9-96.9)a	70.0 (65.3-74.5)
Feet pastosity	27.8 (14.2-45.2)	13.1 (9.9-16.8)

^aP < 0.05 vs the control group.

Table 7 Sensitivity, specificity, and diagnostic accuracy of each of the characteristic dysplastic signs separately in identifying predisposition to bone injury

Characteristic dysplastic signs	Sensitivity (%)	Specificity (%)	Diagnostic accuracy (%)
Asthenic body type	52.8	74.9	73.4
Dolichostenomelia	47.2	82.3	79.9
Arachnodactyly	66.7	68.5	68.4
Narrow facial skeleton	86.1	42.2	45.2
Infundibular chest	25.0	97.8	92.9
Keel-shaped chest	16.7	97.6	92.2
Gothic palate	41.7	91.4	88.1
Keloid scars	47.2	69.9	68.4
Paresthesia	72.2	54.6	55.8
Muscle spasms/сramps	88.9	27.5	31.6

Table 8 Positive and negative predictive value, positive and negative likelihood ratio of each of the characteristic dysplastic features alone in identifying predisposition to bone injury

Characteristic dysplastic signs	Positive predictive value	Negative predictive value	Positive likelihood ratio (%)	Negative likelihood ratio (%)
Asthenic body type	2.1	0.6	43.8	81.1
Dolichostenomelia	2.7	0.6	39.5	86.4
Arachnodactyly	2.1	0.5	52.0	80.1
Narrow facial skeleton	1.5	0.3	68.8	67.2
Infundibular chest	11.4	0.8	30.5	97.1
Keel-shaped chest	7.0	0.9	19.2	97.2
Gothic palate	4.9	0.6	37.1	92.8
Keloid scars	1.6	0.8	41.6	74.5
Paresthesia	1.6	0.5	58.7	68.7
Muscle spasms/cramps	1.2	0.4	77.4	47.0