2. Need of Bone Age Estimation!!
• Medico-legal
• Short stature with Growth Delay
• Monitoring growth hormone and anabolic steroid response
• Monitoring treatment in endocrinopathy
• D/D of sexual precocity
• Prediction of Adult height
• Selection of children in sports
• Comparison of environmental, dietary factors
4. VARIOUS METHODS
• Hand Wrist Radiograph
• Cervical vertebrae
• Sternum
• Pelvic bones
• Frontal sinus
5. Methods of skeletal maturity assessment
• Appearance of fusion and ossification centres
• Gruelich Pyle method (G-P)
• Tanner and Whitehouse II
6. Appearance and fusion of ossification centres
• Sets of radiographs taken-
1. PA view of wrist ,Hand
2. Elbow
3. knee
4. shoulder
5. Pelvis AP for iliac crest fusion and appearance
7. • TO Facilitate bone age
assessment , skeletal
development is divided in
six major categories and
have been highlighted the
specific ossifications centres
that are best predictors of
skeletal maturity for each
group.
1. Infancy- Birth to 10 month(carpal bones and
radial epiphysis).
2. Toddlers-10 month to 2yr (the number of
epiphysis visible in the long bones of the
hand).
3. Pre-Puberty- 2yrs to 7yrs of age (the size of
phalangeal epiphysis).
4. Early and mid puberty- 7yrs to 13 yrs of age
(the size of phalangeal epiphysis).
5. Late Puberty- 13 to 15 yrs of age ( the degree
of epiphyseal fusion).
6. Post puberty-15 to 18yrs of age ( the degree of
epiphyseal fusion of radius and ulna).
7
8.
9. The ossification centres
for capitate and hamate
become apparent at
about 3 months of age
and remain only useful
observable feature for
next six months.
10. • Bone age
determinations are
primarily based on the
assessment of the
number of identifiable
epiphyseal ossification
centres.
• The ossification centres
for the epiphyses of all
phalanges and
metacarpals become
recognizable during this
stage, usually in the
middle finger first, and
the fifth finger last.
11. • During this stage of
development, the
ossification centers for the
epiphyses increase in
width and thickness, and
eventually assume a
transverse diameter as
wide as the metaphyses.
• Depiction of the
progressive growth of the
width of the epiphyses,
which, during this stage of
development, become as
wide as the metaphysis.
12. • Depiction of the
progressive growth of
the epiphysis, which
during this stage of
development, become
larger than the
metaphysis.
• Special attention is also
placed on epiphyseal
shape, which, prior to
epiphyseal fusion,
overlaps the
metaphysis, depicting
tiny hornlike structures
at both ends of the
epiphysis
13. • Depiction, from left to
right, of the
progressive degrees
of fusion of the
epiphyses to the
metaphysis, which
usually begins at the
centre of the physis.
15. • At this stage, all
carpals, metacarpals
and phalanges are
completely developed,
their physis are closed.
• assessments of skeletal
maturity are based on
the degree of
epiphyseal fusion of the
ulna and radius.
16.
17.
18. Age from hip bone examination
• Two pubic rami of the hip (6y)
• Suture at the acetabulum(15yr)
• Ischeal tuberosity with the ischium (21yr)
• Iliac crest with the ilium(23yr)
19.
20. AGE > 4YRS ( Ossific centre at greater
trochanter ) <15yr ( triradiate suture is
opened.
28. (B) Greulich and Pyle method (G-P)
• Published an atlas containing a set (30) of standard radiographs of the wrist and hand
representing a particular bone age at the some 30 points along the maturity scale.
• Standard for boys and girls.
• To determine skeletal maturity, radiograph is matched with those in atlas and as close
as possible determination is selected
• LIMITATIONS-:
1. Subjectivity of matching.
2. Scale used for expressing maturity i.e as close to as possible.
29.
30.
31.
32.
33.
34. (C) Tanner and Whitehouse method
• Principle-
1.Each bone develops to a regional constant functional shape.
2. A sequence of recognized state defined right from appearance to functional shape all along development journey is stated.
3. Both visual and descriptive information is used for assigning the stage.
Technique-
PA xray of Left hand and wrist taken.
Long axis of middle finger , forearm and arm in direct line.
Centering on 3rd metacarpal
20 Bones assessed and score is assigned.
( Carpals score- 7 excluding pisiform
Radius, Ulna, 1,3,5 metacarpal and phalanges of 1,3,5 metacarpals)
Once all the bones have been scored a total score is generated by adding them all and then plotted on a radiograph to
Determine how bone age relates to chronological age.