This document presents a radiographic atlas of skeletal development from newborn to adulthood for both males and females. It includes x-ray images of hands and wrists at various ages along with notes on the appearance and fusion of epiphyses. Standard deviations for age of bone development and tables comparing accelerated and retarded growth to average patterns are also provided.

1. Radiographic Atlas of Skeletal
Development of the hand and
wrist
Greulich and Pyle 2nd edition
Prepared by Robert L Lorenzo, MD

2. Male Newborn

3. Male 3 months

4. Male 6 months

5. Male 9 months

6. Male 1 year

7. Male 1 year and 3 months

8. Male 1 year and 6 months

9. Male 2 years

10. Male 2 years and 8 months

11. Male 3 years

12. Male 3 years and 6 months
Epiphyses of distal phalanges 2-5
clearly visible

13. Male 4 years

14. Male 4 years and 6 months
Middle phalangeal epiphyses of
3rd, 4th fingers now slightly more
than 1/2 as wide as their shafts

15. Male 5 years
Epiphysis of the first
metacarpal is now more
than half as wide as its
metaphysis
The epiphysis of the
distal phalanx of the fifth
finger is now about 2/3’s
as wide as it’s shaft

16. Male 6 years
The base of the second
metacarpal is now
distinctly indented in the
region which will later
articulate with the
trapezoid

17. Male 7 years
The epiphysis of the
middle phalanx of the
fifth finger is now
slightly more than half
as wide as its shaft.

18. Male 8 years
The epiphyses of the distal
phalanges of the second,
third, fourth, and fifth fingers
are now as wide as their
shafts.

19. Male 9 years
The distal ends of the
shafts of the second
and third proximal
phalanges have
become slightly
concave as their
trochlear surfaces begin
to differentiate.

20. Male 10 years
The epiphyses for the distal
phalanges of the second to
fifth fingers are all wider
than their shafts.

21. Male 11 years
The epiphysis of the
proximal phalanx of the
second finger is now as
wide as its shaft.

22. Male 11 years and 6 months
The capitate surface of the
scaphoid now slightly
overlaps the adjacent
portion of the capitate.

23. Male 12 years and 6 months
The epiphysis of the
proximal phalanges of the
3rd, 4th and 5th fingers and
of the middle phalanges of
the 2nd and 3rd fingers are
now as wide as their shafts.

24. Male 13 years
The epiphysis of the middle
phalanx of the fifth finger is
now as wide as its shaft.

25. Male 13 years and 6 months
All of the proximal
epiphyses have begun to
cap their shafts.

26. Male 14 years

27. Male 15 years

28. Male 15 years and 6 months

29. Male 16 years

30. Male 17 years

31. Male 18 years

32. Male 19 years

33. Female Newborn

34. Female 3 months

35. Female 6 months

36. Female 9 months

37. Female 1 year
The epiphyses of the
second and third
metacarpals and the
epiphyses of the
proximal phalanges of
the second, third, and
fourth fingers now
contain small, recently
formed ossification
centers

38. Female 1 year and 3 months

39. Female 1 year and 6 months

40. Female 2 years

41. Female 2 years and 6 months

42. Female 3 years
The epiphyses of the middle
phalanges of the second, third,
and fourth fingers are now
slightly more than half as wide
as their shafts.

43. Female 3 years and 6 months

44. Female 4 years and 2 months

45. Female 5 years
The distal phalangeal
epiphyses of the third,
fourth, and fifth fingers are
now as wide as their
shafts

46. Female 5 years and 9 months

47. Female 6 years and 10 months
The base of the second
metacarpal adjacent to the
trapezoid is now slightly
concave.

48. Female 7 years and 10 months
The epiphysis of the proximal
phalanx of the thumb now
extends farther medially (I.e.,
toward the volar surface) than
does the corresponding border
of its shaft: it has now reached
the dorsal margin…the
epiphyses of the distal
phalanges of the 2nd-5th
fingers are shaping to the
trochlear surfaces of the
middle phalanges.

49. Female 8 years and 10 months
The epiphyses of the
proximal and middle
phalanges of the second,
third, and fourth fingers are
now as wide as their shafts.

50. Female 10 years
The epiphyses of the
proximal and middle
phalanges of the fifth finger
are now as wide as their
shafts.

51. Female 11 years
The epiphyses of the proximal and
middle phalanges of the 2nd-5th
fingers and those of the distal
phalanges of the thumb and 2nd, 4th
and 5th fingers now cap their shafts.

52. Female 12 years
The radial epiphysis caps its shaft
and its ulnar articular surface has
flattened.

53. Female 13 years
The epiphysis of the distal
phalanx of the thumb has begun
to fuse with its shaft.

54. Female 13 years and 6 months

55. Female 14 years

56. Female 15 years

57. Female 16 years

58. Female 17 years

59. Female 18 years

60. Female 28 years

61. Female 50 years

62. Standard Deviation for Boys

63. Standard Deviation for Girls

64. Table IIA Average Boys

65. Table IIB Average Boys

66. Table IIC Accelerated Boys

67. Table IID Accelerated Boys

68. Table IIE Retarded Boys

69. Table IIIA Average Girls

70. Table IIIB Average Girls

71. Table IIIC Accelerated Girls

72. Table IIID Accelerated Girls

73. Table IIIE Retarded Girls

74. Table IIIF Retarded Girls

75. Table I Percent
of mature
height