This document discusses bone age estimation through x-ray imaging of ossification centers in bones. It provides details on which ossification centers appear at different ages, from newborns up to adults. The purpose of bone age estimation is to help manage short stature, determine timing of growth hormone treatment, and predict final height. Key bones discussed include carpals, elbows, ankles, and shoulders. Estimating bone age is most accurate for determining chronological age up to 16-25 years.

1. ESTIMATION OF BONE AGE
DR MOHAMMED ASHFAQUE
DR ANIRUDDHA KULKARNI
DR SHUBHANGI SHETKAR

2. BONE AGE
WHY
HOW
WHAT

3. WHY TO DETERMINE BONE AGE?
1) IMPORTANT IN MANAGEMENT OF SHORT STATURE
BONE AGE < CHRONOLOGICAL AGE= GROWTH HORMONE
DEFICIENCY/ CONSTITITUTIONAL DELAY
BONE AGE=CHRONOLOGICAL AGE = FAMILIAL SHORT STATURE
BONE AGE > CHRONOLOGICAL AGE = HYPERGONADISM, CAH
2) IN DECIDING WHEN TO START AND STOP GROWTH HORMONE
SUPPLIMENTATION.
3) IN FORENSIC MEDICINE- MINOR CANT BE TRIED IN NORMAL
COURTS
4) REPLACEMENT THERAPY FOR HYPOGONADISM.
5) GNRH FOR PRECOCIOUS PUBERTY.
6) PREDICTION OF FINAL HEIGHT.

4. HOW

5. IN NEWBORNS
ONLY INDICATION IS CONGENITAL HYPOTHYROIDIS
EPIPHYSIS AT LOWER END OF FEMUR
AND UPPER END OF TIBIA SHOULD BE
PRESENT IN A NORMAL NEWBORN.
THEIR ABSENCE INDICATES DELAYED
BONE AGE OF INTRAPARTUM CAUSE.
MC IS HYPOTHYROIDISM

7. XRAY OF NEWBORN
IF YOU DONT FIND OSSIFICATION CENTRE FOR ANY CARPAL
BONE THEN THE AGE IS DEFINATELY BETWEEN 1-3 MONTHS
FIRST CARPAL BONE TO APPEAR
CAPITATE

8. XRAY OF 6
MONTHS
BABY
OSSIFICATION CENTRES
PRESENT
CAPITATE (1-3 M)
HAMATE (3-6 M)
ABSENT
DISTAL RADIUS (1 YEAR)

9. PRESENT
CAPITATE
HAMATE
DISTAL RADIUS
THAT 3RD BONE IS ABSENT
BY THE WAY THATS TRIQUETRUM
1- 2 YEARS

10. 3 CARPAL BONES CLEARLY
VISIBLE
CAPITATE
HAMATE
TRIQUETRUM
YET TO APPEAR
LUNATE (3-4)
AGE IS 3-4 YEARS

11. 4 CARPAL BONES CLEARLY
VISIBLE
CAPITATE
HAMATE
TRIQUETRUM
LUNATE (3-4)
YET TO APPEAR
SCAPHOID (5-6)
AGE IS 4-5 YEARS

12. TO FURTHER SIMPLIFY THE THINGS
AFTER 2 YEARS AND UPTO 8 YEARS
NUMBER OF CARPAL BONES= AGE

14. OSSIFICATION CENTRE FOR DISTAL ULNA=8

15. EPIPHYSIS FOR OLECRANON
APPEARS AT 10

16. epiphysis for lateral
epicondyl
appears at
12 years.

17. lateral epicondyle fuses
with capitulum and
trochlea- 13 years

18. Epiphysis head of radius appear - 14 years

19. Fusion of Medial Epicondyle = 15 years

20. OSSIFICATION CENTRES
ELBOW= BY 16 YEARS ALL EPIPHYSIS FUSED
ANKLE= BY 17 YEARS ALL EPIPHYSIS FUSED
KNEE= BY 18 YEARS ALL EPIPHYSIS FUSED
WRIST= BY 19 YEARS ALL EPIPHYSIS FUSED

21. NON FUSED < 16 YRS
FUSED > 16 YEARS
EPIPHYSIS AROUND ELBOW

22. All epiphysis around ankle fuse at 17 yrs

23. EPIPHYSIS AROUND SHOULDER- 18 YEARS

24. EPIPHYSIS AROUND WRIST - 19 YEARS

25. FUSION OF EPIPHYSIS ILIAC CRESTS - 20 YR

26. ON OF OSSIFICATION CENTRE AT MEDIAL END OF CLAVICLE- 21 TO 22

27. IF ALL THE EPIPHYSIS OF LONG BONES ARE FUSED T
AFTER 25 YEARS THE
BONE AGE BECOMES MORE UNCERTAIN.
ALSO BONE AGE ESTIMATION IS OF LITTLE CLINICAL

28. EARS OF AGE SOME BONES LIKE STERNUM CAN BE USED FOR BONE
AGE MORE THAN 15 BUT LESS THAN 20

29. THANK YOU