Skeletal age assessment using the first, second, and third fingers of the hand

Abstract

The purpose of this study was to determine whether skeletal age assessments using the first, second, and third fingers of the hand are as valid as those using the entire hand-wrist. Previous studies have demonstrated that treatment can be better oriented to the unique physiologic characteristics of the individual if skeletal age is used to assess maturational status. The sample was selected from the files of the Bolton-Brush Foundation and consisted of radiographs of 19 male and 20 female subjects whose yearly hand-wrist radiographs were available covering the age span of 10 to 16 years for girls and 12 to 18 years for male subjects. Two maturity indicators, the sesamoid and the epiphyseal-diaphyseal stages of ossification, were evaluated. Reliability of the method was tested by the t test for paired comparisons and the Pearson product-moment correlation. To determine the validity of the method, an analysis of variance (ANOVA) was used. In addition, the Pearson product-moment correlations between the two methods were performed and the 95% confidence intervals for mean differences for each sex and time were calculated. As indicated by the ANOVA, the two methods differed by a statistically significant amount, with the three-fingers assessments being slightly more advanced than the hand-wrist assessments. Although they differed, for the male subjects, the three-fingers method never deviated from that of the hand-wrist by more than 2.89 months with a minimum deviation of 0.32 months. For the female subjects, the maximum deviation was 4.45 months with a minimum of 1.55 months. The maximum deviations occurred during the time of epiphyseal-diaphyseal fusion when growth is nearing its completion and therefore they are of no clinical importance. The advantage of the use of the three-fingers method is that it can be incorporated in the lateral cephalometric radiograph, thus eliminating the need for additional radiographs.