Use of Elbow Radiographs to Assess Skeletal Age in Scoliosis

Abstract

Orthopedics| April 01 2008 Use of Elbow Radiographs to Assess Skeletal Age in Scoliosis AAP Grand Rounds (2008) 19 (4): 40. https://doi.org/10.1542/gr.19-4-40 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Use of Elbow Radiographs to Assess Skeletal Age in Scoliosis. AAP Grand Rounds April 2008; 19 (4): 40. https://doi.org/10.1542/gr.19-4-40 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: bone age, idiopathic scoliosis, olecranon, radiography of elbow, scoliosis Source: Charles YP, Dimeglio A, Canavese F, et al. Skeletal age assessment from the olecranon for idiopathic scoliosis at Risser grade 0. J Bone Joint Surg Am. 2007;89(12):2737–2744; doi:10.2106/JBJS.G.00124 Skeletal maturity and remaining growth must be considered in the evaluation of the risk of curve progression in idiopathic scoliosis. Because spine films are not sensitive enough to measure the progression of skeletal maturity during the rapid growth phase of adolescence, many orthopedists use radiographs of the elbow and the method of Sauvegrain1 to measure skeletal maturational changes during this time period. This French study compared the accuracy of a simplified method2 of assessing skeletal age with traditional methods during the acceleration stage of growth in adolescents with idiopathic scoliosis. The authors retrospectively evaluated data obtained between 1988 and 2006 from 100 boys and 100 girls, randomly selected from a group of 561 patients evaluated for idiopathic scoliosis who had been followed at six-month intervals, had a complete set of radiographs, and had known outcomes. Skeletal maturity was measured using the “simplified olecranon method,” the method of Sauvegrain, and assessment of the triradiate cartilage found in the developing acetabulum. The simplified method of skeletal age assessment evaluates five evolving shapes of the developing olecranon ossification center that change over six-month time intervals using a lateral radiograph of the elbow. The Sauvegrain method determines skeletal age from anteroposterior and lateral radiographs of the left elbow and is based on a 27-point scoring system evaluating four ossification centers. The triradiate cartilage of the developing acetabulum is monitored for fusion, which usually occurs midway through the rapid stage of growth. Radiograph interpretation was performed by three experienced observers blinded to patient information, other than gender. The 100 girls averaged 12.0±1.2 years of age (range 10.0–13.1), and the 100 boys averaged 13.9±1.01 years (range 12.2–15.5). The pubertal growth spurt began at an average skeletal age of 11 years in girls and 13 years in boys with an average annual standing height velocity of 7.2±0.8 cm/year (range 6.0–8.5 cm/year) in girls and 8.1±0.9 cm/year (range 6.0–10.0 cm/year) for boys. Menarche occurred at an average chronological age of 13.11±1.03 years (range 11.0–16.0 years). There was excellent concordance between the simplified olecranon method and the Sauvegrain method, with an average concordance of r = 0.977 for boys and r = 0.938 for girls. The concordance between the three observers was equally excellent. Skeletal age corresponded within six months in 49% of boys and 51% of girls, and was advanced >6 months in approximately 25% and delayed by approximately 25% for both sexes. The triradiate cartilage closed when the olecranon apophysis had a rectangular shape in 61% of girls and 65% of boys and within six months before or after appearance of a rectangular shape in 88% of girls and 91% of boys, corresponding to a skeletal age of 12 years in girls and 14 years in boys. The authors conclude that the morphological development of the olecranon represents a simple but... You do not currently have access to this content.