Determination Of Skeletal Age Research Articles

Evaluation of the Ossification Stage of Proximal Humeral Epiphysis by 1.5-T Magnetic Resonance Imaging for Determination of Skeletal Age.

The aim of the study was to investigate whether the skeletal age can be evaluated assessed by means of analysis of ossification stage at proximal humeral epiphysis using magnetic resonance imaging (MRI). This retrospective study was carried out in the radiology department of a tertiary healthcare center and 1.5-T MRI views of the shoulder obtained from 203 patients aged 8 to 29 years were evaluated. The ossification stage of proximal humeral epiphysis was evaluated on T1-weighted MRI sequences, and its correlation with age was sought. Our series consisted of 77 women (37.9%) and 126 men (62.1%). One hundred forty-seven right humerus (72.4%) and 56 (27.6%) left humerus were examined. The mean age of the patients was 20.60 ± 4.41 years. The patients were in stages 4 (n = 148, 72.9%), 3c (n = 18, 8.9%), 3b (n = 14, 6.9%), 2c (n = 13, 6.4%), and 3a (n = 10, 4.9%). Analysis of the relationship between age and ossification stage of proximal humerus epiphysis indicated that stage increased with the advancement of age. There was a significant correlation between the stage and age variables at a rate of 77% in the positive direction (P < 0.001). Our results demonstrated that MRI of proximal humeral epiphysis can have valuable implications for estimation of the skeletal age. Future prospective studies must be implemented with patients grouped according to socioeconomic status, nutritional habits, and physical activities to explore the actual investigative potential of MRI.

Influence of skeletal maturation on physical fitness of young people with Down syndrome

Individuals with Down syndrome (DS) tend to prematurely reach the skeletal maturation period. In addition, young people with this condition have poor physical fitness and few opportunities to practice physical activity when compared to those without disabilities. The aim of this study was to investigate the skeletal maturation of young people with Down syndrome and its influence on the behavior of physical fitness related to health, after aerobic and resistance training programs. Forty people with DS, with an average age of 15.4 (± 2.6) years, were divided into three groups for a 12 weeks intervention program, AT - aerobic training group (3 times/week; 50 minutes/session), RT - resistance training group (twice/week ; 50 minutes/session) and CG - control group, 9 participants. Determination of skeletal age (EA) was performed using the Greulich-Pyle method. Anthropometric variables, muscle strength and peak VO2 were measured pre and post intervention. It was found that skeletal maturation influenced the effects of training, only being significant for body weight and strength in the upright row variables. In addition, the muscle strength of upper and lower limbs increased significantly after 12 weeks of aerobic or resistance training. Then, we can conclude that the effects of physical training on physical fitness of young people with Down syndrome appear to improve as the bone age increases.

Influence of skeletal maturation on physical fitness of young people with Down syndrome

Individuals with Down syndrome (DS) tend to prematurely reach the skeletal maturation period. In addition, young people with this condition have poor physical fitness and few opportunities to practice physical activity when compared to those without disabilities. The aim of this study was to investigate the skeletal maturation of young people with Down syndrome and its influence on the behavior of physical fitness related to health, after aerobic and resistance training programs. Forty people with DS, with an average age of 15.4 (± 2.6) years, were divided into three groups for a 12 weeks intervention program, AT - aerobic training group (3 times/week; 50 minutes/session), RT - resistance training group (twice/week ; 50 minutes/session) and CG - control group, 9 participants. Determination of skeletal age (EA) was performed using the Greulich-Pyle method. Anthropometric variables, muscle strength and peak VO2 were measured pre and post intervention. It was found that skeletal maturation influenced the effects of training, only being significant for body weight and strength in the upright row variables. In addition, the muscle strength of upper and lower limbs increased significantly after 12 weeks of aerobic or resistance training. Then, we can conclude that the effects of physical training on physical fitness of young people with Down syndrome appear to improve as the bone age increases.

Estimation of Dental and Bone Age in Obese Children of South India.

Aim:Determination of skeletal and dental age is very essential for Pediatric dentist and orthodontist to formulate a treatment plan, and it is a source of supplemental information for Pediatrics, Orthopedics, and Forensics. There are no available studies in the literature about the comparison of dental and bone age with chronological age in obese children of south India. Accordingly, the aim of this study was to evaluate and compare dental age, bone age, and chronological age in obese children of south India.Materials and Methods:Ethical approval was obtained from the ethical committee of college, and informed consent was obtained from parents of the study participants. A total of 100 obese study participants were selected between 8 to 14 years age group. Date of birth was considered to obtain chronological age. Demirjian's method was used to assess dental age. Bjork, Grave, and Brown's method was followed to detect bone age using hand-wrist radiograph. The comparison of three ages was done using the unpaired Student's t-test and Pearson's correlation coefficient.Results:Dental age and bone age were advanced in comparison to chronological age in both sexes and its statistically significant (P < 0.001). There was a positive correlationship between three ages in both sexes.Conclusion:As per our study, dental age and bone age were advanced in obese children, but dental age was more advanced. Dental age and bone age can be considered as variables for diagnosing the impact of growth in obese children. In the future, further studies are required to support our findings.

Estimation of age from the fusion of body of sternum in central India Indore region (M.P.)

Age determination from unknown human skeletal remains or decomposed bodies is an important initial step in forensic investigation. Accurate determination of skeletal age has been a critical issue in medicolegal cases and the accuracy depends on the nature of material available and the methods applied. Sternum is a bone which is easily retrievable even from the advanced decomposed body and also from the bundle of bones, so it becomes a very important bone for age and sex determination in the advanced stage of decomposition and from mutilated, fragmented bodies.

Skeletal Maturation in the pediatric population in a large tertiary care hospital in South India

Background & Objectives: Determination of skeletal age is an important part of examination for many clinical problems with growth disorders. The Greulich and Pyle atlas method and the Tanner Whitehouse technique are used to assess bone age accurately. However time constraints force pediatricians to quickly assess bone age from age of appearance of epiphyseal centres. The aim of this study was to re-examine this method in today’s clinical practice to enable more practical and appropriate use. Methods: The study was undertaken in The Institute of Child Health and Hospital for Children, Egmore,(ICH & HC) Chennai. Normal children less than 12 years were included in the study. The children were grouped in different age groups, 100 girls and 100 boys in each age group totalling 3800 children. Depending on the chronological age of the child only the x ray films of the hand, wrist, elbow, or knees were taken. We used x-rays of hands for all age groups and elbow in those over 5 years. Only the appearance of ossification centers was noted. We also used x-ray of the patella for children in 3 to 5 year age groups. Results: We found that the mean age of appearance of patellar ossification was similar in both boys and girls (mean age 4.8± 0.5). By 3-6 months capitate and hamate were present in all children (mean age 0.5± 0.1). There is high variability in the timing of ossification of carpal bones, which accounts for their elimination for age evaluation. However the pisiform follows a constant mean age at 10.6 for girls and 11.6 for boys. Conclusion: Children can be adequately screened for age assessment from x rays of the hands in the early stages (upto 2 and half years) and later the elbows. We propose the use of knees lateral for patellar centre for children more than 3 and less than 6.

Comparative Evaluation of the Efficacy of Hand-Wrist and Cervical Vertebrae Radiography for the Determination of Skeletal Age.

BackgroundPrediction of skeletal growth is necessary for growth modification and surgical orthodontic treatments and is usually done by assessing skeletal maturity indicators in hand-wrist radiographs. The use of growth stages of cervical vertebrae in lateral cephalograms has been suggested to avoid overexposure.ObjectivesThis study seeks to assess the degree of agreement between hand-wrist and cervical vertebrae maturation stages for skeletal age determination and prediction of the peak growth spurt (PGS).Patients and MethodsThis cross-sectional study was conducted with 67 boys and 66 girls between 8 and 18 years of age, divided into 11 age groups; 266 hand-wrist radiographs and lateral cephalograms were obtained and analyzed. Hand-wrist maturation stages were evaluated according to the Grave and Brown, Bjork system (stages 1 - 9). The cervical vertebral maturation stage (CVMS) was determined on lateral cephalograms based on a system described by Baccetti et al. (CVMS 1-5). To apply the Cohen’s kappa index, the stages of growth were reduced to 5 intervals (A - E) to relate the 5 CVMS to the 9 stages of Bjork hand-wrist analysis.ResultsIn all age groups, the skeletal maturity stages of the hand and wrist bones and the cervical vertebrae of the girls were ahead of the boys. Cohen’s kappa test revealed a low level of agreement between the two methods [Kappa (95% CI) = 0.312 (0.290 - 0.377)]; concordance was slightly higher in males (K = 0.33 for males versus 0.27 for females). Evaluation of concordance coefficients between the stages determined by the two methods indicated the highest concordance in 8- and 9-year-olds and the lowest in 12- and 14-year-olds. The level of agreement between the two methods was only acceptable in 8- and 9-year-olds of both genders and 10-year-old boys. The level of agreement between the two methods in other age groups was not acceptable.ConclusionThe level of agreement between the two methods was low; thus, they cannot be used alternatively to estimate patients’ skeletal age or to predict the PGS. This may be due to the effect of different maturation levels (influenced by the environment, ethnicity, and gender) on the agreement between methods for skeletal age determination.

The growing spine : Normal and abnormal development

Growth of the pediatric spine occurs in phases. The first 5years of life are characterized by rapid growth. The lower extremities and trunk contribute equally to the entire growth by 50 % each. In the following years, until the onset of puberty, asteady but reduced rate of growth is observed. During these years aT1-S1 growth of only 1cm per year can be detected and the spine contributes only one third to the entire growth. Puberty consists of an acceleration phase lasting 2 years. In the first year of this phase the growth peak of the extremities and in the following year the growth peak of the spine can be noticed. The ensuing deceleration phase of puberty lasts for 3years. During that period the development of the Risser sign, menarche, and fusion of the trochanter epiphysis are taking place. Clinical parameters such as sitting height, standing height, and arm span may be used to evaluate growth. Important radiological parameters include the Risser sign, the determination of skeletal age according to Greulich and Pyle, and the T1-T12 height. The use of the olecranon method during the ascending phase of puberty can be recommended. Problems of the developing spine may include malformations, developmental disruptions or deformations. According to their manifestations they have a different prognosis, which can be estimated by knowledge of residual growth and the typical course of spinal growth in childhood.

Physical Improvement and Biological Maturity of Young Athletes (11-12 Years) with Systematic Training.

The aim of this study was to investigate the influence of systematic training in physical growth and biological maturity in prepubertal males and estimate how this affects the physical growth and skeletal maturity. 177 primary school students of the fifth and sixth grade, from schools in Alexandroupolis, participated voluntarily in our study. Questionnaires were used in order to measure physical activity levels. The subjects were subdivided into two groups; control group (prepubertal, whose physical activity was the physical education of their school and which had never participated in systematic training, n = 95) and experimental group (prepubertal, whose weekly physical activity included physical education in their schools and additionally 3-4 training units organized training in various sports clubs in the city, n = 82). The following parameters were recorded: biological age measured by determination of skeletal age; bone density measured by ultrasound methods; anthropometric and morphological features such as height, body composition, selected diameters, circumferences and skinfolds; motor ability features. The experimental group exhibited older biological age (p = 0.033), higher bone density (p < 0.001), lower BMI and body fat (p < 0.001), better anthropometric features and higher performance throughout all motor ability tests (p < 0.05), compared to the control group. The present study demonstrates that systematic physical activity has a positive effect on both the physical and biological maturity of pre-pubertal children. This effect is mainly expressed in bone strengthening as a result of the increased bone density and in improvement of the kinetic skills of pupils who participated in organized extracurricular sport-activities.

Determination of Skeletal Age in Nigerian Children: Applicalibility of the Greulich and Pyle Atlas

Determination of Skeletal Age in Nigerian Children: Applicalibility of the Greulich and Pyle Atlas

The applicability of Greulich and Pyle atlas to assess skeletal age for four ethnic groups

BackgroundRecently, determination of skeletal age, defined as the assessment of bone age, has rapidly become an important task between forensic experts and radiologists. The Greulich–Pyle (GP) atlas is one of the most frequently used methods for the assessment of skeletal age around the world. After presentation of the GP approach for the estimation of the bone age, much research has been conducted to examine the usability of this method in various geographic or ethnic categories. This study investigates on a small-scale and compares the reliability of the GP atlas for assessment of the bone age for four ethnic groups – Asian, African/American, Caucasian and Hispanic – for a different range of ages. Materials and methodsPlain radiographs of 184 left hands and wrists for males from the healthy sample between 1 to 18 years of age for four ethnic groups were taken. The skeletal age (SA) was estimated by a radiologist using the GP atlas. The blind method was utilized. The mean (SA) results were compared with mean chronological ages (CA) for the separate ethnic groups. SPSS was used to conduct the analysis and the paired t-test was applied to show the difference between the mean CA and mean SA achieved from the GP atlas. ResultsThe results from the GP atlas were compared to the CA of the samples. In Asian subjects the mean difference was 0.873 years. The GP atlas showed delayed bone age at 2–7 ages (from 0.2 to 2.3 year) and then advanced bone age for age 8. In the African/American subjects the difference between CA and SA was statistically significant (P-value = 0.048). The mean difference in the Caucasian and Hispanic subjects reflects no considerable distinction with a standard deviation (SD) of 0.3088 and 0.3766, respectively, (P-value >0.05 for both groups). ConclusionAccording to the present study, it is concluded that although the GP atlas is reliable for Caucasian and Hispanic ethnic groups it is not applicable for other ethnic groups for different ranges of age, especially in the sample of the male African/American group from 8 years to 15 years and Asian during childhood. Although it is not clear whether the other references are more useful than this standard, we believe that some enhancement is vital for the GP atlas to obtain more consistent results.

Can orthopaedic clinicians learn to read skeletal bone age? An inter- and intra observer study between specialties

Determination of skeletal age is essential for predicting eventual leg length discrepancies and predicting the accurate timing for surgical intervention in order to correct any discrepancy. To our knowledge, there has not been an interdisciplinary comparison of the degree of agreement in determining skeletal bone age. We evaluated 30 left hand/wrist radiographs (children aged 16months to 10years 6months) on two separate occasions between musculoskeletal paediatric radiologists, paediatric orthopaedic surgeons and a senior radiographer after appropriate training. All clinicians were able to reliably age patients with good intra- and interobserver agreement. We suggest that following tuition, orthopaedic surgeons are able to reliably age patients from X-rays.

Sonographic measurement of calcaneal volume for determination of skeletal age in children

The purposes of this study were first to prospectively evaluate the feasibility of using sonographic measurements of volume of the ossified part of the calcaneus to determine skeletal age in healthy children and second, to provide normal ranges of this volume by sex and age up to 6 years. Four hundred normal girls and boys ranging in age from 1 day to 6 years were examined sonographically to determine the volume of the calcaneal ossification center. The children were randomly divided into 2 groups. The first group (300 children) was used to determine normal values for the mean calcaneal volume by age and sex. The second group (100 children) was used to validate those normal values. The sonographically determined volume of the calcaneal ossification center correlated well with the chronologic age of the children. The calcaneal ossification centers of boys were larger than those of girls within the same age groups from ages 2 to 10 months, but from 11 months to 6 years old, they were larger in the girls. The differences, however, were not statistically significant. The volume of the calcaneal ossification center increased the most between the first and second years of life, reaching 183% and 140% in girls and boys, respectively. Using the normal values obtained from the first group, we correctly predicted the chronologic age in 91% of children in the validation group. Among the remaining 9%, the error in prediction of chronologic age never exceeded 1 age interval. The use of sonography provides a quantitative means of measuring calcaneal volume, and its use is feasible for determining skeletal age in children. The normal values we obtained may be used as a baseline for sonographic assessment of skeletal maturation and diagnosis of growth retardation.

Bone age in children of diverse ethnicity.

Determination of skeletal or bone age is often used in pediatrics and orthopedics. The most commonly used bone age standards in the United States, those published by Greulich and Pyle, were derived from white children of the upper socioeconomic class in 1931-1942. We examined whether these standards apply to the current assessment of bone age in children of diverse ethnicity. Hand radiographs of children less than 19 years old at our institution were evaluated for bone age using the standards of Greulich and Pyle. Differences between bone age and chronologic age were calculated, and the mean differences were compared among subgroups of children on the basis of sex, age, and ethnicity. In Asian and white girls, bone age approximated chronologic age throughout childhood, with the only significant discrepancy being in adolescent white girls, in whom bone age exceeded chronologic age by an average of 4 months. In black girls, bone age exceeded chronologic age except during middle childhood. In late childhood and adolescence, bone age exceeded chronologic age by approximately 10 months. In Hispanic adolescent girls, bone age exceeded chronologic age by nearly 9 months. In black adolescent boys, bone age exceeded chronologic age by 5 months, with no significant discrepancies between bone age and chronologic age at other ages. In white preadolescent boys, bone age lagged behind chronologic age to a statistically significant degree, ranging from approximately 4 to 8 months. Preadolescent Asian boys also showed significant delays in bone age, particularly in middle childhood, when bone age lagged behind chronologic age by nearly 15 months. In adolescent Asian boys, bone age exceeded chronologic age by 9 months 15 days. In adolescent Hispanic boys, bone age exceeded chronologic age by 11 months 15 days. In younger Hispanic boys, delays in bone age occurred but were significant only in early childhood (4-month delay). Using the standards of Greulich and Pyle to determine bone age must be done with reservations, particularly in black and Hispanic girls and in Asian and Hispanic boys in late childhood and adolescence, when bone age may exceed chronologic age by 9 months to 11 months 15 days.

Precision of sonographic measurement of articular cartilage: inter- and intraobserver analysis

To establish the precision of sonographic measurement of the thickness of the articular cartilage of the hip and knee in children. The precision was assessed by evaluating the intra- and interobserver variations in sonographic measurements. A total of 65 healthy children were in the study. The articular cartilage of the right hip and knee of 40 subjects (mean age 10.3 years, range 4-16.9 years) was evaluated in masked fashion by two observers to assess the interobserver variability. The articular cartilage of the right hip and knee of 25 children (mean age 10.4 years, range 6.2-15.5 years) was examined twice by the same observer to assess the intraobserver variability. Discrepancies between repeated measurements were expressed as data differences. The "limits of agreement" of data differences, i.e. the mean +2 SD and the mean -2 SD, ranged from -0.26 to +0.22 mm and from -0.56 to +0.48 mm for the interobserver analysis of the femoral head cartilage (FHC) and femoral condylar cartilage (FCC), respectively. The "limits of agreement" for the intraobserver analysis ranged from -0.16 to +0.15 mm and from -0.51 to +0.41 mm for the FHC and the FCC, respectively. The overall precision of the sonographic measurements was satisfactory. When used for determination of skeletal age, sonographic assessment of FHC thickness resulted in under/overestimation of skeletal age by about 7.5 months. In conclusion, sonographic measurement of articular cartilage is precise enough to be used in clinical practice.

Determination of skeletal age in children with Osgood-Schlatter disease by using radiographs of the knee.

We determined the skeletal age in 26 children (12 girls, 14 boys) with Osgood-Schlatter disease using knee radiographs. The average chronological age was 13.2 +/- 2.2 years, and the average bone age was 13.1 +/- 2.3 years (p > 0.01). All but one of the skeletal ages fell within the normal range. Skeletal maturation in children with Osgood-Schlatter disease is thus normal. With normal skeletal maturation and normal physes histologically (previously shown), it is unlikely that an abnormality of physeal development or structure is the etiology of Osgood-Schlatter disease. Rather, it is most likely a result of tensile stresses on the tibial tuberosity. This is in contrast to slipped capital femoral epiphysis, another common disorder affecting children of the same ages as those with Osgood-Schlatter disease, in which physeal abnormalities and skeletal maturation anomalies do occur.

Skeletal age determination in young children: analysis of three regions of the hand/wrist film.

The determination of skeletal age in young children is useful in predicting eventual leg length discrepancies, but underreading of skeletal age may result in predicting the ultimate leg length to be much longer than it actually will be, with a correspondingly larger discrepancy as well. We evaluated 100 hand/wrist radiographs of 45 children aged between 14 months and 9.8 years. Separate readings were taken of the distal radius and ulna, the carpal bones, and the metacarpals and phalanges. The discrepancy between bone ages and chronologic age was significantly different between regions of the hand and between sexes. When determining bone age in children under age 10 years, care should be taken to consider the entire hand, perhaps with less emphasis on the carpal bones.

Chronological metamorphosis of the auricular surface of the ilium: A new method for the determination of adult skeletal age at death

A new method for the determination of adult skeletal age at death based upon chronological changes in the auricular surface of the ilium is presented. Formal stages have been constructed following extensive tests and refinements in observations made of such changes. Two completely "blind" tests were conducted to assess the accuracy and bias of the new method. Results show that the system is equally accurate to pubic symphyseal aging (although somewhat more difficult to apply), and also carries the advantages of a higher preservation rate for the auricular surface in archaeological populations and continued age-related change beyond the fifth decade.

Determination of skeletal age by histological methods

Determination of skeletal age by histological methods

Study on the Determination of Skeletal Age as an Index of Maturation

Study on the Determination of Skeletal Age as an Index of Maturation