SKELETAL MATURITY INDICATORS
INTRODUCTION
Synonymous terms: biological age, skeletal age, bone age and skeletal maturation
Ideal characteristics of anatomical site:
a) Easily acccessible
b) Contain skeletal units that mature at ifferent timigs and the timings can be standardised
METHODS
1. Hand-wrist radiograph
2. Cervical vertebrae evaluation
3. Examination of stages of tooth development
HAND-WRIST RADIOGRAPHS
Osseous changes – inicators of general skeletal growth
Indications:
a) Marked discrepancy between chronological age an skeletal age
b) Treatment of skeletal class II or class III malocclusion
c) Assess skeletal age in patient whose normal growth is affected by general factors
d) Predict timing and variation of pubertal growth spurts
e) Helps to know whether active growth period is terminated
f) Role of heredity, environment and nutrition on skeletal maturation pattern
ANATOMY OF HAND-WRIST
1. Distal ends of long bones of forearms: radius and ulna
2. Carpals(wrist bones):
Proximal row: scaphoid, lunate, triquetral and pisiform
Distal row: trapezium, trapezoid, capitate and hamate
3. Metacarpals(palm bones): numbered 1-5 starting from thumb to little finger
Primary ossification center: shaft
Secondary ossification center:
Distal end ( metacarpals 2-5)
Proximal end( metacarpal 1)
4. Phalanges : Each finger except thumb- 3 phalanges; thumb – 2 phalanges
5. Sesamoid bone – small nodular bone embedded in tendons in region of thumb
ANATOMY OF HAND-WRIST
Ossification stages of phalanges:
METHODS OF SKELETAL MATURITY ESTIMATION
1 Atlas method - Gruelich and Pyle
2 Bjork, Grave and Brown method
3 Singers method of assessment
4 Fishman’s skeletal maturity indicators
5 Hagg and Taranger method
ATLAS METHOD
Greulich and Pyle
Given ideal pictures of hand and wrist radiographs for different chronological ages and for each sex.
Each photograph in the atlas is representative of a particular skeletal age.
The patient’s radiograph is matched on an overall basis with one of the photographs in the atlas
BJORK, GRAVE AND BROWN METHOD
Given by Bjork (1972)
Later modified by Grave and Brown (1976).
Divided the entire maturational process of the bones of hand between ages 9 and 17 into 9 stages.
Each of these stages represents a level of skeletal maturity.
A total of 14 ossification points were utilized.
SINGER’S METHOD OF ASSESSMENT
Julian Singer in 1980
Proposed a system of hand – wrist radio-graph assessment.
Helps the clinician to rapidly determine the maturational status of the adolescent patient.
FISHMAN’S SKELETAL MATURITY INDICATORS
Leonord S Fishman in 1982
Four anatomical sites located on the thumb (adductor sesamoid), third finger, fifth finger and radius.
MATURATION ASSESSMENT BY HAGG AND TARANGER
Hagg and Taranger (1982)
Sesamoid:
Sesamoid is usually attained during the beginning of acceleration period of the pubertal
growth spurt (onset of peak height velocity - PHV)
Third finger of mile phalanx(MP3)
MP3-F: The epiphysis is as wide as the metaphysis. This stage indicates that more than 80% of
pubertal growth remaining.
MP3-FG: The epiphysis is as wide as the metaphysis and there is distinct medial and lateral border of
the epiphysis forming a line of demarcation at right angles to the distal border. This stage indicates
the accelerating slope of the pubertal growth spurt is attained 1 year before or after peak height.
MP3-G: The sides of epiphysis have thickened and also cap its metaphysis, forming a sharp edge
distally at one or both sides. This stage is attained at about peak height of pubertal growth spurt.
MATURATION ASSESSMENT BY HAGG AND TARANGER
MP3-H: This stage is characterized by the beginning of fusion of the epiphysis and metaphysis. This
stage is indicated by the decelerating slope of the PHV but before end of growth spurt. 47.
MP3-I: This stage is characterized by the completion of fusion of the epiphysis and metaphysis. This
is attained at the end of growth spurt in all subjects except a few girls.
Third Finger Distal Phalanx
DP3-I: Fusion of the epiphysis and metaphysis is completed. It indicates the decelerating period of
the pubertal growth spurt (i.e., end of PHV) by all subjects.
Radius:
R-I: Fusion of the epiphysis and metaphysis on radius has begun. This stage is attained 1 year before
or at the end of growth spurt by about 80% of the girls and about 90% of the boys.
R-IJ: Fusion is almost completed but there is still a gap between the margins
R-J: is characterized by complete fusion of the epiphysis and metaphysis
INFERENCE FROM HAND-WRIST RAIOGRAPH
SKELETAL MATURATION EVALUATION USING CERVICAL VERTEBRAE (CVMI) -
HASSEL AND FARMAN
Shapes of the cervical vertebrae change according to the each level of skeletal development.
Indicates the amount of skeletal maturity of a person and thereby gives an idea of how much
residual growth potential is left over.
Changes in shape:
a) Shapes of C3 and C4 change from wedge shape to rectangular to square
b) Vertical height increases with progress of skeletal maturity
c) Inferior borers are initially flat when immature ; concavities increase with maturation
