Bone age is an attempt to quantify developmental age as seen in bone maturation on X-ray. In some ways it is a reflection of physiological growth and should be compared with height age and chronological age to assess the child's growth status. In normal children, bone age is an accurate reflection of physiological growth; however, in syndromes, growth disturbances, and osteochondrodysplasias (either undergrowth or overgrowth) it may be quite inaccurate. Assessment of bone age is further complicated by differences in the techniques used. Each technique is more or less useful under various circumstances. In spite of these problems, bone age assessment is an important and useful technique in describing the growth and physiological state of a child. It can also be used to predict ultimate height with some accuracy.
Assessment of bone age is dependent on the evolving appearance and growth of epiphyseal growth centers particularly in long bones. In the normal child, there is a predictable pattern of ossification and growth. Two main methods of determining bone age are used:
1. evaluation of the appearance of ossification centers throughout the body;
2. observation of growth and changes in a specific epiphysis or epiphyses and comparison with standards, such as for the hand (Greulich and Pyle) or the knee (Pyle and Hoerr).
In general, appearance of the ossification centers of the feet and knees is thought to be most useful in the young child. After two years of age, changes in specific epiphyses (such as in the hands) are most accurate.
When taking X-rays to establish bone age, one should estimate approximate age to determine which will be the most useful films. Figure 13.1 will help to predict which areas should be studied. The observed areas of ossification are identified and compared to the expected age of ossification (Figs 13.2-13.6). The closest match is determined to be the present bone age.
Age of child in years
Regions and radiographs
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