Early and Midpuberty

Females: 7years to 13 years of age Males: 9 years to 14 years of age

As in pre-pubertal children, assessments of skeletal maturity in early and mid-puberty are also based on the size of the epiphyses in the distal phalanges (first) and the middle phalanges (second). The epiphyses at this stage continue to grow and their widths become greater than the metaphy-

Fig. 8. Depiction of the progressive growth of the epiphyses, which, during this stage of development, become larger than the metaphyses. Special attention is also placed on epiphyseal shape, which, prior to epiphyseal fusion, overlaps the meta-physes, depicting tiny hornlike structures at both ends of the epiphysis (picture at far-right)

Fig. 8. Depiction of the progressive growth of the epiphyses, which, during this stage of development, become larger than the metaphyses. Special attention is also placed on epiphyseal shape, which, prior to epiphyseal fusion, overlaps the meta-physes, depicting tiny hornlike structures at both ends of the epiphysis (picture at far-right)

Fig. 9. During this stage of development, like for prepubertal and late-pubertal children, assessments are based primarily on the distal and middle phalanges ses. Thereafter, the contours of the epiphyses begin to overlap, or cap, the metaphyses. This capping effect is depicted in a two-dimensional radiograph as small bony outgrowths, like tiny horns, on both sides of the shaft.

The pisiform and the sesamoid in the tendon ofthe abductor pollicis, just medial to the head of the first metacarpal, become recognizable during puberty. However, these centers, as well as those of the other carpals and metacarpals, are less reliable as indicators of bone age at this stage of development.

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