Bone age and chronological age1/10/2024 A more recent study compared the atlas-based and bone-specific techniques using a large sample of children aged 2 to 15 years. In contrast, another study assessed 362 bone ages by the same methods and concluded that they do not give equivalent bone age estimates and that the TW2 method was more reproducible. A small study found that the method of Greulich and Pyle was as reproducible as the TW2 method. These methods for assessment of skeletal maturity are difficult to compare. The Fels method is less frequently used and differs in the chronological ages at which assessments are possible, maturity indicators and the scale of maturity. These maturity indicators were then evaluated not in relation to chronological age, but in relation to their appearance within the full passage of each specific bone from immaturity to maturity. They defined a series of eight maturity indicators for each bone of the hand and wrist and nine for the radius. The original system (TW1) was refined and published as TW2 and, recently, as TW3. A diffuse method based on these principles was conceived by Tanner and Whitehouse and named TW after their initials. The result of such a system would provide maturity standards for each bone considered. Īs an alternative to atlas-based techniques, other methods were developed that independently assess the maturation of each bone. The models were generated through rigorous analyses of the maturation of each ossification center in the hands and wrists of healthy children and the construction of virtual images that incorporate composites of the average development for each ossification center in each age group. Recently, these obstacles were circumvented through the selection of an alternative approach: the creation of artificial, idealized, sex- and age-specific images of skeletal development. However, the design of computer algorithms capable of automatically rendering bone age has been impeded by the complexity of evaluating the wide variations in bone mineralization tempo, shape and size encompassed in the large number of ossification centers in the hand and wrist. With the advent of digital imaging, multiple attempts have been made to develop image-processing techniques that automatically extract the key morphological features of ossification in the bones to provide a more effective and scientific approach to skeletal maturity assessments. The Greulich-Pyle atlas is founded on the assumption that the skeleton matures in a uniform fashion and is based on a reference collection of radiographs from normal Caucasian children of high socioeconomic status at different chronological ages. All use left hand and wrist radiographs to estimate a bone age, but the former differs in concept and method from the latter two. There are several methods to assess skeletal maturity, but the most commonly used in clinical practice is the atlas-based technique of Greulich and Pyle, followed by the Tanner–Whitehouse bone-specific scoring technique and the Fels method. Indeed, children with the same bone age may have very divergent bone dimensions and chronological age associated to full skeletal maturity varies greatly among subjects. Moreover, skeletal maturation is only related to bone size in very general terms. Skeletal maturation is a temporal process only loosely linked to chronological age and, while expressed in years and months, there is no constant relationship between bone and chronological age. Although measures of skeletal maturation are often confused with measures of skeletal growth, growth and maturation reflect different processes growth represents a quantitative increase in size or mass, while maturation is a sequence of changes that lead to a highly organized, specialized and mature state. Assessments of skeletal maturation are frequently used as a diagnostic tool to evaluate clinical conditions associated with generalized growth abnormalities, to monitor response to medical treatment and to determine the growth potential of children. Skeletal maturity is a measure of development incorporating the size, shape and degree of mineralization of the epiphyses and physeal plates of bone to define their proximity to full maturity. Stefano Mora, Vicente Gilsanz, in Osteoporosis in Men (Second Edition), 2010 Skeletal Maturation
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