Given the lack of ossification centers, skeletal maturity before age 3 months is often assessed on a conventional lateral radiograph of the lower leg and ankle. Width of distal and middle epiphyses greater than width of metaphysesĭegree of epiphyseal fusion of the radius and ulnaĮpiphyseal fusion in the ulna occurs before the radius Width of epiphyses approaches width of diaphyses distal epiphyses are most relevant Number of epiphyses visible in the tubular bones of the handĭistal phalanges (exceptions: distal phalanx of thumb earlier and middle phalanx of fifth ray later than the rest finally all epiphyses are formed) Ossification centers appear first in the capitate and hamate, finally in the distal radial epiphysis Ossification centers that best predict skeletal maturityĭevelopmental stages (relevant to skeletal age determination) Six stages in the ossification of the hand and wrist bones Schematic representation (source: Schmitt and Lanz 2008). Nelson 1959: 12–61 Skeletal development of the hand. Stuttgart: Thieme 2008 Stuart HC, Stevenson SS. Das typische Röntgenbild des Skeletts: Standardbefunde und Varietäten vom Erwachsenen und Kind. 17.2shows the order of appearance of the individual ossification centers, and Table 17.2lists the ages at which ossification centers appear in the carpals and metacarpals. The various methods of determining skeletal age are based on this developmental pattern. Specific ossification centers in different age groups are the best predictors of skeletal maturity ( Fig. The skeletal development of the hand can be divided into six stages. Indicators of Skeletal Development in the Hand Sesamoid bones do not appear until after 12 years of age and are variable in their temporal development and number. Puberty: Skeletal development concludes with epiphy-seal closure during puberty. The epiphyses of the radius and short tubular bones do not appear until the second year of life. The first ossification centers in the wrist become radiographically visible during the third month of life. Maturation of the epiphyses and ossification of the epiphyseal plates follows a timetable that is subject to intraindividual and interindividual variations. At birth, the diaphyses of all the tubular bones are present along with the epiphyseal ossification centers of the distal femur, proximal tibia, talus, calcaneus, and cuboid.Īfter birth: Postnatal longitudinal growth of the tubular bones parallels the ossification of the epiphyses and apophyses. Basically, the development of the skeleton proceeds in three consecutive stages:īefore birth: Ossification of the skeleton begins during the second month of intrauterine development. This process requires a fundamental knowledge of bone growth.
Wrist xray full#
The assessment of skeletal maturity is a process that evaluates the size and shape of bones and their degree of mineralization to predict the time remaining to full maturity. Practical implementation is difficult, however, because of interindividual differences in the rates of bone growth and the variable shape and size of many ossification centers. With the development and use of digital imaging techniques, there have been increasing attempts to determine the morphologic hallmarks of ossification using computer-assisted techniques to permit a more effective and objective determination. For decades, skeletal maturity was determined by making a visual assessment of the skeletal development of the hand and wrist. After 2 months of age, these values can be determined on a radiograph of the left hand because the hand bones, with their numerous secondary ossification centers, are considered representative of the skeletal system as a whole. When conventional radiographs are used, present skeletal age and predicted adult height can be calculated on the basis of statistical tables. Because radiographs alone do not meet the legal requirement of establishing age with a “probability bordering on certainty,” these cases additionally require a physical and dental examination (including a panoramic radiograph). In rare cases, skeletal age determination is also required in judicial proceedings to determine, for example, whether a suspect should be charged as a juvenile or an adult. It also allows for growth prediction, so skeletal age determination is important for orthopedic procedures in which it is essential to know the remaining potential for longitudinal growth. Skeletal age determination is carried out for the purpose of evaluating growth in pediatric patients and for the diagnosis of many endocrine disorders and pediatric syndromes. Skeletal age is considered the most important and most representative criterion of biological maturity.
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