Approach to skeletal maturation

Skeletal maturation is marked by an orderly and reproducible sequence of recognizable changes in the appearance of the skeleton during childhood. Such changes include the timing and sequence of the appearance of the centers of ossification, specific alterations in the contours of the bones, and the timing and sequence of the ultimate closure of the growth plates. Radiographically, skeletal maturity can be assessed by comparing the radiographic appearance of portions of an individual child's skeleton with the standardized appearance in a comparable population of children at various stages in their progress toward maturity. Radiographic assessment of skeletal maturity in the child is most frequently based on the appearance of the hand and wrist. Considerable normative data are available for this examination. The Greulich-Pyle atlas is the system which is most frequently used in the United States. Assessment of skeletal maturity can be useful in the evaluation and management of children with various endocrinopathies (especially those involving the pituitary, thyroid, and gonads) and in children with malformation syndromes. Skeletal maturity assessment is also frequently requested as part of the evaluation of children who are either too tall or too short for their chronologic age and can be used to predict height at maturity. Such assessment can also be useful in planning orthopedic procedures in which the outcome may be influenced by subsequent growth of the child (e.g., surgical management of scoliosis or leg-length discrepancy).