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Skeletal age estimation in leg length discrepancy.

P Cundy1, D Paterson, L Morris

  • 1Department of Orthopaedic Surgery, Adelaide Children's Hospital, Australia.

Journal of Pediatric Orthopedics
|September 1, 1988
PubMed
Summary
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Radiologists show significant variation when estimating skeletal age from hand radiographs in children with leg length discrepancy. This variability, especially in females, can impact surgical timing for leg length equalization.

Area of Science:

  • Pediatric Orthopedics
  • Radiology
  • Skeletal Age Assessment

Background:

  • Leg length discrepancy (LLD) is a common pediatric orthopedic condition.
  • Accurate skeletal age assessment is crucial for predicting growth and planning surgical interventions like leg length equalization.
  • The Greulich and Pyle Atlas is a widely used method for skeletal age estimation.

Purpose of the Study:

  • To evaluate the inter-observer reliability of skeletal age estimation using the Greulich and Pyle Atlas in children with LLD.
  • To identify potential biases in skeletal age assessment for this specific pediatric population.
  • To determine the impact of skeletal age variability on the timing of orthopedic surgery.

Main Methods:

  • A "blind" review of sixty hand radiographs from children with known LLD was conducted.

Related Experiment Videos

  • Four independent radiologists assessed skeletal age using the Greulich and Pyle Atlas.
  • Statistical analysis was performed to assess inter-observer variation and potential gender-based differences.

    • Main Results:

    • Significant inter-observer variation in skeletal age assignment was observed.
    • Fifty percent of children had skeletal age estimates differing by over 1 year between radiologists.
    • Female skeletal age was underestimated by an average of 11 months, and variability was higher in children with LLD.

    Conclusions:

    • Skeletal age estimation using the Greulich and Pyle Atlas demonstrates considerable variability among radiologists in children with LLD.
    • This variability is a significant source of error in surgical timing for leg length equalization.
    • Skeletal age assessment appears less reliable in children with leg length discrepancy, particularly for females.