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A practical tip for estimating skeletal maturation in children aged < 3 years using humeral ossification on chest

Tomohiro Tsuru1, Shota Inoue1, Hiromi Edo2

  • 1Department of Pediatrics, National Defense Medical College, Saitama, Japan.

European Journal of Pediatrics
|January 29, 2026
PubMed

Insights

Assessing bone age in young children is challenging. This study shows humeral head ossification on chest X-rays provides a reliable method to estimate skeletal age in children under three years old.

Area of Science:

  • Pediatric Radiology
  • Skeletal Development
  • Medical Imaging Analysis

Background:

  • Bone age assessment in children under three years old is difficult due to underdeveloped carpal ossification centers.
  • Traditional hand-based methods for bone age assessment are often unreliable and necessitate additional imaging.

Purpose of the Study:

  • To evaluate skeletal maturation patterns in relation to chronological age using humeral ossification on chest radiographs in children under three years.
  • To establish reference ranges and estimation formulas for skeletal age assessment.

Main Methods:

  • Retrospective review of 187 chest radiographs from children aged 0 to <3 years.
  • Independent measurement of the humeral head epiphyseal ossification centre's longitudinal diameter by three readers.
  • Statistical analysis including interobserver agreement (ICC), Pearson's correlation, and linear regression.

Main Results:

  • A strong positive correlation (r > 0.88) was found between ossification centre diameter and chronological age.
  • Excellent interobserver agreement (ICC = 0.96) was achieved.
  • Established reference ranges (±2 SD) and sex-specific simplified estimation formulas for practical clinical use.

Conclusions:

  • Routine chest radiographs offer a simple, reproducible supplementary tool for assessing skeletal maturation in children under three years.
  • This method allows for the approximation of chronological age without requiring additional imaging.
  • The humeral head ossification provides a robust indicator of skeletal development in this age group.

Keywords:
Chest radiographyHumeral head ossification centrePaediatric growth assessmentSkeletal maturation

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