Applicability of Shoulder, Olecranon, and Wrist-based Skeletal Maturity Estimation Systems to the Modern Pediatric Population

Furdock, Ryan; Kuo, Andy; Chen, Kallie J.; Liu, Raymond W.

doi:10.1097/bpo.0000000000002430

Cited by 4 publications

(1 citation statement)

References 26 publications

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“…Third, another study compared updated versions of the modified Fels, olecranon apophyseal ossification system, and proximal humeral ossification systems with the classic Greulich and Pyle (GP) system. There were relatively small differences between the methods, mostly based on race and sex 62 .…”

Section: Evaluating Skeletal Age and Maturitymentioning

confidence: 97%

What’s New in Pediatric Orthopaedics

Hardesty

2023

Journal of Bone and Joint Surgery

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InfectionPediatric acute hematogenous osteomyelitis can cause severe illness in children, and a study from New Zealand found that the development of acute (early) complications was more likely to occur if the C-reactive protein (CRP) failed to reduce by 50% at days 4 and 5 after the initiation of treatment 12 . Furthermore, Disclosure: The Disclosure of Potential Conflicts of Interest form is provided with the online version of the article (http://links.lww.com/JBJS/H805).

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Section: Evaluating Skeletal Age and Maturitymentioning

confidence: 97%

What’s New in Pediatric Orthopaedics

Hardesty

2023

Journal of Bone and Joint Surgery

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Proposed complementary osteological indicators: Advancing the estimation of puberty stages in Bioarcheology

Bareggi,

Giuffra,

Riccomi

2024

American Journal of Biological Anthropology

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ObjectivesThe study of puberty is a well‐established area of bioarcheological research, which greatly enhances our understanding of adolescence and growth in the past. Since the publications of Shapland and Lewis' works, which have become “standards” for estimating puberty in skeletal material, no additional osteological indicators of puberty have been proposed. Nevertheless, clinical practice constantly develops skeletal maturation markers that could be useful in bioarcheology. This study aims to assess the applicability and reliability of novel puberty indicators as a complementary tool to estimate puberty in skeletal remains.Materials and MethodsFour new maturation markers including spheno‐occipital synchondrosis, humeral head ossification, calcaneal apophysis ossification, and mandibular premolar mineralization were selected and applied to a sample of 85 adolescents from pre‐Roman southern Italy (Pontecagnano, 7th–4th BCE).ResultsDespite some limits in adapting the original clinical methods to osteoarcheological material, the use of these novel skeletal indicators had moderate to excellent scoring repeatability and an overall high agreement with the puberty and menarche status previously estimated with standard methods. These results encourage us to apply these markers in bioarcheology. In some cases, minor adaptations of the original scoring systems are suggested to enhance reliability.DiscussionIncluding the proposed indicators in routine puberty data collection allows us to refine puberty estimation and improve the ability to identify key growth milestones in poorly preserved skeletons. Further application to osteological collections with diverse chronology and geographical differences is needed to assess how and to what extent the newly proposed maturation markers perform.

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The Addition of Hand-specific Skeletal Maturity Parameters Does Not Improve Skeletal Maturity Estimation Accuracy of the Modified Fels Wrist System

Sinkler,

Furdock,

Halloran

et al. 2024

Journal of Pediatric Orthopaedics

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Background: The Modified Fels Wrist system is potentially the most accurate clinically accessible skeletal maturity system utilizing hand or wrist radiographs. During development, parameters distal to the metacarpals were excluded. We attempted to further optimize the Modified Fels wrist system through the inclusion of hand parameters distal to the metacarpals. Methods: Forty-three new anteroposterior (AP) hand radiographic parameters were identified from the Fels and Greulich and Pyle (GP) skeletal maturity systems. Twelve parameters were eliminated from further evaluation for poor correlation with skeletal maturity, poor reliability, and lack of relevance in the peripubertal years. In addition to the 8 previously described Modified Fels Wrist parameters, 31 hand radiographic parameters were evaluated on serial peripubertal AP hand radiographs to identify the ones most important for accurately estimating skeletal age. This process produced a “Modified Fels hand-wrist” model; its performance was compared with (1) GP only; (2) Sanders Hand (SH) only; (3) age, sex, and GP; (4) age, sex, and SH; and (5) Modified Fels Wrist system. Results: Three hundred seventy-two radiographs from 42 girls and 38 boys were included. Of the 39 radiographic parameters that underwent full evaluation, 9 remained in the combined Modified Fels Hand-Wrist system in addition to chronological age and sex. Four parameters are wrist specific, and the remaining 5 are hand specific. The Hand-Wrist system outperformed both GP and SH in estimating skeletal maturity (P<0.001). When compared with the Modified Fels Wrist system, the Modified Fels Hand-Wrist system performed similarly regarding skeletal maturity estimation (0.36±0.32 vs. 0.34±0.26, P=0.59) but had an increased (worse) rate of outlier predictions >1 year discrepant from true skeletal maturity (4.9% vs. 1.9%, P=0.01). Conclusions: The addition of hand parameters to the existing Modified Fels Wrist system did not improve skeletal maturity estimation accuracy and worsened the rate of outlier estimations. When an AP hand-wrist radiograph is available, the existing Modified Fels wrist system is best for skeletal maturity estimation. Level of Evidence: Level III.

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Applicability of Shoulder, Olecranon, and Wrist-based Skeletal Maturity Estimation Systems to the Modern Pediatric Population

Cited by 4 publications

References 26 publications

What’s New in Pediatric Orthopaedics

What’s New in Pediatric Orthopaedics

Proposed complementary osteological indicators: Advancing the estimation of puberty stages in Bioarcheology

The Addition of Hand-specific Skeletal Maturity Parameters Does Not Improve Skeletal Maturity Estimation Accuracy of the Modified Fels Wrist System

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