Differences between the hand–wrist and the knee in assigned skeletal ages

Abstract

Skeletal ages were assessed for 4,902 pairs of hand-wrist and knee radiographs of children aged 2-17 years. The FELS method was used to assess the hand-wrist, and the RWT method was used to assess the knee. These methods have the same conceptual and statistical basis. The mean absolute differences, within age- and sex-specific groups, ranged from 0.34 to 0.87 years. The SD of the differences ranged from 0.31 to 0.68 years and, like the means, tended to increase with age until about 8-11 years. The means and SD were generally larger for the boys than for the girls, except after 14 years. Within age- and sex-specific groups, the maximum absolute differences were from 1.45 to 2.99 years. These maximum differences changed irregularly with age but tended to increase until 11 years in the boys and 9 years in the girls. These large absolute differences between the skeletal ages of the hand-wrist and the knee cannot be explained completely by the effects of observer errors. The means of the relative (signed) differences between the skeletal ages of the hand-wrist and the knee were all close to zero, but there was a wide range within age- and sex-specific groups. These skeletal ages of the hand-wrist and the knee are not interchangeable. The 95th percentiles of the absolute differences show that, in at least 5% of children, the choice of the area for skeletal age assessment will markedly influence the evaluation of individuals. They also demonstrate that descriptions of populations based on distributions of skeletal ages from one part of the skeleton may be misleading.

Effect of familial distress on growth and maturation of girls: A longitudinal study

“…Observations by Anderson et al (1965). Xi andRoche (1990), andAicardi et al (2000) show that at the moment of full maturity of bones of the hand and wrist, ossification of the bones of the knee was not completed. Finally, several reports indicate accelerated sexual maturation in association with a stressful family environment (see Kim et al, 1997;Hulanicka, 1999).…”

Value of MRI of the hand and the wrist in evaluation of bone age: Preliminary results

“…Both methods rely on x‐ray radiographic examination of the hand and wrist. Although bone age assessment of only one part of the skeleton may sometimes be misleading, radiography of the hand is generally considered to be indicative of skeletal maturity ().…”

Assessment of skeletal maturity of the hand‐wrist and knee: A comparison among methods

“…Considerable independence between bone ages assessed at the hand-wrist and knee has been reported (Roche et al, 1975), reflecting the presence of important intraindividual differences in maturity levels of different skeletal areas. When examined by the FELS-RWT system, at least 5% of cases presented larger differences than could be attributed to unusually large observer errors (Xi and Roche, 1990). In addition, under conditions involving modifications in maturation tempo, the RWT method for the assessment of skeletal age of the knee proved to be less sensitive than the TW-RUS hand-wrist method in quantifying maturity advancement or delay (Vignolo et al, 1989).…”