Combined Skeletal Age of Hand, Elbow, and Pelvis X-Rays: A Pilot Retrospective StudyNyaluma N. Wagala1, Joanne Abby M. Marasigan, MD1, Richard M. Schwend, MD2

1University of Missouri-Kansas City, Kansas City, MO 2Children’s Mercy Hospital, Kansas City, MO

INTRODUCTION• Identifying skeletal age (SA) is important in

disease treatment dependent on growth, including adolescent idiopathic scoliosis (AIS).

• No true gold standard exists for SA, therefore several radiographic (XRs) methods are used including hand, elbow, pelvis, and knee XRs.

• Most commonly used is a left hand XR.• Determining SA using hand, elbow, and pelvis

XRs is common practice in our pediatric spine clinic. However no published studies exist that evaluate the combined use of all 3.

• Our primary objectives are to identify the 3 SA methods, 1 method per XR, that best correlates with chronological age (CA); and determine if using 3 XR methods correlates better with CA than any 1 or 2 XR methods.

• Our secondary objectives are to perform sub-analyses with regards to sex, race, and age ranges as our data allows

METHODS• Retrospective cross-sectional chart review of

225 pts evaluated at our New Patient Spine Clinic. 109 pts were included, 92 girls, 17 boys.

• Inclusion: AIS, 2012-2018, girls 9-15yrs, boys 11-17yrs, all XRs obtained on same date

• Exclusion: History affecting XRs obtained, osseous abnormalities, inadequate XRs

• 3 blinded evaluators: senior attending, junior attending, and senior resident

• Hand XR: Greulich and Pyle, Tanner-Whitehouse 3 (TW3), and Sanders;

• Elbow XR: Dimeglio• Pelvis XR: Risser sign and tri-radiate

RESULTS AND DISCUSSION• Results pending

REFERENCES• Reynolds, E. Radiographic atlas of skeletal development of the hand and wrist. By

W. W. Greulich and S. I. Pyle. Stanford University Press. 1950.• Tanner, J.M. Assessment of Skeletal Maturity and Prediction of Adult Height (TW3

Method). 3rd Bk&CD edition. Healy M., Goldstein H., and Cameron N. W.B. Saunders, 2001.

• Sanders JO, Khoury JG, Kishan S, et al. Predicting scoliosis progression from skeletal maturity: a simplified classification during adolescence. J Bone Joint Surg Am. 2008 Mar;90(3):540-53.

• Diméglio A, Charles YP, Daures JP, de Rosa V, Kaboré B. Accuracy of the Sauvegrainmethod in determining skeletal age during puberty. J Bone Joint Surg Am. 2005 Aug;87(8):1689-96. PubMed PMID: 16085606.

• Brand RA. 50 years ago in CORR: the iliac apophysis: an invaluable sign in the management of scoliosis Joseph C. Risser MD CORR 1958;11:111-119. Clin OrthopRelat Res. 2008 Jun;466(6):1516-7.

Fig 1. PA hand XR

Fig 3. Dimeglio method of olecranon.

Figure 2. Risser Classification of iliac apophysis

HYPOTHESIS• We believe using these 3 XRs to determine SA

correlates with CA better than any combination of 1 or 2 XR SA methods alone, and will be a better evaluation of growth remaining.

Fig 2. Distal radius TW3 method

Fig 3. Stages 5-8 of Sanders classification

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