Bone age assessment

In this presentation we will discuss the bone age assessment mainly focusing wrist radiograph.
we shall also highlights some points in adult bone age
Basically it is an introduction. We shall not discuss its judicial importance

1. Bone Age Assessment Dr. Muhammad Bin Zulfiqar Alnoor Diagnostic Centre

2. Introduction Bone age assessment is frequently performed in pediatric patients to evaluate growth and to diagnose and manage a multitude of endocrine disorders and pediatric syndromes For decades, the determination of bone maturity has relied on a visual evaluation of the skeletal development of the hand and wrist, most commonly using the Greulich and Pyle atlas

3. Clinical Applications for Skeletal Determinations A single reading of skeletal age informs the clinician of the relative maturity of a patient at a particular time in his or her life, Integrated with other clinical findings, separates the normal from the relatively advanced or retarded

4. Clinical Applications for Skeletal Determinations Successive skeletal age readings –Treatment response. In normal subjects, bone age should be roughly within 10 per cent of the chronological age. Greater discordance between skeletal age and chronological age occurs in children who are obese or who start puberty early, as their skeletal age is accelerated.

5. Applications There are two main applications for evaluations of skeletal maturation: the diagnosis of growth disorders the prediction of final adult height. V. Gilsanz /O. Ratib · Hand Bone Age

6. Methods Estimation from Hands and Wrist. Estimation from hip. Estimation from foot Elbow and Shoulder

7. Skeletal Developemental To facilitate bone age assessments , skeletal development is divided into six major categories

8. Stages of Skeletal Maturity Infancy (the carpal bones and radial epiphyses); Toddlers (the number of epiphyses visible in the long bones of the hand); Pre-puberty (the size of the phalangeal epiphyses); Early and Mid-puberty (the size of the phalangeal epiphyses); Late Puberty (the degree of epiphyseal fusion); and, Post-puberty (the degree of epiphyseal fusion of the radius and ulna ).

9. Infancy Females : Birth to 10 months of age Males : Birth to 14 months of age All carpal bones and all epiphyses in the phalanges, metacarpals , radius and ulna lack ossification in the full-term newborn. The ossification centers of the capitate and hamate become apparent at about 3 months of age and remain the only useful observable features for the next six months

10. Infancy

11. Toddlers Females : 10 months to 2 years of age Males : 14 months to 3 years of age The ossification centers for the epiphyses of all phalanges and metacarpals become recognizable during this stage, usually in the middle finger first, and the fifth finger last.

12. Toddlers

13. Toddlers

14. Toddlers

15. Toddlers

16. Pre-puberty Females : 2 years to 7 years of age Males : 3 years to 9 years of age Assessments of skeletal maturity in prepubertal children are primarily based on the epiphyseal size of the phalanges as they relate to the adjacent metaphyses

17. Pre-puberty Depiction of the progressive growth of the width of the epiphyses , which, during this stage of development , become as wide as the metaphyses

18. Pre-puberty

19. Pre-puberty

20. Pre-puberty

21. Early and Mid-puberty Females : 7 years to 13 years of age Males : 9 years to 14 years of age As in pre-pubertal children, assessments of skeletal maturity in early and mid-puberty are also based on the size of the epiphyses in the distal phalanges ( first) and the middle phalanges (second). The epiphyses at this stage continue to grow and their widths become greater than the metaphyses

22. Early and Mid-puberty

23. Early and Mid-puberty

24. Early and Mid-puberty

25. Late Puberty Females : 13 years to 15 years of age Males : 14 years to 16 years of age Assessments of skeletal maturity in this stage are primarily based on the degree of epiphyseal fusion of the distal phalanges.

26. Late Puberty Fusion of the epiphyses to the metaphyses in the long bones of the hand tends to occur in an orderly characteristic pattern, as follows Fusion of the distal phalanges; Fusion of the metacarpals; Fusion of the proximal phalanges; and, Fusion of the middle phalanges.

27. Late Puberty

28. Post-puberty Females : 15 years to 17 years of age Males : 17 years to 19 years of age At this stage, all carpals, metacarpals and phalanges are completely developed, their physes are closed A ssessments of skeletal maturity are based on the degree of epiphyseal fusion of the ulna and radius .

29. Post-puberty

30. Age from upper limb examination At the wrist and shoulder joint (lower ends of radius and ulna and head of the humerus)19-20 years . At the elbow region: trochlea and capitulum ( 14 years )-trochlea and capitulum + lower end of the humerus ( 15years) Lat.epicondyle and head of ulna(17 years). Med epicondyles and the head of the radius (18years ) Metacarpals and phalanges (16 y in females and 18 years in males).

31. Age from lower limb examination Lesser trochanter (16y)----- Greater trochanter (17y) ------ Head of the femur (18y). Lower end of the femur + shaft (21y). Upper end of the tibia +shaft (21y). Lower end of the tibia +shaft (18 y ). By foot examination ossific center appears at calcanium at 6 years and union of epiphysis at the calcanium at 14 years ,so examining only this bone gives us a range of 8 years

32. Calcaneal Epiphysis

33. Age from hip bone examination Two pubic rami of the hip (6y) Suture at the acetabulum (15y). Ischeal tuberosity with the ischium (21y). Iliac crest with the ilium (23y).

34. After 25 years If all epiphysis of long bones are united individual is more than 25 years. After 25 years Hyoid bone ossification (40-60 years) Xiphisternum with body (60-70 years) Skull Sutures (30-60 years)

35. Order of suture closure in skull 30-40 years: Posterior 1 / 3 rd of sagittal suture 40-50 years: Anterior 1 / 3 rd of sagittal suture and lower half of coronal sutures 50-60 years: Middle sagittal and upper half of coronal suture Fusion of squamous part of temporal bone > 60 years Maximum closure of lambdoid suture at 55

36. THANX