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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

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Bone age assessment

  1. 1. Bone Age Assessment Dr. Muhammad Bin Zulfiqar Alnoor Diagnostic Centre
  2. 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. 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. 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. 5. Applications • There are two main applications for evaluations of skeletal maturation: 1. the diagnosis of growth disorders 2. the prediction of final adult height. V. Gilsanz /O. Ratib · Hand Bone Age
  6. 6. Methods • Estimation from Hands and Wrist. • Estimation from hip. • Estimation from foot • Elbow and Shoulder
  7. 7. Skeletal Developemental • To facilitate bone age assessments, skeletal development is divided into six major categories
  8. 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. 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. 10. Infancy
  11. 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. 12. Toddlers
  13. 13. Toddlers
  14. 14. Toddlers
  15. 15. Toddlers
  16. 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. 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. 18. Pre-puberty
  19. 19. Pre-puberty
  20. 20. Pre-puberty
  21. 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. 22. Early and Mid-puberty
  23. 23. Early and Mid-puberty
  24. 24. Early and Mid-puberty
  25. 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. 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 1. Fusion of the distal phalanges; 2. Fusion of the metacarpals; 3. Fusion of the proximal phalanges; and, 4. Fusion of the middle phalanges.
  27. 27. Late Puberty
  28. 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 • Assessments of skeletal maturity are based on the degree of epiphyseal fusion of the ulna and radius.
  29. 29. Post-puberty
  30. 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. 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. 32. Calcaneal Epiphysis
  33. 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. 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. 35. Order of suture closure in skull • 30-40 years: Posterior 1 / 3rd of sagittal suture • 40-50 years: Anterior 1 / 3rd 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. 36. THANX