Bone age assessment: a large scale comparison of the Greulich and Pyle, and Tanner and Whitehouse (TW2) methods

Bull, R K; Edwards, Pamela J.; Kemp, P. M.; Fry, SW; Hughes, I A

doi:10.1136/adc.81.2.172

Cited by 200 publications

(143 citation statements)

References 3 publications

(4 reference statements)

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“…In order to deal with bone age of individual bones, and to give the readings in terms of years of delay for each individual bone, we had to use the Greulich and Pyle method (5). The two methods of bone age assessment as used in clinical practice do not give equivalent estimates of bone age (14). Yet, this article averaged bones and ignored the carpals.…”

Section: Discussionmentioning

confidence: 99%

Role of growth hormone in enchondroplasia and chondral osteogenesis: evaluation by X-ray of the hand

et al. 2014

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Background:The process of growth and maturation of long (radius and ulna) and short (metacarpals and phalanges) bones of the hand (enchondroplasia) differs from that of the carpal cuboid bones (chondral osteogenesis). This study aimed to assess the impact of growth hormone (GH) on these two processes of bone maturation. Methods: Subjects of the study were 95 prepubertal children: 30 children with GH deficiency and 65 children with idiopathic short stature, aged 7.4 ± 1.9 y (mean ± SD) (trial registration number 98-0198-033). Bone maturation was assessed by the Greulich and Pyle method from X-rays obtained at the start and at 1 and 2 y of GH treatment, separately for carpals, long bones, and short bones, and was expressed as years of delay relative to chronological age. results: At GH start, the delay in bone maturation in the GH-deficient group was significantly greater for carpals (3.6 ± 1.3 y) than for long (3.0 ± 1.3 y) and short (1.7 ± 1.1 y) bones. The delay was nonsignificantly greater for carpal bones in GH-deficient subjects than in subjects with idiopathic short stature (3.6 ± 1.3 vs. 3.1 ± 1.1 y, respectively) and was normalized after 2 y of GH treatment. conclusion: The dominant effect of GH was on chondral osteogenesis, with milder effect on enchondroplasia. A distinct delay in carpal and long-bone maturation, which normalizes during 2 y of GH treatment, was typical in GH-deficient children. Therefore, separate carpal bone assessment in bone age reading is needed. t he maturation of bones and their linear growth are due to the combination of chondral osteogenesis and enchondroplasia, defined jointly as enchondral ossification (1), occurring under the influence of several hormones and growth factors, with growth hormone (GH) and insulin-like growth factor 1 playing important roles (1,2). At birth, the primary ossification centers of the long bones and the short bones in the hand are well ossified; however, the cuboid carpal bones are still undergoing chondral osteogenesis. During early childhood, X-rays initially show chondral osteogenesis of the secondary ossification centers in the epiphyses of long and short bones, followed by the development and expansion of the growth plate cleft, a process referred to as enchondroplasia (2). Therefore, during childhood, there are differences in terms of maturation status between the long (radius and ulna) and short (metacarpals and phalanges) (enchondroplasia) bones of the hand on the one hand and the carpal bones (chondral osteogenesis) on the other (3,4); maturation of the latter represents maturation of the cuboid vertebrae. We have previously hypothesized the importance of conducting a separate analysis of the carpal cuboid bones and the long and the short bones to enable better understanding of the physiology and endocrine control of bone maturation (1). Preliminary observations showed that the greatest delay in bone maturation within the hand occurs in the carpal bones for both GH deficiency (GHD) and GH insensitivity (Laron syndrome). This is consistent w...

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Section: Discussionmentioning

confidence: 99%

Role of growth hormone in enchondroplasia and chondral osteogenesis: evaluation by X-ray of the hand

et al. 2014

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“…İngiltere'de her iki metodu karşılaş-tıran bir çalışma yapılmıştır, 2-18 yaş arası olguların el bileği grafilerinin incelenmesi sonucunda GP metoduna göre ortalama 0,14, TWA yöntemine göre 0,01 yıllık bir sapma olduğu görülmüş ve İngiliz toplumu için TWA standartının geçerliliğinin daha fazla olduğu belirtilmiştir [12]. TW standartları esas alınarak yapılan bir çalışmada, 7-17 yaş arası Çinli çocukların el bilek kemik gelişimlerinin İngiliz ço-cuklarına göre 6 ay ileri olduğu görülmüştür [13].…”

Section: Literatür Derlemesiunclassified

Methods for age estimation

Demirkıran¹,

Çelikel²,

Zeren³

et al. 2014

Diclemedj

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“…Her iki metodun karfl›laflt›r›lma-s›n› amaçlayan bir çal›flmada ‹ngiltere'de 2-18 yafl aras› kiflilerin el bile¤i grafilerinin incelenmesi sonucunda, Greulich-Pyle metoduna göre ortalama 0.14, Tanner-Whitehouse yöntemine göre ise 0.01 y›ll›k bir sapma oldu¤u görülmüfl ve ‹ngiliz toplumu için Tanner-Whitehouse standartlar›n›n geçerlili¤inin daha fazla oldu¤u belirtilmifltir (22).…”

Section: Tartifimaunclassified

Yaş Tayini Uygulamalarında Epifiz Plağı Kapanma Derecelerinin İncelenmesi

Yarımoğlu¹,

Alper²,

Meral³

et al. 2005

Bull Leg Med

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N. Yafl tayini uygulamalar›nda epifiz pla¤› kapanma derecelerinin incelenmesi.Adli T›p Bülteni, 2005;10(3):84-89. Adli T›p uygulamalar›nda yafl tayini önemli bir yer tutmaktad›r. Ülkemizde, kiflilerin nüfus kay›tlar› düzenli olarak tutulmad›¤›ndan, baz› hukuki durumlarda flah›slar›n gerçek yafllar›-n›n tespiti gerekmektedir. Bu konuda en s›k kullan›lan yön-tem, belirli yafl gruplar›nda belirli bölgelerin grafilerinin çekile-rek epifiz plaklar›n›n kapanma derecelerini saptamak ve flahs›n yafl›n› belirlemektir. Bu amaçla, Greulich-Pyle ve Tanner-Whitehouse Atlaslar› kullan›lmaktad›r. Ülkemizde, uygulama kolayl›¤› bak›m›ndan en çok tercih edilen yöntem Greulich-Pyle yöntemidir.Son zamanlarda yap›lan araflt›rmalarda, günümüz çocuklar›-n›n büyüme temposunun artt›¤› ve olgunlaflman›n daha erken oldu¤u bilinmektedir. Bizim çal›flmam›zda, halen kullan›lan yöntemlerin uyumlulu¤unun test edilmesi amac›yla, de¤iflik yafl gruplar›ndan çekilen 570 adet grafi incelenmifltir. Buna gö-re, el bile¤i, omuz ve pelvis grafilerinde 16 yafltan itibaren kapanmalar›n bafllad›¤›; gerçek yafl› 17 olan olgular›n el bile¤i grafilerinin %100'ünde, omuz ve pelvis grafilerinin %81.8'inde epifizlerin tam olarak kapand›¤› görülmüfltür. Sonuç olarak; halen uygulanmakta olan yöntemlerle, kronolojik yafl, kemik yafl›n›n çok gerisinde kalmaktad›r. Bunun için, nüfus kay›tlar› kesin olarak do¤rulanan sa¤l›kl› bireylerin grafileri üzerinde incelemeler yaparak toplumumuza özgü standart de¤erlerin oluflturulmas› gerekmektedir.Anahtar kelimeler: El bile¤i, epifiz, omuz, pelvis, yafl tayini.Age assessment has an important place in Forensic Medicine. Estimation of the accurate age is required in some legal processes as demographic records are not properly performed in Turkey. Age determination by researching the epiphyseal union of some specific joints in the specific age groups is the commonly used method. Most commonly used methods are GreulichPyle and Tanner-Whitehouse methods for this purpose Greulich-Pyle method is preferred in our country usually because of easy applicability.According to some recent studies, the rate of growth and development is quicker and so the maturation occurs earlier. In our study, 570 x-rays of different ages are evaluated to test the correlation of recent methods. We found that the epiphyseal union started at the age of 16, in hand-wrist, shoulder and pelvis. At the age of 17, the epiphyseal union was completed in 100% of the hand-wrist x-ray and 81.8% of the shoulder and pelvis roentgenograms.As a result, bone age is advanced in comparison with the chronological age by using recent methods. Standard data for domestic population must be collected by means of the x-rays of healthy people having regular demographic records and new standards should be established to prevent misinterpretation of the cases.

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Bone age assessment: a large scale comparison of the Greulich and Pyle, and Tanner and Whitehouse (TW2) methods

Cited by 200 publications

References 3 publications

Role of growth hormone in enchondroplasia and chondral osteogenesis: evaluation by X-ray of the hand

Role of growth hormone in enchondroplasia and chondral osteogenesis: evaluation by X-ray of the hand

Methods for age estimation

Yaş Tayini Uygulamalarında Epifiz Plağı Kapanma Derecelerinin İncelenmesi

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