Development of a simplified new method of bone age estimation using three bones of the hand and wrist

• Published in: Endocrine 2024-06, Vol.84 (3), p.1135-1145
• Main Authors: Khadilkar, Vaman, Mondkar, Shruti, Desai, Keyur, Oza, Chirantap, Yewale, Sushil, Dange, Nimisha, Lohiya, Nikhil, Patil, Prashant, Prasad, Hemchand Krishna, Shah, Nikhil, Karguppikar, Madhura, Maheshwari, Ankita, Khadilkar, Anuradha
• Format: Article
• Language: English
• Subjects: Adolescent; Age determination; Age Determination by Skeleton - methods; Bone Development - physiology; Bones; Child; Child, Preschool; Developmental stages; Diabetes; Endocrinology; Epiphysis; Female; Finger; Finger Phalanges - anatomy & histology; Finger Phalanges - diagnostic imaging; Hand; Hand Bones - anatomy & histology; Hand Bones - diagnostic imaging; Hand Bones - growth & development; Humanities and Social Sciences; Humans; Internal Medicine; Male; Maturation; Medicine; Medicine & Public Health; multidisciplinary; Observer Variation; Original Article; Radius; Radius - anatomy & histology; Radius - diagnostic imaging; Reproducibility of Results; Science; Wrist; Wrist - anatomy & histology; Wrist - diagnostic imaging
• ISSN: 1559-0100; 1355-008X; 1559-0100
• DOI: 10.1007/s12020-024-03684-9

Though the Greulich and Pyle (GP) method is easy, inter-observer variability, differential maturation of hand bones influences ratings. The Tanner-Whitehouse (TW) method is more accurate, but cumbersome. A simpler method combining the above, such that it utilizes fewer bones without affecting accuracy, would be widely used and more applicable in clinical practice. Objectives 1. Devising a simplified method utilizing three bones of the hand and wrist for bone age (BA) assessment. 2. Testing whether the 3 bone method gives comparable results to standard methods (GP,TW2,TW3) in Indian children. Methods Developmental stages and corresponding BA for radius, hamate, terminal phalanx (left middle finger) epiphyses combining stages from GP,TW3 atlases were described; BA were rated by two blinded observers. 3 bone method ratings were compared with the same dataset analyzed earlier using GP,TW2,TW3 (4 raters). Results Radiographs analysed:493 (Girls=226). Mean chronological age:9.4 ± 4.6 yrs, mean BA 3 bone:9.8 ± 4.8 yrs, GP:9.6 ± 4.8 yrs, TW3:9.3 ± 4.5 yrs, TW2:9.9 ± 5.0 yrs. The 3 bone method demonstrated no significant inter-observer variability ( p  = 0.3, mean difference = 0.02 ± 0.6 yrs); a strong positive correlation ( p