We also discuss the clinical relevance of each method.Īssessment of skeletal age was made on a set of anteroposterior left hand and lateral elbow radiographs using the simplified methods Dimeglio et al 12 for the elbow and Sanders et al 15 for the simplified digital method. This study compares the accuracy of both methods during the pubertal growth spurt and investigates the accuracy in relation to the experience of the assessor. 12īoth Dimeglio et al’s 12 and Sanders et al’s 15 simplified methods of assessing skeletal age have been reported to have a modest learning curve and ease of clinical application. 2 Radiographs showing stages 3 and 4 (of the digital skeletal maturity assessment 15 covering the same growth period as the olecranon sequence. 14, 15, 17- 20 Stages 1 and 2 correspond to the pre-pubertal period, stages 3 and 4 correspond to the pubertal growth spurt (Risser grade 0), and stages 5 to 8 cover the period from Risser grade 1 to 5, at which stage full skeletal maturity has occurred ( Fig. The simplified digital method provides several markers prior to the Risser 1 stage of skeletal maturity, it has been shown by various authors to add helpful information to the Risser stage 0 13 and covers the period from Risser 1 to Risser 5. In 2008, Sanders et al 15 presented a new method of digital skeletal age assessment derived from the Tanner-Whitehouse-III method, 16 which is based on a radiological analysis of the metacarpals and fingers on anteroposterior hand radiographs. 1 Radiological sequence of skeletal age assessment based on the olecranon from 11 to 13 years in girls and 13 to 15 years in boys. 13 Closure of the epiphyses at the elbow indicates the end of the accelerated growth spurt, when the adolescent is entering the decelerating phase of pubertal growth. 12 This sequence is clinically relevant because the olecranon exhibits a clear and regular morphological development during the pubertal growth spurt, when the Risser sign is still 0. In 2005, Dimeglio et al 12 simplified the original Sauvegrain method and demonstrated that morphology of the olecranon apophysis on lateral radiographs goes through five distinct and characteristic appearances, which are easy to distinguish at six-month intervals ( Fig. Sauvegrain, Nahm and Bronstein 11 first developed a method to determine skeletal age from anteroposterior and lateral elbow radiographs in 1962. 8- 10 The pubertal growth spurt occurs at around 11 to 13 years of skeletal age in girls and 13 to 15 years in boys. 1- 7 The first two years of puberty are characterised by a significant growth spurt, followed by three years of gradual growth. Different methods are described using hand, elbow, foot, knee or pelvic radiographs for reference. Skeletal age represents a useful parameter for decision making in paediatric orthopaedics. The olecranon method offers detailed information during the pubertal growth spurt, while the digital method is as accurate but less detailed, making it more useful after the pubertal growth spurt once the olecranon has ossified.Ĭite this article: Bone Joint J 2014 3:1556–60 The two methods are equally reliable in assessing skeletal maturity. There was no significant (p <</a> 0.05) difference between the levels of experience. There was an equally strong ICC for the assessment effect (ICC ≤ 0.4%) and observer effect (ICC ≤ 3%) for each method. The correlation was equal between first and second assessment, and between the observer groups (r ≥ 0.82). The overall correlation between the two methods was r = 0.83 for boys and r = 0.84 for girls. Interclass correlation coefficients (ICC) evaluated the reproducibility of the two methods. The correlation between the two methods was determined per assessment and per observer groups. These raters were required to determined skeletal ages twice at six-week intervals.
A
We also investigated the influence of assessor experience on applying these two methods. Both methods have been described previously with one based on the appearance of the epiphysis at the olecranon and the other on the digital epiphyses. We compared two simplified methods used in the assessment of skeletal age. Assessment of skeletal age is important in children’s orthopaedics.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |