Skeletal age and its prediction in Philadephia children.

Abstract

THE concept of skeletal age has become an accepted technique in the assessment of the maturational status of children, whether considered individually or collectively. The assignment of a developmental age based upon the progress of the skeleton toward its ultimate mature state permits a rapid placement of a given child along a graduated scale, the end points of which are fixed biological entities. In addition, research has shown correlation with certain phases of growth, as well as with endocrine pathology, environmental deprivations and other factors, all of which make this concept one which can be employed as an aid in clinical diagnosis. However, as with all evaluations of normality, interest is immediately focused upon the standards of reference employed, and the extent to which they adequately portray a normal course of development. In the case of skeletal age, these standards of reference have generally consisted of a series of x-ray plates, which form a scale of composite pictures of average skeletal development for successive chronological ages, with the necessary differentiations for sex. Assessment is made by selecting the plate, or plates, most nearly corresponding to the x-ray of the individual child, through the use of maturity indicators. For children of the USA, these standards have been derived from the Brush Foundation Series, Cleveland, Ohio initially studied by Todd, and furthered by other investigators such as Greulich, Pyle, Hoerr, and Francis. Although recent research by Garn and Eohmann (1960) has indicated that the sequence of appearance of centers of ossification may be more variable intrinsically than had previously been believed, the sequence of maturity indicators following this initial step has been shown to be relatively constant in any normal group studied. However, this state-

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