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Topic:

​

Issue:

​

Category:

Developmental

Title:

The Creation and Validation of an Ankle Bone Age Atlas and Data Predicting Remaining Ankle Growth

Author:

Pennock, Andrew T. MD; Bomar, James D. MPH; Pedowitz, Jason M. MD; Carveth, Stephen L. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

March 2024

Reference:

44(3): p e278-e284, DOI: 10.1097/BPO.0000000000002601

Level Of Evidence:

IV

# of Patients:

270 patients for the creation of the atlas
90 patients for the validation of the atlas
41 patients for comparison with left-hand radiographs
304 serial images of the distal tibia for growth data

Study Type:

Retrospective cohort study

Location:

Not specified

Summary:

This study created and validated an ankle bone age atlas spanning pediatric and adolescent years. It also developed a predictive model for remaining ankle growth, using serial radiographs to measure distal tibia/fibula growth.

Methods:

Atlas Creation: Radiographs were analyzed for distinguishable features in the tibia, fibula, hindfoot, and midfoot. A "standard" for each age and sex was selected from the cohort of 270 patients. Validation: A separate cohort of 90 patients was used to validate the created atlas. A subcohort of 41 patients was also analyzed, comparing ankle bone age to left-hand radiographs. Growth Prediction: Harris growth lines were evaluated in 304 serial images of the distal tibia to predict the remaining growth.

Exclusions:

Not specified

Results:

Best Age Assessments: Early Childhood (1-8 years for males, 1-4 years for females): Distal tibia/fibula ossification centers. Preadolescent Stage (6-14 years for males, 5-12 years for females): Ossification/fusion of the calcaneal apophysis. Skeletal Maturity (14-16 years for males, 12-14 years for females): Closure of the distal tib/fib physes. Reliability: The ankle atlas demonstrated excellent interobserver (ICC=0.993, P<0.001) and intraobserver (ICC=0.998, P<0.001) reliability. Correlation: There was a strong correlation between the patient's chronological age and ankle bone age (r=0.984, P<0.001). The ankle bone age was also well-correlated with the Greulich and Pyle method (rs=0.822, P<0.001). Growth Prediction: Males with a bone age of ≥15 years and females with a bone age of ≥13 years had ≤2 mm of residual growth in the distal tibia/fibula physes.

Conclusions:

The ankle bone age atlas and predictive growth model can be used to assess bone age and predict remaining growth using ankle radiographs. This method may be clinically useful when managing patients with ankle trauma, especially in those with premature physeal closure.

Relevance:

Limitations:

Perspective:

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