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Topic:

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Issue:

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Category:

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Title:

Correlations Between Eight Comprehensive Skeletal Maturity Systems in a Modern Peripubertal Pediatric Population

Author:

Chen, Kallie J. MD; Mysore, Amog BS; Furdock, Ryan J. MD; Sattar, Abdus PhD; Sinkler, Margaret A. MD; Glotzbecker, Michael P. MD; Liu, Raymond W. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

January 2024

Reference:

44(1): p e51-e56, DOI: 10.1097/BPO.0000000000002533

Level Of Evidence:

III

# of Patients:

350 modern patients (700 radiographs), 66 historic patients (954 radiographs)

Study Type:

Retrospective study

Location:

Not specified

Summary:

This study compares the agreement among 8 different skeletal maturity systems in modern pediatric patients and examines trends in discrepancies between modern and historic children.

Methods:

Inclusion Criteria: Peripubertal patients who had at least two radiographs of different anatomic regions obtained ≤3 months apart. Exclusion Criteria: Abnormal radiographs (evidence of fracture or congenital deformity) or low-quality images. Skeletal Maturity Systems Assessed: Proximal humerus ossification system (PHOS) Olecranon apophysis ossification staging system (OAOSS) Lateral elbow system Modified Fels wrist system Sanders Hand Classification Optimized Oxford hip system Modified Fels knee system Calcaneal apophysis ossification staging system (CAOSS) Data Collection: Radiographs were compared, and SEM (standard error of measurement) skeletal age variance was calculated to assess system precision.

Exclusions:

Not specified

Results:

Modern Cohort: Greatest Variance: PHOS (SEM: 0.28 y), Sanders Hand (0.26 y), CAOSS (0.25 y) Smallest Variance: Modified Fels knee system (0.20 y) Historic Cohort: Least Precise: PHOS, OAOSS, and CAOSS (all SEM: 0.20 y) Other systems showed similar precision with SEMs between 0.18 and 0.19 y Comparison of Systems: The lateral elbow system performed with greater precision than the OAOSS in both cohorts.

Conclusions:

The precision of skeletal maturity systems varies depending on the anatomic region assessed. Staged, single-parameter systems (e.g., PHOS, Sanders Hand, OAOSS, and CAOSS) may show lower correlation with other systems compared to systems with more parameters.

Relevance:

Limitations:

Perspective:

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