ONSETS, COMPLETIONS AND SPANS OF OSSIFICATION IN THE 29 BONE-GROWTH CENTERS OF THE HAND AND WRIST

T ms i@ii reports ages of onset and of completion of ossification in each of the 29 bone growth centers of the hand and wrist, based on the study of roentgeno grams of children followed periodically from 3 months to 18 years of age. The time intervals in terms of months which separate these two osseous maturity indicators are also included for each center. The intervals referred to as spans, when used in conjunc tion with ages of onset, represent the age period during which the process of ossifica tion takes place in each center. Norms in terms of means and standard deviations are presented for onsets, completions and spans for the groups of boys and of girls studied. Also patterns of development revealed by these occurrences are given for four chil dren, selected on the basis of marked dif ferences in ultimate stature, to show ex amples of individual variabilities and one aspect of inter-relationships.

The data presented are derived from longitudinal studies of child health and de velopment conducted under the direction of one of us (H. C. S.) at the Harvard School of Public Health between 1930 and 1956. The relevant features of this project have been previously described.' The second part of the report dealt with assessments of skeletal age (hand), made by one of us (S. I. P.), who also made all assessments of ossffication used in this report. A more re cent report2 deals with onsets, completions and spans of ossffication in 21 bone-growth centers selected from five regions of the ex

0 Longitudinal Studies of Child Health and De velopment, Harvard School of Public Health, Se

ries II, No. 13.

tremities, including seven from the hand and wrist. The purpose in selecting the 21 centers used in that report was twofold: to permit recognition of any differences in ages of onsets or completions between cen ters of long, short or round bones, and to

select key bone-growth centers from the many clusters of them that tend to have

their onsets simultaneously. For this pur pose seven of each form were selected: that is, the epiphyses of seven bong and seven short bones, and seven of the carpals and tarsals, or round bones. That report pro vided, by sex, the mean and standard de viation value for onset, completion and span of each of the 21 centers. A skeletal ma turity chart was presented, showing graphi

cally the variabilities in the age periods

during which ossffication of individual cen ters occurs. Furthermore the methodologies involved in making and using these assess ments were discussed at some length. Ref erence should be made to this preceding re port2 for much of the background relevant to this study of the 29 centers in the hand.

Roentgenograms of the hand and wrist had been obtained periodically between the

age of 3 months and 18 years on 66 boys

and 67 girls, who constitute what has been referred to as the Maturity Series of these longitudinal studies. A roentgenogram of the hand is the most easily obtained and most commonly used film for skeletal ma turity assessment. It should be noted, how ever, that the 29 centers in the hand de velop in 19 short, 8 round and 2 bong bones, namely, in disproportionate num bers. For consideration of variabilities in ages of onsets and completions that relate

PEDIATRICS, February 1962 ADDRESS: (H.C.S.) 55 Shattuck Street, Boston 15, Massachusetts.

237

ONSETS, COMPLETIONS AND SPANS OF OSSIFICATION IN

THE 29 BONE-GROWTH CENTERSOF THE HAND

AND WRIST*

Harold C. Stuart, M.D., S. Idell Pyle, Ph.D., Joan Cornoni, B.A.,

and Robert B. Reed, Ph.D.

to the form of bone from which the center stems, the study of seven centers of each form is preferable.

The age equivalents for osseous develop mental levels, which are usually referred to in terms of skeletal ages, are summa tions of over-all age values derived from in dividual bone ages by referring the film of the region to a standard of reference, ap propriately constructed after study of an adequate series of roentgenograms at each age. The onsets and completions of ossifica tion, being the initial and final maturity in dicators of every bone-growth center, serve only briefly and in part as the criteria for assignment of “¿skeletalages―for the region they represent. Onsets are important for this purpose in infancy and early childhood and completions during adolescence. Thus averages derived solely from a summation of assessments of onsets and completions of the 29 bone-growth centers of the hand differ from skeletal age values as published

for the hand. Not only does skeletal age

(hand) take into account other develop mental stages, but it is a clinically esti mated “¿average―of all the criteria used in this assessment, as observed in the hand film at the age taken. The growth periods during which onsets and completions pre dominate as the osseous features in skeletal age (hand) assessments are fully considered in the Atlas of Greulich and Pyle.'

It can be inferred from knowledge of other aspects of development that bone growth centers may be particularly vulner able to unfavorable environmental influ

ences and, therefore, more subject to delay

in their maturation, at immature stages of the ossification process. For this reason, on sets are of special interest in studies of the inter-relationships between health and de

velopment. It is not the purpose of this pa

per to report on such inter-relationships, but rather to present the data derived from these case studies, with particular emphasis on the patterns of individual variabilities, center by center. However, these patterns are presented for four contrasting children in relation to their respective patterns of

growth in height, as one example of the uses of the data available, in the study of inter relationships.

Cam and Rohmann4 have presented data regarding the order of ossification of the centers of the hand, based upon studies of children followed both longitudinally and in a multidisciplinary manner at the Fels Re search Institute. These authors emphasize the necessity of having complete serial hand-wrist roentgenograms for such a

study, and they point out that “¿onlyby as

certaining individual ossification sequences is it possible to determine whether aberrant sequences are associated with delayed ma turation or heightened illness experiences.―

No relationship was found by these authors

between the children with “¿deviantosseous orders― and “¿episodesof illness―during the first 7 years of life. Actual delays in succes sive closely timed onsets were not con sidered in relation to these episodes.

STATISTICALCHARACTERISTICSOF ONSET,

COMPLETION AND SPAN DISTRIBUTIONS

Mean and standard deviation values have been obtained for ages of onset, completion and span for each of the 29 centers in the hand. These are presented in Table I for

boys and girls separately. The first column

for each sex in this Table gives numbers in dicating order of onset in terms of the mean ages. The second gives the number of chil dren whose roentgenograms were satisfac tory for all three assessments of the center indicated and, therefore, the number which provided the statistics that follow in the ad ditional columns. This arrangement permits ready comparison between time-order for the male and female.

C .9 0. a C c)• CO —¿ 2*2*O'0'0'0©C-C-P2*C-'0'0O2*2*2**0'0O@'02*0CC.. CO

C-‘¿02* 2* 0 —¿ ‘¿0‘¿0-P @P ‘¿0‘¿0‘¿0C- C- ‘¿0 2* 2* —¿ ‘¿0‘¿0‘¿0*0 ‘¿0—¿ —¿ 2* C

2*0*0

-, *0*0 *0 ‘¿0*0*0 *0*0 ‘¿0'O‘¿0‘¿0 C- C- @0 C- C- C- ‘¿0‘¿0 ‘¿0 —¿ C-‘¿00 0 ‘¿0‘¿0‘¿0*0 ‘¿0*0 ‘¿0‘¿0‘¿0*0 ‘¿0‘¿0‘¿0‘¿0‘¿0‘¿0‘¿0‘¿0*0 ‘¿0‘¿0‘¿0‘¿0‘¿0

.9

2. a

C.)COC0*

0* ‘¿00* ‘¿0‘¿0‘¿0‘¿0‘¿0‘¿0‘¿0‘¿0‘¿00* 0* ‘¿0‘¿0 ‘¿0‘¿0 C

—¿â€” —¿â€” —¿â€”

‘¿0'0'0P@'0@

‘¿0'0O2*@2*2*'02*2*2*2*2*2*2*'0'0X'02*'0'0'02*'0'0O0C

c,:;

4?C-'0*0'0C'0'02*C-'0*0C@@PCo*

@ 0* *0 C- 0) 2* 0 —¿â€˜¿0

@ ‘¿0*0 C- C- 2* 0 —¿ *0 —¿â€”¿â€˜¿0 2* 0* 0* 0 0

‘¿0*00) ‘¿0*0*0*0 ‘¿0'0'0C- C- C-*0*0 C- t-'0 *00) 0)00 *00 *0'O 0* *0 *0 @0'0 .0'O*0 ‘¿0*0‘¿0*0*0 @0'0 ‘¿0*0*0 ‘¿0‘¿0*0‘¿0‘¿0‘¿0‘¿00*0*

ARTICLES

C- ‘¿0Q'O ‘¿0.0 ‘¿0@‘¿0 ‘¿02k 2* ‘¿0‘¿02* 2* -P @P'0'0 2* ‘¿0‘¿0‘¿02* 2*

239 C C 0. CO * I, a z a z 0 z F, 0 0 0 F' z 2. ‘¿0 0 r12 ‘¿0 0 F' 0 z 2. Cl) F' a z z 0 2. 0 a z F' 0) z 0 0 0 .@ CO

C _{C ‘¿0 @0'0'0 C- C C- ‘¿0 @0)'0 *00 2* ‘¿0 -P 2* 2* —¿}

C@ C- C- C- C-*0 t-*0 C-*0 *0 *0*0*0 ‘¿0‘¿0‘¿0‘¿0 —¿ —¿ —¿ 0* C C 0. CO -C C 0 a .@

:1

@ .c.o 4.o.o

@ .0

0. 0. 0. .@ 2. 2 0. 2. .9@ 2.@ 2 8

.@@FFH @ @ @‘¿.‘¿@‘¿@ @ I 4 @

•¿@0.20.0.0.0.22.C 404? 2. 0.20.0.20. 4?

4?@@@4? _@4__

@ ...5

@000G*@'02@.@9'0

@ .@

@ —¿@s@ a

this trend in a few centers. In contrast to the

onsets, the mean ages for completions occur

within a much more limited period; with one exception within 2 years for boys and with

two exceptions within 3 for girls. The stand

ard deviation values also are more alike than

are those for onsets.

The most striking feature of sex difference

is that the mean age for every onset and every completion is earlier for girls than boys. This difference for onsets tends to in crease absolutely, although not proportion ally, with advancing mean age, but this does not hold for completions. The amount of difference in months varies for onsets from 0.4 to 23.0, and for completions from 8 to 27.

Since 1906, when Pryor5 demonstrated some of the variabilities as well as the se

quential nature of onset of ossification in

the hand as a region, tables and charts showing expected age-order of onsets and completions have been extensively dis cussed. The consensus is that completions are clustered so extensively that it is nearly impossible to compose a useful age-order tabulation of the 30 centers from this in dicator. It is possible, however, with due precautions, to assemble a rather meaning ful onset chart.

The sequences for boys and girls, re spectively, in Table I have been assigned mean values calculated from the assess ments of onsets by interpolation as de scribed by Pyle and Sontag6 and Greulich and Pyle.3 Thus in this study onset de notes the age at which the same kind of

minute nodule presumably was deposited

in each growth center; if a film had been ob tained for each child between two selected, regularly scheduled films, the assumption is

that onset of ossification would then have been visible roentgenographically for the first time. This method reduces to a mini mum the clustering of centers, yet several mean ages as seen in Table I are closely spaced. For example, 15 centers for girls show mean onsets between age 12 months and 26 months. Regardless of the method of assessment used, it has been established

that clustering of two, three or more onsets is a naturally occurring phenomenon, par ticularly in short and round bones, and therefore in the centers of the hand. How ever clustering can be utilized2 as an ad vantageous rather than a strictly limiting occurrence. Individual difference, for ex ample, is indicated whenever one member of a cluster is distinctly early or late in first appearance.

It is apparent from Table II that a sub stantial sex difference in order of onset of ossification throughout the wrist has not been demonstrated. Our intention has been to demonstrate an onset profile and a com pletion profile from means and standard deviations so that the meaningfulness of de

lay or advancement of onset in single

centers or usual clusters may be evaluated

for individual children.

Few sex differences are revealed in the order columns in Table I. Since the listing of the names of centers was by order of on set for boys, sex differences are recogniz

able in the differing order column for girls. The latter shows that, with the exception of the triquetral, which for boys is number 16 and for girls 23, the order of onset is the same for the first 22 and the last 2 centers. The differences in order for the intervening five centers are minor, except that the lu nate is relatively late and the middle phalan geal epiphysis of finger 5 is relatively early, as compared with the mean ages for boys. Therefore, the most substantial sex differ ence in order of appearance is that of the triquetral, and its lateness in girls should be considered (Figs. 1 and 2) when a child's onsets are interpreted.

Bone-growth CenterBoysGirlsNumbero@

_arut

.

CompletzononsetaniiSpanNumberOnset

and

.

CompletwnOnset

and

SpanCapitate56+0.08—0.0753+O.1@—0.07Hamate56+0.18—0.0553+0.1@—0.11Radius,

distal

epiphysis25—0.@0—0.6544+0.23—0.11Fingers,prox.phal.epiph.57+0.@3—0.1456+0.38+0.13FingerQ,prox.phal.epiph.56+0.18—0.@156+0.4@+0.19Finger4,prox.phal.epiph.56+0.@1—0.1856+0.34+0.08Metacarpal

@,

Epiphysis56+0.16—0.2653+0.33+0.09Finger 1, distal phal.

epiph.58+0.15—0.3556+0.37—0.15Metacarpal3,epiphysis56+0.15—0.3553+0.@1—0.09Finger

5, prox. phal.

epiph.56+0.06—0.4@56+0.37+0.06Metacarpal 4,

epiphysis56+0.16—0.3753+0.17—0.10Finger

8, middle phal.

epiph.56+0.07—0.3856+0.39—0.06Finger 4, middle phal.

epiph.56+0.08—0.4155+0.36—0.09Finger

2, middle phal.

epiph.56+0.10—0.4@56+0.45—0.00Metacarpal

5,

epiphysis56+0.16—0.4353+0.33—0.05Triquetral57+0.08—0.7855+0.@4—0.79Finger

3, distal phal.

epiph.57+0.@3—0.3157+0.41—0.13Finger4,distalphal.epiph57+0.@1—0.3457+0.41—0.10Metacarpal

1,

epiphysis56+0.@0—0.5355+0.36—0.07Finger

1, prox. phal.

epiph.56+0.18—0.4557+0.33—0.@4Finger 2, distal phal.

epiph.57+0.16—0.4857+0.37—0.@.5Finger 5, distal phal.

epiph.57+0.15—0.5557+0.@3—0.@3Lunate58+0.@5—0.7555+0.43—0.84Finger

5, middle phal.

epiph.56+0.30—0.5455+0.33—0.34Scaphoid58+0.@6—0.7654+0.17—0.80Trapezoid58+0.4Q—0.7555+0.30—0.73Trapezium58+0.@4—0.8@54+0.H—0.85Ulna,

distal epiphysis@6+0 . 14—0. 7651+0 .

53—0.49Adductor

sesamoid (thumb)50+0 . 50—0 . 5147+0 .43—0.34

ARTICLES 241

TABLE II

CORRELATIONS BETWEEN AGES OF ONSET AND COMPLETION AND BETWEEN AGES OF ONSET AND SPAN FOR

@9BONE-GROWTHCENTERS IN THE HAND

are positive, except for one boy. The mag nitudes of these positive values usually are of low order, tending to be somewhat higher for girls than boys and also somewhat higher for the centers of late rather than early onset. There are, however, numerous exceptions to these generalizations.

The correlations between onset and span differ from the correlations between onset and completion in that they are always negative for boys and usually so for girls.

COMMENTS ON FIGURES

Figures 1 and 2 portray for boys and girls, respectively, the mean and standard deviation values for the onsets and comple

tions of the 29 bone-growth centers under study. The names of the centers are given for ready identification, and their numbers in the left columns correspond with those in the same columns of Figures 3 to 6. The centers in all these Figures are listed in the order of onset for the sex repre sented.

NAMES OF HAND CENTERS ORDER OF ONSETS IN @OMPLET1ONPROFILE 21 REGIONAL CENTERS ORDER,FORBOYS,

OF ONSETS IN _{ONSET PROFILE:}

29 HAND CENTERS MEAN ± @ 2 3 4 5 6 7 8 9 12 ‘¿3 14 IS 16 17 18 19 20 21 @.1 1@ -a- * I. S •¿ I, 2' 3, 4, 5 6 7 8 9 10 l2 13 ‘¿4 15 16 ‘¿7 18 19 20 21 22 23 24 25 26 27 28 29 Copitate Hamote

Radius,distalepiph. (completion) Finger3,prox.phal.epiph.

Finger2,prox.phol.epiph. Finger4,prox.phol.epiph. Metacarpal2, epiph. FingerI,distalphoLepiph. Metacarpal3, epiph.

a

0.

Finger5, prox. phal.epiph.

Metocorpol 4, eplph.

Finger3,middlephal.epiph.

Finger4, middle phoLepiph.

Finger2,middlephaL epiph.

Metacarpal 5, epiph.

Triquetral

Finger3, distalphal.epiph Finger4, distalphotepiph

Metacorpel I, epiph

Finger I, prox.phaLepiph.

Finger2, distalphaLepiph. Finger5, distalphoLepiph.

l0

a

* Lunate

Finger 5, middle phal. epiph.

Scaphoid

Trapezoid

@ Trapezium a

Ulna distalepiph.

AdductorSesomoid(Thumb) •¿* ___________

24 48 72 96 120 144 168 192 216

CHRONOLOGICALAGE IN MONTHS

Fic. 1. Profile chart, for boys, of onsets and completions of ossification of bone-growth centers. Each

mean value is indicated by a short vertical line, plotted against age; standard deviations are indicated by

breadths of the accompanying horizontal lines. The dots give the mean ages for 21 regional centers. The

names of the regional centers, in order of onset, are 1) tibia, distal epiphysis, 2) lateral cuneiform, 3) humerus, capitulum, 4) fibula, distal epiphysis, 5) humerus, greater tubercle, 6) finger 3, proximal

phalangeal epiphysis. 7) toe I, distal phalangeal epiphysis. 8) medial cuneiform, 9) triquetral, 10) toe V,

proximal phalangeal epiphysis, 11) navicular (foot), 12) finger 1, proximal phalangeal epiphysis, 13) finger 2, distal phalangeal epiphysis, 14) lunate, 15) fibula, proximal epiphysis, 16) metatarsal V, epiphysis, 17) radius, proximal epiphysis, 18) scaphoid, 19) calcaneus, epiphysis, 20) ulna, olecranon, 21) adductor

sesamoid (thumb).

column identify the latter centers by name in the accompanying footnotes.

The upper portions of Figures 3 and 4 for boys and Figures 5 and 6 for girls are con structed in the same manner as are Figures

ARTICLES

24 48 72 96 120 144 168 192 216

CHRONOLOGICAL AGE IN MONTHS

2@43

Fic. 2. Profile chart, for girls, of onsets and completions of ossification of bone-growth centers. The lines

give means and standard deviations for the centers of hand and the dots give the means for 21 regional centers, as in Figure 1. The names of the regional centers, in order of onset, are 1) lateral cuneiform, 2) tibia distal epiphysis, 3) humerus, capitulum, 4) humerus, greater tubercle, 5) fibula, distal epiphysis, 6) toe 1, distal phalangeal epiphysis, 7) finger 3, proximal phalangeal epiphysis, 8) medial cuneiform, 9) toe V,

proximal phalangeal epiphysis, 10) finger 1, proximal phalangeal epiphysis, 11) navicular, 12) finger 2,

distal phalangeal epiphysis, 13) triquetral, 14) fibula, proximal epiphysis, 15) lunate, 16) metatarsal V,

epiphysis, 17) scaphoid, 18) radius, proximal epiphysis, 19) calcaneus, epiphysis, 20) nina, olecranon, 21) adductor sesamoid (thumb).

ORDER,FORGIRLS.

OF ONSETS IN

29 HAND

CENTERS

I Capitate

2

@ Hamate

3 •¿...L. (completion) Radius,distal epiph.

4 .4— . Finger3, prox.phal. epiph.

5 —¿@ Finger 2, prox. phal. epiph.

6 Finger 4, prox. phal. epiph.

7 Metacarpal 2, epiph.

8 FingerI,distalepiph.

9 Metacarpal3,epiph.

10 ...L.. Finger5, prox.phal. epiph.

II —¿b- Metacarpal4, epiph 12 @—¿@--. Finger3,middlephatepiph.

13 Finger4,middlephaLepiph.

14 @@1@@ Finger 2, middle phal. epiph

IS —¿@— Metacarpal 5, epiph.

16 —¿@-s@ Finger3, distal phal.epiph.

I? —¿1—s Finger4,distal phd.epiph.

8 —¿i-— Metacarpal I, epiph.

19 —¿-s-' FingerI,prox.phaLepiph.

20 —¿4--— Finger2, distal phal.epiph.

2 I —¿i——. FingerS,distalphaiepiph.

22 —¿--@-—--. FingerS, middle phal.epiph.

23 * Triquetral

24 Lunate

25 —¿Trapezoid

26 ‘¿â€¢¿ Trapezium

27 -. Scaphoid

28 •¿ •¿Ulna,distalepiph

29 AdductorSesamoid(Thum@ a'

ORDER OF

ONSETS IN 21 REGIONAL

CENTERS

2

3

4

5

6

7

8 9

I0

12

13

14

IS

16

IT

18

‘¿9

20

21

ONSET PROFILE: —¿â€˜--—MEANt (

NAMES OF HAND CENTERS

COMPLETION PROFILE:

. *

-I

5

* .

S.

•¿

*

.-a *

* -a

4

.1

•¿

indicate the ages at which a selected child

arrived at these successive stages of ossifica

tion. The cases presented have been selected to compare the onsets and completions in

growth centers of children who differed markedly in height at their eighteenth year,

that is, near the termination of growth in this dimension. In Figures 3 and 4 profile charts for the shortest and the tallest boy are presented, and in Figures 5 and 6 for the shortest and the tallest girl.

FORNAMEOF

ONSETPROFILE: —¿â€˜---MEAN±6' COMPLETION PROFILE

NUMBERSF1GI •¿SHORTESTBOY 246

2

3. ...&.. ...—‘—

@

4. . _@.

5. •¿..@

6 ..@— ._@ ‘¿

7, •¿â€”J— —¿4———S

8 •¿@— •¿

9 ..1.. I

10 —¿@— •¿

II, -@ —¿ •¿

12 —¿@—- —¿ •¿

13 —¿.@-— •¿1

4 .@J •¿

15 s •¿

16 •¿â€˜

17 S—'-— •¿

18 .—‘--—

19

2C _____ •¿

21 •¿

22 •¿â€¢¿ ____

23 •¿ ______

24 •¿ •¿

25

26 IS

27 •¿ i—

28 ‘¿t •¿

29 •¿ •¿ •¿

I I I I

24 48 72 96 120 144. 68 92 216

CHRONOLOGICAL AGE IN MONTHS

* Atter Age 18yrs.

DEVELOPMENTALRANGE GRAPH BOY 246

+24

F -24 _{Least AdvancedCenter}

24 48 72 96 120 144 68 192 216

CHRONOLOGICALAGE IN MONTHS

ARTICLES 245

FOR NAME OF

CORRESPONDING ONSETPROFILE: I MEAN ±6' COMPLETION PROFILE:

NUMBERS FIG.I

a ‘¿TALLESTBOY 270

I, I@ —¿.--.

2--b 5*

3, —¿#-— ._@_•

4, .4— ______

5' .,J. ______

6- -a-'-— a

7,

8' —¿b--- a'

9, *5

10 —¿Ã´-— ______

II —¿s-J-— —¿--s

2' —¿â€˜-s -_____

13 a

14 —¿â€¢@-— a

5' a

16 * ____

17' —¿â€˜â€”-- ________

18 19

20 * ____

21 a'

22 •¿â€˜ ________

23 a a

24 *

25 •¿1

26 - a

27 •¿â€˜

28 I * .5

29 •¿ ____

24 48 72 96 20 144 168 92 216

CHRONOLOGICAL AGE IN MONTHS

* No Film Available

DEVELOPMENTAL RANGE GRAPH

BOY 270

4

5 +24

...

@ Most Advance Center

O

p.,. /

/ Least Advanced Center

(Ii ‘¿.‘.“¿.,

@ -24 ‘¿. “¿...

24 48 72 96, 120 144 168 192 216

CHRONOLOGICALAGE IN MONTHS

Fic. 4. Top: Profile chart. Centers of hand for boy 270 are plotted against norms for onsets and com

FORNAMESOF

CENTERS SEE ONSET PROFILE: —¿â€˜â€”—MEAN ±6 COMPLETION PROFILE:

CORRESPONDING

NUMBERS FIG. 2

a ‘¿SHORTESTGIRL 29

I •¿a

21-3.-'— •¿ *

4 a@ -a

5 a-'— •¿ a

6 @‘¿- •¿ a

7 @I •¿

8

@ •¿ a

9 5—'--. •¿ .

10 a1- ‘¿â€”a

II —¿a

12 a—1—- _____

13 a—1--- •¿

14

.—1-15 s--s— __________

6 a@ •¿ a

17 a@ *

8 s-1- _________

9 a—'—- ________

20

@ .

21 .@ ,

22 ______

23 —¿â€˜¿a__ _____

24 ___

25 @a •¿

26 —¿ —¿â€˜â€”-a

27 “¿ ___

28 —¿â€”—¿ a

29 •¿â€”* —¿a

24 48 72 96 120 144 168 92 216

CHRONOLOGICALAGE IN MONTHS * After Age l8yrt

z DEVELOPMENTALRANGEGRAPH

GIRL 29

5 424

U,

ox ...

O (I@1111:::::::.―:::::::::.::.::::::::, MastMvancedCenter

•¿.“ Least Advanced Center

-24

24 48 72 96 20 44 68 192 26

CHRONOLOGICAL AGE IN MONTHS

Fic. 5. Top: Profile chart. Centers of hand for girl 29 are plotted against norms for onsets and com

ARTICLES 247

FOR NAMESOF CENTERSSEE

CORRESPONDING ONSETPROFILE: @@1-@MEAN±6 COMPLETIONPROFILE:

NUMBERS FIG.2

•¿= TALLEST GIRL 271

I'

‘¿-2'. - i—

3. .1- *—t

—¿a-4 -4.

5 —¿b

6 —¿@ a'

7 -4- —¿

8 —¿ia- 5

9 .4—. a.

10 ‘¿. II -a'—

12 @a

13 —¿1-.a I

14 —¿@----a a

15 -a'—.

16 —¿â€˜--

-17 —¿1--a

IS s—i-— a

19 L ‘¿â€¢

2( —¿â€˜--a —¿a'

21 —¿-—a .

22 a

23 a •¿â€˜

24 a a'

25 a —¿a-'

26 ‘¿a —¿S--I-—

27 I •¿ —¿a'

28 •¿ ______

29 1' a __________

24 48 72 96 120 144 168 192 216

CHRONOLOGICAL AGE IN MONTHS

DEVELOPMENTALRANGEGRAPH

GIRL 271

co +24 Mast AdvancedCenter

@ @-.‘,‘

@ ..•••...•

@ S&(HOnd) Center

24 48 72 96 120 144 168 92 216

CHRONOLOGICAL AGE IN MONTHS

Fic. 6. Top: Profile chart. Centers of hand for girl 271 are plotted against norms for onsets and com

248

this shortest boy was usually early in on set (i.e., in 22 of 29 centers) and late in completion (i.e., 28 of 29 centers) in respect to the means. Figure 4 shows in contrast that the tallest boy was not consistently ad vanced or delayed in his onsets. Although 21 of his 29 centers had completions some what earlier than their mean ages, none was advanced as much as one standard de viation in value.

Figure 5 shows that most of the onsets for the shortest girl in this series occurred early, several of them advanced more than one standard deviation. It shows also that completions were regularly delayed, nearly half more than one standard deviation. Fig ure 6 shows that for the tallest girl, although the first few onsets were at or in advance of the mean, the others tended to be mod erately delayed. Completions, on the other hand, were moderately advanced in 24 of the 29 centers. It may be said, therefore, that for the most part the shortest boy and the shortest girl had long spans, whereas the tallest boy was irregular in his spans but the tallest girl had short ones. It is planned to study these relationships between ultimate stature and the spans for bone-growth cen ters further to learn to what extent these four children are representative of their peers.

The bottom portions of Figures 3 through 6 present developmental range graphs of the hand for the same four children repre sented in the upper portions. The zero on the left in these Figures represents the skeletal age (hand) of the standard in the Creulich and Pyle Atlas.3 The solid curve gives the skeletal age (hand) values for the child represented. The upper broken line gives the level of his or her most advanced bone-growth center of the hand at each age. The lower broken line similarly gives the least advanced center. It must be kept in mind, in comparing these developmental range graphs with onsets and completions, that the former include many more de velopmental criteria, observable between onsets and completions. Thus most and least advanced centers in infancy are based

primarily on onsets and in late adolescence

on completions. During the intervening years they are based for the most part on other skeletal indicators. These range graphs, however, do provide a different view of the tendency of each case toward advancement or delay by age periods. In the Figures 3 through 6 there were several centers with the same bone age among the “¿mostadvanced―; this occurred less regu larly among the “¿leastadvanced.―

ADDENDUM

A second study of onset of ossification in the

hand and wrist by Garn and RohmannT and one by

Hansman and Maresh were published while this

study was in the final stage of its preparation.

These and the former one by Cam and Rohmann,4 like the present and other recent reports of “¿bone

development― from our studies,1

@ have been

based upon long-term film series of healthy chil

dren. The collection of the films in these three centers had been in process concurrently, and the examination schedules were similar, covering the period from birth through adolescence. However, our method of assessing age of onset, as well as age of completion of ossification, differs from that

used by the other authorscited.This differencein

method has been discussed in the present paper and should be taken into consideration when eval

uating differences as well as similarities shown by

the respective findings. Otherwise, these studies

permit comparisons of rate of bone development between three groups of essentially healthy Ameri can children.

SUMMARY

The film series of the right hands of 133 Boston children have been studied inde pendenfly to obtain age equivalents for on set of ossification and completion of ossi fication in 29 bone-growth centers of the hand. Each of the intervals between onset and completion, namely, span of the osse ous stage, has been calculated, and the means and standard deviations of each of the three variables are summarized.

ARTICLES 249

mean and standard deviation values for each sex.

The data reported in this paper for the 29 centers of the hand and previously for 21 centers from five regions of the body, show the following: 1) The time-order of onset differs significantly from the time order of completion. 2) The time-order on set profile reveals a characteristic clustering of onsets. 3) The correlations between on set and completion ages for the 133 cliii dren do not show that the time of comple tion can be routinely forecast by onset ages. However, the later the onset the better the prediction of completion time. 4) A de velopmental range graph constructed from assessments of skeletal age of the 29 centers of the hand reflects the schedules of onsets and completions for individual children. However, the “¿lifetime―of each of the on sets and completions is very brief and cor responds closely with the skeletal age curve during the first 4 years and during adoles

cence.

REFERENCES

1. Pyle, S. I., Reed, R. B., and Stuart, H. C.:

Longitudinal Studies of Child Health and

Development, Harvard School of Public

Health—Series II, No. 2: Patterns of skeletal

development in the hand. PEDIATRICS,24 (Suppl.): 888, 1959.

2. Pyle, S. I., et al.: Longitudinal Studies of Child

HealtL and Development, Harvard School of

Public Health—Series II, No. 12: Onsets, completions and spans of the osseous stage of

development in representative bone growth

centers of the extremities. Monogr. Soc. Res.

Child Develop. Vol. 26, No. 1, Serial No. 79,

1981.

3. Greulich, W. W., and Pyle, S. I.: Radiographic

Atlas of Skeletal Development of the Hand

and Wrist, Ed. 2. Stanford, California, Stan

ford Univ. Press, 1959.

4. Cam, S. M., and Rohmann, C. C.: Variability in the order of ossification of the bony cen

ters of the hand and wrist. Amer. J. Phys.

Anthropol. (N.S.), 18:219, 1960.

5. Pryor, J. W.: Some Observations on the Os sification of the Epiphyses of the Hand. Lex ington, Kentucky, Transylvania Press, 1906. 8. Pyle, S. I., and Sontag, L. W.: Variability in onset of ossffication in epiphyses and short bones of the extremities. Amer. J. Roentgenol.,

49:795, 1943.

7. Cam, S. M., and Rohmann, C. C.: The number

of hand-wrist centers, Amer. J. Phys. Anthro

pol., 18:293, 1960.

8. Hansman, C. F., and Maresh, M.: A longitudi

nal study of skeletal maturation. Amer. J. Dis.

1962;29;237

Pediatrics

Harold C. Stuart, S. Idell Pyle, Joan Cornoni and Robert B. Reed

BONE-GROWTH CENTERS OF THE HAND AND WRIST

ONSETS, COMPLETIONS AND SPANS OF OSSIFICATION IN THE 29

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1962;29;237

Pediatrics

Harold C. Stuart, S. Idell Pyle, Joan Cornoni and Robert B. Reed

BONE-GROWTH CENTERS OF THE HAND AND WRIST

ONSETS, COMPLETIONS AND SPANS OF OSSIFICATION IN THE 29

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