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Development of a simplified new method of bone age estimation using three bones of the hand and wrist

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Abstract

Though the Greulich and Pyle (GP) method is easy, inter-observer variability, differential maturation of hand bones influences ratings. The Tanner-Whitehouse (TW) method is more accurate, but cumbersome. A simpler method combining the above, such that it utilizes fewer bones without affecting accuracy, would be widely used and more applicable in clinical practice.

Objectives

1. Devising a simplified method utilizing three bones of the hand and wrist for bone age (BA) assessment. 2. Testing whether the 3 bone method gives comparable results to standard methods (GP,TW2,TW3) in Indian children.

Methods

Developmental stages and corresponding BA for radius, hamate, terminal phalanx (left middle finger) epiphyses combining stages from GP,TW3 atlases were described; BA were rated by two blinded observers. 3 bone method ratings were compared with the same dataset analyzed earlier using GP,TW2,TW3 (4 raters).

Results

Radiographs analysed:493 (Girls=226). Mean chronological age:9.4 ± 4.6 yrs, mean BA 3 bone:9.8 ± 4.8 yrs, GP:9.6 ± 4.8 yrs, TW3:9.3 ± 4.5 yrs, TW2:9.9 ± 5.0 yrs. The 3 bone method demonstrated no significant inter-observer variability (p = 0.3, mean difference = 0.02 ± 0.6 yrs); a strong positive correlation (p < 0.0001) with GP (r = 0.985), TW3 (r = 0.983) and TW2 (r = 0.982) was noted. Bland-Altman plots demonstrated good agreement; the root mean square errors between 3 bone and GP,TW3,TW2 ratings were 0.6,0.7,0.6 years; mean differences were 0.19,0.49,−0.14 years respectively. Greatest proportion of outliers (beyond ±1.96 SD of mean difference) was between 6 and 8 years age for difference in 3 bone and GP, and between 4–6 years for difference in 3 bone and TW3,TW2.

Conclusion

The 3 bone method has multiple advantages; it is easier, tackles differential maturation of wrist and hand bones, has good reproducibility, without compromising on accuracy rendering it suitable for office practice.

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Authors and Affiliations

  1. Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India

    Vaman Khadilkar, Shruti Mondkar, Chirantap Oza, Sushil Yewale, Nimisha Dange, Nikhil Shah, Madhura Karguppikar & Anuradha Khadilkar

  2. Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India

    Vaman Khadilkar & Anuradha Khadilkar

  3. Department of Orthopedics, Adhikari Lifeline Multispeciality Hospital, Boisar, India

    Keyur Desai

  4. Endogrow Pediatric and Adolescent Endocrine centre, Ahmedabad, India

    Chirantap Oza

  5. Division of Growth & Endocrinology, Silver Lining Pediatric Super Speciality Centre for Growth Development & Endocrine Care, Nagpur, India

    Nikhil Lohiya

  6. SRCC NH Children’s Hospital, Mumbai and Apollo Hospital, Navi Mumbai, India

    Prashant Patil

  7. Department of Pediatric Endocrinology, Mehta Hospital, Chennai, India

    Hemchand Krishna Prasad

  8. Division of Pediatric Endocrinology, Department of Pediatrics, Surya Children’s Hospital, Chembur, Mumbai, India

    Nikhil Shah

  9. Smt. Kashibai Navale Medical College and Hospital, Pune, India

    Madhura Karguppikar

  10. Sri Aurobindo Institute of Medical Sciences, Indore, India

    Ankita Maheshwari

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  1. Vaman Khadilkar
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Contributions

All authors played a role in the conceptualization, planning, execution, bone age rating, analysis and writing of the manuscript and they all agree and accept responsibility for the contents of the manuscript submitted to the journal.

Corresponding author

Correspondence to Anuradha Khadilkar.

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The authors declare no competing interests.

Consent for publication

The participants have consented to use their data for the purpose of publication.

Consent to participate

Informed consent/assent was obtained from all participants/ their parents for the study.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Deidentified radiographs of children aged 0–18 years from a previous dataset were used. The original study was approved by the institutional ethics committee (original approval was dated 7 Aug 2019) and written informed consent/assent was given by all participants/parents. As we used deidentified data in the current study, a waiver was granted by the ethics committee.

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Khadilkar, V., Mondkar, S., Desai, K. et al. Development of a simplified new method of bone age estimation using three bones of the hand and wrist. Endocrine (2024). https://doi.org/10.1007/s12020-024-03684-9

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