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Bone Joint J. 2018 Aug;100-B(8):1106-1111. doi: 10.1302/0301-620X.100B8.BJJ-2017-1489.R1.

A quantitative method for the radiological assessment of skeletal maturity using the distal femur.

Author information

University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA and Rainbow Babies and Children's Hospital at Case Western Reserve University, Cleveland, Ohio, USA.
University of Rochester, Rochester, New York, USA.
Division of Endocrinology and Diabetes, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
Department of Orthopaedics and Rehabilitation, Yale University, New Haven, Connecticut, USA.



Using 90% of final height as a benchmark, we sought to develop a quick, quantitative and reproducible method of estimating skeletal maturity based on topographical changes in the distal femoral physis.

Patients and Methods:

Serial radiographs of the distal femoral physis three years prior to, during, and two years following the chronological age associated with 90% of final height were analyzed in 81 healthy children. The distance from the tip of the central peak of the distal femoral physis to a line drawn across the physis was normalized to the physeal width.


A total of 389 radiographs of the distal femur with corresponding Greulich and Pyle bone ages and known chronological ages were measured. Children reached 90% of final height at a mean age of 11.3 years (sd 0.8) for girls and 13.2 years (sd 0.6) for boys. Linear regression analysis showed higher correlation coefficent in predicting the true age at 90% of final height using chronological age + gender + central peak value (R2 = 0.900) than chronological age + gender (R2 = 0.879) and Greulich and Pyle bone age + gender (R2 = 0.878).


Chronological age + gender + central peak value provides more accurate prediction of 90% of final height compared with chronological age + gender and Greulich and Pyle bone age + gender. Cite this article: Bone Joint J 2018;100-B:1106-11.


Chronological age; Distal femur; Peak height velocity; Skeletal maturity

[Available on 2019-08-01]
[Indexed for MEDLINE]

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