RESUMO
To assess the degree of applicability of bone age calculated by Greulich and Pyle Atlas in estimation of chronological age for therapeutic and medico legal purposes. Two Hundred and Twenty children [139 males, 81 females] between ages of 56 and 113 months [4.5 to 9.5 years] were randomly selected from 4 primary schools of Shireen Jinnah and Clifton, Karachi. Digital images of hand and wrist radiographs were obtained by a computed radiography at Ziauddin Hospital Clifton. Bone ages were computed using Greulich and Pyle Atlas by radiologists at Ziauddin Hospital, North Nazimabad, Karachi. On average, the Greulich and Pyle Atlas underestimates chronological age by 6.65 +/- 13.47 months in females and 15.78 +/- 12.83 months in males [p-values < 0.001]. High correlation was found between chronological age and bone age in both genders [Females r=0.778; p-value < 0.001, Males r=0.816; p-value < 0.001]. Bone age calculated by Greulich and Pyle Atlas should not be used for estimating chronological age in children of ages 56-113 months in situations where high accuracy is required [e.g. medicolegal cases]. However, serial measurements of bone age by this atlas can be used in management of growth related endocrine disorders in these children
RESUMO
The bone age of a child indicates his/her level of biological and structural maturity better than the chronological age calculated from the date of birth. Radiography of the hand and wrist is the commonest modality used to calculate bone age. Automated methods for evaluation of hand and wrist radiographs are also being developed which reduce inter rater variability compared to manual methods. Non radiation based techniques of visualizing hand and wrist bones such as ultrasonography for bone age calculation have been theorized but are not as accurate as radiographic methods. By the age of 18 years, bone age cannot be computed from hand and wrist radiographs, therefore the medial end of the clavicle is used for bone age calculation in individuals aged 18-22 years. CT visualization of the clavicle has been extensively studied but requires a high dose of radiation. MRI based methods are being developed but require more research. Dental age is an alternate form of bone age determination, which also gives an estimate of skeletal maturity. The iliac bone and femoral head have also been studied for computation of bone age but no standardized methods have yet been generated. As different modalities of bone age estimation provide different results and their applicability differs in different ethnicities, we need to design studies in order to compare them and select the method best suited to Pakistani children. Recent articles published between years 2004-2013 obtained from online search engines Pubmed and Google Scholar were used in preparation of this review