A New Validated Shorthand Method for Determining Bone AgeHeyworth BE, Goldstein M, Schneider R, Gholve PA, Widmann RF, Green DW, Burke SW, Scher DM

Hospital for Special Surgery, New York, NY

PurposeTo investigate a novel method of radiographic assessment of bone age to serve as a simpler and more efficient alternative to the current standard methods, including use of the Radiographic Atlas of Skeletal Development of the Hand and Wrist published by Greulich and Pyle in 1950.

MethodsA shorthand bone age method devel-oped at our institution for male patients was compared against the Gruelich and Pyle method from which it was derived. Sixty-three standard left hand bone age radiographs of male patients, previously assigned skele-tal ages ranging from 12.5 years to 16 years by radiologists using the Gruelich and Pyle radiographic at-las, were read, using the shorthand method, by three pediatric orthopae-dic attendings, a musculoskeletal ra-diologist, a pediatric orthopaedic fel-low, and an orthopaedic resident. The shorthand method utilizes a single written criteria for each age, rather than a radiographic image and multi-ple criteria. Inter-observer reliability and agreement with the previous read-ings made using the atlas were calcu-lated using weighted kappa values.

ResultsThe shorthand bone age method demonstrated high agreement with readings by the Gruelich and Pyle atlas, demonstrating weighted kappa values ranging from 0.73-0.79, and high inter-oberver reliability, with values ranging from 0.66-0.87.

DiscussionThese results for male patients are comparable or superior to previous reports investigating validity and reliability of other bone age assess-ment tools, such as the Gruelich and Pyle system. Moreover, the assess-ment was performed in a time effi-cient manner without necessitating reference to the Greulich and Pyle atlas, utilizing criteria that are eas-ily and rapidly committed to mem-ory. Further research assessing fe-male age groups is warranted.

This validated shorthand bone age assessment tool offers a reliable, sim-pler and more efficient alternative to current methods, for use by residents, fellows, radiologists, and pediatric orthopaedic surgeons.

Appearance of hook of hamate

12.5Proximal aspect of radial

epiphysis has extended to meet the maximum width of the distal metaphysis, but

neither radial-sided nor ulnar sided capping is completed

Completion of capping of distal radius epiphysis

Closure of thumb distal phalanx

physis

Closure of index finger distal phalanx physis and Closure

of thumb metacarpel

Closure index finger proximal phalanx physis

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Appearance of MP thump

sesamoid

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For access to this poster and a printable version of a handout with the shorthand method available to surgeons and radiologists for clinical use, please refer to www.hss.edu/boneage

Correspondence: scherd@hss.edu

Male Ages (in Years)

Male Ages (in Years)

15.5