Development of A Simplified New Method of Bone Age Estimation Using Three Bones of the Hand and Wrist

Abstract

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 ± 4.6yrs, mean BA 3 bone:9.8 ± 4.8yrs, GP:9.6 ± 4.8yrs, TW3:9.3 ± 4.5yrs, TW2:9.9 ± 5.0yrs. The 3 bone method demonstrated no significant inter-observer variability(p = 0.3, mean difference = 0.02 ± 0.6yrs); 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 ± 1.96SD of mean difference) was between 6–8 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.