Skeletal maturation

The process of increasing ossification of the ends of bone with eventual closure of the growth plates is termed skeletal maturation. Various

methods are available to determine skeletal maturation. The most practical is the use of various atlases. The hand atlas of Greulich and Pyle is suitable for most children over two years of age. Alternatively a scoring method may be used such as the TW2 method. In infants and children under two years of age there is relatively little change in maturation with time in the hand standards. Additional use of the foot and knee atlases is of value in such situations. There are some racial differences in maturation; although, these are relatively small. Nutrition plays an important part in affecting maturation and growth. Generally speaking malnutrition, either due to lack of food or secondary to chronic disease, affects growth more than maturation. This results in a short adult stature at maturity since growth is more affected than skeletal maturation, and growth therefore ceases relatively prematurely in relation to attained size. It is the interaction between growth and maturation that determines the final stature. Skeletal maturation is also affected by various hormones, particularly sex and thyroid hormones. Hypothyroidism severely retards skeletal maturation as does absence of growth hormone. Absence of sex hormones in older children causes a delay in maturation since epiphyseal closure is dependent on their presence. Absence of sex hormones has little effect in early childhood since they have little effect on onset of ossification. Excess thyroid hormone and premature sex hormone secretion as may occur in precocious puberty cause marked advancement of skeletal maturation. Skeletal maturation may be disharmonic, where not all the centres follow the same sequence as the normal standard. Disharmony is common in many congenital malformation syndromes and when maturation is markedly retarded or advanced. Some disharmony of maturation may occur in normal children. Individual growth plates may close prematurely in congenital disorders and may affect specific bones. An example of this is the premature closure of the 3rd, 4th, and 5th metacarpal head growth plates resulting in the shortening of these bones in pseudohypoparathyroidism and in Turner syndrome.

Andrew K. Poznanski