A comparison between methods of calculating skeletal age (Greulich-Pyle)

The skeletal age of each individual bone of the hand-wrist was assessed in serial radiographs of 169 Melbourne children. Seven different methods were used to obtain area skeletal ages from these bone skeletal ages. Methods employing arithmetic means of all the bone skeletal ages, excluding only extreme values, excluding those derived from the carpals or from other selected bones yielded similar means during the age range studied in each sex. There were large, but not significant, differences between the means derived from averages of the skeletal ages of the most and least mature bones and those derived from all the bone skeletal ages. A system of weighting and exclusion of bone skeletal ages led to the recording of area skeletal ages that differed from the others and fluctuated markedly for individuals until ossification had occurred in every carpal bone. The findings suggest that the exclusion of the skeletal ages of the carpal bones or the use of selected skeletal ages could lead to quicker assessments without real changes in means and variability.