Use of the Greulich-Pyle "Atlas of Skeletal Development of the Hand and Wrist" in a clinical context

Assessments of the relative maturity of individual children have been widely used to improve estimations of future growth as well as in evaluations of physiological disorders. Skeletal age (Hand) has been the most commonly used method for these estimations. In the clinical use of skeletal ages, certain problems are inherent regardless of which standard is selected. One of these is the method of reporting so that the cliniciam may learn of the normal variation at each age as well as the operational error of the specific assessor. Another problem lies in the proper clinical interpretation to be put upon significantly variant skeletal age readings in infancy, in childhood, or in adolescence. A third problem arises in limiting the use of skeletal ages which are read from areas which are involved with osseous pathology. And fourthly, a child's level of maturity is not static throughout his growing years; even with no change in therapeutic regime, marked shifts in relative maturity have been often noted. The wealth of experience which has now been acquired with the Greulich-Pyle standard is not the least of the advantages in using the Hand for the assessment of skeletal age. The 30 centers in this small area of the body, however, may be harmonious in development or may vary in “maturity” by as much as three years in a single hand. The problems then are: Which centers best represent the individual child? Which centers are most closely related to growth? Is growth in the hand and accurate index of the growth in other areas of the body? In total stature? The clinical assessment of future growth may best be made from a consideration of the whole child: his size, his physical characteristics, and his skeletal age, as well as the pattern of change-with-age in each of these. These problems will be discussed with illustrations drawn from the longitudinal Growth Study at this institution.