By Cree M. Gaskin

Bone age evaluation, an important a part of the analysis and administration of pediatric development problems in addition to the timing of yes pediatric orthopedic strategies, has for many years relied on the meticulous exam of simple radiographs. reading the delicate adjustments current in the maturing human hand usually proves to be tough and time-consuming.Building at the renowned Greulich and Pyle atlas, this e-book modernizes the tactic for pediatric skeletal adulthood selection. It deals a wealth of pictures, conscientiously mined from millions of electronic radiographs from college of Virginia's photograph Archiving and communique approach (PACS), edited to most sensible reveal vital developmental bone good points, and arranged by means of age and intercourse for swift reference. To expedite studying and medical photograph research, photos are available in pairs: annotated and unannotated, for simple comparability. Succinct annotations at the photos substitute long textual content to supply a speedier and clearer knowing of the skeletal age. those annotations spotlight very important and sophisticated beneficial properties to assist distinguish photos that another way glance superficially alike. the result's an atlas of particularly top of the range skeletal radiographic criteria that catch either the foremost and finer information of the accredited criteria of Greulich and Pyle. The simple layout of this booklet allows a swifter, extra actual, and extra academic method of settling on skeletal adulthood. The electronic Bone Age significant other packaged with the ebook is a working laptop or computer application that enables viewing of the atlas photos in electronic structure. clients can simply zoom in on radiographic beneficial properties, set picture point and width to their choice, and evaluate or 3 reference criteria side-by-side for tough situations. most significantly, this system expedites review, optimizes workflow, and minimizes user-introduced error with the trustworthy bone age calculator and integrated record generator. The electronic layout can also be on hand for integration together with your Radiology info method (RIS) for additional workflow enhancement.Given the wide program of pediatric bone getting older, Skeletal improvement of the Hand and Wrist is not just meant for practising and coaching radiologists, yet for all of these who hire bone age reports as a part of their perform.

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Male Standards Male Skeletal Age: 3 Months 17 Skeletal Development of the Hand and Wrist Skeletal Age: 6 Months Male The metacarpals have distinct individual differences in morphology The capitate and hamate have enlarged but, both remain rounded. The long axis of the capitate is now established. 18 Pronounced flaring of the ends of the distal radius and ulna Male Standards Male Skeletal Age: 6 Months 19 Skeletal Development of the Hand and Wrist Skeletal Age: 9 Months Male 2nd – 5th metacarpal bases and distal 1st metacarpal now rounded and broader relative to their constricted shafts Mild flattening of the hamate surface of the capitate 20 Male Standards Male Skeletal Age: 9 Months 21 Skeletal Development of the Hand and Wrist Skeletal Age: 1 Year Male Mild constriction or slight flattening of the radial and ulnar aspects of the distal tips of the 3rd and 4th proximal phalanges The capitate and hamate have enlarged and grown closer together Further flattening of the hamate surface of the capitate 22 Male Standards Male Skeletal Age: 1 Year 23 Skeletal Development of the Hand and Wrist Skeletal Age: 1 Year and 3 Months Male The sides of the distal ends of the 3rd and 4th proximal phalanges are now somewhat flattened The portion of the 2nd metacarpal that will articulate with the capitate has begun to flatten The capitate surface of the hamate has begun to flatten Progressive flattening of the hamate surface of the capitate 24 The trapezoid margin of the capitate may be convex, flat, or slightly concave A small ossification center is now visible at the distal radial epiphysis Male Standards Male Skeletal Age: 1 Year and 3 Months 25 Skeletal Development of the Hand and Wrist Skeletal Age: 1 Year and 6 Months Male Ossification centers are now present at the heads of the 2nd – 4th metacarpals, the bases of the 2nd – 4th proximal phalanges, and the distal phalanx of the thumb Mild enlargement of the distal radial epiphysis (Not shown: the ulnar aspect may be pointed relative to a thicker radial aspect) 26 Male Standards Male Skeletal Age: 1 Year and 6 Months 27 Skeletal Development of the Hand and Wrist Skeletal Age: 2 Years Male Ossification has now begun in the following epiphyses: middle & distal phalanges of 3rd and 4th digits 5th proximal phalanx 5th metacarpal head The capitate and hamate have increased further in size 28 The epiphyses of the proximal phalanges of the 2nd – 4th digits and the distal phalanx of the thumb are now disc shaped Male Standards Male Skeletal Age: 2 Years 29 Skeletal Development of the Hand and Wrist Skeletal Age: 2 Years and 8 Months Male The epiphyses of the proximal phalanges of the 2nd – 5th fingers are at least ½ as wide as their shafts Ossification has now begun in the following epiphyses: middle phalanx of the 2nd digit 1st proximal phalanx 1st metacarpal Ossification of the triquetrum has begun (start time is quite variable) 30 Elongation or flattening of this epiphysis The epiphysis of the radius has become wedge-shaped due to relative thickening of its radial aspect Male Standards Male Skeletal Age: 2 Years and 8 Months 31 Skeletal Development of the Hand and Wrist Skeletal Age: 3 Years Male Phalangeal ossification centers are slightly larger and more disc shaped Metacarpal ossification centers are slightly larger Lunate ossification has begun, although precociously 32 Volar (white line) and dorsal (more distal margin) surfaces of the radial epiphysis can now be distinguished Male Standards Male Skeletal Age: 3 Years 33 Skeletal Development of the Hand and Wrist Skeletal Age: 3 Years and 6 Months Male The epiphyses of the 2nd and 5th distal phalanges are now visible Increased ossification of the lunate and triquetrum 34 The epiphyses of the 3rd and 4th distal phalanges are now disc shaped Flattening of the base of the second metacarpal where it will articulate with the trapezoid Male Standards Male Skeletal Age: 3 Years and 6 Months 35 Skeletal Development of the Hand and Wrist Skeletal Age: 4 Years Male Ossification centers have appeared in all phalangeal epiphyses, including that of the 5th middle phalanx Ossification of the trapezium has appeared somewhat precociously.

The long axis of the capitate is now established. 18 Pronounced flaring of the ends of the distal radius and ulna Male Standards Male Skeletal Age: 6 Months 19 Skeletal Development of the Hand and Wrist Skeletal Age: 9 Months Male 2nd – 5th metacarpal bases and distal 1st metacarpal now rounded and broader relative to their constricted shafts Mild flattening of the hamate surface of the capitate 20 Male Standards Male Skeletal Age: 9 Months 21 Skeletal Development of the Hand and Wrist Skeletal Age: 1 Year Male Mild constriction or slight flattening of the radial and ulnar aspects of the distal tips of the 3rd and 4th proximal phalanges The capitate and hamate have enlarged and grown closer together Further flattening of the hamate surface of the capitate 22 Male Standards Male Skeletal Age: 1 Year 23 Skeletal Development of the Hand and Wrist Skeletal Age: 1 Year and 3 Months Male The sides of the distal ends of the 3rd and 4th proximal phalanges are now somewhat flattened The portion of the 2nd metacarpal that will articulate with the capitate has begun to flatten The capitate surface of the hamate has begun to flatten Progressive flattening of the hamate surface of the capitate 24 The trapezoid margin of the capitate may be convex, flat, or slightly concave A small ossification center is now visible at the distal radial epiphysis Male Standards Male Skeletal Age: 1 Year and 3 Months 25 Skeletal Development of the Hand and Wrist Skeletal Age: 1 Year and 6 Months Male Ossification centers are now present at the heads of the 2nd – 4th metacarpals, the bases of the 2nd – 4th proximal phalanges, and the distal phalanx of the thumb Mild enlargement of the distal radial epiphysis (Not shown: the ulnar aspect may be pointed relative to a thicker radial aspect) 26 Male Standards Male Skeletal Age: 1 Year and 6 Months 27 Skeletal Development of the Hand and Wrist Skeletal Age: 2 Years Male Ossification has now begun in the following epiphyses: middle & distal phalanges of 3rd and 4th digits 5th proximal phalanx 5th metacarpal head The capitate and hamate have increased further in size 28 The epiphyses of the proximal phalanges of the 2nd – 4th digits and the distal phalanx of the thumb are now disc shaped Male Standards Male Skeletal Age: 2 Years 29 Skeletal Development of the Hand and Wrist Skeletal Age: 2 Years and 8 Months Male The epiphyses of the proximal phalanges of the 2nd – 5th fingers are at least ½ as wide as their shafts Ossification has now begun in the following epiphyses: middle phalanx of the 2nd digit 1st proximal phalanx 1st metacarpal Ossification of the triquetrum has begun (start time is quite variable) 30 Elongation or flattening of this epiphysis The epiphysis of the radius has become wedge-shaped due to relative thickening of its radial aspect Male Standards Male Skeletal Age: 2 Years and 8 Months 31 Skeletal Development of the Hand and Wrist Skeletal Age: 3 Years Male Phalangeal ossification centers are slightly larger and more disc shaped Metacarpal ossification centers are slightly larger Lunate ossification has begun, although precociously 32 Volar (white line) and dorsal (more distal margin) surfaces of the radial epiphysis can now be distinguished Male Standards Male Skeletal Age: 3 Years 33 Skeletal Development of the Hand and Wrist Skeletal Age: 3 Years and 6 Months Male The epiphyses of the 2nd and 5th distal phalanges are now visible Increased ossification of the lunate and triquetrum 34 The epiphyses of the 3rd and 4th distal phalanges are now disc shaped Flattening of the base of the second metacarpal where it will articulate with the trapezoid Male Standards Male Skeletal Age: 3 Years and 6 Months 35 Skeletal Development of the Hand and Wrist Skeletal Age: 4 Years Male Ossification centers have appeared in all phalangeal epiphyses, including that of the 5th middle phalanx Ossification of the trapezium has appeared somewhat precociously.

18 Pronounced flaring of the ends of the distal radius and ulna Male Standards Male Skeletal Age: 6 Months 19 Skeletal Development of the Hand and Wrist Skeletal Age: 9 Months Male 2nd – 5th metacarpal bases and distal 1st metacarpal now rounded and broader relative to their constricted shafts Mild flattening of the hamate surface of the capitate 20 Male Standards Male Skeletal Age: 9 Months 21 Skeletal Development of the Hand and Wrist Skeletal Age: 1 Year Male Mild constriction or slight flattening of the radial and ulnar aspects of the distal tips of the 3rd and 4th proximal phalanges The capitate and hamate have enlarged and grown closer together Further flattening of the hamate surface of the capitate 22 Male Standards Male Skeletal Age: 1 Year 23 Skeletal Development of the Hand and Wrist Skeletal Age: 1 Year and 3 Months Male The sides of the distal ends of the 3rd and 4th proximal phalanges are now somewhat flattened The portion of the 2nd metacarpal that will articulate with the capitate has begun to flatten The capitate surface of the hamate has begun to flatten Progressive flattening of the hamate surface of the capitate 24 The trapezoid margin of the capitate may be convex, flat, or slightly concave A small ossification center is now visible at the distal radial epiphysis Male Standards Male Skeletal Age: 1 Year and 3 Months 25 Skeletal Development of the Hand and Wrist Skeletal Age: 1 Year and 6 Months Male Ossification centers are now present at the heads of the 2nd – 4th metacarpals, the bases of the 2nd – 4th proximal phalanges, and the distal phalanx of the thumb Mild enlargement of the distal radial epiphysis (Not shown: the ulnar aspect may be pointed relative to a thicker radial aspect) 26 Male Standards Male Skeletal Age: 1 Year and 6 Months 27 Skeletal Development of the Hand and Wrist Skeletal Age: 2 Years Male Ossification has now begun in the following epiphyses: middle & distal phalanges of 3rd and 4th digits 5th proximal phalanx 5th metacarpal head The capitate and hamate have increased further in size 28 The epiphyses of the proximal phalanges of the 2nd – 4th digits and the distal phalanx of the thumb are now disc shaped Male Standards Male Skeletal Age: 2 Years 29 Skeletal Development of the Hand and Wrist Skeletal Age: 2 Years and 8 Months Male The epiphyses of the proximal phalanges of the 2nd – 5th fingers are at least ½ as wide as their shafts Ossification has now begun in the following epiphyses: middle phalanx of the 2nd digit 1st proximal phalanx 1st metacarpal Ossification of the triquetrum has begun (start time is quite variable) 30 Elongation or flattening of this epiphysis The epiphysis of the radius has become wedge-shaped due to relative thickening of its radial aspect Male Standards Male Skeletal Age: 2 Years and 8 Months 31 Skeletal Development of the Hand and Wrist Skeletal Age: 3 Years Male Phalangeal ossification centers are slightly larger and more disc shaped Metacarpal ossification centers are slightly larger Lunate ossification has begun, although precociously 32 Volar (white line) and dorsal (more distal margin) surfaces of the radial epiphysis can now be distinguished Male Standards Male Skeletal Age: 3 Years 33 Skeletal Development of the Hand and Wrist Skeletal Age: 3 Years and 6 Months Male The epiphyses of the 2nd and 5th distal phalanges are now visible Increased ossification of the lunate and triquetrum 34 The epiphyses of the 3rd and 4th distal phalanges are now disc shaped Flattening of the base of the second metacarpal where it will articulate with the trapezoid Male Standards Male Skeletal Age: 3 Years and 6 Months 35 Skeletal Development of the Hand and Wrist Skeletal Age: 4 Years Male Ossification centers have appeared in all phalangeal epiphyses, including that of the 5th middle phalanx Ossification of the trapezium has appeared somewhat precociously.

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