Hand Wrist Radiography
Write short note on hand-wrist radiograph.
Answer. Hand-wrist region is made by multiple small bones which show a predictable and scheduled pattern of appearance, ossification and union from birth to maturity. So by merely comparing patient’s hand wrist radiograph with standard radiographs which represent different skeletal ages, one can be able to determine skeletal maturation status of that individual.
Most commonly used methods to access skeletal maturity by using hand-wrist radiographs are:
- Bjork, Grave and Brown method
- Hagg and Taranger method
- Fishman’s skeletal maturity indicator
- Atlas method by Greulich and Pyle
Bjork, Grave and Brown Method
They divided skeletal development in nine stages. All of these stages represent a level of skeletal maturity.
Appropriate chronological age for each of the stage was given by Schopf
Following are the stages:
- Stage 1 (Males 10.6 years, Females 8.1 years): Both epiphysis and the diaphysis of proximal phalanx of the index finger are equal. This occurs approximately 3 years before the peak of pubertal growth spurt.
- Stage 2 (Males 12.0 years, Females 8.1 years): Epiphysis and diaphysis of middle phalanx of the index finger are equal. It is noticed before the peak of pubertal growth spurt.
- Stage 3 (Males 12.6 years, Females 9.6 years): It is characterized by presence of three areas of ossification i.e. hamular process of hamate exhibits ossification, ossification of the pisiform, epiphysis and diaphysis of radius are equal.
- Stage 4 (Males 13 years, Females 10.6 years): This stage marks the beginning of pubertal growth spurt which is characterized by the initial mineralization of ulnar sesamoid of thumb and increase in ossification of hamular process of hamate bone.
- Stage 5 (Males 14 years, Females 1 year): It heralds the peak of pubertal growth spurt. Capping of the diaphysis by epiphysis is seen in middle phalanx of third finger, proximal phalanx of thumb and radius.
- Stage 6 (Males 15 years, Females 13 years): It signifies the end of pubertal growth spurt. It is characterized by union between epiphysis and diaphysis of distal phalanx of middle finger.
- Stage 7 (Males 15.9 years, Females 13.3 years): Union of both epiphysis and diaphysis of proximal phalanx of litt
- e finger occur. This is seen a year after growth spurt.
- Stage 8 (Males 15.9 years, Females 13.9 years): It shows fusion between epiphysis and diaphysis of middle phalanx of middle finger.
- Stage 9 (Males 18.5 years, Females 16.0 years): It is the last stage and signifies end of skeletal growth. This is characterized by fusion of epiphysis and diaphysis of radius.
Maturation Assessment by Hagg and Taranger
Development of skeleton in hand and wrist is analyzed by annual radiographs which are taken between ages of 6 and 18 years, by assessing the ossifiation of ulnar sesamoid of metacarpophalangeal joint of fist figer (S) and certain specific stages of three epiphyseal bones i.e. middle and distal phalanges of third figer (MP3 and DP3) and distal epiphysis of radius (R)
Sesamoid
It is attained during the acceleration period of the pubertal growth spurt. i.e. the onset of peak height velocity.
Third Finger Middle Phalanx (MP3)
- Stage 6: Here epiphysis as wide as metaphysis. 40% of person attains this stage before the onset of peak height velocity. At peak height velocity many of the persons attain this.
- Stage 6: Here epiphysis is wide as metaphysis and there is distinct medial and/or lateral border of epiphysis which forms the line of demarcation at right angle to the distal border. About 90% of persons attain this stage 1 year before peak height velocity.
- Stage 7: Sides of epiphysis are thickened and there is capping of the metaphysis which form the sharp edge distally at either one end or at both the ends. About 90% of persons attain it at or 1 year after peak height velocity.
- Stage 8: Fusion of the epiphysis and metaphysis has begun and is attained after peak height velocity 90% of girls and all the boys attain it after peak height velocity but before end of pubertal growth spurt.
- Stage 9: Fusion of both the epiphysis and metaphysis is completed. All persons except few girls have ended pubertal growth spurt.
Third Finger Distal Phalanx
DP3 – I: Completion of fusion of epiphysis and metaphysis. It signifies fusion of epiphysis and metaphysis and is attained at the deceleration period of pubertal growth spurt by all persons.
Radius
- R – I: Beginning of fusion of epiphysis and metaphysis. It is attained one year before or at end of growth spurt by about 80% of girls and about 90% of boys.
- R – IJ At this stage fusion is almost completed but there is still a small gap at either one or at both the margins.
- R – J: It is characterized by the fusion of epiphysis and metaphysis
Above stages were not attained before end of peak height velocity by any of the person.
Atlas Method by Greulich and Pyle
- Gruelich and pile publish an atlas containing pictures of wrist – hand for different chronological ages for both males and females.
- Radiographs of patient’s are matched with one of the photograph in the atlas which is representative of particular skeletal age.
Indications of Hand-wrist Radiograph
- In cases with major discrepancies between chronological and dental age.
- In cases where prediction of pubertal growth spurt is required.
- In cases with skeletal Class II and Class III malocclusion before beginning their treatment so that their growth potential is assessed.
- For skeletal age assessment to study growth of an individual.
- Indicated in research studies to make out the effect of hereditary and environment on dentofacial growth.
- In patients with skeletal malocclusion and need orthognathic surgery.
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