Applicability of the Greulich and Pyle skeletal age standards to black and white children of today
R. T. Loder, D. T. Estle, K. Morrison, D. Eggleston, D. N. Fish, M. L. Greenfield and K. E. Guire
Section of Orthopedic Surgery, University of Michigan, Ann Arbor 48109-0328.
OBJECTIVE--The Greulich and Pyle skeletal age atlas was derived from white
children of upper socioeconomic level during the 1930s. To our knowledge,
the Greulich and Pyle standards have not been reassessed for both black and
white children; it was the purpose of this study to reassess the
applicability of these standards to today's children. DESIGN--A "blinded"
review of hand roentgenograms taken for the evaluation of trauma was
performed. Age of the subjects was evenly distributed between 0 and 18
years. The roentgenograms were scored for bone age by five individuals from
different disciplines and levels of training. The difference between the
median bone age and the child's chronologic age was calculated for each
roentgenogram and stratified into four age groups: early childhood (0 to 4
years), middle childhood (4 to 8 years), late childhood (8 to 13 years),
and adolescence (13 to 18 years). SETTING--The roentgenograms were obtained
from four hospital emergency rooms in the Lake Erie basin area, the same
geographic area from which the Greulich and Pyle standards originated.
PATIENTS--There were 841 children: 452 boys and 389 girls, 461 black and
380 white children. RESULTS--The bone ages and chronologic ages were
similar for white girls of all ages. Black girls were skeletally advanced
by 0.4 to 0.7 year (P < .001), except during middle childhood. White
boys were skeletally delayed during middle childhood by 0.9 year (P <
.001) and during late childhood by 0.4 year (P < .01), but they were
advanced during the adolescent years by 0.5 year (P < .01). Black boys
showed no difference except for the adolescent group, which was skeletally
advanced by 0.4 year (P < .02). CONCLUSIONS--The Greulich and Pyle atlas
is not applicable to all children today, especially black girls. We should
be aware of this information when making clinical decisions requiring
accurate bone ages.
