This process requires a fundamental knowledge of bone growth. The assessment of skeletal maturity is a process that evaluates the size and shape of bones and their degree of mineralization to predict the time remaining to full maturity. Practical implementation is difficult, however, because of interindividual differences in the rates of bone growth and the variable shape and size of many ossification centers. With the development and use of digital imaging techniques, there have been increasing attempts to determine the morphologic hallmarks of ossification using computer-assisted techniques to permit a more effective and objective determination. For decades, skeletal maturity was determined by making a visual assessment of the skeletal development of the hand and wrist. After 2 months of age, these values can be determined on a radiograph of the left hand because the hand bones, with their numerous secondary ossification centers, are considered representative of the skeletal system as a whole. When conventional radiographs are used, present skeletal age and predicted adult height can be calculated on the basis of statistical tables. Because radiographs alone do not meet the legal requirement of establishing age with a “probability bordering on certainty,” these cases additionally require a physical and dental examination (including a panoramic radiograph). In rare cases, skeletal age determination is also required in judicial proceedings to determine, for example, whether a suspect should be charged as a juvenile or an adult. It also allows for growth prediction, so skeletal age determination is important for orthopedic procedures in which it is essential to know the remaining potential for longitudinal growth. Skeletal age determination is carried out for the purpose of evaluating growth in pediatric patients and for the diagnosis of many endocrine disorders and pediatric syndromes. Kappa is available only for tables in which both variables use the same category values and both variables have the same number of categories.Skeletal age is considered the most important and most representative criterion of biological maturity. A value of 0 indicates that agreement is no better than chance. A value of 1 indicates perfect agreement. Cohen's kappa measures the agreement between the evaluations of two investigators when both are rating the same object. The Kappa statistic for concordance was 0.846 ( P <. Agreement of the skeletal maturity indicator assessment occurred in 23 of 25 cases. The interexaminer error was calculated using the same radiographs of the same 25 patients and reevaluated by another orthodontist. Twenty-four of 25 interpretations were the same at the second examination. 8 Randomly selected lateral cephalometric and hand-wrist radiographs for both methods were evaluated by the investigator and then reevaluated by the same investigator after 3 weeks. The intraexaminer error was calculated for 25 patients (following protocol from a previous study). However, the low correlations found between the chronological age and both CVM and HWM showed that the chronological age was not suitable to measure skeletal maturity. Low correlations were found between the CVM and chronological age (male r = 0.7577 female r = 0.7877) and between the HWM and chronological age (male r = 0.7492 female r = 0.7758).Ĭonclusions: CVM is a valid indicator of skeletal growth during the circumpubertal and has a high correlation with the HWM for the southern Chinese population. All patients in the cervical maturation stage (CS3) of CVM were discovered to be in the skeletal maturational indicator (SMI2 or SMI3) stages of hand-wrist maturation (HWM), which was around the peak of the growth spurt. Results: The CVM was significantly correlated with the hand-wrist skeletal age (Spearman r male = 0.9206, female = 0.9363). These two methods and the chronological age were correlated using the Spearman rank correlation analysis. The CVM was assessed using the method developed by Baccetti and coworkers, but the hand-wrist maturation was assessed using the method developed by Fishman. The female subjects were between 10 and 15 years of age, and the male subjects were between 12 and 17 years of age all subjects were within the circumpubertal period. Materials and Methods: Four hundred contemporary hand-wrist and lateral cephalometric radiographs of southern Chinese subjects were randomly selected and analyzed. Objective: To investigate the correlation between chronological age, cervical vertebral maturation (CVM), and Fishman's hand-wrist skeletal maturity indicators in southern Chinese.
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