Skeletal age determination from the elbow during pubertal growth

The Sauvegrain et al. method of assessing skeletal age from elbow radiographs is useful during the 2 years of the pubertal growth spurt: between 11 and 13 years in girls and between 13 and 15 years in boys. This method uses four ossification centers of the elbow: lateral condyle, trochlea, olecranon apophysis, and proximal radial epiphysis. It is based on a 27-point scoring system. The scores of these structures are summed, a total score is determined, and a graph is then used to determine the skeletal age. This simple, reliable, and reproducible method complements the Greulich and Pyle atlas, which does not allow assessment of skeletal age in 6-month intervals during the phase of accelerating growth velocity. In clinical practice, maturity can best be evaluated by associating skeletal age, annual growth rate, and Tanner stages. Skeletal age assessment from the elbow is useful to plan the timing of epiphysiodesis in limb length inequality or to evaluate the progression risk of idiopathic scoliosis.