Interrelationship and limitations of conventional radiographic assessments of skeletal maturation

Assessments of skeletal maturation (ASM) are used by clinicians to optimize treatments for each patient. This study examines the interrelationship between and limitations of hand-wrist and cervical vertebrae maturation methods in adolescent patients. Radiographs (hand-wrist and lateral cephalometric) were obtained from patients (n = 62, 11 to 17 years of age) at two-time periods (T1/T2) with time intervals of 9.75 to 16.50 months. Radiographs were scored using cervical vertebral maturation staging (CS) and Fishman's skeletal maturation indices (SMI). Functional data analysis was used to visually assess maturational changes of the cervical vertebrae. Both SMI and CS increased over the period of observation. Age was moderately correlated with SMI (0.707/0.651 at T1/T2) and mildly correlated with CS (0.431/0.314 at T1/T2). There was some evidence of gender variability in SMI. The correlations between SMI and CS were 0.513 and 0.372 at T1 and T2, respectively. Functional data analysis illustrated the difficulty in differentiating contiguous cervical stages. Discrepancies exist between both scoring methods. Further studies are needed to overcome the difficulties encountered with CS. Clinicians are advised to use ASM methods with caution in adolescent patients given the aforementioned discrepancies. Separate references for boys and girls are not required.