A number of conditions could contribute to delayed bone age, including5: Any child crossing up or down percentiles in childhoodafter age 3 years and before pubertyshould be referred, Kutney said. Tanner JM. doi: 10.1111/j.1651-2227.1975.tb03936.x. In particular, the method of medical age assessment proposed consisted of taking X-rays of wisdom teeth and MRI scans of knee joints, which are then analyzed by dentists and radiologists. Poulton AS, Bui Q, Melzer E, Evans R. Stimulant medication effects on growth and bone age in children with attention-deficit/hyperactivity disorder: a prospective cohort study. Thereafter, the pisiform and the sesamoid become recognizable. Prediction of adult height by Tanner-Whitehouse method in young Caucasian male athletes. Ann Hum Biol. Thus, gender-specific images are compared with the one obtained by patients by evaluating first the nearest chronological age and subsequently the adjacent standards. Ossification centers are defective, appearing in an irregular and mottled pattern, with multiple foci that coalesce to give a porous or fragmented appearance. Obesity (Silver Spring). Greulich WW. (127) started a computerization project of reading using phalanxes length compared to atlas. London: Academic Press (1983). (2016) 37:13587. doi: 10.1203/00006450-200111000-00015, 85. Pearson's correlation analysis revealed that was strong . The GreulichPyle tables can be applied in subjects belonging to Australia and the Middle East (108110) but not to African or Asian populations (106, 111, 112). (2005) 19:20915. In particular, bone age is more advanced in female than in male individuals with the same chronological age. [2], In the United States, bone age is usually determined by comparing an x-ray of the patient's left hand and wrist to a set of reference images contained in the Greulich and Pyle atlas. The image in the reference atlas that most closely resembles the patient's x-ray is then used to assign a bone age to the patient. The CDC and WHO growth charts are available at http://www.cdc.gov/growthcharts/ and http://www.who.int/childgrowth/standards/en/. This means a child tends to be shorter than average and to enter puberty later than average, while growing at a normal rate. The most common measurement standards used for bone age are the Greulich and Pyle Atlas 2 and the Tanner-Whitehouse 3 assessments. Tanner-Whitehouse method of assessing skeletal maturity: problems and common errors. IEEE Trans Med Imaging. Aicardi G, Vignolo M, Milani S, Naselli A, Magliano P, Garzia P. Assessment of skeletal maturity of the hand-wrist and knee: a comparison among methods. Assessing the skeletal maturity of the hand-wrist: FELS method. J Forensic Leg Med. Guidelines on Policies and Procedures in Dealing With Unaccompanied Children Seeking Asylum. But perfectly healthy kids also can have bone ages that differ from their actual ages. New York, NY: Springer (2012). chronological age and bone age in both genders (Females r=0.778; p-value < 0.001, Males r=0.816; p-value < 0.001). Pediatr Radiol. (2009) 39:5917. IEEE Trans Med Imaging. Horm Res. There are extremes to be mindful of, Kutney added. Hand radiographs in Russell-Silver syndrome. Albanese A, Stanhope R. Predictive factors in the determination of final height in boys with constitutional delay of growth and puberty. (2001) 50:6248. doi: 10.1093/bmb/lds014. The main advantage of this procedure related to the evaluation of each bone segment, thus minimizing the interoperator variability. This means that a girl who will have a final adult height of 55 but will undergo puberty earlier than average may grow along the 80th percentile in early childhood. There have been two updates since the first publication of the TW method in 1962: the TW2 method in 1975 and the TW3 method in 2001. p. 70932. 1988, $57.50. De Sanctis V, Soliman AT, Di Maio S, Bedair S. Are the new automated methods for bone age estimation advantageous over the manual approaches? doi: 10.1097/MPG.0000000000000848, 57. Every 6-12 months, height and bone age should be assessed. Springfield, IL: Blackwell Scientific Publications (1962). Assessment of bone age is often required during international immigration programs (68, 69). Therefore, chronological age differs from bone age, so the two indexes need to be distinguished: chronological age is defined as the age in years between birth and the evaluation of a subject; bone age is defined by the age expressed in years that corresponds to the level of maturation of bones. In children, bone age serves as a measure of physiological maturity and aids in the diagnosis of growth abnormalities, endocrine disorders, and other medical conditions. Moreover, the score based on 20 bone segments was abolished, and the reference values and the graphs were modified and based on data obtained from native North American children. For males, one takes the maternal height and adds 5 inches or 13 centimeters, and averages this value with the paternal height to obtain the mid-parental height. During a hand and wrist X-ray procedure, the child is exposed to <0.00012 mSv of radiation, thus lower than other daily physiological risk (86), however resulting in irrelevant relative risk of 40-year mortality equal to 5.1 108 (calculated for an exposure dose of 0.00015 mSv) (8789). doi: 10.1111/j.1651-2227.1984.tb09966.x, 15. 47. Those with an advanced bone age typically hit a growth spurt early on but stop growing at an earlier age. This system allows the computer to perform reading operations. (2011) 76:19. N Engl J Med. Tall stature is defined as a height more than two standard deviations above the mean for age (greater than the 97th percentile). Measurement of Bone Mineral Content of the Lumbar Spine by Dual Energy At this stage, children should track along a percentile, and variation should stay within two large bands on the growth chart. Using an atlas-based method gives a great possibility of intra- and interoperator variability (142). Particularly, the tables are based on the assumption that there is a correlation between the proportion of adult stature reached at that time and skeletal age. (2016) 52:5238. This process is strongly affected by numerous factors, including GH and insulin-like growth factor-1 (IGF-1). This information, associated to the characterization of the shape and changes of bone components configuration, represent an important factor of the biological maturation process of a subject. doi: 10.1088/0952-4746/23/1/302, 88. Giovanni XXIII Children's Hospital, Italy, University of Modena and Reggio Emilia, Italy, Children's Hospital at Montefiore, United States. It is important to highlight that all the available methods might be carefully used in the daily clinical approach in order to avoid unreliable expectation in children and parents. Although the Khamis-Roche method is considered an accurate predictor, it is not as accurate as methods using the bone age. (2015) 49:8529. Pediatr. doi: 10.1007/s00414-008-0237-3, 65. There is a separate equation for each half year of chronological age; and for pre- and postmenarcheal girls at ages 11 to 14. Radiographic evaluation of skeletal maturation. Although several bones have been studied to better define bone age, the hand and wrist X-rays are the most used images. Cerbone M, Dattani MT. In order to achieve a greater accuracy and diagnostic reproducibility, it is important that bone age determination has the lowest intra- and interoperator variability. doi: 10.1590/S0004-27302007000300021, 64. However, the GP method requires a continuous and long experience in order to optimize bone age determination. Morla Baez E, Dorantes Alvarez LM, Chavarria Bonequi C. Growth in children with diabetes insipidus. Martin DD, Wit JM, Hochberg Z, Savendahl L, van Rijn RR, Fricke O, et al. (2015) 16:2015. Conclusions: Hormonal effects associated with adiposity and sexual maturity likely influence skeletal maturation. Tall stature has the same prevalence as short stature, but it is a much less common reason for referral to subspecialty care. Physical examination may reveal microphallus or midline craniofacial abnormalities. Pediatr Endocrinol Rev. Woods CP, Argese N, Chapman M, Boot C, Webster R, Dabhi V, et al. An appraisal of Greulich-Pyle Atlas for skeletal age assessment in Pakistan. Evaluation of skeletal maturity is a common procedure frequently performed in clinical practice. doi: 10.1002/1520-6300(200009/10)12:5<610::AID-AJHB5>3.0.CO;2-D. 82. Precocious puberty and statural growth - Oxford Academic Condo R, Costacurta M, Maturo P, Docimo R. The dental age in the child with coeliac disease. (1973) 83:2336. Taranger J, Karlberg J, Bruning B, Engstrom I. doi: 10.1111/j.1651-2227.1988.tb10615.x, 46. 1. The issue here is the size of the standard deviation (SD) of the difference between bone age and chronological age, which is 15 months or more. Wong SC, Smyth A, McNeill E, Galloway PJ, Hassan K, McGrogan P, et al. Effective dose and energy imparted in diagnostic radiology. (2012) 46:7709. For this reason, pediatricians should evaluate each prediction of future height on the bases of all the available knowledge about the child, particularly their personal growth history. Front. Bone age (BA) is a measure of the skeletal maturity of an individual and tells us about the growth potential of a child. Deviations from these patterns, or other signs of delayed bone growth need to be investigated by a specialist, Kutney stated. [15] An alternative approach to the atlas method just described is the so-called "single-bone method" where maturity scales are assigned to individual bones. Performing bone age assessments can assist clinicians in diagnosing central precocious puberty. After dividing the population into two different age groups: children < 11 years and adolescents 11 years, children showed an average delay in bone age of 3.4 months and adolescents of 2.4 months. The Pediatric Endocrine Society website was searched for consensus statements and clinical guidelines. Clin Endocrinol. (2016) 31:939. (1989). (2011) 12:1848. doi: 10.1006/clim.2000.4838, 35. Most children will achieve a final height within 4 inches of the mid-parental height estimate, she said. doi: 10.1016/j.forsciint.2014.02.030. What's my body age? - coalitionbrewing.com 113. Arch Dis Child. The normal range is represented by 2 standard deviations (SD) above and below the mean (white area on this chart). then every 6 months. [] The other applications of BA include height prediction and estimation of age in children seeking asylum in other countries and in competitive sports where chronological age (CA) may be unknown. (1989) 1:17583. Data Sources: We searched PubMed, Agency for Healthcare Research and Quality, Cochrane Database of Systematic Reviews, and National Guidelines Clearinghouse. Soudack M, Ben-Shlush A, Jacobson J, Raviv-Zilka L, Eshed I, Hamiel O. AJR Am J Roentgenol. For patients two to 20 years of age, weight, height, and body mass index should be plotted. Nemours Kids Health. doi: 10.1093/med/9780199782055.001.0001, 10. Common normal variants of short stature are familial short stature, constitutional delay of growth and puberty, and idiopathic short stature. J Forensic Sci. [16], The bones considered in the TW3 method include the distal radius and ulna, the metacarpals and phalanges of the 1st, 3rd, and 5th fingers, and all of the carpal bones except the pisiform. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. As these cartilaginous zones become obliterated, the epiphyses are said to be "closed" and no further lengthening of the bones will occur. Bone age and factors affecting skeletal maturation at diagnosis of paediatric Cushing's disease. Relationship between height age, bone age and chronological age in 2nd ed. Pathologic causes of short stature include chronic diseases; growth hormone deficiency; and genetic disorders, such as Turner syndrome. Arq Bras Endocrinol Metabol. Oxford University Press (2011). Topor LS, Feldman H. Variation in methods of predicting adult height for children with idiopathic short stature. There are also exceptions with people who have a delayed bone age (bone age is younger than chronological age) due to being a late bloomer (someone starting puberty and hitting PHV later than average), being a late bloomer with delayed puberty, or having another condition. N Engl J Med. 134. doi: 10.1159/000053086, 49. In fact, if a simple comparison is made, it is likely inadequate when the proximal and distal bones vary in maturation, sometimes by several years. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. Apart from the ability to assess the chronological age of a person, the evaluation of growth remaining in a person can be extremely beneficial to a clinician in different circumstances, as previously discussed. Statistics have been compiled to indicate the percentage of height growth remaining at a given bone age. [36], Bone maturation is delayed with the variation of normal development termed constitutional delay of growth and puberty, but delay also accompanies growth failure due to growth hormone deficiency and hypothyroidism.[37][38]. Ostojic SM. doi: 10.1080/03014460500087725, 119. Office of the United Nations High Commissioner for Refugees. Maes M, Vandeweghe M. A valuable improvement of adult height prediction methods in short normal children. This was followed by a comparison between the skeletal age estimates and the chronological ages of the patients. Katherine Kutney, MD, a pediatric endocrinologist at Rainbow Babies and Childrens Hospital in Cleveland, Ohio, said bone age assessments are typically done with an x-ray of the left hand. King DG, Steventon DM, O'Sullivan MP, Cook AM, Hornsby VP, Jefferson IG, et al. A difference between a child's bone age and their chronological age might indicate a growth problem. 69. Height Calculator - How Tall Will I Be? Arntzenius A, van Galen L. Budesonide-related adrenal insufficiency. [21] Other downsides are that the atlas has not been updated since 1959 and the images in the atlas were acquired from healthy white children living in Cleveland, Ohio in the 1930s and 1940s and therefore may not yield accurate bone age assignments when applied to non-white patients or unhealthy children. A child's current height and bone age can be used to predict adult height. In this way, a maturity score is obtained for each area of clinical interest, generally categorized as A, B, C, D, E, F, G, H, and I. Other causes include renal, hepatic, and gastrointestinal diseases, and other genetic syndromes.1015, The initial evaluation of short stature (Figure 1) should include a history and physical examination, accurate growth assessment, calculation of the growth velocity and midparental height, and radiography to evaluate bone age.16 Drugs known to cause short stature include steroids (chronic use), attention-deficit/hyperactivity disorder medications, and anticonvulsants. Therefore, the complete characterization of the main methods and procedure available and particularly of all their advantages and disadvantages need to be known in order to properly utilized this information for all its medical and non-medical main fields of application. [42][43] The bones of the limbs form and lengthen through endochondral ossification beginning by the 12th week after fertilization.[41]. [41] The cells of the mesenchyme can become bone by one of two primary methods: (1) intramembranous ossification where mesenchymal cells differentiate directly into bone or (2) endochondral ossification where mesenchymal cells become a cartilaginous model of chondrocytes which then become bone. 4 Growth at Adolescence. Vignolo M, Milani S, DiBattista E, Naselli A, Mostert M, Aicardi G. Modified Greulich-Pyle, Tanner-Whitehouse, and Roche-Wainer-Thissen (knee) methods for skeletal age assessment in a group of Italian children and adolescents. Bone age advancement in prepubertal children with obesity and premature adrenarche: possible potentiating factors. Advanced bone age and hyperinsulinemia in overweight and obese children. Patil ST, Parchand MP, Meshram MM, Kamdi NY. Bone age assessment can be of utmost importance in various complicated situations involving medical, surgical, forensic, and legal issues. Thodberg HH, Kreiborg S, Juul A, Pedersen KD. MSK Taskforce Recommendation on Bone age for chronological age - ESPR Soegiharto BM, Cunningham SJ, Moles DR. Skeletal maturation in Indonesian and white children assessed with hand-wrist and cervical vertebrae methods. Using an atlas-based method gives a great possibility of intra- and interoperator variability, so in the last 20 years, new methods have been studied such as computerized automatic systems. In several conditions involving atypical growth, bone age height predictions are less accurate. Final height in boys with untreated constitutional delay in growth and puberty. Midparental height growth velocity should be calculated to evaluate a child's growth vs. potential height. Rosemont, IL: American Academy of Orthopaedic Surgeons (2000). Crowne EC, Shalet SM, Wallace WH, Eminson DM, Price DA. The keywords for the research have been bone age and skeletal maturation.. (2009) 94:223944. (1987) 14:35765. Arch Dis Child. Issues and advances in adolescent growth and development. CT Analysis Demonstrates That Cochlear Height Does Not Change with Age For this reason, pediatricians should evaluate patients on the bases of all the available knowledge about the child, particularly their personal growth history. 103. [5][2][3][1] Drs. Sweden Begins New Asylum Seeker Age Assessment Tests. (10), adult height may be overestimated in constitutional delay, and at the same time, it may be underestimated in idiopathic short stature. Thorne MC. In: Preedy V, editor. Springfield, IL: Charles C. Thomas. [35], An advanced or delayed bone age does not always indicate disease or "pathologic" growth. Growth and development: congenital adrenal hyperplasia-glucocorticoids and height. CG has organized the material. Am J Hum Biol. A fuller description of the use of bone age films from the University of Utrecht. Vaska AI, Benson J, Eliott JA, Williams J. [12] The Greulich and Pyle atlas contains x-ray images of the left hands and wrists of different children deemed to be good models of the average appearance of the bones of the hand at a given age. As growth nears conclusion and attainment of adult height, bones begin to approach the size and shape of adult bones. [39] Liver weight increases with age and is different between males and females. Berlin; Heidelberg. Child Adolesc Psychiatry Ment Health. (2009) 58:38290. Puberty onset according to elbow occurred slightly earlier than expected. Statistical Confirmation of a Method of US Determination of Bone Age Sopher AB, Jean AM, Zwany SK, Winston DM, Pomeranz CB, Bell JJ, et al. doi: 10.1016/0197-0070(87)90048-9, 84. In the United States, the most common technique for estimating a person's bone age is to compare an x-ray of the patient's left hand and wrist to a reference atlas containing x-ray images of the left hands of children considered to be representative of how the skeletal structure of the hand appears for the average person at a given age. This evaluation is more detailed than a simple comparison and takes into consideration a detailed analysis of structural characteristics of different bones with the assignment of a score to each element (3, 113, 114). Bone age may be affected by several factors, including gender, nutrition, as well as metabolic, genetic, and social factors and either acute or chronic diseases, including endocrine dysfunction (39). (2015) 24:14352. Intestinal inflammatory chronic conditions. doi: 10.1038/oby.2010.305, 51. Br J Sports Med. Principal pros and cons related to the different methods utilized for the definition of skeletal age [82, 85, 94, 95, 97, 98, 102, 116, 121, 122, 123, 126, 129,132, 135,137, 138]. A child whose growth is initially normal but then falls progressively further off the growth curve may have growth hormone deficiency. Clin Immunol. Most children with short stature have normal variants such as familial short stature, constitutional delay of growth and puberty, or idiopathic short stature. It is defined by the age expressed in years that corresponds to the level of maturation of bones. Bone age is distinct from an individual's biological or chronological age, which is the amount of time that has elapsed since birth. Insulinlike growth factor has been used in children with insulinlike growth factor deficiency. External validation of deep learning-based bone-age software: a Growth Horm IGF Res. Malina RM, Rogol AD, Cumming SP, Coelho e Silva MJ, Figueiredo AJ. 9 Articles, This article is part of the Research Topic, Standardization of Hand and Wrist Radiography, Assessment Methods for Evaluating Bone Age, Computerized Automatic Systems for Reading Bone Age: Potentials and Limits, Relevance of the Variability Related to the Operator and Between the Operators, https://treaties.un.org/Pages/ViewDetails.aspx?src=IND&mtdsg_no=IV-1&chapter=4&clang=_en, http://www.ice.gov/doclib/foia/dro_policy_memos/agedeterminationproceduresforcustodydecisionsaug202004.pdf, http://www.unhcr.org/publications/legal/3d4f91cf4/guidelines-policies-procedures-dealing-unaccompanied-children-seeking-asylum.html, https://www.rch.org.au/immigranthealth/clinical/Birth_date_issues/, www.thelocal.se/20170307/sweden-begins-newasylum-seeker-age-assessment-tests, Creative Commons Attribution License (CC BY), Department of Pediatrics, University of Chieti-Pescara, Chieti, Italy. doi: 10.1136/adc.65.10.1109, 14. The most common measurement standards used for bone age are the Greulich and Pyle Atlas2 and the Tanner-Whitehouse3 assessments.4. Overall results indicated that use of the GP atlas underestimated Botswana female age by 0.64 years, while age for males was underestimated by 0.50 years. Ann Hum Biol. Herman-Giddens ME. A projected height that differs from the midparental height by more than 10 cm suggests a possible pathologic condition. Horm Res. Available online at: www.thelocal.se/20170307/sweden-begins-newasylum-seeker-age-assessment-tests. The atlas is based on data from many other kids of the same gender and age. New growth references for assessment of stature and skeletal maturation in Australians. The main aspects of these differences are summarized in Table 1 focused on variability, time of execution, radiation risk, and standardization. (2013) 106:3415. These tables, the Bayley-Pinneau tables, are included as an appendix in the Greulich and Pyle atlas. Tanner JM WR, Cameron N, Marshall WA, Healy MJR, Goldstein H. Assessment of Skeletal Maturity and Prediction of Adult Height (TW2 Method). (2012) 42:3438. doi: 10.1002/ajhb.1310010413, 125. I NTRODUCTION. [1 2 3]The two major methods of BA assessment used commonly are i . Bergeron MF, Bahr R, Bartsch P, Bourdon L, Calbet JA, Carlsen KH, et al. There are different methods to predict adult height, but the most used are the BayleyPinneau method and RocheWainerThissen method. The bone age will determine the maturity of your child's bones, compared to your child's chronological (actual or "birthday") age. Just as there is wide variation among the normal population in age of losing teeth or experiencing the first menstrual period, the bone age of a healthy child may be a year or two advanced or delayed. doi: 10.1007/s00247-019-04435-z. In some psychiatric conditions, such as anorexia and in subjects with states of psychosocial stress or abuse, the presence of delayed skeletal maturation is documented (4345). For specific medical advice, diagnoses, and treatment, consult your doctor. Prepubertal gynecomastia linked to lavender and tea tree oils. During puberty, the contours of the epiphyses begin to overlap, or cap, the metaphyses. TannerWhitehouse method is more complex and time consuming, requiring approximately 7.9 min if the TW2 (121) method is used. The chronological age (CA) is the child's actual age, based on birth date. [2][5] Studies of bone age in children allow physicians to correlate a child's current height and bone age to their predicted future maximum height in adulthood.[3][5]. Table 3 includes the differential diagnosis of short stature.1,2,4,1618, If the initial evaluation suggests a genetic, endocrine, or gastrointestinal disorder, laboratory testing should be performed (Table 4).1,3,13,14,16,19,20 In an asymptomatic child with short stature, an evaluation of the growth curve may provide clues to the underlying pathology. Speiser PW. In the table below, you can find a few other numbers for different ages. Then, the final report is done, making an average of the measurements. However, she will stop growing earlier than her peers to attain a final adult height at the 50th percentile, Kutney noted. GreulichPyle distinguished two standard templates: 31 and 27 radiographic images, in male and female individuals, respectively, which illustrate different phases of bone maturation between 0 and 18 or 19 years, respectively. 1, Fig. Schmidt S, Nitz I, Schulz R, Schmeling A. Applicability of the skeletal age determination method of Tanner and Whitehouse for forensic age diagnostics. The bone age (also called the skeletal age) is measured in years. 104. The long bones include the femurs, tibias, and fibulas of the lower limb, the humeri, radii, and ulnas of the upper limb (arm + forearm), and the phalanges of the fingers and toes. Table 2 includes normal growth velocity by age.1,9. (2016) 8:4751. Bone age should be compared with chronologic age to narrow the differential diagnosis of short stature.5,10,11 The traditional method compares a plain radiograph of the left wrist and hand to a database of norms, although various methods are now available.1012 Children with normal variations of growth may have advanced or delayed bone age, but a bone age that is more than two standard deviations from the mean for age is likely due to a pathologic condition. They can be seen on an X-ray because they're softer and contain less mineral, making them appear darker on an X-ray image than the rest of the bone. Tall stature is defined as a height more than two standard deviations above the mean for age (greater than the 97th percentile). Then, the remaining centers progressively appear (Figure 1) (80). X-rays are commonly done in doctors offices, radiology departments, imaging centers, and dentists offices. doi: 10.1016/j.gcb.2008.09.020, 30. This information, associated with the characterization of the shape and changes of bones, represents an important factor of the biological maturation process. Revised for use with the Greulich-Pyle hands standards. doi: 10.1136/bjsports-2012-091296. J Coll Physicians Surg Pak. Evaluation of two methods of bone age assessment in peripubertal Projected height can be estimated by projecting the current growth curve to adulthood in children with normal bone age, or by using a bone age atlas in those with delayed bone age. Age, height, weight, BMI z-score, and BA/CA were similar in the PA and control groups . 1996;45:5355. Calculating the midparental height (Table 1) is an important part of the evaluation because most short or tall children have short or tall parents. 110. doi: 10.1016/j.forsciint.2011.09.022, 101. Extensive clinical experience: nonclassical 21-hydroxylase deficiency. [29] A girl has reached 99% of her adult height at a bone age of 15 years and has a small amount of height growth left from this point on. (2015) 7:1827. Effect of a gluten-free diet on bone mineral density in children with celiac disease. 2 ). Pediatric Endocrine Associates | Growth Delay Treatments Applicability of the Greulich and Pyle skeletal age standards to black and white children of today. Acta Paediatr. Bone growth estimation using radiology (GreulichPyle and Tanner-Whitehouse Methods). A small amount of spinal growth concludes an adolescent's growth. Bone age is measured in years and assigned by a trained radiologist or endocrinologist by comparing the childs measurements with existing standards. doi: 10.1016/S0022-3476(73)80481-0, 19. Then the remaining centers appear, including Triquetrum at 2 years in females and 3 years in males, Lunate at 3 years in females and 4 years in males, Trapezium at 3 years in females and 4 years in males, Trapezoid at 4 years in females and 6 years in males, Scaphoid at 4 years in females and 6 years in males, Pisiform at 9 years in females and 12 years in males [77].