Hand Bone Age



Skeletal maturity is a measure of growth, combining the size, shape and degree of bone mineralization to determine full maturity. Evaluation of skeletal maturity involves rigorous examination of many factors and a basic knowledge of the various processes that the bone develops. The longitudinal development in the long bones of the extremities occurs through central cartilage endostasis. Although many flattened bones, including the carpal tunnel, emerge entirely from this center, all long bones develop secondary centers, which appear in the cartilage of the limbs of the bone.

Hand Bone Age

Maturation at these centers proceeds in a similar way to the main centers with the ossification of the cartilage and the destruction of osteoclasts and osteoblasts. The ossification from the center is the skeletal body, while the bones from the secondary center are synaptic cartilage (Epiphyses).

Indicators of bone maturation in children and young people

The purpose of this section is to describe which bones in the hands and wrists are the most suitable indicator for bone maturation during the different stages of postnatal development. In most healthy children, a ossification chain is formed in the carpal tunnel (Figure 3), the table bone and the knucklebone, which is notable and similar for both sexes.

Indicators of palm bone age maturity in children and young people

In general, the first ossification center to appear on hand and wrist radiographs is the whole, and lastly most is the sesame bone of the thumb. The first synaptic cartilage center to appear is the rotating bone tip, followed by the proximal knuckles, the knuckles, the middle knuckles, the distal knuckles, and finally the cylindrical bone. Due to the predictive value of different centers of chemistry and changes during growth, the doctor should mainly focus on the centers that are most characteristic for the development of the skeleton over time of age. young. To facilitate bone age assessment, we have divided skeletal development into six main categories and highlighted in parentheses specific ossification centers as the best predictor of bone maturation. for each group:

  • Infants (carpal tunnel and spun synaptic cartilage);
  • Toddlers (amount of visible synaptic cartilage in the long bones of the hands);
  • Pre-puberty (the size of cartilage syncing the knuckles);
  • Pre-puberty and mid-puberty (the size of the cartilage syncing the knuckles);
  • Late puberty (degree of fusion of synaptic cartilage);
  • 6) Post-puberty (degree of consolidation of the rotational and cylindrical synaptic cartilage).


Females: Birth to 10 months of age
Males: Birth to 14 months of age

All wrist bones and all synaptic cartilage in the knuckles, table knocks, spine and pillars are unexplained in term infants.

The age of a young hand is born

The bones of both the capitate and the hamate become apparent by around 3 months of age and remain the only useful observational property in the next six months. At about 10 months of age for girls and about 1 year 3 months for boys, a small ossification center in the synaptic cartilage of the spine appears. Due to the lack of ossification centers, it is difficult to evaluate bone maturity using X-rays of the hands and wrists in infancy. Estimation of bone maturity during the first year of life usually requires an assessment of the number, size and shape of secondary ossification centers in the upper and lower extremities.


Females: 10 months to 2 years of age
Males: 14 months to 3 years of age

The ossification centers for the synaptic cartilage of all the knuckles and knuckles become recognizable during this period, usually first in the middle and last in the fifth finger. Determination of bone age is mainly based on the assessment of the number of ossification centers in synaptic cartilage, usually appearing in a characteristic phenotype in the following order:

  1. Epiphyses of the proximal phalanges; (synaptic cartilage of the proximal knuckles
  2. Epiphyses of the metacarpals; (synaptic cartilage of the carpal tunnel)
  3. Epiphyses of the middle phalanges; and, (synaptic cartilage of the inter-fingers)
  4. Epiphyses of the distal phalanges. (synaptic cartilage of the distal knuckles)

Two common exceptions to this rule are:

  1. Early appearance of the core of the core of the distal thumb of the thumb, usually noticeable at 1 year and 3 months in men, and 1 year and 6 months in women.
  2. Late emergence of the ossification center of the middle knuckles of the fifth finger, which is the last synaptic cartilage of the knuckles appears.

The number and maturity level of the carpal tunnel are less useful indicators during this period, as only three or four bones (whole, hook, and, sometimes, trapezoid) can be get out.

Hand age of a toddler

Pre-puberty (Puberty)
Females: 2 years to 7 years of age
Males: 3 years to 9 years of age

Evaluation of skeletal maturation in pre-pubertal children is mainly based on the epithelial size of the knuckles as they relate to the adjacent skeletal planets. During this stage of development, the ossification centers for the synaptic cartilage increase in width and thickness, and eventually the transverse diameter is as wide as the alveolar lobes. However, since the growth of the distal knuckles appears similar at different ages, sometimes the assessment is also based on the maturity of the synaptic cartilage of the middle toe. In very rare cases, when suspicion continues, the development of the proximal knuckle may be taken into account. The synaptic cartilage of the cylindrical bone and all wrist bones, except the pisiform, often becomes recognizable before puberty.

pre-puberty palm bone age

Early and Mid-puberty (Puberty and puberty)
Females: 7 years to 13 years of age
Males: 9 years to 14 years of age

As in pre-pubertal children, early and mid-puberty assessment of skeletal maturity is based on the size of the synaptic cartilage in the distal (first) and knuckle. middle (second). The synaptic cartilage at this stage continues to grow and their width becomes larger than the skeletal actuaries. Then, the contours of the synaptic cartilage begin to overlap, or clog, the onions.

Pre-puberty palm bone age

Puberty of the palm bone

Late Puberty
Females: 13 years to 15 years of age
Males: 14 years to 16 years of age

Evaluation of the maturity of the skeleton during this period is mainly based on the degree of synaptic cartilage fusion of the distal knuckles. The fusion of the cartilage synapses with the ions in the long bones of the hands tends to occur in a characteristic pattern that has the following order:

  • Fusion of the distal phalanges; (Fusion of the distal knuckles)
  • Fusion of the metacarpals; (Fusion of the wrist bones)
  • Fusion of the proximal phalanges; (Merge of the proximal knuckles)
  • Fusion of the middle phalanges. (Merge of the middle knuckle)

Due to their morphology, synaptic cartilage fusion of the carpal bones is poorly displayed by radiography and therefore, greater attention is placed on the degree of consolidation at the knuckles. Since all carpal tunnel bones have attained their early mature shape, they are of little value for determining bone age.

Females: 15 years to 17 years of age
Males: 17 years to 19 years of age

At this stage, all the wrist, bench and knuckle bones are fully developed, the torso is closed, and bone maturation is assessed based on degree of further cartilage fusion. of the cylindrical and rotational bones.



Age of palm bone is 11 years old

13 years old hand bone

Age 14 years old palm bone

age 15 years old knuckles

16 years old hand bone

17 years old hand bone

18 years old palm bone

Translation: Dr. Tran Nam Anh

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