Evidence brief
Skeletal Maturity Assessment: Greulich-Pyle Atlas
Left hand/wrist PA radiograph compared to atlas
Determines skeletal age vs chronological age
Guides timing of growth modulation procedures
Combined with other maturity markers
Digital methods now available
Bone age assessment is fundamental to timing pediatric orthopaedic procedures, particularly growth modulation for limb length and angular deformities.
Know when bone age matters: leg length inequality, angular deformity, scoliosis, SCFE. Greulich-Pyle vs TW3 methods. Risser sign for spine. Sanders staging for growth potential. Multiplier method for leg length prediction. Timing of epiphysiodesis.
Greulich WW, Pyle SI. Radiographic Atlas of Skeletal Development of the Hand and Wrist. 2nd ed. Stanford University Press; 1959.
Level V
Expert opinion or mechanism-based reasoning