For decades, skeletal maturity was determined by making a visual assessment of the skeletal development of the hand and wrist. After 2 months of age, these values can be determined on a radiograph of the left hand because the hand bones, with their numerous secondary ossification centers, are considered representative of the skeletal system as a whole. When conventional radiographs are used, present skeletal age and predicted adult height can be calculated on the basis of statistical tables. Because radiographs alone do not meet the legal requirement of establishing age with a “probability bordering on certainty,” these cases additionally require a physical and dental examination (including a panoramic radiograph). In rare cases, skeletal age determination is also required in judicial proceedings to determine, for example, whether a suspect should be charged as a juvenile or an adult. It also allows for growth prediction, so skeletal age determination is important for orthopedic procedures in which it is essential to know the remaining potential for longitudinal growth. Skeletal age determination is carried out for the purpose of evaluating growth in pediatric patients and for the diagnosis of many endocrine disorders and pediatric syndromes. Skeletal age is considered the most important and most representative criterion of biological maturity.
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