Review Question - QID 4430

Of the methods given, the Tanner-Whitehouse III RUS (radius, ulna, selected metacarpals and phalanges) correlates most closely with the curve acceleration phase for children with idiopathic scoliosis.

Assessing a child's skeletal maturity has important clinical implications when treating patients with idiopathic scoliosis. Current methods include the Greulich and Pyle method, the Oxford method, the Risser sign, and the Tanner-Whitehouse III method. The Tanner-Whitehouse III method specifically uses the distal radial and ulnar epiphyses and the metacarpal and phalangeal epiphyses of the first, third, and fifth digits for determination of skeletal age. In contrast, the Risser sign refers to the amount of calcification of the human pelvis as a measure of maturity. While the Tanner-Whitehouse method is more time consuming, it provides a better assessment of maturity and prognosis determination for curve progression in idiopathic scoliosis.

Sanders et al. (2007) evaluated a variety of maturity measurements and how closely they are related to scoliosis progression. They found the Tanner-Whitehouse-III RUS method was superior to all other indicators of maturity.

Sanders et al (2008) discussed a simplified version of the Tanner-Whitehouse III classification for skeletal maturity assessment. Their classification consists of 8 stages, from the juvenile slow stage to the mature stage, and is based on the radiographic appearance of all digital epiphyses. They found high intra- and extra-observer reliability, and a close correlation to the behavior of idiopathic scoliosis.

The following example shows how to use the Tanner-Whitehouse method. Illustration A shows the regions of interest. All bones are given a grade, as shown in Illustration B. The grade is then converted into a score, as shown in Illustration C. This data is then plotted on Illustration D to determine skeletal maturity. Illustration E shows a correlation between the Tanner-Whitehouse-III system and the Risser staging.

Incorrect Answers:
Answer 1: The Lenke classification refers to scoliotic curves, not skeletal age determination.
Answer 2, 3, 5: The Tanner-Whitehouse RUS method more closely correlates with the curve acceleration phase than either the Oxford method, Risser sign, or the Greulich and Pyle method.