Review Question - QID 4696

There are two stages of life where the velocity of postnatal skeletal growth is most rapid. These are: (1) during the first year of life and (2) puberty. Both correlate with a Risser sign of 0. Risser 0 covers the first 2/3rd of the pubertal growth spurt and correlates with the greatest velocity of skeletal linear growth.

Risser grades range from 0 to V and are a measure of the progression of ossification in the pelvis. The Risser sign is usually referenced in clinical decision-making regarding adolescent idiopathic scoliosis.

Biondi et al. examined 111 patients to determine the relationship between the accuracy of the Risser sign and bone age determinations. They found that the iliac crest apophysis maturation correlated with skeletal age assessment. They suggest that Risser sign is a reliable method for assessing skeletal bone age.

Illustration A shows an AP pelvis radiograph of a patient that is a Risser II based on the iliac crest apophysis maturation scale. Illustration B shows a chart showing the rate of growth correlated with the Risser staging system. Illustration C shows the Risser staging system from 0 - V.

Risser I: is given when the ilium calcification measures 25%. As this stage the velocity of linear skeletal growth is on a descending slope.

Risser II: the greater trochanteric apophysis unites with the femur and Ilium calcification measures 50%. There is usually 3 cm of sitting growth remaining and no further growth in the lower extremities.

Risser III: Ilium calcification measures 75%. There is usually 2 cm of sitting growth remaining.

Risser IV: Ilium calcification is almost complete. There is usually 1 cm of sitting growth remaining.

Risser V marks complete skeletal maturation.

Incorrect Answers:
Answers 2-5: During Risser 0, the velocity of linear skeletal growth has peaked. Between Risser I through IV the rate of growth progressively declines until growth stops in Risser V.