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Thread: Risser Sign: A Major Method of Estimating Skeletal Maturity

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    Join Date
    Mar 2009

    Risser Sign: A Major Method of Estimating Skeletal Maturity

    I was asked to locate some information for a forum member regarding the Risser sign. I will post some links here to help people if they have questions regarding this method of estimating skeletal maturity.

    Risser sign basics:

    Everything you ever wanted to know about the Risser sign and skeletal growth. The information starts on page 47-57 of Lovell and Winter's pediatric orthopaedics and in relation to scoliosis on page 55 at "Scoliosis and Puberty" :

    The problems with using the Risser sign to estimate skeletal maturity:

    "Orthopedic surgeons commonly use the Risser sign to estimate skeletal maturity; however, the data presented in the orthopedic literature supporting the accuracy of the Risser sign in estimating skeletal maturity do not stand up to critical statistical analysis. The Risser sign is less accurate than chronologic age as a predictor of skeletal age and should not be used as a substitute for a hand and wrist radiograph in most cases. The Risser sign is also no better a predictor of scoliosis progression than is chronologic age."

    "The Risser grades of capping or fusion could be more precisely diagnosed using lateral radiograph in complement to the frontal one. The conclusions drawn from this study were: (1) Currently used Risser sign grading does not consider the actual excursion of the iliac apophysis, because one-third of the apophysis cannot be observed on the frontal radiograph. (2) Iliac apophysis full excursion or fusion can be more accurately estimated when the lateral spinal radiograph is analyzed with Lateral Risser Modifiers.

    The latest just published study from Korea:

    "Our results suggested that by using the combination of Risser sign, knee epiphyseal closure, and GP bone age, one can calculate a person's chronological age most accurately."

    GP bone age is the Greulich and Pyle method using an x-ray of the fingers, hand and wrist.

    And then, of course, the link where we discussed how spinal growth can occur after both major methods of estimating skeletal maturity say bone growth is complete:

    Growth Bone Beyond Skeletal Maturity
    Last edited by Ballet Mom; 03-24-2011 at 11:34 PM.

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