title: Assessment of skeletal age in multiple epiphyseal dysplasia.
abstract: BACKGROUND
  Determining the skeletal age in patients with multiple epiphyseal dysplasia (MED) is essential for predicting the adult height and guiding the timing of limb lengthening, epiphysiodesis, and other surgical procedures. In the present study, we examined the patterns of skeletal age delay using 3 different methods, the Greulich-Pyle (GP) atlas method, the Tanner-Whitehouse 3 (TW3) method using radius-ulna-short bones (RUS) scoring system, and the TW3 method using the carpal bone maturity scoring system.
  
  
  METHODS
  Left hand radiographs from 23 patients (age range, 3 to 14 y) with MED were examined to determine the skeletal age. We examined the reliability of the 3 different methods and evaluated the difference between the chronological age and the skeletal age.
  
  
  RESULTS
  The interobserver and intraobserver reliabilities were higher with the GP atlas method and the TW3 RUS method compared with the TW3 carpal bone maturity scoring system. There was significant skeletal age delay irrespective of the method used (P<0.01). When we used the TW3 carpal method, the pattern of skeletal age delay was significantly distinct from the other 2 methods. According to the measurement method, there was no statistically significant difference in the developmental skeletal age pattern among the COMP gene group, the MATN3 gene group, and other gene groups.
  
  
  CONCLUSIONS
  Our findings indicate that there is a distinct skeletal maturation pattern in patients with MED. The skeletal age is relatively delayed compared with the chronological age irrespective of the measuring method utilized. However, use of either the GP atlas or the TW3 RUS method provided more accurate information on the skeletal development in the patients with MED than that provided by the TW3 carpal bone maturity scoring system.
  
  
  METHODS
  Level I. Diagnostic study.
authors.affiliation: *Institute for Rare Diseases and Department of Orthopaedic Surgery, Korea University Medical Center, Guro Hospital, Seoul †Pohang St.Mary's Hospital, Pohang, Korea.
authors.forename: Kwang-Won
authors.initials: KW
authors.lastname: Park
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Sam
authors.initials: S
authors.lastname: Sung
authors.forename: Min Young
authors.initials: MY
authors.lastname: Lee
authors.forename: Hae-Ryong
authors.initials: HR
authors.lastname: Song
mesh_terms: D000293:Adolescent; D000365:Age Determination by Skeleton / Q000379:methods*; D002348:Carpal Bones / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010009:Osteochondrodysplasias / Q000175:diagnosis*; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies