Comparison of Tanner‐Whitehouse and Greulich‐Pyle methods in a large scale Danish survey

Abstract In Denmark no systematic investigation of skeletal development had been made prior to this investigation which involved 1009 school children aged 7–18 years in a transverse examination. The skeletal age was estimated according to the American atlas of Greulich‐Pyle. The English system of Tanner‐Whitehouse was also applied. In this latter method the stage of development of 20 selected bones in the hand and wrist is rated on a scale of 8 (in one case 9) possible stages. Each bone is awarded points according to its stage of development. These points are totalled for the 20 bones and reference to a table gives the skeletal age. The problem with this system is that the later stages of carpal bone development cannot be reliably placed on the scale. Their point system is calculated in such a way that a difference of one stage in rating of a single carpal bone in older children would give rise to a difference of up to two years in the skeletal age estimation. For younger children the method is, however, quite reliable. The investigation has shown that Greulich‐Pyle's atlas can be applied to Danish children of 7‐18 years of age provided that a correction of six months is made. A variable error of about four months was found when using Greulich‐Pyle compared to about two months with Tanner‐Whitehouse.