The Tanner-Whitehouse II Skeletal Maturity Method: Rationale and Applicability

Abstract

The problem of skeletal maturity assessment is to measure, stage by stage, the metamorphosis of the cartilaginous and membranous skeleton of the foetus into the fully ossified bones of the adult. Whilst skeletal maturation is a continuous process its assessment requires the identification of discrete indicators of development that are sequential, invariate between individuals, universal, and that cover the full range of development from birth to full maturity. The Tanner-Whitehouse II method is a bone-specific scoring technique in which a numerical score is assigned to selected hand-wrist bones depending on the appearance of certain well defined maturity indicators. The advantage of this technique over previous Atlas methods is that the maturational differences between bones is statistically minimised thus reducing disagreement between bones. The resulting bone maturity score is indicative of a specific maturational level in the sample to which the bone maturity scores are compared. Whilst the TWII technique has been applied to a variety of samples from many countries it is accepted that population and geographic differences exist in rate of maturation and that, therefore, there is a need to develop population specific “standards”. Such national standards would allow the sensitive diagnosis and treatment of children with growth disorders. © 1993, The Japanese Society for Pediatric Endocrinology. All rights reserved.