The Journal of Bone and Joint Surgery (American). 2005;87:1689-1696.
doi:10.2106/JBJS.D.02418
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Accuracy of the Sauvegrain Method in Determining Skeletal Age During Puberty

Alain Diméglio, MD1, Yann Philippe Charles, MD1, Jean-Pierre Daures, PhD, MD2, Vincenzo de Rosa, MD1 and Boniface Kaboré, MD1

1 Service d'Orthopédie Pédiatrique, Hôpital Lapeyronie, 371 Avenue du Doyen G. Giraud, F-34295 Montpellier Cedex 5, France. E-mail address for A. Diméglio: a-dimeglio{at}chu-montpellier.fr
2 Institut Universitaire de Recherche Clinique, 641 Avenue du Doyen G. Giraud, F-34093 Montpellier Cedex 5, France

Investigation performed at the Service d'Orthopédie Pédiatrique, Hôpital Lapeyronie, Montpellier, and the Institut Universitaire de Recherche Clinique, Montpellier, France

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The method of Sauvegrain et al. for the assessment of skeletal age from radiographs of the elbow is useful during the two years of the pubertal growth spurt. The purpose of this study was to determine the accuracy of the method and its value in pediatric orthopaedics.

Methods: The Sauvegrain method uses four anatomical landmarks of the elbow: the lateral condyle, trochlea, olecranon apophysis, and proximal radial epiphysis. It is based on a 27-point scoring system. The scores for these structures are summed, and a total score is determined. A graph is then used to determine the skeletal age. The method was evaluated by three independent observers who used it to assess skeletal age on anteroposterior and lateral radiographs of the left elbow of sixty boys and sixty girls and compared the results with assessments made with use of the Greulich and Pyle atlas on posteroanterior radiographs of the left hand and wrist. Skeletal age determinations were performed twice by each observer at a four-week interval.

Results: The skeletal age determination from radiographs of the elbow was more precise because a clear semiannual age determination was possible. On the basis of the rating by the observers, the Sauvegrain method presented excellent interobserver correlation (r = 0.93) and excellent reproducibility (r = 0.96). The correlation between the methods of Sauvegrain et al. and Greulich and Pyle was good (r = 0.85). Nevertheless, certain elbow growth centers showed an intermediate developmental morphology, which failed to correspond to the score described by Sauvegrain et al. This led to errors in the interpretation of data. We suggest an intermediate score for these cases, and we modified the original graph to make it more accurate.

Conclusions: The modified method of Sauvegrain et al. is simple, reliable, and reproducible, and it complements the Greulich and Pyle atlas. In clinical practice, maturity can best be evaluated by associating skeletal age, annual growth rate, and secondary sexual characteristics. Therefore, this method is useful when major decisions such as the timing of epiphysiodesis or spinal arthrodesis are necessary during puberty.

Level of Evidence: Diagnostic Level II. See Instructions to Authors for a complete description of levels of evidence.


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Letters to the Editor:

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Determining Skeletal Age During Puberty
Weerachai Kosuwon, M.D.
JBJS Online, 26 Sep 2005 [Full text]
Dr. Dimeglio and colleagues respond to Dr. Kosuwon
Alain Dimeglio, M.D., et al.
JBJS Online, 5 Oct 2005 [Full text]