IS Case 558: Dysharmonic skeletal maturation

Sirisha Jasti, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-09-25


Patient is a 4-year-old female with history of X-linked hypophosphatemic rickets.


AP view of the left hand showed dysharmonic skeletal maturation of the hand, with decreasing maturation of bones going distally. The epiphysis of the distal phalanges were much less skeletally mature compared to the metacarpals.


Dysharmonic skeletal maturation


Bone age is usually determined by using a radiograph of the left hand to compare with images in Greulich-Pyle atlas and approximating the closest skeletal age. Dysharmonic skeletal maturation refers to different levels of maturation of different bones in the hand, and this poses a problem when trying to approximate the skeletal age. In such cases, different sets of bones in the hand (like the radius and ulna, the carpal bones, the metacarpals, the thumb, the proximal phalanges, middle phalanges and distal phalanges of the second to fifth fingers) are compared individually to images in Greulich and Pyle atlas to approximate bone ages for each set of bones. It is then determined as to which set of bones is advanced or delayed in maturation based on standard deviation.

Similar to asymmetry in maturation of different bones of the hand, side to side asymmetry can also occur with different skeletal maturations in the right and left hands. This can occur in conditions which lead to increased or decreased vascular supply on one side to the other like in rheumatoid arthritis.


  1. Poznanski AK, Garn SM, Kuhns LR, Sandusky ST. Dysharmonic maturation of the hand in the congenital malformation syndromes. Am J Phys Anthropol. 1971 Nov;35(3):417-32.

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