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
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.