u/Automatic-County6151

Biological sex: male

The carpal ossification centers are fully established, with the pisiform well ossified and approaching its mature configuration. The proximal and middle phalangeal epiphyses are well developed and closely conform to their respective metaphyses, with pronounced metaphyseal capping and only minimal residual physeal separation. The distal phalangeal epiphyses are broad and substantially mature in appearance, with the physes now indistinguishable. Sclerotic epiphyseal scars remain appreciable at the fourth and fifth distal phalanges, while those of the remaining basal phalangeal elements are variably faint or persistent.

The metacarpal epiphyses are well ossified and increasingly incorporated into the contours of the metaphyses, with prominent capping and progressive reduction of the remaining physeal spaces. In particular, the second and third metacarpal epiphyses are fully mature, while the fourth and fifth demonstrate near-complete physeal ossification with only thin residual radiolucent clefts.

The distal radial epiphysis is broad and mature in configuration, with increasing irregularity and narrowing of the physis but persistent radiolucent separation; the radial styloid is substantially developed and considered stable in configuration. The distal ulnar epiphysis is well formed and horizontally oriented, with a relatively narrow, distinctly undulated residual physis and a well-developed ulnar styloid process with relatively stable maturation. No complete osseous physeal fusion is evident, although the overall appearance indicates commitment of advanced skeletal maturation to union.

Good evening, enthusiasts!

Earlier this year, on January 5th, we officially terminated tailored bone age estimations using the radiographs alone. This was confirmed after I consulted a lawyer to see where the limits shoukf strictly lie. That is still a permanent change; however, I have found a way to make this happen - in a way.

Many of you will be excited, but it is imperative that I address some limitations with that: it is approximate and not definitive. This will not be the same as directly reading an x-ray, and giving a number.

"Will bone age estimations ever return?"

Yes. We can now help with estimating skeletal age from detailed written hand + wrist radiograph reports, even when the original radiograph is not available (do not include the radiographs). If a report describes the maturation of the individual epiphyses, physes, carpal bones, and other relevant structures in sufficient, greater detail, those findings can sometimes be used to arrive at a reasonable approximate BA range, and potentially a narrower numeric estimate.

To do this, we’ll need the complete report, along with the person's sex and chronological age at the time of the x-ray. If the report specifies the BA method used (such as Greulich-Pyle, Tanner-Whitehouse/TW3, or Fels), include that as well. The more detailed the report is about individual skeletal structures, the more useful it will be.

There are important limitations. A written report cannot substitute for actually reviewing the radiograph, because the report may omit features that would be visible on the image. Therefore, we should generally provide an estimated range or approximate numerical BA, rather than claiming that a report proves an exact value such as 13.0 years. Instead, it would be interpreted as "~13Y".

Please also understand that these estimates are educational and approximate, not medical assessments. If the report is too vague, contradictory, or lacks enough developmental detail, the appropriate conclusion may simply be that there isn't enough information to estimate the bone age reliably. This does substantially differentiate from reading a radiograph in a medico-legal context, just for clarity.

If you have a detailed report you'd like to have discussed, post the full unedited text along with the chronological age and sex at the time of imaging. We can then explain which skeletal findings support the estimated range and how strongly each finding contributes to it.

Thank you,

• Automatic-County6151; lead moderator and foundational owner

It's not gonna read like a riddle just yet, but that may be the direction I take it down in the future. For now, a simple description.

It will go in random order from BA 0-18Y or 0-19Y, depending on biological sex. All the individual skeletal ages are intended on being covered.

Your only hint is to look for specific keywords that denote the physeal status of certain skeletal age marking points.

Biological sex: male

Carpal ossification centers are well established, with the pisiform ossification center identified, remaining small and ovoid in configuration. The proximal and middle phalangeal epiphyses are well ossified and demonstrate increasing conformity with the adjacent metaphyses, with mild metaphyseal capping. Distal phalangeal epiphyses are broad and relatively rectangular in configuration, with persistent radiolucency of the physes.

The metacarpal epiphyses are well developed, with progressive metaphyseal capping most evident at the third through fifth metacarpals. The distal radial epiphysis is broad and transversely oriented, with a gently undulating articular contour and a clearly patent physis - the radial styloid demonstrates incomplete development. The distal ulnar epiphysis is smaller and more rounded/ovoid horizontally, with persistent physeal separation and a rising process. No focal physeal bridging or osseous fusion is evident.

E

I only have the femur down. Other long bones were a work-in-progress.

https://docs.google.com/document/d/1KvTzmMtjn2jpSSfJcAsQzO0fE3dxSfmX1ps\_ugeR1ms/edit?usp=drivesdk

I have begun work on my document regarding the distal radius-ulna classification system. It will go over many things:

1. What the DRU class. system is and the reasoning behind developing a dedicated classification for distal radius and ulna maturation (basically, a little history dump like I always do).

2. The different stages of distal radial and ulnar maturation, from an open physis through progressive narrowing and fusion to complete closure, and what they usually mean for growth.

3. Why the radius and ulna should be assessed separately, since they don't always mature synchronously.

4. The importance of transitional stages, rather than treating physeal status as simply “open” or “closed.”

5. How the system can be used to describe radiographs more consistently and provide a standardized vocabulary for distal forearm maturity.

6. How DRU classification relates to BA, including why it should complement rather than replace established skeletal-age methods.

7. Limitations of the system, particularly that a DRU stage is a measure of skeletal maturation and isn't by itself a precise predictor of remaining height.

8. Practical examples and radiographic patterns demonstrating how the classifications are distinguished.

And some exercises at the end to test your knowledge on growth interpretation with varying levels of asynchronous development involved to enhance your understanding of the relevance of the DRU classification system with other major skeletal age assessment atlases.

Feel free to screw around with this and whatnot. Just make sure you review this post before proceeding. It is in the community highlights for frequent access: https://www.reddit.com/r/growthplates/s/1OVywsrucq

This manuscript is my proposal of a conceptual framework for a future vertebral skeletal maturity atlas that explores the spine as an additional indicator of biological skeletal development. By examining vertebral body morphology, ring apophyseal development, endplate changes, secondary ossification centers, and other maturational features, the framework outlines how a multi-structure spinal assessment system could complement other existing skeletal age methods. Here and there, my model emphasizes weighted scoring, imaging integration, and future computational analysis while recognizing that extensive validation through longitudinal cohorts, standardized imaging, reliability testing, and growth outcome correlation would be required before clinical application.

In this test, you are tasked with tracking a fictional male child's growth curve from the pre-pubertal years to the pubertal years. The following information is at your disposal (use context clues to find the answer faster):

• BA maturation over a period of about eight years.

• The child's growth trajectory across elementary school and near the beginning of high school. Assume the patient is still high school-aged, and the information is limited to grades one through nine (ages 6.7-14.7 years). Info for the ninth to tenth grades does not exist as the patient is just entering the ninth grade.

• Any signs of gonadal maturation or male androgenization later on.

• The growth chart itself and the child's weight + BMI index.

• Parental heights.

Maturation of BA will be charted on an annual basis, while observations of growth will continue on a bi-annual to a tri-annual basis until middle adolescence. The formula for finding the BA advancement rate for each year will be provided when the test begins.

Your goals: make an educated guess on the child's FAH across a slightly broader range and identify when the child is likely to enter PHV based on changes associated with male androgenization and gonadarche, noteable shifts in BA advancement rate (acceleration + appearance of certain features in the hand and wrist that can indicate adolescent maturation), and noteable shifts in the adolescent curve. Identify roughly when the child was likely getting close to the pubertal transition using the child's growth velocity and gradual progression of testicular enlargement toward the Tanner II baseline (sharp pauses and dips that may correlate with the "pre-pubescent dip", or sudden bursts in GV that may overlap with gonadarche, etc).

Bonus: discover the reason(s) as to why the child's skeletal maturation has been closely tracked for eight consecutive years. Until then, mere hints within the data can be suggestive of the purpose. Otherwise, the pattern will be overt if I summarize it.

The next case will involve a female across a similar age range and timeframe.

The BA advancement formula: bone age (BA) time change change over chronological age (CA) time change. Find how many years are in between the old BA and the updated BA, then divide that by the number of years in between the old CA and the new CA between phases.

Test VI

The patient's DOB (MM-DD-YYYY): 12-15-2011

Biological mother's height: 5'9½" (176.5 cm)

Biological father's height: 6'2¾" (189.7 cm)

The mother's developmental years displayed no overt signs of delayed or abnormally early onset of puberty, which began at an estimated age of 11-12 years. She reported a cessation in growth by age 17 years, which the endocrinologist deemed a slightly late termination in growth but within perfectly normal bounds. She recalled attaining menarche shortly after her thirteenth birthday, but that she continued to grow, and remembered being several inches taller than most of her peers months later. The endocrinologist deemed this pattern typical, as PHV can be achieved for girls at anytime around the first menstrual cycle. When asked if she could provide any numeric values, the mother, who used her mother's height as a reference, stated that she was about five feet and four inches tall when she got her first period, and then about five feet and six inches tall several months later. She reported noteable "prolonged" growth into her freshman and sophomore years of high school before a sudden plateau during her junior year.

The father's developmental years yielded some signs hinting at a constitutional delay of growth and puberty; however, he reports his puberty began at around age 12, as well. He reported the cessation of growth "after high school". When asked to elaborate, he made a rudimentary guess of about 19-20 years when his doctor informed him that he had reached his final adult height. He stated he likely only grew about an inch "or a little more from the start of the twelfth grade to about a year or two post-graduation" and that "it kind of tapered slowly, and then suddenly stopped."

Phase I: the first grade

A male patient at the chronological age of six years and nine months presents with a radiograph of the left hand and wrist, of which the skeletal age was estimated to be five years and five months. His percentile data has been tracked across three time points across an eleven-month interval:

6Y 9M: 45.7" (116.1 cm); 41.5 lbs (18.8 kg / BMI 14)

7Y 2M: 47" (119.4 cm); 43.7 lbs (19.8 kg / BMI 13.9)

7Y 8M: 48.4" (122.9 cm); 46.3 lbs (21.0 kg / BMI 13.9)

Phase II: the second grade

The male patient at the chronological age of seven years and eight months presents with a radiograph of the left hand and wrist, displaying an estimated skeletal age of six and a half years. His percentile data was tracked twice across a six-month interval, starting about three months after the acquisition of the updated skeletal age:

7Y 11M: 49.1" (124.7 cm); 48.1 lbs (21.8 kg; BMI 14.0)

8Y 5M: 50.5" (128.3 cm); 51.4 lbs (23.3 kg; BMI 14.1)

Phase III: the third grade

The male patient at the chronological age of eight years and five months presents with a radiograph of the left hand and wrist, displaying an estimated skeletal age of seven years and four months. His percentile data was tracked thrice across a twelve-month interval, starting about three months after the acquisition of the updated skeletal age:

8Y 8M: 51.2" (130 cm); 52.6 lbs (23.9 kg; BMI 14.1)

9Y 2M: 53.6" (136.1 cm); 56.0 lbs (25.4 kg; BMI 13.7)

9Y 8M: 55.2" (140.2 cm); 59.5 lbs (27.0 kg; BMI 13.7)

Phase IV: the fourth grade

The male patient at the chronological age of nine years and eight months presents with a radiograph of the left hand and wrist, displaying an estimated skeletal age of eight years and seven months. His percentile data was tracked thrice across a nine-month interval, starting about three months after the acquisition of the updated skeletal age:

9Y 11M: 55.7" (141.5 cm); 60.6 lbs (27.5 kg; BMI 13.7)

10Y 5M: 57" (144.8 cm); 63.5 lbs (28.8 kg; BMI 13.7)

10Y 8M: 57.7" (146.5 cm); 65.4 lbs (29.7 kg; BMI 13.8)

Phase V: the fifth grade

The male patient at the chronological age of ten years and eight months presents with a radiograph of the left hand and wrist, displaying an estimated skeletal age of nine years and eight months. His percentile data was tracked thrice across a nine-month interval, starting about three months after the acquisition of the updated skeletal age:

10Y 11M: 58.3" (148.1 cm); 67.6 lbs (30.7 kg; BMI 14)

11Y 4M: 59.6" (151.4 cm); 69.1 lbs (31.3 kg; BMI 13.7)

11Y 8M: 60.6" (154 cm); 71.5 lbs (32.4 kg; BMI 13.7)

Phase VI: the sixth grade

The male patient at the chronological age of eleven years and eight months presents with a radiograph of the left hand and wrist, displaying an estimated skeletal age of ten years and nine months. His percentile data was tracked thrice across a nine-month interval, starting about three months after the acquisition of the updated skeletal age:

11Y 11M: 61.3" (155.7 cm); 73.2 lbs (33.2 kg; BMI 13.7)

12Y 4M: 62.5" (158.8 cm); 76.8 lbs (34.8 kg; BMI 13.8)

12Y 8M: 63.7" (163.1 cm); 82.4 lbs (37.4 kg; BMI 14.1)

Phase VII: the seventh grade

The male patient at the chronological age of twelve years and eight months presents with a radiograph of the left hand and wrist, displaying an estimated skeletal age of twelve years and three months. Compared with previous annual studies, the endocrinologist noted a measurable increase in the rate of skeletal maturation, accompanied by the earliest radiographic features suggestive of the transition toward adolescent development (rapid enlargement of the pisiform and the rapid appearance of thumb sesamoids), with no narrowing of the basal growth plates in the phalanges or the wrists. Physical examination revealed bilateral testicular enlargement (approximately 4 mL) at the CA of 12Y 4M, corresponding to Tanner stage II gonadarche, with minimal scrotal thinning and erythema. At 12Y 8M, enlargement reached about 4.6 mL). At 11Y 11M, the testicular volume was only 2.5 mL. No appreciable facial hair, vocal deepening, or acne was observed at either 12Y 4M or 12Y 8M. Sparse, lightly pigmented pubic hair was noted along the base of the penis by 12Y 8M, and modest distribution was observed over the four-month interval.

His percentile data was tracked three times across a nine-month interval, starting about three months after the acquisition of the updated skeletal age:

12Y 11M: 64.8" (164.6 cm); 87.2 lbs (39.6 kg; BMI 14.6)

13Y 5M: 67.5" (171.5 cm); 98.5 lbs (44.7 kg; BMI 15.2)

13Y 8M: 69.2" (175.8 cm); 107.9 lbs (49.0 kg; BMI 15.9)

Phase VIII: the eighth grade

The male patient at the chronological age of thirteen years and eight months presents with a radiograph of the left hand and wrist, displaying an estimated skeletal age of thirteen years and five months. Compared with the previous study, continued substantial acceleration of skeletal maturation was observed, with further enlargement of the thumb sesamoids, increased development of the carpal bones, and early narrowing of select phalangeal growth plates along DPs 1-3. However, the majority of the growth plates of the digits, palm, and wrist remained clearly open and not yet initiating changes associated with observable puberty-related senescence.

Physical examination demonstrated continued progression of gonadal maturation. Testicular volume increased from approximately 4.6 mL at 12Y 8M to approximately 8.8 mL, consistent with early-phase progression into Tanner stage III gonadarche. Pubic hair became darker, coarser, and more extensive, and the advancing distribution from base of penis to the scrotum appeared imminent but largely absent. Mild acne and early changes in body odor were reported, and normal asynchrony has been noted in the enlargement of the hands, feet, and legs relative to the rest of the body. No significant facial hair development was observed.

The endocrinologist noted that the patient appeared to be entering the period immediately preceding PHV, given the combination of accelerating growth velocity, advancing bone-age, and progression through mid-puberty. The patient is likely to enter his PHV soon.

Due to a suspected high-magnitude peak growth velocity, his percentile data was tracked three times across an eight-month interval and measurement frequency has reduced to every four months, starting about three months after the acquisition of the updated skeletal age:

13Y 11M: 71.5" (181.6 cm); 115.5 lbs (52.4 kg; BMI 15.8)

14Y 3M: 74.0" (188.0 cm); 126.5 lbs (57.4 kg; BMI 16.2)

14Y 7M: 75.3" (191.3 cm); 134.0 lbs (60.8 kg; BMI 16.6)

Upon the terminus of Phase VIII, the endocrinologist concluded that the patient had entered the ascending phase of his pubertal growth spurt but had not yet definitively reached the apex of PHV. Although his skeletal age of 13Y 5M at a chronological age of 13Y 8M was entering within the range commonly associated with the male PHV interval (about 13.5-14.5Y), the broader developmental picture suggested that the patient was still approaching the highest-amplitude portion of his growth curve rather than moving beyond it.

The patient's height progression from 69.2 inches at 13Y 8M to 75.3 inches at 14Y 7M represented approximately 6.1 inches (15.5 cm) of growth over eleven months, corresponding to an annualized velocity in the range of 16-17 cm/year. While this represented an unusually strong growth velocity, the endocrinologist interpreted the measurement in the context of the patient's rapidly changing developmental state, recognizing that shorter intervals may capture the steepest portion of acceleration. The magnitude of growth, combined with the recent increase in skeletal maturation rate and progression through Tanner stage III, suggested that PHV was either imminent or actively developing.

The most recent skeletal-age examination yielded a bone-age of fourteen years and three months at CA 14Y 8M. Despite the advancement of skeletal age, the radiographic findings indicated that the patient retained considerable growth potential. The continued openness of the majority of the phalangeal, metacarpal, and wrist growth plates, alongside only early narrowing of select epiphyses, suggested that the skeleton had entered adolescent maturation but is still quite distant from the later stages of pubertal senescence. The endocrinologist therefore considered the bone age findings supportive of a boy approaching PHV rather than one who had already completed his peak.

Pubertal maturation continued to progress appropriately through Tanner stage III. Testicular volume had increased from approximately 2.5 mL at 11Y 11M to 4.6 mL at 12Y 8M and subsequently to approximately 8.8 mL at 13Y 8M to 10.2 mL at 14Y 8M, demonstrating clear progression of gonadarche. Scrotal enlargement and thinning became increasingly apparent, while pubic hair continued to transition from sparse early pigmentation into darker, coarser terminal hair with expansion beyond the base of the penis. However, the patient remained in mid-puberty rather than late puberty, as facial hair development, significant voice deepening, and more advanced androgenic changes had not yet emerged.

The continued disproportion between limb and trunk development was also considered consistent with this stage of maturation. The patient's hands, feet, and lower extremities had experienced pronounced growth ahead of proportional trunk broadening, reflecting the typical sequence in which distal skeletal segments accelerate earlier during the pubertal growth spurt. The endocrinologist noted that further increases in trunk growth, muscle mass, and shoulder breadth were expected as puberty progressed.

At the conclusion of Phase VIII, the overall interpretation was that the patient was very close to his maximum pubertal growth velocity but likely had not yet passed the peak. The combination of Tanner III progression, accelerating skeletal maturation, rapid linear growth, and persistent open growth plates indicated that the following several months would likely represent the period in which the patient's true PHV would become apparent. The purpose of continued close monitoring was to capture the transition from acceleration into peak velocity and determine the eventual magnitude and duration of his pubertal growth spurt.

With the hefty clues now revealed, from delayed skeletal maturation, accelerating BA, progressive androgenization, and the approach toward a high-amplitude pubertal growth spurt, one solid question remains: can you predict the curve and determine how this unique developmental trajectory will unfold through the peak and beyond, and how could his FAH be quantified?

I was thinking about it off and on earlier this week. Creating some kind of a podcast or a new YouTube channel dedicated specifically to lecturing about or discussing human development - whether it's factual or theoretical. I could pre-release episodes of documents that I will eventually publish to the subreddit.

It was just something that's been at the back of my mind, and I've had someone bring it up to me in the past. They wished I had a platform where I could actually speak about these topics with my own actual voice. Thought it sounded neat, but it's still tentative.

Posting update

P.S. I know it's been a while - about 4-5 weeks now - since my last post. Just to let you all know of what's upcoming, I have started work on the next post - an exploratory / conceptual skeletal age atlas for the spine - about a 2-3 weeks ago that I have written a fair amount of already, but I paused on it. This week, I have been on vacation, so little to no progress has been made. So, it is still an active work-in-progress.

This series of tests explores the different ways your growth potential can be estimated, from your current height and family genetics to BA, growth plate status, growth patterns, and serial height measurements. Some of these tests focus on estimating a fictional patient's remaining growth, while others take a more comprehensive approach by combining multiple biological and developmental indicators. The final test introduces a more detailed tri-phase analysis (which is still incomplete), examining growth across different stages and different, unique patients to better understand where each child is in the overall growth process. In the future, you may have the opportunity to try and predict for a fictional outlier.

The purpose: to teach much your growth history can reveal about your final height, and what may be used to help find how your growth trajectory is moving and where you are in skeletal maturation.

Test #1: https://www.reddit.com/r/heightgrowth/s/QmCa3eEtez

Test #2: https://www.reddit.com/r/heightgrowth/s/S3TKbLPzPz

Test #3: https://www.reddit.com/r/heightgrowth/s/d3wImpTWmA

Test #4: https://www.reddit.com/r/heightgrowth/s/KA0OwmU8sP

Test #5: https://www.reddit.com/r/heightgrowth/s/ExEHgJ280C

One day, a paper appears on PubMed. Within 24 hours, it's everywhere and it is a massive hit. Another impossible just became a possible.

The authors report they've successfully rejuvenated and reopened fused human growth plates in adults using a targeted regenerative therapy. Multiple independent groups replicate the findings within weeks. It becomes one of the biggest medical breakthroughs of the century - harnessing full power over human skeletal development and controlling it however we desire.

But, there's a catch.

You get complete control over how your renewed growth plates behave...

You can decide how long they remain active, how sensitive they are to hGH + IGF-1, whether they respond normally to estrogen or become partially resistant, whether different regions (legs, spine, clavicles, etc.) grow synchronously or asynchronously, the overall growth velocity and timing of spurts, abd when they permanently senesce again. Essentially, you're designing your own secondary post-adolescent growth phase.

But, there's a harder catch.

You must consider the dangerous effects of indeterminate growth.

- Potential spinal deformities due to ongoing, abnormally-prolonged spinal elongation.

- Increased risk of infections going dangerously unnoticed as an indirect result of slower nerve conduction from the longer distances nerve signals must travel down the body.

- Increased difficulty with circulatory efficiency due to increased extreme distance that blood can effectively circulate.

- Increased burden on the respiratory and circulatory organs from having to sustain a bigger body structure and the increasing mass of the body itself.

- More energy required for basic daily activities like walking or even moving your arms around.

- Heightened risk of degeneration earlier in adulthood due to the greater biomechanical stresses on musculoskeletal structures, especially larger joints like the knees, and hip instability.

What settings are you choosing, and what would your final height goal be? And more importantly, what can you ensure remains within your control while you are growing in a way that maintains your health to the safest extent - considering your own current physical flaws or advantages?

Last but not least, how badly does this subreddit and its affiliates implode within the first week (ahem - mods 😉)?