u/Automatic-County6151

You are tasked with estimating the below patient's remaining growth using the growth history, skeletal age, and other biological details. The patient will have two separate visits with two different skeletal age reports over a chronological time gap of approximately 2.7 years.

First visit:

A female patient at the chronological age of ten years and six months presents an anteroposterior radiograph obtained of the left hand and wrist, with the skeletal age report displaying a hand-wrist bone age of twelve years and nine months using the Greulich-Pyle method.

Based on recent sexual maturation patterns consistent with the approach into Tanner B3, the patient was observed in being late in the second Tanner B stage, with a serum estradiol concentration of 29 pg/mL. The growth plates in the distal radius and ulna have both been identified as being in the early-to-mid stages of narrowing (U6 in intermediate progression; R8 in early progression).

Despite some DRU-hand asynchrony, the GP report assigned BA 12Y 9M.

The growth history:

6Y 8M - 51.3"

7Y 4M - 52.8"

7Y 11M - 53.5"

8Y 6M - 55.2"

9Y 4M - 57"

9Y 9M - 58.5"

10Y 3M - 61.8"

10Y 6M - 63.3"

Second visit:

The patient, at the chronological age of thirteen years and three months, presents an anteroposterior radiograph taken of the left hand and wrist, displaying a bone age of fifteen years and one month using the Gruelich-Pyle method.

Based on recent sexual maturation patterns consistent with the approach into Tanner B5, the patient was observed in being intermediate in the fourth Tanner B stage, with a total serum estradiol concentration of 72 pg/mL. The growth plates in the distal radius and ulna have both been identified as being in the latest stages of narrowing, with signs of impending early osseous bridging manifesting in the distal ulnar physis (U7 transitioning; R9).

Growth since the previous visit:

The patient has grown approximately one and a half inches since the last visit.

Additional details:

Due to a suspected unusual thoracolumbar curve, the patient had received a three-part imaging sequence of the thoracolumbar spine and the lower lumbar quadrants. The radiographer noted a "significant curve", which equated to a Cobb angle of 24.1⁰ and 30.8⁰. No other abnormal curvatures were externally noted at any other point along the vertebral column.

At the time of examination, the patient was chronologically nine years and ten months of age. The patient's Risser stage was approximately one, and all ring apophyses were readily available to view across the first and second sacral vertebrae to the inferior border of the T6 vertebra. The radiographer had not noted any narrowing of the growth plates visible.

At interval two, the patient returned for a review of her scoliosis. Chronologically, she was twelve years and two months of age, and the following details were given regarding the status of her scoliosis:

● An increase from 24.1⁰ to 28.4⁰ along the upper lumbar and lower thoracic quadrants, and an increase from 30.8⁰ to 33.2⁰ along the lower thoracic and middle thoracic quadrants. Imaging had been extended to view the entire thoracic spine, which showed no visible structural abnormalities beyond the T3-T4 junction.

Regarding her Risser staging:

● The patient's Risser stage had progressed from Risser 1 to Risser 3.

Regarding her spinal maturity:

● The growth plates along the T2-T7 quadrant were shown to be entering the early stages of union, while the majority of the growth plates along T8-L5 retained a large amount of radiolucency at one or both vertebral ends. The radiologist reported that the patient's scoliosis likely would not worsen significantly because of the extent of maturation.

Determine the patient's growth pattern:

A) Monophasic

B) Biphasic

C) Compressed

D) Blunted

E) Prolonged

F) Rebound

Hybrid patterns or degrees of pace (slow-leaning, intermediate, fast-leaning) are permitted.

Identify roughly when the patient entered the second gonadal stage based on their growth history and extent of G2 progression. Identify whether the PHV has traditionally passed and how long it has been since the full pubertal transition (out of the rapid growth window), if it has occurred - utilizing any skeletal maturation markers given in the report.

The scoliosis findings are provided as an additional source of skeletal maturity data. Participants should consider the Risser staging, vertebral ring apophyseal maturation, and curve progression when estimating the patient's remaining growth and timing of PHV.

After identifying the PHV pattern and any subdivisions of maturational rate or the confirmation of any hybrid patterns, please answer these four questions in as much detail as you wish:

To what extent do the spinal maturity findings support or contradict the hand-wrist bone ages and DRU staging?

Based on the curve progression, Risser advancement, and vertebral maturation, do the spinal findings support substantial remaining statural growth, or do they indicate that the patient has largely exited the rapid pubertal growth period?

Are the following findings mutually consistent? If not, which markers would you weigh most heavily when estimating the patient's remaining growth?

Using both the scoliosis progression and the hand-wrist findings, how many years have elapsed since PHV?

I have been getting some new requests for topics to cover. To make this organized into one place, please utilize this link to submit a post request in the commentary section. The link will direct you to a post schedule I have highlighted - created two months ago. Thank you!

https://www.reddit.com/r/growthplates/s/2EtO7xW1UG

● Risser Classification System for the Bones of the Hands and Wrists - An Overview

● Exploratory Atlas for the Spine - A Conceptual Framework

No, this is not a "will I grow". I'm 19, and I know better, nor am I worried about that.

However, I notice (without stadiometric measurement) that my morning height could be higher than the average measurement (5'11½) that I have been getting consistently for the last 2-2.5 years.

I am sometimes told to just raise the bar. I can even say "I'm about 6 feet tall", but my precise mind just won't accept that. "No, I am 5'11½, or just 5'11".

The things I notice include, but are not limited to:

• Commuting to work early in the morning (within 30 minutes of waking up) and comparing my inability to see the vehicles behind me (within 2-3+ car lengths) in my rearview mirror versus my ability to see any vehicles behind me within 2-3+ car lengths away about 8-9+ hours later. This is an almost immediate conscious realization, which makes me consider whether my absolute max might be above 5'11½. My seat never changes position, and I always sit up relatively straight when driving. It's cool watching my spine diurnally fluctuate, but it makes me consider shifting my precision once I confirm 5'11½+.

• For example, I have several things in the household that are relatively 6 feet above the floor. Standing near these or at eye level (incidentally. I just happen to be right there), and I quickly notice that my vision appears to be looking at a moderately higher point on the object compared to later in the day when it's much shorter - same exact position, came distance. I've been tracking this.

• Not to mention, my dad. Big guy, strong guy, and 6'1. I nearly meet his eye level in the evening, but I am kind of at eye level with him in the morning. I can look him in the eye with a near-perfect horizontal planar gaze like a man.

I cannot measure accurately at any point in the day because I only have a tape measurer, and those things are quite flimsy especially when you are doing it yourself. I do not want to come off as old 15-year-old me again to my mom, obsessed with growth and every little mm. Unfortunately, it is the latter this time and not both, and for the greater good of my manhood.

Thankfully with a consistent work schedule, I always get about 7-8 hours of sleep with no breaks in between, and I am always getting the same consistent daily activity (constant walking and standing).

So, tell me. What do you think? Am I failing to see that I might be closer than I think? I've always been big on precision (though my attention to detail lacks), and while it's not a huge bother, it's a minor "itch" in comparison.

P.S. my evening height is centered at almost exactly 5'11¼ - about 5'11.25" to 5'11.4".

My a** is grass. Has been, but I just never said it aloud. Let me tell you a tale of how the grassy a** came about.

You see, there was a time when my a** was not grass.

There was a time when every six months brought new possibilities. A quarter inch here, half an inch there. The tape measure was my friend, not an enemy - it was almost a professional relationship. I visit it every month, and it's there in the exact spot I left it a month before. "Let's see what you got this time," I'd say. The annual physical was an event to look forward to with anxiety rather than a formality.

Back then, the future was unwritten. The growth plates still had dreams, though in a narrowing sequence as I began to truly care. The skeleton still had ambition, but I had more.

I walked through life with the quiet confidence of a man whose a** was, at least for the foreseeable future, not grass.

But time is undefeated, and grass grows longer.

One day, without fanfare or ceremony, the final millimeter was claimed. The last chondrocyte clocked out. The paperwork was filed. The epiphyseal scars settled in like retirees on a Floridian beach. The bunch they were...

And now I stand before you a changed man. A wiser man.

A man who understands that he will never again wake up and discover that he is mysteriously half an inch taller than he was yesterday.

"That silly boy," as I say looking back at my 8th-10th grade school photos.

8th grade - an era of which the lies about my height began. My growth plates would have been wide open, and I was working my happy a** up to 5'8 within two months time. Before then, three inches - easy. I said 6'1, and no one questioned it - because everything was virtual then. I knew I could get away with that... until someone questioned it. They inferred 5'8-5'9, and I admitted it like a man, though after much questioning out of concern: calm, yet disappointed, I asked: "I don't even look 5'10?"

"Not really. Probably not even over 5'9."

"Would you say 5'8?"

"Probably about 5'8 - 5'7 at least"

He told me it was because he was 5'10. I said "well, you're 17. I'm 13. I will outgrow you."

"We'll see." He said, laughing.

"The irony,'" I would later say. It took me a little under a year to do it.

I also climbed trees, but not because I wanted to grow. Rather, it was because I was bored and impulsive. That's it.

9th grade - grew my hair out, messed around, and my insecurities for my height grew larger. Dare I say insecurity now... I was reckless. Poor judgment. Discarded any consideration for my grades. I look back now, and I say: "that silly boy." I knew my a** was probably going to be grass soon, but I was always hyping myself up for another inch in a couple months. And one inch it was, but I was, of course, greedy - as they discuss in the Bible.

10th grade - the period of my adolescence where I felt truly like a bull in a ring - internally, at least. Always anxious, always angry, always indifferent in tone, always impatient, and always expecting one more inch. That I did grow, but I wanted more - the greed they discuss in the Bible. But, was my a** grass? Perhaps so, but I wasn't willing to even entertain that. I saw I gained another inch, and I quickly became arrogant - I would grow more, and I knew it.

Months later.

Yup. My a** was grass.

And now - June 26, 2026. My a**, dear friends, was once fertile soil for hope and possibility. I remember a time when I thought this: come back, Bone Age. It was too old to reconsider another recourse - one or two years too late now.

Today, however, my a** is ten thousand percent grass, and time itself has a lawnmower.

Could I care less?

Yeah. I could. I'll cut that grass, matter of fact. The lawn won't mow itself.

Disclaimer: this work is a fictional biological allegory inspired by the themes of brotherhood, sacrifice, and perseverance found in historical accounts of war. It is not intended to diminish or trivialize the experiences of those who fought and died in real conflicts, whose courage and suffering remain beyond comparison.

Synopsis

A biologically true story of heroism on the battlefield

In the distant realm of the Growth Plate Front, a great war has raged since the earliest days of life. The Chondrocyte Division, a brotherhood of tireless young warriors, advances inch by inch across the long bones, expanding the territory of the kingdom through courage, sacrifice, and unyielding determination.

Supporting them in their greatest campaigns are the Androgen Regiments, powerful allies whose arrival marks a turning point in the war. Under their command, the Chondrocytes achieve victories never before thought possible, driving forward in the Great Pubertal Offensive and securing the largest territorial gains in the history of the conflict. Yet, as the war drags on, an ancient government carries out laws older than any living chondrocyte could remember.

The ancient Osteogenic High Command, together with the relentless Armies of Senescence, begins its final campaign. What was once an alliance slowly becomes a betrayal, as the Androgen Regiments unknowingly aid the very powers destined to bring the Chondrocyte Legion to its end.

Behind the advancing armies march the silent Osteoblast Burial Corps - the silent undertakers of the battlefield. Their solemn duty is to entomb the fallen beneath layers of osteoid, transforming the battle-worn frontiers into permanent stone and ensuring that no ground, once won, shall ever be lost again.

Inspired by the courage, sacrifice, and brotherhood found in the great stories of the Second World War, Battle for the Inches is an allegorical tale of growth, loyalty, and inevitable change - a war where every inch of victory is paid for by those who fought to create it, and where even heroes cannot escape the march of time.

The men of the Chondrocyte Division were young - far too young for war.

Most had known only the quiet order of the resting zone, where generations before them had prepared for a future they could scarcely understand. Most sought neither glory nor greatness. Yet when their brothers marched to the front, few could bear to remain behind. Yet history, as it so often does, had other plans. Since the First World War of Infancy, most of their forebearers would have urged them not to join up.

And when the call came, they marched to the proliferative front.

There, amid the endless demands of growth and the unrelenting pressure of time, boys became hardened veterans. Side by side, they pushed the frontier forward, gaining precious inches for a kingdom they would never live to see completed. As instinct would have it, and as much as most truly strived against pressing forward on the lines, it was a must and an effort - a valiant effort.

The Androgen Regiments arrived as liberators and brothers-in-arms, bringing strength, confidence, and the promise of victory. Under their banner came the Great Pubertal Offensive, the largest advance in living memory. Spirits soared, and many believed the war might continue forever. The HPG Axis - the Supreme Allied Command.

No war remains confined to a single front. Other regions of the kingdom were drawn into the struggle; not through ambition, but through duty, and through a shared desire to aid their fellow brothers on the lines. Yet, each theater fought according to its own timetable. Some had already endured their hardest campaigns and now stood as seasoned veterans, while others had only begun to hear the distant echoes of war. The hands and feet marched early, answering the call long before the greater campaigns had begun. The elbows, wrists, and ankles soon followed, undergoing a period of great refinement and preparation. The hips and shoulders, steadfast and industrious, contributed greatly to the kingdom through years of tireless appositional work. The knees - early on - bore the immense burden of the Great Pubertal Offensive, becoming the decisive theater of the war, while the spine held the lines long after many believed the conflict to be nearing its end.

Far beyond the battlefield, the Osteogenic High Command prepared its final campaign. The ancient laws of maturation could not be delayed indefinitely. One by one, the young warriors who had built the nation with their own sacrifice fell, their bodies entrusted to the solemn Osteoblast Burial Corps, who laid them to rest beneath enduring stone.

No monuments bore their names. No songs remembered their deeds. Yet every inch of the kingdom stood as proof that they had lived, fought, and given everything they had.

They were not born heroes.

They were merely young men, placed in terrible circumstances, who did their duty until the very end.

1. Pyle-Hoerr Knee Skeletal Age Atlas - An Educational Overview

- BA milestones and rough estimates of remaining growth for the average male (0-19Y) or female (0-18Y)

2. A History of Forensic Age Estimation: What Adolescent Skeletal Remains Have Taught Us About Human Growth and Maturation

- Bones of young WW1 and WW2 soldiers that have been recovered from the ground where they fell during action.

- Ancient Skeletal Remains of Young Children.

- An Educational Overview of Growth Plate Maturity through Youth and Bony Union at the Physis (with pictures of such bone ends).

Vote.

This one just crossed my mind, so it'll be quicker.

Many people tend to conflate "fusion" and "closing" when, while part of the same general process, indicate two separate phases of senescence.

Closure = used to indicate that the growth plate is actively undergoing puberty-driven senescence, from the earliest narrowing stage years before definitive fusion to full union much later.

Fusion = the actual process of bony union at the growth plate, where the metaphysis and epiphysis make official contact.

The "merge" is often described throughout this general process. The growth plate progressively narrows or gets thinner, and the near-mature epiphysis and metaphysis merge closer with time and maturation of the physis. At early narrowing, epiphysis is generally about 2 mm away from the metaphyseal front, depending on the bone. At mid stage narrowing, this distance becomes further widened to about 1-2 mm or so. At late narrowing, the epiphysis and metaphysis are generally no farther than 1 mm apart, and this is roughly close enough for trabecular bridges to begin forming and bridging the two regions of bone effectively. At early union, the physis is merely compartmentalized and no longer considered unrestricted, whole in microstructure, or fully functional. Instead, its functionality reduces greatly over the coming months to a couple of years; proliferative figures dropping, central fusion initiating, and peripheral regions remaining wider due to biomechanics. Varies by the bone end and type of bone.

At this stage, a doctor would generally refer to this process as "union" or "fusion". Before then, the doctor may call the process "closure" or say the growth plates have begun closing. Some doctors may interchange the two, though.

For most long bone ends, the narrowing process generally initiates roughly immediately after PHV, or within the first months after. Some bone ends may begin narrowing around the time of PHV or during the months leading up to it, specifically the phalanges in the fingers and toes as one example.

Over the last few months, I steadily shed about 16-20 pounds off of my frame, and within the last 4-5 - about 10-12 pounds. However, my skeleton remains where it is in vertical measure; 71.5 inches at the near-max - a metric that now officially holds the two-year milestone of tenure.

Jokes aside, I focused far more on the milestone. I couldn't help but nod in appreciation when the doctor noted the reduction.

Moral of the story: when you are old enough to work full-time (like when you've graduated from high school), it wouldn't be a bad idea to start somewhere where you are able to work on your feet consistently, like blue collar. If you have goals to shed some unneeded pounds, that's one of the strongest lifestyle changes I'd recommend. Even if you have a difficult time losing weight, it's more likely to help you drop some of that weight steadily over multiple months. A schedule like that may also help you ensure that you are getting balanced meals everyday instead of just constant snacking and random instances where you don't eat. It's also useful to keep in mind that being overweight for long stretches of time can potentially advance your skeletal development, in total reducing the overall time for growth at varying rates. I don't have this burden on me anymore, since I'd bet I am skeletally mature or almost there, but it still has impact on your bone health and overall on your body.

Additionally, it entails working in the heat and getting sufficient Vitamin D from sunlight exposure. For all y'all late bloomers (seemingly everyone on here by now), you could put that to the test.

I didn't know how else to share this milestone with a space that I frequent often that deals purely with growth-related concerns. Did the best I could with the loose correlation I attempted to do here. Thanks for reading this. 😂

Dear enthusiasts,

I missed the milestone.

We have surpassed 500 members!

Since March 2025, this space has been one of Reddit's largest hotspots for all things growth plates, and I cannot thank each and every one of you enough. I know this space has also seen some shortcomings, like the permanent cancelation of staff-given bone age estimates from back in January. But, I promised better things, and I have been here as consistently as possible to deliver. I try to be a man of my word.

You guys have helped fuel and bring what younger me would have called a pipe dream (this was bigger than my YouTube channel of 11 years) - wondering why growth plates lengthened bones later in elementary school, to exploring the human body off an on during my pre-teens, to delving in further amidst my early-pubertal concerns at age 12, to linking it with an understanding of my own growth early on in my 15th year of life (ages 14 to 15). Ages 15-18 were my peak years in retrospect, and this space has only seen a fraction of it.

Seriously. What an endeavor it's been with you guys, and here's a cheers for what's to continue!

From the OGs of r/growthplates to those who came along the bridge from r/heightgrowth, thank you guys so much.

• Richie 🍻

Disclaimer: phases will be in separate posts, spread out throughout the day to prevent excess length of the test

In this sequence, you will be tasked with assessing the overall skeletal maturity of three separate patients and estimating remaining growth potential from the data shown. All patients are eugonadal and are of normal stature. Features like R/U stages, Risser signs, knee skeletal age, PFMI grades, and cervical stages will be provided.

The purpose of these tests are meant to convey asynchrony among different skeletal regions and small or big mismatches in growth velocity, Tanner stage, and bone age, and to teach that not everything about development has to be a perfect match.

Radiographic sequences:

● One anteroposterior (AP) image of the left hand and wrist.

● One anteroposterior image of the left or right knee.

● One anteroposterior image of the pelvis.

● A lateral cephalometric image of the cervical spine.

Phase I

A male patient at the chronological age of fourteen years and nine months presents with five radiographs, each taken once of the hand and wrist, the knee region, the pelvic girdle, and the cervical region. Puberty onset was observed to have occurred at a median age of 11.4Y (±0.2Y), and he is currently in the earliest phase of the fourth gonadal stage.

The patient's growth history:

10Y 9M - 52.2"

11Y 3M - 53.2"

11Y 9M - 55.7"

12Y 5M - 57.3"

12Y 9M - 58.5"

13Y 2M - 60.8"

13Y 6M - 63.2"

13Y 10M - 66.8"

14Y 3M - 68.1"

14Y 9M - 69.5"

The bone age of the left hand and wrist is estimated to be fifteen years and four months. On the DRU classification scale, the distal radius is currently in the ninth stage, and the distal ulna is currently in the eighth stage.

The patient's cervical stage, as measured using the CVM scale, was estimated to be approaching the fifth stage.

The patient's knee imaging displayed epiphyseal plates in the early narrowing stages for the distal femur and proximal tibia; however, the physis of the proximal fibula remains fully demarcated. The skeletal age, using the Hoerr-Pyle knee bone age atlas, was estimated to be 14.8Y (±0.2Y).

The patient's pelvic girdle imaging displayed fused triradial cartilage of the acetabulum, suggesting hip growth at the pelvic junction is complete. All other noteable apophyses are unfused, but advanced in maturation. The featured lumbar vertebrae (L3-5) display clear separations between the bodies and the ringed apophyses at both ends. The grading of the iliac crests estimated a grade of approximately four, while the proximal femoral grading index would appear to agree with a grade of four, as well. In this case, the PFMI grade and Risser sign both match.

Your job: estimate the remaining growth potential to the best of your ability using these above details, and keep in mind any potential mismatches in growth velocity, Tanner stage, and bone age, as well as his growth pattern and tempo. Identify whether the patient's overall skeletal maturation is delayed, timely, or advanced relative to his chronological age.

Test III - dual-phase

In this activity, you will be tasked with estimating a pediatric patient's remaining growth using one or more BA reports, with two separate phases. As well, determine whether the given BA, G stage, and growth velocity at the time of examination all match, and identify the peak pattern to help you determine this.

Phase I will feature just one BA result, a compact growth history, and additional biological details. The full report will exist at your disposal.

Patient 1 is eugonadal, has no identifiable hypothalamic signaling deficits or malignancies, and he is of normal-stature.

Patient 2 has a diagnosed CDGP with slow progression (she is pubescent), a healthy-functioning hypothalamus, and no identifiable malignancies. She has a reported deficit in estradiol production due to an aromatase deficiency, and has expressed changes appropriate for the second gonadal stage, with no clear progress being made toward the third gonadal stage.

Phase II will feature multiple BA results, where you will identify the advancement rate using the equation provided, a compact growth history, and other details. The full report will exist at your disposal.

Phase I

A male at the chronological age of seventeen years and four months presents with an anteroposterior radiograph taken of the left hand and wrist that has a documented bone age of fifteen years and ten months. Puberty onset was observed at a median of 12.7Y (±0.2Y), and the patient is currently in the fifth gonadal stage.

Growth history:

12Y 4M - 60.5"

12Y 10M - 62.4"

13Y 4M - 64.5"

13Y 8M - 65.8"

14Y 1M - 68.6"

14Y 4M - 69.8"

14Y 8M - 71"

15Y 1M - 72.5"

15Y 8M - 73.7"

16Y 3M - 74.8"

16Y 10M - 76"

17Y 4M - 76.7"

Phase II

A female at the chronological age of fourteen years and eleven months presents with diagnostic imaging of the left hand and wrist that shows an estimated bone age of eleven years and two months. Puberty onset was observed to have occurred at a median of 14.3Y (±0.2Y). At the chronological age of thirteen years and ten months, she was presented with the concern of attenuated growth velocity since ages five to six years. Her bone age was estimated to be ten years and seven months at the time.

Equation for BA advancement rate: BA time change (how many years gap the two BA values) divided by the chronological time change (how many years are in between the two chronological ages).

Her growth history is as follows:

12Y 10M - 57.8"

13Y 4M - 58.6"

13Y 10M - 59.5"

14Y 3M - 60.6"

14Y 7M - 61.5"

14Y 11M - 62.4"

Your tasks: evaluate the BA advancement rate, then use this rate to estimate remaining growth potential across chronological time, and determine whether the GV, G stage, and the BA all match; identify any mismatches, and further implement these to find roughly how much growth remains. Assess the peak pattern and use that to your knowledge, as well as the timing of the peak, if such exists. If no peak has been attained yet, assess the overall growth pattern.

For a bonus updoot, determine roughly when Patient 1 may attain skeletal maturity of the hand and wrist in chronological time.

I'm having too much fun making these.

The second test brings forth a new challenge in random order. The six answer choices are presented below, and you are tasked in finding the growth pattern of a fictional adolescent:

A) Monophasic

B) Biphasic

C) Compressed

D) Prolonged

E) Blunted

G) Rebound

And in identifying the timing: early, intermediate, or late.

Test II

12Y 4M - 60.6"

12Y 10M - 62.2"

13Y 3M - 63.1"

13Y 10M - 64.5"

14Y 4M - 65.8"

14Y 8M - 67"

14Y 11M - 67.7"

15Y 5M - 69.5"

15Y 11M - 71.3"

16Y 5M - 72.7"

16Y 11M - 73.7"

17Y 5M - 75.1"

18Y 0M - 76.1"

18Y 6M - 76.6"

19Y 2M - 77.3"

19Y 9M - 77.8"

20Y 4M - 78.1"

21Y 3M - 78.3"

22Y 3M - 78.3"

23Y 3M - 78.3"