Bone Age in Girls Aged 14 Months — Greulich-Pyle Hand and Wrist X-Ray Reference
Bone age assessment using the Greulich-Pyle atlas involves comparing a left-hand and wrist radiograph to standard reference plates derived from a healthy pediatric population, providing an estimate of skeletal maturity independent of chronological age. In girls aged 14 months, this evaluation helps clinicians identify deviations in skeletal maturation that may signal underlying endocrine, nutritional, or genetic conditions. Early and accurate bone age determination guides workup for growth disorders, hypothyroidism, and other systemic diseases affecting skeletal development.
Expected Ossification Centers and Skeletal Findings
At 14 months of age in girls, the Greulich-Pyle atlas anticipates a limited but developing constellation of ossification centers in the hand and wrist. The capitate and hamate are typically the earliest carpal bones to ossify, appearing around 3 and 6 months respectively, and should be well established by 14 months. The triquetral ossification center emerges between approximately 2 and 3 years in girls and is generally not expected to be visible at this age.
The distal radial epiphysis typically appears around 12 months and may be just visible or in early development at 14 months in girls, given that female skeletal maturation is consistently ahead of males. The epiphyses of the proximal and middle phalanges and metacarpals may begin to show early ossification signals around this period. The lunate, scaphoid, trapezium, trapezoid, and pisiform ossification centers are not expected at this age.
- Capitate: Present (ossifies ~3 months)
- Hamate: Present (ossifies ~6 months)
- Distal radial epiphysis: Early appearance expected (~12 months)
- Triquetral, lunate, scaphoid, and other carpals: Not yet expected at 14 months
- Phalangeal and metacarpal epiphyses: May be emerging
Clinical Pearls
At 14 months, normal skeletal maturation in girls carries a standard deviation of approximately ±3–4 months, so mild variation from expected findings should be interpreted cautiously. Girls are skeletally advanced relative to boys by roughly 1–2 months at this early age, a gap that widens significantly through puberty. A bone age notably advanced beyond 14 months may raise concern for precocious puberty, congenital adrenal hyperplasia, or exogenous androgen exposure, while a delayed bone age warrants consideration of hypothyroidism, growth hormone deficiency, or malnutrition. A key interpretive pitfall at this age is over-relying on a single ossification center; the overall pattern of skeletal maturation—not any one center in isolation—should guide clinical conclusions. Reference: Greulich WW, Pyle SI. Radiographic Atlas of Skeletal Development of the Hand and Wrist. 2nd ed. Stanford University Press, 1959.
