Bone Age in Girls Aged 16 Years — Greulich-Pyle Hand and Wrist X-Ray Reference
Bone age assessment using a left-hand and wrist radiograph is a fundamental tool in pediatric radiology, allowing clinicians to estimate skeletal maturity independent of chronological age. The Greulich-Pyle method compares a patient’s radiograph against standardized atlas plates derived from a reference population. In adolescent girls, bone age evaluation at 16 years is particularly relevant in the workup of growth disorders, menstrual irregularities, endocrine conditions, and forensic age estimation.
Expected Ossification Centers and Skeletal Findings
By 16 years of age in girls, skeletal maturation is typically advanced and approaching completion. All eight carpal bones — capitate, hamate, triquetral, lunate, scaphoid, trapezium, trapezoid, and pisiform — are well ossified and should demonstrate mature morphology. The pisiform, which typically appears between approximately 9 and 12 years in girls, is fully visible and well-developed by this age.
At 16 years, epiphyseal-diaphyseal fusion is a defining radiographic feature. The epiphyses of the distal radius and distal ulna are typically fusing or may already show complete fusion in many girls. Fusion of the phalangeal and metacarpal epiphyses is expected to be complete or nearly complete. The adductor sesamoid of the thumb, which appears in the peripubertal period (typically around 11–13 years in girls), is fully ossified. Overall, the skeletal findings at this age reflect a bone age near or at full skeletal maturity, which in girls is conventionally defined as approximately 15–17 years by Greulich-Pyle standards.
- Carpal bones: All eight present and fully ossified
- Distal radius and ulna epiphyses: Fusing or fused
- Phalangeal epiphyses: Fused or near complete fusion
- Pisiform: Fully ossified
- Thumb sesamoid: Fully ossified
Clinical Pearls
Girls typically achieve skeletal maturity approximately 1–2 years ahead of boys of the same chronological age, a well-established sex difference reflected throughout the Greulich-Pyle atlas. At 16 years, a bone age significantly advanced beyond chronological age may suggest a history of precocious puberty or exogenous sex steroid exposure, whereas a substantially delayed bone age raises concern for conditions such as growth hormone deficiency, hypothyroidism, or constitutional delay of growth and puberty. In girls, Turner syndrome should be considered when bone age delay is accompanied by short stature and other clinical features. A key interpretive pitfall at this advanced maturational stage is that once epiphyseal fusion is complete, bone age can no longer be estimated with precision — the radiograph may simply reflect “skeletal maturity attained,” limiting further discrimination between, for example, 16 and 18 years.
Reference: Greulich WW, Pyle SI. Radiographic Atlas of Skeletal Development of the Hand and Wrist. 2nd ed. Stanford University Press, 1959.
