Bone Age in Girls Aged 5 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 child’s radiograph against standardized atlas plates to identify the closest matching skeletal age. In girls aged 5 years, this assessment is particularly valuable when evaluating early or delayed puberty, growth hormone deficiency, hypothyroidism, and other endocrine or metabolic conditions affecting skeletal maturation.
Expected Ossification Centers and Skeletal Findings
By 5 years of age in girls, the majority of the primary carpal ossification centers are typically present. The capitate and hamate ossify very early (around 3 and 6 months, respectively) and are well established by this age. The triquetral (appearing around 2–3 years) and lunate (approximately 3–4 years) are generally visible, and the scaphoid, trapezium, and trapezoid — which typically appear between 4 and 6 years — are expected to be emerging or already present in most girls at this age.
The distal radial epiphysis, which typically ossifies around 1 year of age, is well-developed by 5 years. The distal ulnar epiphysis typically appears between 5 and 7 years and may be just becoming visible at this age in girls. Epiphyses of the metacarpals and phalanges are present and show progressive definition. The pisiform and the thumb sesamoid are not yet expected at this age, as they typically appear around 9–12 years and peripubertally in girls, respectively.
- Capitate and hamate: well ossified
- Triquetral and lunate: typically present
- Scaphoid, trapezium, trapezoid: appearing or present
- Distal radial epiphysis: well formed
- Distal ulnar epiphysis: may be just emerging
- Pisiform and thumb sesamoid: not yet expected
Clinical Pearls
Girls are skeletally more advanced than boys throughout childhood, with a maturation advantage of approximately 1–2 years at this age. A bone age more than 2 standard deviations above the mean (approximately ±1 year at age 5) warrants evaluation for precocious puberty, exogenous androgen or estrogen exposure, or congenital adrenal hyperplasia. Conversely, a significantly delayed bone age may suggest growth hormone deficiency, hypothyroidism, or constitutional delay of growth and puberty. A key pitfall is over-relying on a single ossification center: skeletal maturity should be assessed globally across all visible centers rather than focusing on any one landmark. Reference: Greulich WW, Pyle SI. Radiographic Atlas of Skeletal Development of the Hand and Wrist. 2nd ed. Stanford University Press, 1959.
