Long bones in miniature are connected to the carpals, or wrist bones, at the

wrist and connect from there to the phalanges, or finger bones.

The bones of the fingers and of the toes. There are generally three phalanges

(distal, middle and proximal) for each digit except the thumbs and large toes.

A small nodular bone, which is most often found embedded within the

tendons in the region of the thumb.

The singuular of phalanges is _____

The phalanges are ossified from a _____ of the shaft and

_______

Ossification in the shaft (primary centers) begins

The epiphyseal centers (secondary centers) appear ______ around _________

3 STAGES: The epiphysis and diaphysis are equal

3 STAGES: The epiphysis caps the diaphysis by covering it like a cap

3 STAGES: Fusion occurs between epiphysis and the diaphysis

Radiograph is compared with a standard series of films, representative of

normal children at different chronological ages and for each sex.

They published an atlas, containing ideal skeletal age pictures of the hand

wrist for different chronological ages of males and females.

The skeletal age of the patient is assessed by matching the patient's

radiograph on an overall basis with one of the photograph in the atlas

• 9 skeletal developmental stages

• Each of these stages represents the level of skeletal maturity

• 1982, ______ proposed a system of evaluation for

skeletal maturation,

• Used 4 anatomical landmark sites(thumb, third finger, fifth finger, radius)

• 11 discreet adolescent skeletal maturity Ą indicators (SMI) were

proposed that gives the approximate chronological age and

percentage of growth corresponding to each of the 11 SMIs.

• A relatively rapid and easier method of skeletal maturity assessment

base on hand-wrist radiograph was developed by ______ in 1980.

• Analyzed the hand wrist radiograph's of individual taken annually between the ages of 6 and 18 years and studied the ossification of the following bones:

SINGER'S METHOD: In this stage, the pisiform and the hook of hamate are still absent and

epiphysis and proximal phalanx of second finger is narrower than its

diaphysis.

SINGER'S METHOD:

-This stage is characterized by initial ossification of hook of the hamate

and that of pisiform. The epiphysis and diaphysis of the proximal

phalanx of second finger become equal

• It represents the prepubertal period prior to the onset of adolescent

growth spurt, during which significant amount of normal growth is still

remaining

SINGER'S METHOD:

It is characterized by the beginning of calcification of the sesamoid,

increased width of the epiphysis of proximal phalanx of the second

fingers and increased calcification of the hamate and pisiform.

SINGER'S METHOD:

• It is characterized by calcification of the sesamoid and capping of the diaphysis of the middle phalanx of third finger by its epiphysis.

SINGER'S METHOD:

• This stage is characterized by fully calcifi fusion of epiphysis of distal phalanx of third its shaft and epiphyses of radius and ulnar with their respective shafts. Ideally, active orthodontic therapy completed by this stage and patient should period.

SINGER'S METHOD:

• No remaining growth sites are seen.

Ulnar Sesamoid (s) Certain stages of 3 epiphyseal bones namely, the

➢ First one to devlop a system of skeletal maturation assesment

➢ They use cervical vertebrae as a tool to identify skeletal maturation

➢ Cervical Vertebrae Maturity indicator

➢ It is a method that is being used increasingly in the past year compared to conventional.

➢ Popular because it is a method that can be assess only in lateral cephalogram.

➢ stated that cervical and the hsnf wrist can be both statistically and clinically reliable in assessing head Most methods of CVMI are based on morphological changes that occur in cervical bodies as growth progresses • They use C1, C2, C3, C4