The reliability of the Greulich–Pyle method in bone age determination among Australian children


  • ML Paxton MBBS; AC Lamont MBChB FRCR FRANZCR; AP Stillwell MBBS.
  • Conflict of interest: None declared.


Dr Mark L Paxton, C/O The Townsville Hospital, Angus Smith Drive, Townsville, Qld 4810, Australia.




Bone age (BA) determination in skeletally immature children has been used as a measurement of growth for many years. The Greulich–Pyle (G&P) method of estimating BA is most commonly used. The standards used within this atlas were compiled from research conducted on normal white children in the United States, during the 1930s. The applicability of G&P beyond populations similar to its own can be variable. The aim of this study was to determine the accuracy of G&P in BA determination among Australian children.

Methods and Materials

Hand X-rays of children under the age of 18, investigated for trauma, were recruited. Mean differences between BA, according to the standards of G&P, and chronological age (CA) were compared among all patients and subgroups according to age, gender and left versus right hand.


Between January and December 2010, 654 children underwent hand X-rays, 406 of these were included (276 males and 130 females). Overall BA was 2.2 months less than CA (P-value = 0.005). BA of males and females was estimated to be 1.5 months (P-value = 0.142) and 3.7 months (P-value = 0.002) less than their CA respectively. No statistically significant difference was identified with intra-observer (P-value = 0.846) and inter-observer interpretations (P-value = 0.102).


Our results show that the standards of G&P are an accurate means of BA determination in Australian children.