An early hand-wrist atlas and its implications for secular change in bone age

A little-known 'Skiagraphic Atlas' documenting radiographic changes in the bones of the hand and wrist was published by Poland in 1898. Nineteen skiagrams of British children, 1-17 years of age, were included. Tanner-Whitehouse-2 bone ages were assessed for 15 individuals in this series and differences from chronological ages were calculated. Mean differences for 20-bone, RUS and carpal bone ages are significantly larger than zero. Hence, these children were relatively advanced compared to present children. Comparisons of Poland's expected ages for onset and fusion of secondary ossification centres in the hand and wrist with more recent reference data indicated a secular increase in the rates of skeletal maturation of approximately 0·22-0·66 year/decade, with relatively greater change in expected ages of fusion.