{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:35:23Z","timestamp":1787754923726,"version":"build-2784847793"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2019,10,16]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>We recently developed a classification system to assess skeletal maturity by scoring proximal humeral ossification in a similar way to the canonical Risser sign. The purpose of the present study was to determine whether our system can be used to reliably assess radiographs of the spine for modern patients with idiopathic scoliosis, whether it can be used in combination with the Sanders hand system, and whether the consideration of patient factors such as age, sex, and standing height improves the accuracy of predictions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively reviewed 414 randomized radiographs from 216 modern patients with scoliosis and measured reliability with use of the intraclass correlation coefficient (ICC). We then analyzed 606 proximal humeral radiographs for 70 children from a historical collection to determine the value of integrating multiple classification systems. The age of peak height velocity (PHV) was predicted with use of linear regression models, and performance was evaluated with use of tenfold cross-validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The proximal humeral ossification system demonstrated excellent reliability in modern patients with scoliosis, with an ICC of 0.97 and 0.92 for intraobserver and interobserver comparisons, respectively. The use of our system in combination with the Sanders hand system yielded 7 categories prior to PHV and demonstrated better results compared with either system alone. Linear regression algorithms showed that integration of the proximal part of the humerus, patient factors, and other classification systems outperformed models based on canonical Risser and triradiate-closure methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Humeral head ossification can be reliably assessed in modern patients with scoliosis. Furthermore, the system described here can be used in combination with other parameters such as the Sanders hand system, age, sex, and height to predict PHV and percent growth remaining with high accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>The proximal humeral ossification system can improve the prediction of PHV in patients with scoliosis on the basis of a standard spine radiograph without a hand radiograph for the determination of bone age. This increased accuracy for predicting maturity will allow physicians to better assess patient maturity relative to PHV and therefore can help to guide treatment decision-making without increasing radiation exposure, time, or cost. The present study demonstrates that assessment of the proximal humeral physis is a viable and valuable aid in the determination of skeletal maturity as obtained from radiographs of the spine that happen to include the shoulder in adolescent patients with idiopathic scoliosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.19.00296","type":"journal-article","created":{"date-parts":[[2019,10,17]],"date-time":"2019-10-17T06:17:32Z","timestamp":1571293052000},"page":"1868-1874","source":"Crossref","is-referenced-by-count":45,"title":["The Proximal Humeral Ossification System Improves Assessment of Maturity in Patients with Scoliosis"],"prefix":"10.2106","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7547-4022","authenticated-orcid":false,"given":"Don T.","family":"Li","sequence":"first","affiliation":[{"name":"Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0074-0346","authenticated-orcid":false,"given":"George C.","family":"Linderman","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8944-0402","authenticated-orcid":false,"given":"Jonathan J.","family":"Cui","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2888-9951","authenticated-orcid":false,"given":"Stephen","family":"DeVries","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2178-9277","authenticated-orcid":false,"given":"Allen D.","family":"Nicholson","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2788-2923","authenticated-orcid":false,"given":"Eric","family":"Li","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1276-0432","authenticated-orcid":false,"given":"Logan","family":"Petit","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1088-954X","authenticated-orcid":false,"given":"Joseph B.","family":"Kahan","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8742-3799","authenticated-orcid":false,"given":"Ronan","family":"Talty","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3035-071X","authenticated-orcid":false,"given":"Yuval","family":"Kluger","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7750-2020","authenticated-orcid":false,"given":"Daniel R.","family":"Cooperman","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9607-6429","authenticated-orcid":false,"given":"Brian G.","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Orthopaedics and Scoliosis, Texas Children\u2019s Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"2","key":"bib1-20230811","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S0022-3476(48)80003-X","article-title":"A substitute for skeletal age (Todd) for clinical use: the red graph method","volume":"32","author":"Pyle","year":"1948","journal-title":"J Pediatr."},{"key":"bib2-20230811","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1542\/peds.24.5.886","article-title":"Patterns of skeletal development in the hand","volume":"24","author":"Pyle","year":"1959","journal-title":"Pediatrics."},{"issue":"3","key":"bib3-20230811","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1002\/ajpa.1330350306","article-title":"Attributes of the radiographic standard of reference for the National Health Examination Survey","volume":"35","author":"Pyle","year":"1971","journal-title":"Am J Phys Anthropol."},{"issue":"3","key":"bib4-20230811","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/S0022-3476(85)80501-1","article-title":"Clinical longitudinal standards for height and height velocity for North American children","volume":"107","author":"Tanner","year":"1985","journal-title":"J Pediatr."},{"issue":"220","key":"bib5-20230811","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1136\/adc.41.220.613","article-title":"Standards from birth to maturity for height, weight, height velocity, and weight velocity: British children, 1965. II","volume":"41","author":"Tanner","year":"1966","journal-title":"Arch Dis Child."},{"issue":"7","key":"bib6-20230811","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.2106\/00004623-198466070-00013","article-title":"The prediction of curve progression in untreated idiopathic scoliosis during growth","volume":"66","author":"Lonstein","year":"1984","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib7-20230811","doi-asserted-by":"crossref","first-page":"823","DOI":"10.2106\/00004623-199506000-00002","article-title":"Prediction of progression of the curve in girls who have adolescent idiopathic scoliosis of moderate severity. Logistic regression analysis based on data from The Brace Study of the Scoliosis Research Society","volume":"77","author":"Peterson","year":"1995","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib8-20230811","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1097\/01202412-200509000-00002","article-title":"Growth and progression of adolescent idiopathic scoliosis in girls","volume":"14","author":"Ylikoski","year":"2005","journal-title":"J Pediatr Orthop B."},{"issue":"3","key":"bib9-20230811","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1097\/BPO.0b013e3182471eb4","article-title":"Prediction of contralateral slipped capital femoral epiphysis using the modified Oxford bone age score","volume":"32","author":"Popejoy","year":"2012","journal-title":"J Pediatr Orthop."},{"issue":"8","key":"bib10-20230811","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.2106\/00004623-199608000-00004","article-title":"Slipped capital femoral epiphysis. Prediction of contralateral involvement","volume":"78","author":"Stasikelis","year":"1996","journal-title":"J Bone Joint Surg Am."},{"issue":"9","key":"bib11-20230811","doi-asserted-by":"crossref","first-page":"e546","DOI":"10.1097\/BPO.0000000000001232","article-title":"Humeral head ossification predicts peak height velocity timing and percentage of growth remaining in children","volume":"38","author":"Li","year":"2018","journal-title":"J Pediatr Orthop."},{"issue":"1","key":"bib12-20230811","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/j.1556-4029.2012.02294.x","article-title":"The reliability of the Greulich and Pyle atlas when applied to a modern Scottish population","volume":"58","author":"Hackman","year":"2013","journal-title":"J Forensic Sci."},{"issue":"1","key":"bib13-20230811","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1097\/BPO.0000000000001058","article-title":"Applicability of the calcaneal apophysis ossification staging system to the modern pediatric population","volume":"39","author":"Li","year":"2019","journal-title":"J Pediatr Orthop."},{"issue":"8","key":"bib14-20230811","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1302\/0301-620X.100B8.BJJ-2017-1489.R1","article-title":"A quantitative method for the radiological assessment of skeletal maturity using the distal femur","volume":"100-B","author":"Knapik","year":"2018","journal-title":"Bone Joint J."},{"issue":"1","key":"bib15-20230811","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1302\/1863-2548.12.170164","article-title":"Ossification of the phalanges of the foot and its relationship to peak height velocity and the calcaneal system","volume":"12","author":"Garcia","year":"2018","journal-title":"J Child Orthop."},{"issue":"12","key":"bib16-20230811","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1302\/0301-620X.97B12.36574","article-title":"The relationship of calcaneal apophyseal ossification and Sanders hand scores to the timing of peak height velocity in adolescents","volume":"97-B","author":"Nicholson","year":"2015","journal-title":"Bone Joint J."},{"issue":"1","key":"bib17-20230811","doi-asserted-by":"crossref","first-page":"64","DOI":"10.2106\/JBJS.F.00067","article-title":"Maturity assessment and curve progression in girls with idiopathic scoliosis","volume":"89","author":"Sanders","year":"2007","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib18-20230811","doi-asserted-by":"crossref","first-page":"540","DOI":"10.2106\/JBJS.G.00004","article-title":"Predicting scoliosis progression from skeletal maturity: a simplified classification during adolescence","volume":"90","author":"Sanders","year":"2008","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib19-20230811","doi-asserted-by":"crossref","first-page":"e246","DOI":"10.1097\/BPO.0000000000000891","article-title":"The Interobserver and intraobserver reliability of the Sanders classification versus the Risser stage","volume":"37","author":"Vira","year":"2017","journal-title":"J Pediatr Orthop."},{"issue":"1","key":"bib20-20230811","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/(SICI)1520-6300(200001\/02)12:1<1::AID-AJHB1>3.0.CO;2-3","article-title":"The Brush Inquiry: an opportunity to investigate health outcomes in a well-characterized cohort","volume":"12","author":"Nelson","year":"2000","journal-title":"Am J Hum Biol."},{"issue":"2","key":"bib21-20230811","doi-asserted-by":"crossref","first-page":"147","DOI":"10.2106\/JBJS.N.00671","article-title":"Relationship of calcaneal and iliac apophyseal ossification to peak height velocity timing in children","volume":"97","author":"Nicholson","year":"2015","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib22-20230811","doi-asserted-by":"crossref","first-page":"563","DOI":"10.2319\/071312-580.1","article-title":"Maxillary growth and maturation during infancy and early childhood","volume":"83","author":"Laowansiri","year":"2013","journal-title":"Angle Orthod."},{"issue":"1","key":"bib23-20230811","doi-asserted-by":"crossref","first-page":"16705","DOI":"10.1038\/s41598-017-16996-w","article-title":"The uniform pattern of growth and skeletal maturation during the human adolescent growth spurt","volume":"7","author":"Sanders","year":"2017","journal-title":"Sci Rep."},{"key":"bib24-20230811","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.neuroimage.2013.09.073","article-title":"The influence of puberty on subcortical brain development","volume":"88","author":"Goddings","year":"2014","journal-title":"Neuroimage."},{"issue":"8","key":"bib25-20230811","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1373\/clinchem.2013.204123","article-title":"Complex biological pattern of fertility hormones in children and adolescents: a study of healthy children from the CALIPER cohort and establishment of pediatric reference intervals","volume":"59","author":"Konforte","year":"2013","journal-title":"Clin Chem."},{"issue":"2","key":"bib26-20230811","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1302\/0301-620X.67B2.3980521","article-title":"Idiopathic scoliosis. Prevalence and ethnic distribution in Singapore schoolchildren","volume":"67","author":"Daruwalla","year":"1985","journal-title":"J Bone Joint Surg Br."},{"issue":"1","key":"bib27-20230811","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s11832-012-0457-4","article-title":"Epidemiology of adolescent idiopathic scoliosis","volume":"7","author":"Konieczny","year":"2013","journal-title":"J Child Orthop."},{"issue":"10","key":"bib28-20230811","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.2106\/00004623-199710000-00006","article-title":"School-screening for scoliosis. A prospective epidemiological study in northwestern and central Greece","volume":"79","author":"Soucacos","year":"1997","journal-title":"J Bone Joint Surg Am."},{"issue":"11","key":"bib29-20230811","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1097\/BRS.0b013e3181d88e78","article-title":"Geographic and demographic variability of cost and surgical treatment of idiopathic scoliosis","volume":"35","author":"Daffner","year":"2010","journal-title":"Spine (Phila Pa 1976)."},{"issue":"18","key":"bib30-20230811","doi-asserted-by":"crossref","first-page":"2387","DOI":"10.1097\/00007632-200009150-00019","article-title":"The estimated cost of school scoliosis screening","volume":"25","author":"Yawn","year":"2000","journal-title":"Spine (Phila Pa 1976)."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.00296","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:34:49Z","timestamp":1787751289000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.00296"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,16]]},"references-count":30,"journal-issue":{"issue":"20","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.19.00296","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,16]]}}}