# Ultrasound supports clinical decision-making in determining the Sanders’ skeletal maturity score of the hand

## TL;DR

This study shows that ultrasound can effectively assess skeletal maturity in children, reducing the need for X-rays.

## Contribution

The study demonstrates the feasibility of using ultrasound for determining specific stages of the Sanders skeletal maturity score.

## Key findings

- Ultrasound achieved high concordance for SMS stages 3 and 4 (76.7%) and stages 7 and 8 (79.7%).
- Ultrasound offers a radiation-free alternative for assessing skeletal maturity in children.
- Interrater reliability was stronger for radiographs than for ultrasound in both scoring systems.

## Abstract

The Sanders Scoring System has revolutionized the way we assess the remaining growth potential of the skeleton. However, because it involves radiation exposure, it must be used with caution in children. The purpose of the study was to evaluate whether the Sanders skeletal maturity score (SMS) could be accurately determined using ultrasound (U).

We took radiographs (R) of the hand and performed U of the thumb and index finger in 115 patients between six and 19 years of age who were undergoing treatment for scoliosis or limb deformities. Paediatric orthopaedic surgeons, a paediatrician, and a paediatric radiologist were evaluated the blinded images. Those classified images are based on the SMS and the Thumb Ossification Composite Index (TOCI).

Intrarater reliability was high for SMS and slightly weaker for TOCI, but still significant. Interrater reliability was clear for R and weaker for U in both staging systems. Ultimately, SMS 3 and 7 achieved the highest percentage of concordance (P) of 71.7% and 66.0%, respectively, when U was performed. Combining the clinically relevant groups of SMS 3&4 and SMS 7&8 also significantly increased peak scores (SMS 3 and 4 P = 76.7%; SMS 7 and 8 P = 79.7%). The probabilities of peak scores were significantly weaker when the TOCI score was examined.

Our study shows that U can be used effectively especially to measure stages 3 and 4 and stages 7 and 8 of SMS. The U method is easy to use and therefore may offer advantages in clinical practice without the need for radiation exposure.