The Dimeglio Olecranon Method Is Reliable in Diverse, Contemporary Patients for Predicting Future Growth

J Pediatr Orthop. 2023 Mar 1;43(3):e249-e253. doi: 10.1097/BPO.0000000000002328. Epub 2022 Dec 15.

Abstract

Background: Growth assessment, which relies on a combination of radiographic and clinical markers, is an integral part of clinical decision-making in pediatric orthopaedics. The aim of this study is to evaluate the accuracy and reliability of the Diméglio skeletal age system using a modern cohort of pediatric patients.

Methods: A retrospective review was undertaken of all patients at a large tertiary pediatric hospital who had lateral forearm radiographs (before the age of 14 y for females and before 16 y for males). In addition, all of these patients had height measurements within 60 days of their forearm x-ray and a final height listed in their medical records. The x-rays were graded by 5 reviewers according to the Diméglio skeletal age system. Inter and intraobserver reliability was tested.

Results: One hundred forty-seven patients with complete radiographs and height data were evaluated by 5 observers ranging in experience from medical students to senior pediatric orthopaedic surgeons. The Diméglio system demonstrated excellent reliability across levels of training with an intraobserver correlation coefficient of 0.995 (95% CI, 0.991-0.997) and an interobserver correlation coefficient of 0.906 (95% CI, 0.857-0.943). When the Diméglio stage was paired with age and sex in a multivariable linear regression model predicting the percent of final height, the adjusted R2 was 78.7% (model P value <0.001), suggesting a strong relationship between the Diméglio stage (plus age and sex) and percent of final height.

Conclusion: This unique approach to maturity assessment demonstrates that the Diméglio staging system can be used effectively in a modern, diverse patient population.

Level of evidence: Level II; retrospective cohort study.

MeSH terms

  • Child
  • Female
  • Humans
  • Male
  • Observer Variation
  • Olecranon Process*
  • Radiography
  • Reproducibility of Results
  • Retrospective Studies
  • Ulna / diagnostic imaging