A Comparison of Hand-wrist Bone and Cervical Vertebral Analyses in Measuring Skeletal Maturation

Objective: To compare skeletal maturation as measured by hand-wrist bone analysis and by
cervical vertebral analysis.
Materials and Methods: A radiographic hand-wrist bone analysis and cephalometric cervical
vertebral analysis of 30 patients (14 males and 16 females; 7–18 years of age) were examined.
The hand-wrist bone analysis was evaluated by the Bjork index, whereas the cervical vertebral
analysis was assessed by the cervical vertebral maturation stage (CVMS) method. To define
vertebral stages, the analysis consisted of both cephalometric (13 points) and morphologic evaluation of three cervical vertebrae (concavity of second, third, and fourth vertebrae and shape of
third and fourth vertebrae). These measurements were then compared with the hand-wrist bone
analysis, and the results were statistically analyzed by the Cohen . concordance index. The same
procedure was repeated after 6 months and showed identical results.
Results: The Cohen . index obtained (mean . SD) was 0.783 . 0.098, which is in the significant
range. The results show a concordance of 83.3%, considering that the estimated percentage for
each case is 23.3%. The results also show a correlation of CVMS I with Bjork stages 1–3 (interval
A), CVMS II with Bjork stage 4 (interval B), CVMS III with Bjork stage 5 (interval C), CVMS IV
with Bjork stages 6 and 7 (interval D), and CVMS V with Bjork stages 8 and 9 (interval E).
Conclusions: Vertebral analysis on a lateral cephalogram is as valid as the hand-wrist bone
analysis with the advantage of reducing the radiation exposure of growing subjects.