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16. Appendices
16.4
Hand-wrist Image Evaluation References
Radiographic Evaluation of Skeletal Maturation. A clinically oriented method
based on hand-wrist films.
Fishman LS. 1982
System of Skeletal Maturation Assessment (SMA)
The System uses only four stages of bone maturation, all found at six anatomical sites
located on thumb, third finger, fifth finger and radius, as seen Fig.1. Eleven discrete
adolescent skeletal maturational indicators (SMI's), covering the entire period of
adolescent development, are found on these six sites (Fig.1 orange circles).
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[Fig1. Site of skeletal maturity indicators]
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