In skeletal age estimation using the hand-wrist radiograph (Greulich and Pyle atlas), fusion of which epiphysis indicates that skeletal maturity is essentially complete?

• A Distal ulnar epiphysis
• B Distal radial epiphysis ✓
• C Proximal phalangeal epiphyses
• D Metacarpal head epiphyses

Explanation

The distal radial epiphysis is the last to fuse in the hand-wrist radiograph (around 18–19 years in females and 19–21 years in males) and serves as the final marker of skeletal maturity in this atlas. Before it fuses, the growth plate of the distal radius is the site of Salter-Harris fractures in children. Proximal phalangeal and metacarpal epiphyses fuse earlier (15–17 years). The distal ulnar epiphysis fuses slightly after the distal radius. In forensic age estimation, fusion of the medial clavicular epiphysis (up to 25 years) supplements the hand-wrist assessment for late adolescence.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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