15. Appendices
176 Green Smart User Manual
D. Fusion
1. Third finger –distal phalanx
2. Third finger – Proximal phalanx
3. Third finger – middle phalanx
4. Radius
Eleven Skeletal maturity indicators (SMIs)
The System uses only four stages of bone maturation, all found at six anatomical sites
located on the 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).
[Fig3. Eleven Skeletal maturity indicators (SMIs)]
A systematic observational scheme such as that shown in the figure above can further
facilitate SMI evaluation. With this approach, key stages are checked first, rather than
looking for maturity indicators in numerical order. A useful step is to determine if the
adductor sesamoid of the thumb can be seen (orange circle). If not, then the applicable
SMI will be one of those associated with early epiphyseal widening rather than capping. If
the sesamoid is visible, then either the sesamoid or an SMI based on capping or fusion
will be applicable.
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