In assessing skeletal age it is customary to examine roentgenograms of only one hand and wrist on the assumption that pronounced differences between the two sides are comparatively rare. Although homologous parts of the two sides of the skeleton may show considerable differences in development, the bulk of available evidence supports the thesis that, for all practical purposes, discrepancies between the two sides are too insignificant to constitute a source of error in the determination of skeletal status.1-8 This inference is derived from investigations of the number and size of ossification centers in the hand and wrist, chronological order of appearance of the carpal bones and secondary epiphyses, and detailed measurements of the carpal area.
The delineation of skeletal maturation determiners of the hand and wrist, initiated by Rochlin9 and Todd10 and extended by Greulich and Pyle,11 permits a more precise estimation of the developmental status
DREIZEN S, SNODGRASSE RM, WEBB-PEPLOE H, PARKER GS, SPIES TD. Bilateral Symmetry of Skeletal Maturation in the Human Hand and Wrist. AMA Am J Dis Child. 1957;93(2):122-127. doi:10.1001/archpedi.1957.02060040124004