Extensive studies among various racial groups led Greulich and Pyle1 to conclude that the majority of healthy children have a regular and constant order of onset of ossification in the bony centers of the hand and wrist. This ossification sequence is identical for both sexes and is the same as that found by Sutow2 in Japan and by Mackay3 in Kenya. Pyle and Sontag4 encountered no essential differences in order of appearance of the ossific centers in normal children regardless of their growth rates. Although roentgenographically demonstrable variability in inception of ossification occurred more frequently in the carpals than in the true epiphyses of the metacarpals and phalanges, there was a substantial degree of regularity even in the carpal pattern.
In a series of 154 Ohio children recently reported by Garn and Rohmann5 a clear majority of the girls (61%) and a near majority
DREIZEN S, SPIRAKIS CN, STONE RE. Chronic Undernutrition And Postnatal OssificationEffect on Time and Sequence of Appearance of the Postnatal Ossification Centers in the Human Hand Skeleton. Am J Dis Child. 1964;108(1):44–52. doi:10.1001/archpedi.1964.02090010046006