SA Orthopaedic Journal
Print version ISSN 1681-150X
INTRODUCTION: In scoliosis management the five stages of the Risser sign on the iliac crest have been widely used as a tool to assess skeletal age and remaining spinal growth. However, as with other markers of skeletal age, it is under the influence of genetic and environmental factors. Proof of this was given by Risser, who observed that children in warmer climates developed earlier. Numerous other authors have also shown differences for other measures of maturity between different race groups. OBJECTIVE: This study was aimed at determining the trends of Iliac crest apophyseal ossification as represented by the Risser sign in the South African population and how it compares with that published by Scoles et al in their population group. METHOD: Radiographs of patients between the ages of 8 to 20 years undergoing abdominal X-rays for abdominal pains at our teaching hospitals were collected and assessed by two independent observers for the Risser sign. X-rays of patients with Risser stage 0, skeletal abnormalities and conditions which can affect skeletal growth and maturity were excluded from the study. The Risser stage, the ages and the race of the patients were observed and documented. RESULTS: A total of 743 abdominal X-rays were collected; of those 280 X-rays were excluded as per exclusion criteria leaving 463 X-rays to analyse. Of the 463 X-rays available, 292 were for black patients, 117 whites, 42 coloureds, 11 Indians and 1 Chinese. The average age of Risser stage 1, 2, 3, 4 and 5 were 12.75, 15.38, 15.83, 16.38, and 17.06 years respectively. The girls tended to be of a younger age group in all Risser stages. There were no statistically significant differences in average age of the Risser stages among the black and white population groups except for the white male in Risser stage 1 who had a younger age than the black population in the same Risser stage. The South African boys at Risser stage 1 were of a younger age when compared those published by Scoles et al in their population group. CONCLUSION: The Risser sign can be applied equally among the South African population as no significant statistical differences between the major population groups were found in this study.