Skeletal maturity is indicated by:

Various methods have been proposed for assessment of skeletal maturity. These include: Chronological age Peak height velocity (PHV) Dental age Hand-wrist radiographs Cervical vertebral maturation index (CVMI). Fishman (1982) developed the system for the evaluation of skeletal maturity on a hand-wrist radiograph and investigated its association with craniofacial growth. He called it skeletal maturation assessment (SMA), which is based on skeletal maturity indicators. The system uses only four stages of bone maturation: Epiphyseal widening of the phalanges Ossification of the adductor sesamoid of the thumb Capping of epiphyses over their diaphysis Fusion of epiphyses and diaphysis. These stages of bone formation are found at six anatomical sites located on the thumb, third finger, fifth finger and radius.