The first purpose of this presentation of patterns of skeletal development in the hand has been to demonstrate that essentially normal children, although passing through very similar steps or stages of skeletal development in the hand, do so in a variety of ways in respect to the rates of their progress through these stages or by age periods. The second objective has been to show the kinds of patterns which emerge and the relative frequency with which certain of these are encountered. This has been done by studying the consistency manifest by children in their rate of progress over the whole of childhood as well as by major subdivisions of the developmental period.This Study shows that few children are very irregular in progress or change frequently to any substantial degree in their rate of progress, but many make one or two substantial shifts in rate from one period to another. The most common, marked and understandable shift is the single one occurring roughly between childhood and adolescence. The years close to the dividing line between these two age periods, therefore, are the ones in which change in rate of skeletal development (hand) may be expected most commonly. The changes in rates occurring at other ages, as portrayed in patterns under III or IV (Figs. 15 to 20), are not readily explained on the basis of other features of development. Factors found associated with these different patterns of skeletal development in the children concerned, relating to nutrition, illness experiences, growth in height and other aspects of development will be considered in later reports on interrelationships.Aside from a preliminary report from this laboratory the only other report known to the authors which dealt longitudinally with patterns of skeletal development was published by Kelly in 1937. This concerned children 6 to 18 years of age and used an index derived from measurements of several bones or epiphyses in the hand and wrist; six patterns were derived from these indices and described as convex, linear, concave, convex-concave, linear-convex and concave-convex. Because of the fundamental differences in the data used in this Study, it is not possible to compare Kelly's results with those being reported.
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