Rad

Risser Sign

search

Risser Sign, Risser's Sign, Risser Grade, Risser Grading, Iliac Apophysis Ossification

  • See Also
  1. Tanner Stage
  • Indications
  1. Skeletal Maturity estimation in Scoliosis evaluation
  2. Scoliosis progression risk related to skeletal maturity
  • Physiology
  1. Iliac apophysis calcification begins at Puberty
    1. Calcification completed over 2 year period
    2. Completed with apophysis fusion to iliac crest
  2. Calcification (or ossification) begins anterolaterally
    1. Anterior superior iliac spine is first to calcify
    2. Calcification progresses posteromedially
  • Grading (based on iliac crest divided into 4 quadrants)
  1. Risser 1: 25% Iliac Apophysis Ossification
    1. Anterior Superior iliac spine (anterolateral)
    2. Seen in prepuberty or early Puberty
  2. Risser 2: 50% Iliac Apophysis Ossification
    1. Ossification extends halfway across iliac wing
    2. Seen immediately before or during growth spurt
  3. Risser 3: 75% Iliac Apophysis Ossification
  4. Risser 4: 100% Iliac Apophysis Ossification
    1. Adjacent to sacroiliac joint (posteromedial)
    2. Indicates slowing of growth
  5. Risser 5: Iliac apophysis fuses to iliac crest
    1. Indicates cessation of growth
  • References
  1. Lonstein (July 1989) J Musculoskeletal Med, p. 37-54
  2. Greiner (2002) Am Fam Physician 65(9):1817-22 [PubMed]
  3. Haasbeek (1997) Postgrad Med 101(6):207-16 [PubMed]