# Risser — Risser sign of skeletal maturity

> Grades skeletal maturity from iliac apophysis ossification (US convention).

**Situação:** vigente · **Órgão:** Musculoesquelético · **Órgão emissor:** Orthopedic consensus · **Versão:** current · **Ano:** 1958

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: XR
- Fonte primária: Hacquebord JH, Leopold SS. In Brief: The Risser Classification: A Classic Tool for the Clinician Treating Adolescent Idiopathic Scoliosis (2012) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3392381/
- Última verificação: 2026-06-26
- Última checagem: 2026-06-26

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 0 | Grade 0 | No ossification center is seen in the iliac apophysis; apophyseal ossification has not yet begun. | — | Skeletally most immature with the greatest remaining spinal growth, hence the highest risk of scoliosis curve progression. Peak height velocity and about two-thirds of pubertal growth occur before the first signs of iliac apophysis ossification. | PMC3392381 (Hacquebord & Leopold, CORR 2012), 'The Risser Staging System' (criteria) and 'Purpose' (growth/progression); progression framing corroborated by StatPearls NBK499908. | ✓ |
| 1 | Grade 1 | Ossification of the apophysis up to the first (anterolateral) quarter of the iliac crest, about 25% excursion. | — | Early/prepubertal stage with substantial growth remaining. | PMC3392381, 'The Risser Staging System' (US system divides the apophyseal excursion into quarters, anterolateral to posteromedial); explicit 25% value and prepuberty/early-puberty framing from Wikipedia 'Risser sign' grading list. | ✓ |
| 2 | Grade 2 | Ossification up to the second quarter of the iliac crest, about 50% excursion (progressing anterolateral toward posteromedial). | — | Corresponds to the period before or during the pubertal growth spurt. | PMC3392381, quarters statement; explicit 50% value and growth-spurt framing from Wikipedia 'Risser sign'. | ✓ |
| 3 | Grade 3 | Ossification up to the third quarter of the iliac crest, about 75% excursion. | — | Corresponds to slowing of growth (declining growth velocity). | PMC3392381, quarters statement; explicit 75% value and slowing-of-growth framing from Wikipedia 'Risser sign'. | ✓ |
| 4 | Grade 4 | The apophysis is fully (fourth quarter) ossified across the iliac crest, about 100%, but not yet fused to the ilium. | — | Near-cessation of growth, but not a reliable endpoint: the article warns that trunk growth continues until stage 5 and that stage 4 is not an accurate measure of cessation of curve progression. Skeletal maturity is defined in most studies as Risser 4 or higher in females. | PMC3392381, quarters statement and 'Purpose' (stage 4 not accurate for cessation; growth continues to stage 5); explicit 100% value from Wikipedia 'Risser sign'; female maturity threshold from StatPearls NBK499908. | ✓ |
| 5 | Grade 5 | Complete ossification and fusion of the iliac apophysis to the iliac crest. | — | Skeletal maturity / end of growth; trunk growth completes by this stage. In males, skeletal maturity is defined as Risser 5. | PMC3392381, 'The Risser Staging System' (stage 5 = complete ossification and fusion) and 'Purpose' (trunk growth continues until stage 5); male maturity threshold from StatPearls NBK499908. | ✓ |

### Citações por categoria
- **0**: Hacquebord JH, Leopold SS. In Brief: The Risser Classification: A Classic Tool for the Clinician Treating Adolescent Idiopathic Scoliosis (2012) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3392381/ · PMC3392381 (Hacquebord & Leopold, CORR 2012), 'The Risser Staging System' (criteria) and 'Purpose' (growth/progression); progression framing corroborated by StatPearls NBK499908.
- **1**: Hacquebord JH, Leopold SS. In Brief: The Risser Classification: A Classic Tool for the Clinician Treating Adolescent Idiopathic Scoliosis (2012) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3392381/ · PMC3392381, 'The Risser Staging System' (US system divides the apophyseal excursion into quarters, anterolateral to posteromedial); explicit 25% value and prepuberty/early-puberty framing from Wikipedia 'Risser sign' grading list.
- **2**: Hacquebord JH, Leopold SS. In Brief: The Risser Classification: A Classic Tool for the Clinician Treating Adolescent Idiopathic Scoliosis (2012) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3392381/ · PMC3392381, quarters statement; explicit 50% value and growth-spurt framing from Wikipedia 'Risser sign'.
- **3**: Hacquebord JH, Leopold SS. In Brief: The Risser Classification: A Classic Tool for the Clinician Treating Adolescent Idiopathic Scoliosis (2012) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3392381/ · PMC3392381, quarters statement; explicit 75% value and slowing-of-growth framing from Wikipedia 'Risser sign'.
- **4**: Hacquebord JH, Leopold SS. In Brief: The Risser Classification: A Classic Tool for the Clinician Treating Adolescent Idiopathic Scoliosis (2012) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3392381/ · PMC3392381, quarters statement and 'Purpose' (stage 4 not accurate for cessation; growth continues to stage 5); explicit 100% value from Wikipedia 'Risser sign'; female maturity threshold from StatPearls NBK499908.
- **5**: Hacquebord JH, Leopold SS. In Brief: The Risser Classification: A Classic Tool for the Clinician Treating Adolescent Idiopathic Scoliosis (2012) — https://pmc.ncbi.nlm.nih.gov/articles/PMC3392381/ · PMC3392381, 'The Risser Staging System' (stage 5 = complete ossification and fusion) and 'Purpose' (trunk growth continues until stage 5); male maturity threshold from StatPearls NBK499908.

## Referências cruzadas
- _caracteriza_ → [Lenke — Lenke 2D classification of operative adolescent idiopathic scoliosis](https://radcommons.laudos.ai/systems/lenke.md) — Risser skeletal maturity informs progression risk and timing in idiopathic scoliosis classified by Lenke.


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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