Normal AP Pediatric Hand X-ray — Bone Age

A 4-year-old boy is brought to the pediatric clinic for evaluation of short stature. His parents report normal birth weight and early childhood growth, but slowing of growth over the past 2 years. On examination, he is at the 3rd percentile for height. An AP X-ray of the left hand and wrist is obtained for bone age assessment. The structures marked **A** (carpal bone ossification centers) show ossification of the capitate, hamate, triquetrum, and lunate, but the trapezium, trapezoid, scaphoid, and pisiform remain unossified. Which of the following diagnoses is most consistent with these findings?