Int J Legal Med (2008) 122:51–54 DOI 10.1007/s00414-007-0209-z ORIGINAL ARTICLE Study of age dependence of epiphyseal ossification of the hand skeleton S. Schmidt & U. Baumann & R. Schulz & W. Reisinger & A. Schmeling Received: 11 June 2007 /Accepted: 4 September 2007 / Published online: 5 October 2007 # Springer-Verlag 2007 Abstract Radiological analysis of the hand skeleton is a key Introduction pillar of forensic age diagnostics in living subjects undergo- ing criminal proceedings. The present study investigated Forensic age estimation of living subjects undergoing crim- whether ossification stage classification of selected epiphy- inal proceedings has become a major research area in ses of the hand could provide added value to hand radiograph forensic science during the last few years [1, 2, 7, 9, 14–17]. analysis. Hand radiographs from 265 male and 164 female In these cases, the investigated subjects are nonnationals of subjects aged 10–18years old who had been X-rayed due to critical age who lack valid identification documents, and traumatological indications were therefore assessed. Epiph- forensic age estimation is necessary to decide whether these yseal ossification of selected elements of the hand skeleton persons should be tried as juveniles or adults. (ulna, radius and third metacarpal, basal phalanx, mesopha- The ages of relevance to criminal liability ranges be- lanx and telephalanx) was graded based on the criteria of the tween 14 and 18 years in most countries [3]. five-stage classification system of Schmeling et al. (Int J According to the recommendations of the AGFAD Legal Med, 118:5–8, 2004) for clavicular epiphyseal (Arbeitsgemeinschaft für Forensische Altersdiagnostik, cartilage. Stage 5 (absence of the epiphyseal scar) does Study Group on Forensic Age Diagnostics), forensic age not occur in the radius of men before the age of 18. estimates in living subjects for purposes of medical juris- Stage 5 can therefore be regarded as a potential parameter prudence should be based on the combined examination for valid determination of a minimum age of 18 years for findings in three independent development systems. Phys- forensic age estimation in criminal proceedings. ical maturity is thereby assessed based on an appraisal of anthropometric parameters, secondary sexual characteris- Keywords Forensic age estimation . Skeletal age . tics, and relevant age-related developmental disorders. Hand ossification Dental development is assessed by means of a dental examination, which should include inspection of the oral : S. Schmidt U. Baumann cavity and analysis of an orthopantomogram. Skeletal Institut für Rechtsmedizin, Charité-Universitätsmedizin Berlin, maturity is evaluated by radiological analysis of the left Turmstrasse 21, hand. If it is uncertain whether the subject has reached the 10553 Berlin, Germany age of 21, a conventional radiological or computer to- : R. Schulz A. Schmeling (*) mographic examination of the clavicles should additionally Institut für Rechtsmedizin, be performed to augment the analytical spectrum [12]. Röntgenstrasse 23, Two fundamentally different procedures are used for radio- 48149 Münster, Germany e-mail: [email protected] logical assessment of skeletal development of the hand. The single bone method is performed by analyzing the degree of W. Reisinger maturity of selected skeletal elements [10, 19]. In the atlas Institut für Radiologie (CCM), method, the bone age estimate is obtained by comparing an Charité-Universitätsmedizin Berlin, ’ Schumannstrasse 20/21, X-ray of the test subject s hand with age and sex-matched 10117 Berlin, Germany standard radiographs [20]. 52 Int J Legal Med (2008) 122:51–54 The present study investigated whether ossification-stage Table 2 Statistical parameters in years for women classification of selected epiphyseal centers of the hand Skeletal Mean; LQ; median; Minimum; could provide added value to hand-radiograph analysis. element-stage SD UQ maximum Radius –– – Materials and methods Stage 1 Stage 2 10.9; 0.7 10.4; 10.9; 11.3 10.1; 13.0 Stage 3 13.1; 1.5 12.1; 12.8; 13.9 10.1; 17.8 Hand radiographs from 164 female and 265 male subjects Stage 4 16.5; 1.4 15.6; 16.6; 17.5 12.9; 19.0 aged 10–18 years old were analyzed retrospectively. Table 1 Stage 5 17.8; 1.2 16.6; 18.1; 18.8 16.2; 19.0 shows the age (chronological) and sex distribution of the Ulna patient population. All of the hand X-rays were made Stage 1 11.1; 0.5 10.7; 11.1; 11.5 10.7; 11.5 between 1983 and 2002 at various hospitals in Berlin and Stage 2 11.1; 0.8 10.4; 11.0; 11.5 10.1; 13.0 Leipzig, Germany from patients with traumatological in- Stage 3 13.5; 1.4 12.4;13.4; 14.2 10.6; 17.8 dications. All patients included in the study were children Stage 4 15.6; 1.1 14.8; 15.8; 16.5 13.6; 17.0 Stage 5 17.0; 1.2 16.0; 16.9; 17.8 13.9; 19.0 and adolescents exhibiting age-appropriate physical devel- Metacarpal III opment. Subjects with signs and symptoms of diseases that Stage 1 –– – affect bone development were excluded from the study. Stage 2 11.0; 0.8 10.2; 10.9; 11.5 10.1; 13.0 The epiphyseal ossification stage was determined for the Stage 3 12.4; 1.3 11.5; 12.3; 13.2 10.2; 15.5 following elements of the hand skeleton: the distal radius, Stage 4 14.5; 1.5 13.4; 13.9; 15.7 12.3; 17.8 the distal ulna, the third metacarpal bone, the third basal Stage 5 16.6; 1.4 15.6; 16.6; 17.7 12.9; 19.0 phalanx, the third mesophalanx, and the third telephalanx. Basophalanx III Staging was performed based on the criteria of the five- Stage 1 11.0; 0.0 11.0; 11.0; 11.0 11.0; 11.0 Stage 2 11.0; 0.8 10.2; 10.8; 11.5 10.1; 13.0 stage classification system developed by Schmeling et al. Stage 3 12.7; 1.2 12.1; 12.5; 13.5 10.6; 15.5 [13] for characterization of clavicular ossification: Stage 4 15.8; 1.5 14.7; 15.8; 16.8 12.3; 18.7 – Stage 1: Non-ossified ossification center Stage 5 17.4; 1.4 16.8; 17.7; 18.4 13.8; 19.0 Mesophalanx III – Stage 2: Ossified ossification center with nonossified Stage 1 –– – epiphyseal cartilage Stage 2 11.1; 0.7 10.5; 11.0; 11.7 10.1; 12.5 – Stage 3: Partially ossified epiphyseal cartilage Stage 3 13.1; 1.6 12.2; 12.9; 14.0 10.2; 17.8 – Stage 4: Fully ossified epiphyseal cartilage with Stage 4 15.5; 1.3 14.6; 15.8; 16.6 11.6; 18.0 discernable epiphyseal line Stage 5 17.1; 1.7 16.5; 17.7; 18.5 12.9; 19.0 – Stage 5: Nondiscernable epiphyseal line. Telephalanx III Stage 1 –– – Stage 2 11.2; 0.7 10.6; 11.1; 11.7 10.1; 12.5 Stage 3 12.1; 1.2 11.3; 12.3; 12.9 10.1; 14.2 Results Stage 4 15.5; 1.7 14.2; 15.7; 16.6 11.6; 19.0 Stage 5 16.1; 2.0 14.4; 16.7; 17.8 10.6; 19.0 Tables 2 and 3 present the statistical data on the course of SD Standard deviation; LQ lower quartile; UQ upper quartile epiphyseal ossification over time for all target elements of the hand skeleton in men and women, respectively. The median chronological age of men and women was Table 1 Age and sex found to increase with increasing ossification stage in all distribution of the patient Chronological Women Men skeletal elements analyzed. population age (years) The difference between the median ages of men and 10 19 19 women also decreased with increasing ossification stage to 11 13 22 varying degrees. Consequently, boys increasingly made up 12 24 30 for the initial maturity advance in girls with increasing 13 17 32 skeletal maturity. 14 15 31 Comparison of the course of epiphyseal ossification over 15 23 29 time revealed only slight sex-independent differences in age 16 23 24 for reaching the lower stages of ossification. The higher 17 14 24 stages were associated with increasing age differences. 18 12 30 Σ 164 265 Complete epiphyseal ossification and scar disappearance occurred earliest in the third metacarpal and the third Int J Legal Med (2008) 122:51–54 53 Table 3 Statistical parameters in years for men none were classified as stage 5 in this group. The other Skeletal Mean; LQ; median; Minimum; 28 men in this group exhibited a chronological age of element-stage SD UQ maximum 18 years. In the two remaining cases, stage 5 was diag- nosed at a minimum age of 18.6 years. Radius In the female subjects, stage 5 occurred earlier, at an Stage 1 10.8; 0.7 10.2; 10.6; 10.8 10.1; 12..3 age of 16.2 years. Stage 2 12.3; 1.2 11.5; 12.1; 13.2 10.1; 15.8 Stage 3 14.4; 1.2 13.4; 14.4; 15.2 12.2; 18.0 Stage 4 17.2; 1.3 16.4; 17.6; 18.4 14.5; 18.9 Stage 5 18.8; 0.2 18.7; 18.8; 19.0 18.7; 19.0 Ulna Discussion Stage 1 11.1; 1.3 10.2; 10.5; 11.7 10.1; 14.3 Stage 2 12.5; 1.4 11.3; 12.2; 13.3 10.3; 15.8 The provision of forensic proof that a living subject has Stage 3 13.9; 1.1 12.9; 14.0; 14.7 12.0; 16.4 reached the age of 18 years old is a great diagnostic Stage 4 16.6; 1.3 15.2; 16.7; 17.7 14.5; 18.8 challenge, particularly in medical jurisprudence.