RADIOLOGICAL ASSESSMENT OF AGE FROM EPIPHYSEAL FUSION AT THE KNEE JOINT

Abstract

Objectives: Age determination is needed in administration of justice, employment, marriage, forensic investigation and identification. This cross-sectional study aimed to investigate the relationship between stages of epiphyseal union at the knee joint and chronological age.
Methods: Anterior posterior and lateral knee radiographs of 100 males and 110 females aged 9–19 years were examined. Epiphyseal union was divided into five specific stages in the femur, tibia and fibula. Fusion was scored as stage 0: non-union,stage 1: beginning union, stage 2: active union, stage 3: recent union, and stage 4: complete union.
Results: Mean age gradually increased with each stage of union and varied between males and females. A statistically significant difference in mean age was recorded between stages for the three epiphyses. Epiphyseal union occurred earlier in females than in males. A statistically significant difference was observed between the mean age of union for males and females for stages 1 and 2 for the femur, and stages 0, 1, 2 and 3 for the tibia and fibula.
Conclusion: The results of this study indicate that radiographic analysis of the knee is a valuable alternative for estimation of chronological age.

Keywords

• age estimation
• epiphysis
• fusion
• knee joint
• radiograph
• skeletal maturation

References

1. Dharmesh SP, Harish A, Jigesh VS. Epiphyseal fusion at lower end
2. of radius and ulna valuable tool for age determination. Journal of
3. Indian Academy of Forensic Medicine 2011;33:31–35.
4. Cunha E, Baccino E, Martrille L, Ramsthaler F, Prieto J, Schuliar Y,
5. Lynnerup N, Cattaneo C. The problem of ageing human remains
6. and living individuals: a review. Forensic Sci Int 2009;193:1–13.
7. Cameriere R, Cingolani M, Giuliodori A, De Luca S, Ferrante L.
8. Radiographic analysis of epiphyseal fusion at knee joint to assess likelihood

9. of having attained 18 years of age. Int J Legal Med 2012;126:
10. –99.
11. Swapnil P, Bipinchandra T, Varsha P. Age estimation by radiological
12. assessment of proximal tibial epiphysis. Al Ameen Journal of
13. Medical Sciences 2015;8:144–9.
14. Nemade KS, Kamdi NY, Meshram MM, Parchand MP. A radiological
15. study of epiphyseal union of knee joint for age estimation. Indian
16. Journal of Forensic Medicine and Toxicology 2012;6:68–72.
17. Acheson RM. A method of assessing skeletal maturity from radiographs.
18. A report from the Oxford child health survey. J Anat 1954;
19. :498–508.
20. Stevenson PH. Age order of epiphyseal union in man. Am J Phys
21. Anthropol 1953;7:53–93.
22. Ubelaker DH. The estimation of age at death from immature human
23. bone. In: Iscan MY, editor. Age markers in the human skeleton.
24. Springfield (IL): Charles C Thomas; 1989. p. 57–70.
25. Banerjee KK, Agarwal BBL. Estimation of age from epiphyseal
26. union at the wrist and ankle joints in the capital city of India.
27. Forensic Sci Int 1998;98:31–9.
28. Schaefer MC, Black SM. Comparison of ages of epiphyseal union in
29. North American and Bosnian skeletal material. Forensic Sci Int
30. ;50:777–84.
31. Eveleth P. Tanner JM. Worldwide variation in human growth. 2.
32. Cambridge: Cambridge University Press; 1990.
33. Grelich WW, Pyle SI. Radiographic atlas of skeletal development of
34. the hand and wrist. Stanford (CA): Standford University Press; 1959.
35. Lee MMC. Problems in combining skeletal age for an individual.
36. Am J Phys Anthropol 1971;35:395–8.
37. O’Connor JE, Bogue C, Spence LD, Last J. A method to establish
38. the relationship between chronological age and stage of union from
39. radiographic assessment of epiphyseal fusion at the knee: an Irish
40. population study. J Anat 2008;212:198–209.
41. Roche AF, Roberts J, Hamill PVV. Skeletal maturity of children 6-
42. years: racial, geographic area and socioeconomic differentials,
43. United States. Vital Health Stat 11 1975;149:1–81.
44. Stevenson PH. Age order of epiphyseal union in man. Am J Phys
45. Anthropol 1925;7:53–93.
46. Davies DA, Parsons FG. The age order of the appearance and
47. union of the normal epiphyses as seen by X-rays. J Anat 1927;62:
48. –71.
49. Paterson RS. A radiological investigation of the epiphyses of the long
50. bones. J Anat 1929;64:28–46.
51. Flecker H. Roentgenographic observations of the times of appearance
52. of epiphyses and their fusion with the diaphyses. J Anat 1932;67:
53. –64.
54. Pillai MJS. The study of epiphyseal union for determination of age
55. of South Indians. Ind J Med Res 1936;23:1015–7.
56. Galstaun G. A study of ossification as observed in Indian subjects.
57. Indian J Med Res 1937;25:267–324.
58. Flecker H. Time of appearance and fusion of ossification centres as
59. observed by roentgenographic methods. Am J Roentgenol 1942;47:
60. –159.
61. Aggarwal ML, Pathak IC. Roentgenologic study of epiphyseal union
62. in Punjabi girls for determination of age. Indian J Med Res
63. ;45:283–9.
64. McKern TW, Stewart TD. Skeletal age changes in young American
65. males, analysed from the standpoint of age identification. Natick
66. (MA): Headquarters Quartermaster Research and Development
67. Command, Technical Report EP-45; 1957.
68. Johnston FE. Sequence of epiphyseal union in a prehistoric
69. Kentucky population from Indian Knoll. Hum Biol 1961;33:66–81.
70. Hansman CF. Appearance and fusion of ossification centers in the
71. human skeleton. Am J Roentgenol Radium Ther Nucl Med 1962;88:
72. –82.
73. Saksena JS, Vyas SK. Epiphysial union at wrist, knee and iliac crest
74. in resident of Madhya Pradessh. J Indian Med Assoc 1969;53:67–8.
75. Das Gupta SM, Prasad V, Singh S. A roentgenologic study of epiphyseal
76. union around elbow, wrist and knee joints and the pelvis in
77. boys and girls of Uttar Pradesh. J Indian Med Assoc 1974;62:10–2.
78. Bipinchandra T, Swapnil P, Pankaj M, Ninad N. A radiological
79. study of age estimation from epiphyseal fusion of distal end of femur
80. in the central India population. Journal of Indian Academy of
81. Forensic Medicine 2015;37:8–11.
82. Mellits ED, Dorst JP, Cheek DB. Bone age: it’s contribution to the
83. prediction of maturational or biological age. Am J Phys Anthropol
84. ;35:381–4.
85. Narayan D, Bajaj ID. Ages of epiphyseal union in long bones of inferior
86. extremity in U.P. subjects. Indian J Med Res 1957;45:645–9.
87. Bokariya P, Chowdhary DS, Tirpude BH, Kothari R, Waghmare JE,
88. Tamekar A. A review of the chronology of epiphyseal union in the
89. bones at knee and ankle joint. Journal of Indian Academy of Forensic
90. Medicine 2011;33:258–60.