A New Ultrasonographic Method for Forensic Age Estimation: Distal Ulna Epiphysis and Sesamoid Bone Analysis

Year 2026, Volume: 18 Issue: 1, 23 - 29, 24.03.2026

Enes Emre Öztürk , Bora Büken , Hasan Baki Altınsoy , İlknur Arslanoğlu , Mehmet Saki Çelik , Şengül Cangür

https://doi.org/10.18521/ktd.1586514

https://izlik.org/JA36BF62HT

Abstract

Aim: Forensic age estimation plays a crucial role in various criminal and civil law contexts. In present study, we evaluated a cohort of 107 female and 109 male, aged 4 to 21 years. Ultrasonographic (USG) assessments were conducted on the sesamoid bone of the first metacarpophalangeal (MCP) joint and the distal epiphysis of the ulna. Material and Methods: We developed a USG staging system for the distal ulna comprising six stages, as well as criteria to determine the ossification of the sesamoid bone. Results: Notably, Stage 5 of the ulna epiphysis was absent in all individuals under 12 years of age, while Stage 6 was not observed in any individual under 15 years. In male, the earliest appearances of stages 2 through 6 occurred at ages 6.4, 8.2, 9.5, 13.8, and 17.2 years, respectively. For female, the earliest appearances of the same stages were noted at ages 4.7, 7.5, 8.6, 12.0, and 15.2 years, respectively. The inter-rater reliability for the ulna measurements demonstrated a high level of agreement (ICC=0.941, p<0.001), while the agreement for the sesamoid bone was substantial (Kappa=0.784) between the two researchers. Conclusion: These findings could provide a valuable tool for distinguishing between age groups pertinent to forensic age estimation. Specifically, stage 5 may serve as a quick test to verify that an individual is older than 12 years, while stage 6 could be utilized to indicate that an individual is over 15 years. Moreover, this method could function as a supplementary analytical tool within age estimation procedures.

Keywords

Forensic age estimation , skeletal age , ultrasonography , distal ulna epiphysis , sesamoid bone

Ethical Statement

Ethics Committee, dated 21.01.2019, and numbered 2018/241. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supporting Institution

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

References

• 1. Focardi M, Pinchi V, De Luca F, Norelli GA. Age estimation for forensic purposes in Italy: ethical issues. Int J Legal Med. 2014;128(3):515–22. doi:10.1007/s00414-014-0986-0.
• 2. Schmeling A, Grundmann C, Fuhrmann A, Kaatsch HJ, Knell B, Ramsthaler F, et al. Criteria for age estimation in living individuals. Int J Legal Med. 2008;122:457–60. doi:10.1007/s00414-008-0254-2.
• 3. Richardson DB, Wing S, Hoffmann W. Cancer risk from low-level ionizing radiation: the role of age at exposure. Occup Med. 2001;16(2):191-218.
• 4. Schulz R, Schiborr M, Pfeiffer H, Schmidt S, Schmeling A. Forensic age estimation in living subjects based on ultrasound examination of the ossification of the olecranon. J Forensic Leg Med. 2014;22:68-72. doi:10.1016/j.jflm.2013.12.004.
• 5. Bilgili Y, Hizel S, Kara SA, Sanli C, Erdal HH, Altinok D. Accuracy of skeletalage assessment in children from birth to 6 years of age with the ultrasonographic versionof the Greulich-Pyle atlas. J Ultrasound Med. 2003;22:683-90. doi:10.7863/jum.2003.22.7.683.
• 6. Wagner UA, Diedrich V, Schmitt O. Determination of skeletal maturity by ultrasound: a preliminary report. Skeletal Radiology. 1995;24(6):417-20. doi:10.1007/BF00941236.
• 7. Castriota-Scanderbeg A, Sacco MC, Emberti-Gialloreti L, Fraracci L. Skeletalage assessment in children and young adults: comparison between a newly developed sonographic method and conventional methods. Skeletal Radiol. 1998;27(5):271-7. doi:10.1007/s002560050380.
• 8. Schulz R, Zwiesigk P, Schiborr M, Schmidt S, Schmeling A. Ultrasound studies on the time course of clavicular ossification. Int J Legal Med. 2008;122(2):163-7. doi:10.1007/s00414-007-0220-4.
• 9. Schmidt S, Schiborr M, Pfeiffer H, Schmeling A, Schulz R. Age dependence of epiphyseal ossification of the distal radius in ultrasound diagnostics. Int J Legal Med. 2013;127(4):831-8. doi:10.1007/s00414-013-0871-2.
• 10. Quirmbach F, Ramsthaler F, Verhoff MA. Evaluation of the ossification of the medial clavicular epiphysis with a digital ultrasonic system to determine the age threshold of 21 years. Int J Legal Med. 2009;123(3):241–5. doi:10.1007/s00414-009-0335-x.
• 11. Schulz R, Schiborr M, Pfeiffer H, Schmidt S, Schmeling A. Sonographic assessment of the ossification of the medial clavicular epiphysis in 616 individuals. Forensic Sci Med Pathol. 2013;9(3):351-7. doi:10.1007/s12024-013-9440-8.
• 12. Chaumoître K, Adalian P, Colavolpe N, Ramis O, Marciano S, Leonetti G, Boëtsch G, Panuel M. Quelle valeur accorder à l'os sésamoïde du pouce dans la détermination de l'âge osseux? [Value of the sesamoid bone of the thumb in the determination of bone age]. J Radiol. 2008;89(12):1921-4. French. doi:10.1016/s0221-0363(08)74787-5.
• 13. Altinsoy HB, Alatas O, Gurses MS, Turkmen Inanir N. Forensic age estimation in living individuals by 1.5 T magnetic resonance imaging of the knee: a retrospective MRI study. Aust J Forensic Sci. 2020;52(4):439-53. doi:10.1080/00450618.2018.1545868.
• 14. Gurses MS, Altinsoy HB. Evaluation of distal femoral epiphysis and proximal tibial epiphysis ossification using the Vieth method in living individuals: applicability in the estimation of forensic age. Aust J Forensic Sci. 2021;53(4):431-47. doi:10.1080/00450618.2020.1743357.
• 15. Altinsoy HB, Gurses MS, Alatas O. Evaluation of proximal humeral epiphysis ossification in 3.0 T MR images according to the Dedouit staging method: Is it be used for age of majority? J Forensic Leg Med. 2021;77(4):102095. doi:10.1016/j.jflm.2020.102095.
• 16. Altinsoy HB, Gurses MS, Bogan M, Unlu NE. Applicability of 3.0 T MRI images in the estimation of full age based on shoulder joint ossification: single-centre study. Leg Med (Tokyo). 2020;47:101767. doi:10.1016/j.legalmed.2020.101767.
• 17. Alatas O, Altınsoy HB, Gurses MS, Balci A. Evaluation of knee ossification on 1.5 T magnetic resonance images using the method of Vieth et al.: a retrospective magnetic resonance imaging study. Rechtsmedizin. 2021;31:50-8. doi:10.1007/s00194-020-00432-x.
• 18. Cox LA. The biology of bone maturation and ageing. Acta Paediatrica. 1997;86(S423):107-8. doi:10.1111/j.1651-2227.1997.tb18386.x.
• 19. Manzoor Mughal A, Hassan N, Ahmed A. Bone age assessment methods: a critical review. Pak J Med Sci. 2014;30(1):211-5. doi:10.12669/pjms.301.4295.
• 20. Schmeling A, Dettmeyer R, Rudolf E, Vieth V, Geserick G. Forensic age estimation. Dtsch Ärztebl Int. 2016;113(4):44–50.
• 21. Kose O, Guler F, Turan A, Canbora K, Akalin S. Prevalence and distribution of sesamoid bones of the hand. A radiographic study in Turkish subjects. Int J Morphol. 2012;30(3):1094-9.
• 22. Dharap AS, Al-Hashimi H, Kassab S, Abu-Hijleh MF. Incidence and ossification of sesamoid bones in the hands and feet: a radiographic study in an Arab population. Clin Anat. 2007;20(4):416-23. doi:10.1002/ca.20378.
• 23. Akkoç RF, Şap O, Ögetürk M. Eldeki sesamoid kemiklerin görülme sıklığı ve dağılımı. F.Ü. Sağ Bil Tıp Derg. 2018;32(1):7-11.
• 24. Chen W, Cheng J, Sun R, Zhang Z, Zhu Y, Ipaktchi K, et al. Prevalence and variation of sesamoid bones in the hand: a multi-center radiographic study. Int J Clin Exp Med. 2015;8(7):11721-6.
• 25. Amar E, Rozenblat Y, Chechik O. Sesamoid and accessory bones of the hand--an epidemiologic survey in a Mediterranean population. Clin Anat. 2011;24(2):183-7. doi:10.1002/ca.21077.
• 26. Bizarro AH. On sesamoid and supernumerary bones of the limbs. J Anat. 1921;55(Pt 4):256-68.
• 27. T.C. Adalet Bakanlığı. Türk Ceza Kanunu, Yasa no. 5237. Sayı 25611 [Internet]. Ankara: T.C. Resmi Gazete [Official Gazette of the Republic of Türkiye]; 2004 Oct 12 [cited 2026 Jan 30]. Turkish. Available from: https://www.resmigazete.gov.tr/eskiler/2004/10/20041012.htm