Abstract
Forensic age estimation, a recent topic of research in forensic medicine, is of primary importance to criminal and civil law. Previous studies indicate that the observation of medial clavicular ossification allows for age discrimination along the completed 18th and 21st years of life. Experts recommend that the Schmeling and Kellinghaus methods be used together. In this study, we used these staging methods to retrospectively analyze 725 case studies (385 males, 340 females) of thin-slice computed tomography (CT) images, ranging from 0.6 to 1 mm in thickness, from individuals aged 10 to 35 years. Stage 1 was found at 18 years of age maximum for males, whereas it was found at 17 years of age for females. Stage 2a was found at 18 years of age maximum for both genders. Stage 3c was initially observed at 18 years for both genders. Stage 4 was initially found at 21 years for males and 20 years for females. Stage 5 was initially observed at 25 years for both genders. Of note, stage 3c was found close to 19 years of age for both genders (18.92 years for male, 18.99 years for female), and it may be employed to differentiate along the age majority cutoff. The data obtained from our study were consistent with previous studies. We believe that such a comprehensive database will greatly contribute to future studies focusing on medial clavicular ossification based on thin-slice CT. Moreover, we also recommend that if medial clavicular ossification based on CT is to be examined for forensic age estimation, both methods should be employed together.
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References
Panchbhai AS (2011) Dental radiographic indicators, a key to age estimation. Dentomaxillofac Radiol 40:199–212. doi:10.1259/dmfr/19478385
Büken B, Erzengin OU, Büken E, Safak AA, Yazici B, Erkol Z (2009) Comparison of the three age estimation methods: which is more reliable for Turkish children? Forensic Sci Int 183(1-3):103.e1-7. doi:10.1016/j.forsciint.2008.10.012
Cameriere R, De Luca S, Cingolani M, Ferrante L (2015) Measurements of developing teeth, and carpals and epiphyses of the ulna and radius for assessing new cut-offs at the age thresholds of 10, 11, 12, 13 and 14 years. J Forensic Leg Med 34:50–54. doi:10.1016/j.jflm.2015.05.006
Turkish Penal Code, Law no. 5237, Accepted date: 26 September 2004, Official Gazette 2004 (25611) [in Turkish]
Schmeling A, Garamendi PM, Prieto JL, Landa MI (2011) Forensic age estimation in unaccompanied minors and young living adults. In: Duarte NV (ed) Forensic medicine—from old problems to new challenges. InTech, Rijeka, pp 77–120, http://www.intechopen.com/books/howtoreference/forensic-medicine-from-old-problems-to-new-challenges/forensic-age-estimation-in-unaccompanied-minors- and-young-living-adults. Accessed 27 Dec 2015
Schmeling A, Grundmann C, Fuhrmann A, Kaatsch HJ, Knell B, Ramsthaler F, Reisinger W, Riepert T, Ritz-Timme S, Rösing FW, Rötzscher K, Geserick G (2008) Criteria for age estimation in living individuals. Int J Legal Med 122:457–460. doi:10.1007/s00414-008-0254-2
Stevenson PH (1924) Age order of epiphyseal union in man. Am J Phys Anthropol 7:53–93. doi:10.1002/ajpa.1330070115
Todd TW, D’Errico J (1928) The clavicular epiphyses. Am J Anat 41:25–50. doi:10.1002/aja.1000410103
McKern TW, Stewart TD (1957) Skeletal age changes in young American males. Analysed from the standpoint of age identification. In: Technical report EP-45. Quartermaster Research and Development Center, Environmental Protection Research Division, Natick, Mass. pp 89-97. http://www.dtic.mil/dtic/tr/fulltext/u2/147240.pdf
Szilvassy J (1980) Age determination on the sternal articular faces of the clavicula. J Hum Evol 9:609–610
Webb PA, Suchey JM (1985) Epiphyseal union of the anterior iliac crest and medial clavicle in a modern multiracial sample of American males and females. Am J Phys Anthropol 68:457–466. doi:10.1002/ajpa.1330680402
MacLaughlin SM (1990) Epiphyseal fusion at the sternal end of the clavicle in a modern Portuguese skeletal sample. Antropol Port 8:59–68. https://digitalis-dsp.uc.pt/bitstream/10316.2/30601/1/AntropologiaPortuguesa8_artigo4.pdf?ln=pt-pt
Ji L, Terazawa K, Tsukamoto T, Haga K (1994) Estimation of age from epiphyseal union degrees of the sternal end of the clavicle. Hokkaido Igaky Zasshi 69:104–111
Milenkovic P, Djukic K, Djonic D, Milovanovic P, Djuric M (2013) Skeletal age estimation based on medial clavicle –a test of the method reliability. Int J Legal Med 127:667–676. doi:10.1007/s00414-012-0791-6
Flecker H (1932) Roentgenographic observations of the times of appearance of epiphyses and their fusion with the diaphyses. J Anat 67 (Pt 1):118–164.3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1248962/pdf/janat00546-0137.pdf
Galstaun G (1937) A study of ossification as observed in Indian subjects. Indian J Med Res 25:267–324. http://ijmr.in/CurrentTopicView.aspx?year=Ind,Jour.Med.Res,25,1July,1937.pp%20267-324$Original%20Article
Jit I, Kulkarni M (1976) Times of appearance and fusion of epiphysis at the medial end of the clavicle. Indian J Med Res 64:773–782
Schmeling A, Schulz R, Reisinger W, Mühler M, Wernecke KD, Geserick G (2004) Studies on the time frame for ossification of medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 118:5–8. doi:10.1007/s00414-003-0404-5
Garamendi PM, Landa MI, Botella MC, Alemán I (2011) Forensic age estimation on digital X-ray images: medial epiphyses of the clavicle and first rib ossification in relation to chronological age. J Forensic Sci 56(Suppl 1):S3–S12. doi:10.1111/j.1556-4029.2010.01626.x
Wittschieber D, Ottow C, Schulz R, Püschel K, Bajanowski T, Ramsthaler F, Pfeiffer H, Vieth V, Schmidt S, Schmeling A (2016) Forensic age diagnostics using projection radiography of the clavicle: a prospective multi-center validation study. Int J Legal Med 130:213–219. doi:10.1007/s00414-015-1285-0
Wittschieber D, Ottow C, Vieth V, Küppers M, Schulz R, Hassu J, Bajanowski T, Püschel K, Ramsthaler F, Pfeiffer H, Schmidt S, Schmeling A (2015) Projection radiography of the clavicle: still recommendable for forensic age diagnostics in living individuals? Int J Legal Med 129:187–193. doi:10.1007/s00414-014-1067-0
Brown AA, Derkyi-Kwarteng L, Amonoo-Kuofi HS (2013) Study on the time frame for ossification of the medial clavicular epiphyseal cartilage by X-ray in Ghanaian students. Int J Morphol 31:491–496. doi:10.4067/S0717-95022013000200021
Kreitner KF, Schweden F, Schild HH, Riepert T, Nafe B (1997) Die computertomographisch bestimmte Ausreifung der medialen Klavikulaepiphyse—eine additive Methode zur Altersbestimmung im Adoleszentenalter und in der dritten Lebensdekade? Fortschr Röntgenstr 166:481–486. doi:10.1055/s-2007-1015463
Kreitner KF, Schweden FJ, Riepert T, Nafe B, Thelen M (1998) Bone age determination based on the study of the medial extremity of the clavicle. Eur Radiol 8:1116–1122. doi:10.1007/s003300050518
Schulz R, Mühler M, Mutze S, Schmidt S, Reisinger W, Schmeling A (2005) Studies on the time frame for ossification of the medial epiphysis of the clavicle revealed by CT scans. Int J Legal Med 119:142–145. doi:10.1007/s00414-005-0529-9
Ekizoglu O, Hocaoglu E, Inci E, Sayin I, Solmaz D, Bilgili MG, Can IO (2015) Forensic age estimation by the Schmeling method: computed tomography analysis of the medial clavicular epiphysis. Int J Legal Med 129:203–210. doi:10.1007/s00414-014-1121-y
Kellinghaus M, Schulz R, Vieth V, Schmidt S, Schmeling A (2010) Forensic age estimation in living subjects based on the ossification status of the medial clavicular epiphysis as revealed by thin slice multidetector computed tomography. Int J Legal Med 124:149–154. doi:10.1007/s00414-009-0398-8
Schulze D, Rother U, Fuhrmann A, Richel S, Faulmann G, Heiland M (2006) Correlation of age and ossification of the medial clavicular epiphysis using computed tomography. Forensic Sci Int 158:184–189. doi:10.1016/j.forsciint.2005.05.033
Kellinghaus M, Schulz R, Vieth V, Schmidt S, Pfeiffer H, Schmeling A (2010) Enhanced possibilities to make statements on the ossification status of the medial clavicular epiphysis using an amplified staging scheme in evaluating thin-slice CT scans. Int J Legal Med 124:321–325. doi:10.1007/s00414-010-0448-2
Bassed RB, Drummer OH, Briggs C, Valenzuela A (2011) Age estimation and the medial clavicular epiphysis: analysis of the age of majority in an Australian population using computed tomography. Forensic Sci Med Pathol 7:148–154. doi:10.1007/s12024-010-9200-y
Wittschieber D, Schulz R, Vieth V, Küppers M, Bajanowski T, Ramsthaler F, Püschel K, Pfeiffer H, Schmidt S, Schmeling A (2014) The value of sub-stages and thin slices for the assessment of the medial clavicular epiphysis: a prospective multi-center CT study. Forensic Sci Med Pathol 10:163–169. doi:10.1007/s12024-013-9511-x
Milenkovic P, Djuric M, Milovanovic P, Djukic K, Zivkovic V, Nikolic S (2014) The role of CT analyses of the sternal end of the clavicle and the first costal cartilage in age estimation. Int J Legal Med 128:825–839. doi:10.1007/s00414-014-1026-9
Pattamapaspong N, Madla C, Mekjaidee K, Namwongprom S (2015) Age estimation of a Thai population based on maturation of the medial clavicular epiphysis using computed tomography. Forensic Sci Int 246:123.e1-5. doi:10.1016/j.forsciint.2014.10.044
Zhang K, Chen XG, Zhao H, Dong XA, Deng ZH (2015) Forensic age estimation using thin-slice multidetector CT of the clavicular epiphyses among adolescent Western Chinese. J Forensic Sci 60:675–678. doi:10.1111/1556-4029.12739
Gonsior M, Ramsthaler F, Gehl A, Verhoff MA (2013) Morphology as a cause for different classification of the ossification stage of the medial clavicular epiphysis by ultrasound, computed tomography, and macroscopy. Int J Legal Med 127:1013–1021. doi:10.1007/s00414-013-0889-5
Mühler M, Schulz R, Schmidt S, Schmeling A, Reisinger W (2006) The influence of slice thickness on assessment of clavicle ossification in forensic age diagnostics. Int J Legal Med 120:15–17. doi:10.1007/s00414-005-0010-9
Franklin D, Flavel A (2015) CT evaluation of timing for ossification of the medial clavicular epiphysis in a contemporary Western Australian population. Int J Legal Med 129:583–594. doi:10.1007/s00414-014-1116-8
Houpert T, Rérolle C, Savall F, Telmon N, Saint-Martin P (2016) Is a CT-scan of the medial clavicle epiphysis a good exam to attest to the 18-year threshold in forensic age estimation? Forensic Sci Int 260:103.e1-3. doi:10.1016/j.forsciint.2015.12.007
Schulz R, Zwiesigk P, Schiborr M, Schmidt S, Schmeling A (2008) Ultrasound studies on the time course of clavicular ossification. Int J Legal Med 122:163–167. doi:10.1007/s00414-007-0220-4
Quirmbach F, Ramsthaler F, Verhoff MA (2009) 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 123:241–245. doi:10.1007/s00414-009-0335-x
Schulz R, Schiborr M, Pfeiffer H, Schmidt S, Schmeling A (2013) Sonographic assessment of the ossification of the medial clavicular epiphysis in 616 individuals. Forensic Sci Med Pathol 9:351–357. doi:10.1007/s12024-013-9440-8
Schmidt S, Mühler M, Schmeling A, Reisinger W, Schulz R (2007) Magnetic resonance imaging of the clavicular ossification. Int J Legal Med 121:321–324. doi:10.1007/s00414-007-0160-z
Hillewig E, Degroote J, Van der Paelt T, Visscher A, Vandemaele P, Lutin B, D’Hooghe L, Vandriessche V, Piette M, Verstraete K (2013) Magnetic resonance imaging of the sternal extremity of the clavicle in forensic age estimation: towards more sound age estimates. Int J Legal Med 127:677–689. doi:10.1007/s00414-012-0798-z
Wittschieber D, Schulz R, Vieth V, Küppers M, Bajanowski T, Ramsthaler F, Püschel K, Pfeiffer H, Schmidt S, Schmeling A (2014) Influence of the examiner’s qualification and sources of error during stage determination of the medial clavicular epiphysis by means of computed tomography. Int J Legal Med 128:183–191. doi:10.1007/s00414-013-0932-6
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Ekizoglu O, Hocaoglu E, Inci E, Can IO, Aksoy S, Sayin I (2015) Estimation of forensic age using substages of ossification of the medial clavicle in living individuals. Int J Legal Med 129:1259–1264. doi:10.1007/s00414-015-1234-y
Yüksel A, Tümer AR, Odabaşı Balseven A (2008) Adli Yaş Tayininde Medial Klavikular Epifizyal Kartilajdaki Kemikleşmenin Bilgisayarlı Tomografi ile Değerlendirilmesi. Türkiye Klinikleri J Foren Med 5:1-5. http://www.turkiyeklinikleri.com/article/tr-adli-yas-tayininde-medial-klavikular-epifizyal-kartilajdaki-kemiklesmenin-bilgisayarli-tomografi-ile-degerlendirilmesi-50375.html
Ufuk F, Agladioglu K, Karabulut N (2016) CT evaluation of medial clavicular epiphysis as a method of bone age determination in adolescents and young adults. Diagn Interv Radiol 22:241–246. doi:10.5152/dir.2016.15355
Schmeling A, Reisinger W, Loreck D, Vendura K, Markus W, Geserick G (2000) Effects of ethnicity on skeletal maturation: consequences for forensic age estimations. Int J Legal Med 113:253–258. doi:10.1007/s004149900102
Meijerman L, Maat GJ, Schulz R, Schmeling A (2007) Variables affecting the probability of complete fusion of the medial clavicular epiphysis. Int J Legal Med 121:463–468. doi:10.1007/s00414-007-0189-z
United Nations Development Programme, Human development reports 2015. http://hdr.undp.org/sites/default/files/ranking.pdf Accessed 15 Mar 2016
Büken B, Büken E, Şafak AA, Yazıcı B, Erkol Z, Mayda A (2008) Is the Gök Atlas sufficiently reliable for forensic age determination of Turkish children? Turk J Med Sci 38:319–327
Orhan K, Ozer L, Orhan AI, Dogan S, Paksoy CS (2007) Radiographic evaluation of third molar development in relation to chronological age among Turkish children and youth. Forensic Sci Int 165:46–51. doi:10.1016/j.forsciint.2006.02.046
Turkish citizens living abroad. Republic of Turkey Ministry of Foreign Affairs, main issues. http://www.mfa.gov.tr/the-expatriate-turkish-citizens.en.mfa Accessed 15 Mar 2016
World Migration, International Organization for migration https://www.iom.int/world-migration Accessed 10 Mar 2016
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Gurses, M.S., Inanir, N.T., Gokalp, G. et al. Evaluation of age estimation in forensic medicine by examination of medial clavicular ossification from thin-slice computed tomography images. Int J Legal Med 130, 1343–1352 (2016). https://doi.org/10.1007/s00414-016-1408-2
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DOI: https://doi.org/10.1007/s00414-016-1408-2