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International Journal of Legal Medicine

, Volume 130, Issue 4, pp 1101–1107 | Cite as

Computed tomography evaluation of the iliac crest apophysis: age estimation in living individuals

  • Oguzhan Ekizoglu
  • Ercan Inci
  • Irem Erdil
  • Elif Hocaoglu
  • Mustafa Gokhan Bilgili
  • Cemal Kazimoglu
  • Ali Reisoglu
  • Ismail Ozgur Can
Original Article

Abstract

Determination of the ossification properties of the iliac apophysis is important not only in the clinical evaluation of patients undergoing orthopedic surgery but also in age estimation studies for forensic purposes. The literature includes both anthropological and radiological (conventional radiography, ultrasonography, and magnetic resonance imaging modalities) investigations of the different staging systems used for these purposes. In this study, we assessed the utility of computed tomography (CT) of the iliac crest apophysis in estimating forensic age. CT scans of the iliac crest apophysis of 380 patients (187 females, 193 males, and 10–29 years of age) were evaluated according to the four-stage system. Further subclassification did not give data properly due to the reference length measurement of the iliac wing with CT. Thus, in our series, stage 2 was first seen in 12 years of age and stage 3 in those 14 years of age in both sexes and on both sides of the pelvis. Stage 4 was first seen in 17 years of both sexes but only on the right side; on the left side, it appeared in females 18 years of age and in males 17 years of age. Present data was found consistent with previous pelvic radiographic findings. First seen ages for stage 2 and 3 are 12 and 14 years respectively which presented valuable information for legally important age thresholds. However, disadvantages of CT, including high-dose radiation exposure to gonads, the difficulty of evaluating the iliac crest, and the age boundary of 17 years, could make this method infeasible, as compared with hand wrist and pelvic radiographic methods. CT of the iliac crest has probably a greater utility where preexisting CT scans of the pelvic region are available, and it may be considered as a supportive method for age-estimation purposes.

Keywords

Age estimation Computed tomography Iliac crest apophysis 

Notes

Compliance with ethical standards

The ethics board of our institution approved the study protocol.

References

  1. 1.
    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(6):457–460. doi: 10.1007/s00414-008-0254-2 CrossRefPubMedGoogle Scholar
  2. 2.
    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: 30 October 2014Google Scholar
  3. 3.
    Schmeling A, Olze A, Reisinger W, Geserick G (2001) Age estimation of living people undergoing criminal proceedings. Lancet 358:89–90. doi: 10.1016/S0140-6736(01)05379-X CrossRefPubMedGoogle Scholar
  4. 4.
    Schmeling A, Reisinger W, Geserick G, Olze A (2005) The current state of forensic age estimation of live subjects for the purpose of criminal prosecution. Forensic Sci Med Pathol 1:239–246. doi: 10.1385/FSMP:1:4:239 CrossRefPubMedGoogle Scholar
  5. 5.
    Cameriere R, De Luca S, De Angelis D, Merelli V, Giuliodori A, Cingolani M, Cattaneo C, Ferrante L (2012) Reliability of Schmeling’s stages of ossification of medial clavicular epiphyses and its validity to assess 18 years of age in living subjects. Int J Legal Med 126(6):923–932. doi: 10.1007/s00414-012-0769-4 CrossRefPubMedGoogle Scholar
  6. 6.
    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(4):321–325. doi: 10.1007/s00414-010-0448-2 CrossRefPubMedGoogle Scholar
  7. 7.
    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(2):163–169. doi: 10.1007/s12024-013-9511-x CrossRefPubMedGoogle Scholar
  8. 8.
    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 CrossRefPubMedGoogle Scholar
  9. 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(1):203–210. doi: 10.1007/s00414-014-1121-y CrossRefPubMedGoogle Scholar
  10. 10.
    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 CrossRefPubMedGoogle Scholar
  11. 11.
    Wittschieber D, Schmidt S, Vieth V, Schulz R, Püschel K, Pfeiffer H, Schmeling A (2014) Subclassification of clavicular substage 3a is useful for diagnosing the age of 17 years. Rechtsmedizin 24:485–488. doi: 10.1007/s00194-014-0990-1 CrossRefGoogle Scholar
  12. 12.
    Franklin D, Flavel A (2014) CT evaluation of timing for ossification of the medial clavicular epiphysis in a contemporary Western Australian population. Int J Legal Med. doi: 10.1007/s00414-014-1116-8 Google Scholar
  13. 13.
    Risser JC, Ferguson AB (1936) Scoliosis: its prognosis. J Bone Joint Surg 18:667–670Google Scholar
  14. 14.
    Risser JC (1948) Important practical facts in the treatment of scoliosis. Instr Course Lect 5:248–260Google Scholar
  15. 15.
    Risser JC (1958) The Iliac apophysis: an invaluable sign in the management of scoliosis. Clin Orthop 11:111–119PubMedGoogle Scholar
  16. 16.
    Diedrichs V, Wagner UA, Seiler W, Schmitt O (1998) Reference values for development of the iliac crest apophysis (Risser sign). Z Orthop Ihre Grenzgeb 136(3):226–229CrossRefPubMedGoogle Scholar
  17. 17.
    Scoles PV, Salvagno R, Villalba K, Riew D (1988) Relationship of iliac crest maturation to skeletal and chronologic age. J Pediatr Orthop 8(6):639–644CrossRefPubMedGoogle Scholar
  18. 18.
    Bitan FD, Veliskakis KP, Campbell BC (2005) Differences in the Risser grading systems in the United States and France. Clin Orthop Relat Res 436:190–195CrossRefPubMedGoogle Scholar
  19. 19.
    Coqueugniot H, Weaver TD (2007) Brief communication: infracranial maturation in the skeletal collection from Coimbra, Portugal: new aging standards for epiphyseal union. Am J Phys Anthropol 134(3):424–437CrossRefPubMedGoogle Scholar
  20. 20.
    Owings-Webb PA, Myers-Suchey J (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(4):457–466CrossRefGoogle Scholar
  21. 21.
    Güvener M, Korel N, Reimann F (1984) Can the development and maturation of the pelvic bones be used to support and amplify the determination of bone age in adolescents and young adults? Rontgenpraxis 37:264–268PubMedGoogle Scholar
  22. 22.
    Wittschieber D, Schmeling A, Schmidt S, Heindel W, Pfeiffer H, Vieth V (2013) The Risser sign for forensic age estimation in living individuals: a study of 643 pelvic radiographs. Forensic Sci Med Pathol 9:36–43CrossRefPubMedGoogle Scholar
  23. 23.
    Wittschieber D, Vieth V, Domnick C, Pfeiffer H, Schmeling A (2013) The iliac crest in forensic age diagnostics: evaluation of the apophyseal ossification in conventional radiography. Int J Legal Med 127:473–479CrossRefPubMedGoogle Scholar
  24. 24.
    Wittschieber D, Vieth V, Wierer T, Pfeiffer H, Schmeling A (2013) Cameriere’s approach modified for pelvic radiographs: a novel method to assess apophyseal iliac crest ossification for the purpose of forensic age diagnostics. Int J Legal Med 127:825–829CrossRefPubMedGoogle Scholar
  25. 25.
    Schmidt S, Schmeling A, Zwiesigk P, Pfeiffer H, Schulz R (2011) Sonographic evaluation of apophyseal ossification of the iliac crest in forensic age diagnostics in living individuals. Int J Legal Med 125(2):271–276CrossRefPubMedGoogle Scholar
  26. 26.
    Schmidt S, Schiborr M, Pfeiffer H, Schmeling A, Schulz R (2013) Sonographic examination of the apophysis of the iliac crest for forensic age estimation in living individuals. Sci Justice 53(4):395–401CrossRefPubMedGoogle Scholar
  27. 27.
    Wittschieber D, Vieth V, Timme M, Dvorak J, Schmeling A (2014) Magnetic resonance imaging of the iliac crest: age estimation in under 20 soccer players. Forensic Sci Med Pathol 10(2):198–202CrossRefPubMedGoogle Scholar
  28. 28.
    Kreitner KF, Schweden F, Schild HH, Riepert T, Nafe B (1997) Computerized tomography of the epiphyseal union of the medial clavicle: an auxiliary method of age determination during adolescence and the 3rd decade of life? Röfo 166(6):481–486PubMedGoogle Scholar
  29. 29.
    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(2):163–167CrossRefPubMedGoogle Scholar
  30. 30.
    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/s00414990010227 CrossRefPubMedGoogle Scholar
  31. 31.
    Schmeling A, Olze A, Reisinger W, Geserick G (2005) Forensic age estimation and ethnicity. Legal Med 7:134–137. doi: 10.1016/j.legalmed.2004.07.004 CrossRefPubMedGoogle Scholar
  32. 32.
    United Nations Development Programme Human Development Reports (2014) http://www.hdr.undp.org/en/data. Accessed: 30 November 2015
  33. 33.
    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 CrossRefPubMedGoogle Scholar
  34. 34.
    Gray H (1918) The hip bone. In: Anatomy of the Human Body. Philadelphia: Lea & Febiger, 1918; Bartleby.com, 2000. http://www.bartleby.com/107/57.html. Accessed: 20 January 2016
  35. 35.
    Ramsthaler F, Proschek P, Betz W, Verhoff MA (2009) How reliable are the risk estimates for X-ray examinations in forensic age estimations? A safety update. Int J Legal Med 123(3):199–204. doi: 10.1007/s00414-009-0322-2 CrossRefPubMedGoogle Scholar
  36. 36.
    Okkalides D, Fotakis M (1994) Patient effective dose resulting from radiographic examinations. Br J Radiol 67:564–572CrossRefPubMedGoogle Scholar
  37. 37.
    Kwong LM, Johanson PH, Zinar DM, Lenihan MR, Herman MW (1990) Shielding of the patient’s gonads during intramedullary interlocking femoral nailing. J Bone Joint Surg Am 72(10):1523–1526PubMedGoogle Scholar
  38. 38.
    Wainwright AM (2000) Shielding reproductive organs of orthopaedic patients during pelvic radiography. Ann R Coll Surg Engl 82(5):318–321PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Oguzhan Ekizoglu
    • 1
  • Ercan Inci
    • 2
  • Irem Erdil
    • 2
  • Elif Hocaoglu
    • 2
  • Mustafa Gokhan Bilgili
    • 3
  • Cemal Kazimoglu
    • 4
  • Ali Reisoglu
    • 5
  • Ismail Ozgur Can
    • 6
  1. 1.Department of Forensic MedicineTepecik Training and Research HospitalIzmirTurkey
  2. 2.Department of RadiologyBakirkoy Dr. Sadi Konuk Training and Research HospitalIstanbulTurkey
  3. 3.Department of OrthopaedicsBakirkoy Dr. Sadi Konuk Training and Research HospitalIstanbulTurkey
  4. 4.Department of Orthopaedics, Faculty of MedicineKatip Celebi UniversityIzmirTurkey
  5. 5.Department of OrthopaedicsTepecik Training and Research HospitalIzmirTurkey
  6. 6.Department of Forensic Medicine, Faculty of MedicineDokuz Eylul UniversityIzmirTurkey

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