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International Journal of Legal Medicine

, Volume 133, Issue 5, pp 1517–1528 | Cite as

Anatomic shape variants of extremitas sternalis claviculae as collected from sternoclavicular thin-slice CT-studies of 2820 male borderline-adults

  • Ernst Rudolf
  • Josef Kramer
  • Sven Schmidt
  • Volker Vieth
  • Ingemar Winkler
  • Andreas Schmeling
Original Article

Abstract

Within medical age assessment practice, the indicator “medial clavicular ossification” constitutes crucial evidence capable of excluding age minority “beyond reasonable doubt” concerning age-disputed individuals doubtfully claiming children’s rights during legal procedures. Yet, one of its characteristics affects the morphological variability including a fair amount of downright peculiar appearances. As a result, inexperienced examiners are tempted to classify actually not-assessable formations according to the two established developmental typologies of Schmeling et al. and Kellinghaus et al. being at the same time the most frequent systemic error of age-related clavicular taxation. Since a respective overview appears missing, the study extracts not-assessable shape variants of the medial collar bone from a large sample of 2820 male borderline-adults as seen from thin-slice, sternoclavicular computed tomography. The two already highlighted configurations “more than one, medial, secondary ossification centres” and “medial metaphyseal concavity” are found as the most commonly encountered features impeding reliable delineation of staging criteria. In accordance with previous literature, it is emphasized that “qualified” rating of extremitas sternalis claviculae within age assessment practice presupposes “knowledge about the diversity of [its] anatomic shape variants.”

Keywords

Medical age assessment Medial clavicular ossification Not-assessable shape variants Computed tomography 

Notes

Acknowledgments

The authors would like to thank Herr A. Böhm from “Siemens Healthineers Austria” for suggesting 3D-“cinematic rendering” by means of syngo.via® software, which allows for viewing photorealistic, plastic renditions of ESC-appearances, and Mrs. Liu Ping for translating [104].

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Administrative High Court Bremen 04.06.2018, 1 B 82/18Google Scholar
  2. 2.
  3. 3.
  4. 4.
    Austrian Supreme Court 08.11.2017, 21 Bs 309/17wGoogle Scholar
  5. 5.
    Baker ME, Martinez S, Kier R, Wain S (1988) High resolution computed tomography of the cadaveric sternoclavicular joint: findings in degenerative joint disease. J Comput Tomogr 12(1):13ff.  https://doi.org/10.1016/0149-936X(88)90022-7 CrossRefGoogle Scholar
  6. 6.
    Bassed RB, Briggs C, Drummer OH (2011) Age estimation using CT imaging of the third molar tooth, the medial clavicular epiphysis, and the spheno-occipital synchondrosis: a multifactorial approach. Forensic Sci Int 212(1-3):273.e1ff.  https://doi.org/10.1016/j.forsciint.2011.06.007 CrossRefGoogle Scholar
  7. 7.
    Bassed RB, Briggs C, Drummer OH, 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(2):148ff.  https://doi.org/10.1007/s12024-010-9200-y CrossRefGoogle Scholar
  8. 8.
    Bassed RB, Briggs C, Drummer OH (2012) The incidence of asymmetrical left/right skeletal and dental development in an Australian population and the effect of this on forensic age estimations. Int J Legal Med 126(2):251ff.  https://doi.org/10.1007/s00414-011-0621-2 CrossRefGoogle Scholar
  9. 9.
    Bavarian Administrative High Court, 23.09.2014, 12 C 14.1865Google Scholar
  10. 10.
    Black S, Scheuer L (1996) Age changes in the clavicle: from the early neonatal period to skeletal maturity. Int J Osteoarchaeol 6(5):425ff.  https://doi.org/10.1002/(SICI)1099-1212(199612)6:5 CrossRefGoogle Scholar
  11. 11.
    Brinkmeier PAW (2013) Altersdiagnostik bei U20-Fußballspielern durch prospektive Untersuchung der Ossifikation der medialen Claviculaepiphyse im 3 T – MRT. Thesis University MünsterGoogle Scholar
  12. 12.
    Butting H (2008) Die Computertomographisch ermittelte Ausreifung der medialen Claviculaepiphyse als Untersuchungsmethode der Lebensaltersbestimmung. Thesis University HamburgGoogle Scholar
  13. 13.
    Cameriere R, De Luca S, De Angelis D (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):23ff.  https://doi.org/10.1007/s00414-012-0769-4 CrossRefGoogle Scholar
  14. 14.
    Carrol MB (2011) Sternoclavicular hyperostosis: a review. Ther Adv Musculoskelet Dis 3(2):101ff.  https://doi.org/10.1177/1759720X11398333 CrossRefGoogle Scholar
  15. 15.
    De Maeseneer M, Lenchik L, Buls N et al (2016) High-resolution CT of the sternoclavicular joint and first costochondral synchondrosis in asymptomatic individuals. Skelet Radiol 45(9):1257ff.  https://doi.org/10.1007/s00256-016-2414-7 CrossRefGoogle Scholar
  16. 16.
    De Meulenaere A (2012) Radiological evaluation of the clavicula for determination of skeletal age: deepening morphology and classification. Thesis University GentGoogle Scholar
  17. 17.
    Ekizoglu O, Hoçaoglu E, Inci E et al (2015) Estimation of forensic age using substages of ossification of the medial clavicle in living individuals. Int J Legal Med 129(6):1259ff.  https://doi.org/10.1007/s00414-015-1234-y CrossRefGoogle Scholar
  18. 18.
    Ekizoglu O, Hoçaoglu E, Inci E et al (2015) Forensic age estimation by the Schmeling method: computed tomography analysis of the medial clavicular epiphysis. Int J Legal Med 129(1):203ff.  https://doi.org/10.1007/s00414-014-1121-y CrossRefGoogle Scholar
  19. 19.
    El Morsi DA, El-Atta HMA, El-Maadawy M et al (2015) Age estimation from ossification of the medial clavicular epiphysis by computed tomography. Int J Morphol 33(4):1419ff.  https://doi.org/10.4067/S0717-95022015000400038 CrossRefGoogle Scholar
  20. 20.
    El-Gerby KM, Mohammad AS, Gomaa MS (2013) Using thin-slice multidetector computed tomography in forensic age estimation based on the ossification status of the medial clavicular epiphysis among Egyptian subjects. Med J Cairo Univ 81(2):221ffGoogle Scholar
  21. 21.
    EU-“Asylum Procedure” Directive 2013/32/EU (26.06.2013)Google Scholar
  22. 22.
    EU-“Family Reunification” Directive 2003/86/EC (22.09.2003)Google Scholar
  23. 23.
    EU-“Qualification” Directive 2011/95/EU (13.12.2011)Google Scholar
  24. 24.
    EU-“Radiation Protection” Directive 2013/59/EURATOM (05.12.2013)Google Scholar
  25. 25.
    EU-“Returning” Directive 2008/115/EC (16.12.2008)Google Scholar
  26. 26.
    EU-„Dublin III“ Regulation 604/2013 (26.06.2013)Google Scholar
  27. 27.
    European Asylum Support Office – EASO (2012–2018) Newsletters: https://www.easo.europa.eu/news-events/newsletters-archive. Access date: 15.02.2019
  28. 28.
    European Border and Coast Guard Agency – Frontex (2011–2018) Risk analysis network quarterly reports: http://frontex.europa.eu/publications/. Access date: 15.02.2019
  29. 29.
    European Migration Network (2018) Approaches to Unaccompanied Minors Following Status Determination in the EU plus Norway: https://www.emn.at/wp-content/uploads/2018/07/emn-synthesis-report-2018_-unaccompanied-minors-following-status-determination.pdf. Access date: 15.02.2019
  30. 30.
    Fischer E (1957) Persistierende Klavikulaapophyse. Fortschr Röntgenstr 86(4):532f.  https://doi.org/10.1055/s-0029-1213187 CrossRefGoogle Scholar
  31. 31.
    Flecker H (1932) Roentgenographic observations of the times of appearance of epiphyses and their fusion with the diaphyses. J Anat 67(1):118ffGoogle Scholar
  32. 32.
    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(3):583ff.  https://doi.org/10.1007/s00414-014-1116-8 CrossRefGoogle Scholar
  33. 33.
    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):S3ff.  https://doi.org/10.1111/j.1556-4029.2010.01626.x CrossRefGoogle Scholar
  34. 34.
    Gonsior M (2017) Die Ossifikation der medialen Klavikulaepiphyse in der forensischen Altersdiagnostik zur Feststellung der Vollendung des 21. Lebensjahres – Sonografische Beurteilung und morphologische Ursachen für Differenzen zur Computertomografie und Makroskopie. Thesis University GießenGoogle Scholar
  35. 35.
    Gunawardena SA, Liyanage UA, Weeratna JB et al (2017) Forensic age estimation in anti-piracy trials in Seychelles: experiences and challenges faced. Forensic Sci Int:270, 278.e1ff.  https://doi.org/10.1016/j.forsciint.2016.11.010
  36. 36.
    Gurses MS, Inanir NT, Gokalp E et al (2016) Evaluation of age estimation in forensic medicine by examination of medial clavicular ossification from thin-slice computed tomography images. Int J Legal Med 130(5):1343ff.  https://doi.org/10.1007/s00414-016-1408-2 CrossRefGoogle Scholar
  37. 37.
    Gurses MS, Inanir NT, Soylu E et al (2017) Evaluation of the ossification of the medial clavicle according to the Kellinghaus substage system in identifying the 18-year-old age limit in the estimation of forensic age - is it necessary. Int J Legal Med 131(2):585ff.  https://doi.org/10.1007/s00414-016-1515-0 CrossRefGoogle Scholar
  38. 38.
    Heiß H (1922) Untersuchung über die Epiphysennarbe des menschlichen Skeletts. Archiv Entwicklungsmechanik der Organismen 50(3-4):375ffCrossRefGoogle Scholar
  39. 39.
    Holder J, Kolla S, Lehto S (2017) Clavicle fractures: Allman and Neer classification. J Adv Radiol Med Image 2(1):1ff.  https://doi.org/10.15744/2456-5504.2.102 CrossRefGoogle Scholar
  40. 40.
    Houpert T, Rérolle C, Savall F et al (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.e1ff.  https://doi.org/10.1016/j.forsciint.2015.12.007 CrossRefGoogle Scholar
  41. 41.
    Inthasan C, Mahakkanukrauh P (2017) Age estimation from clavicle by histomorphometry method: a review. Med Health 12(1):4ff.  https://doi.org/10.17576/MH.2017.1201.02 CrossRefGoogle Scholar
  42. 42.
    Jit I, Kulkarni M (1976) Times of appearances and fusion of epiphysis at the medial end of the clavicle. Indian J Med Res 64(5):773ffGoogle Scholar
  43. 43.
    Keats TE, Anderson WA (1996) Atlas of normal Roentgen variants that may simulate disease. Mosby-Year Book, Inc., St. LouisGoogle Scholar
  44. 44.
    Kellinghaus M, Schulz R, Vieth V et al (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):321ff.  https://doi.org/10.1007/s00414-010-0448-2 CrossRefGoogle Scholar
  45. 45.
    Kellinghaus M, Schulz R, Vieth V et al (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(2):149ff.  https://doi.org/10.1007/s00414-009-0398-8 CrossRefGoogle Scholar
  46. 46.
    Konermann Ph (2014) Lateralität der sternalen Clavikularentwicklung am nativen Knochen - Implikationen für die forensische Altersdiagnostik. Thesis University ViennaGoogle Scholar
  47. 47.
    Kreitner KF, Schweden F, Schild HH (1997) The epiphyseal union of the medial clavicle determined by CT - an axillary method in age identification during adolescence und 3rd decade of life. Fortschr Röntgenstr 166(6):481ff.  https://doi.org/10.1055/s-2007-1015463 CrossRefGoogle Scholar
  48. 48.
    Kreitner KF, Schweden FJ, Riepert T et al (1998) Bone age determination based on the study of the medial extremity of the clavicle. Eur Radiol 8(7):1116ff.  https://doi.org/10.1007/s003300050518 CrossRefGoogle Scholar
  49. 49.
    Kumar R, Madewell JE, Swischuk LE (1989) The clavicle: normal and abnormal. Radiographics 9(4):677ff.  https://doi.org/10.1148/radiographics.9.4.2756192 CrossRefGoogle Scholar
  50. 50.
    Küppers MA (2013) Die computertomographische Analyse der medialen Klavikulaepiphyse zur Lebensaltersbestimmung und der Einfluss von Schichtdicke und Erfahrung des Untersuchers auf die Stadieneinteilung. Thesis University EssenGoogle Scholar
  51. 51.
    Lucet L, Le Loët X, Ménard JF et al (1996) Computed tomography of the normal sternoclavicular joint. Skelet Radiol 25(3):237ffCrossRefGoogle Scholar
  52. 52.
    Magu NK, Singla R, Devgan A, Gogna P (2014) Congenital pseudoarthrosis of the clavicle with bifurcation. Indian J Orthop 48(4):435ff.  https://doi.org/10.4103/0019-5413.136314 CrossRefGoogle Scholar
  53. 53.
    McKern TW, Stewart TD (1957) Skeletal age changes in young American males. Quartermaster Research and Development Center, Environmental Protection Research Division. Technical Report EP-45. https://apps.dtic.mil/dtic/tr/fulltext/u2/147240.pdf. Access date: 15.02.2019
  54. 54.
    Milenkovic P, Djukic K, Djonic D et al (2013) Skeletal age estimation based on medial clavicle—a test of the method reliability. Int J Legal Med 127(3):667ff.  https://doi.org/10.1007/s00414-012-0791-6 CrossRefGoogle Scholar
  55. 55.
    Milenkovic P, Djuric M, Milovanovic P et al (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(5):825ff.  https://doi.org/10.1007/s00414-014-1026-9 CrossRefGoogle Scholar
  56. 56.
    Ottow C, Krämer JA, Olze A et al (2015) Magnetic resonance tomography studies on age estimation of unaccompanied minor refugees. Rechtsmedizin 25(1):12ff.  https://doi.org/10.1007/s00194-014-0991-0 CrossRefGoogle Scholar
  57. 57.
    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):457ff.  https://doi.org/10.1002/ajpa.1330680402 CrossRefGoogle Scholar
  58. 58.
    Paraskevas GK (2016) What morphological pattern of “impressio ligament costoclavicularis” is the most predominant. Surg Radiol Anat 38(1):161ff.  https://doi.org/10.1007/s00276-015-1528-2 CrossRefGoogle Scholar
  59. 59.
    Patil PM, Kiran R, Maled V, Dakhankar S (2018) The chronology of medial clavicle epiphysis ossification using computed tomography. IJARS 7(1):23ff.  https://doi.org/10.7860/IJARS/2018/32595:2357 CrossRefGoogle Scholar
  60. 60.
    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.e1ff.  https://doi.org/10.1016/j.forsciint.2014.10.044 CrossRefGoogle Scholar
  61. 61.
    Price MD (2017) Age estimation using the sternal end of the clavicle: a test of the Falys and Prangle (2014) archaeological method for forensic application. Thesis University BostonGoogle Scholar
  62. 62.
    Ramadan SU, Gurses MS, Inanir NT et al (2017) Evaluation of the medial clavicular epiphysis according to the Schmeling and Kellinghaus method in living individuals: a retrospective CT study. Legal Med 25:16ff.  https://doi.org/10.1016/j.legalmed.2016.12.012 CrossRefGoogle Scholar
  63. 63.
    Ravelli A (1955) Über eine eigenartige Form des sternalen Schlüsselbeins (“Fischmaulform”). Fortschr Röntgenstr 82:827fCrossRefGoogle Scholar
  64. 64.
    Richel S (2005) Der Stellenwert verschiedener röntgenologischer Kriterien in der Panoramaschichtaufnahme sowie der medialen Claviculaepiphyse im Rahmen von Altersbestimmungen. Thesis University HamburgGoogle Scholar
  65. 65.
    Roche AF, Sunderland S (1959) Multiple ossification centres in the epiphyses of the long bones of the human hand and foot. J Bone Joint Surg (Br) 41-B(2):375ff.  https://doi.org/10.1302/0301-620X.41B2.375 CrossRefGoogle Scholar
  66. 66.
    Roscam Abbing HDC (2011) Age determination of unaccompanied asylum seeking minors in the European Union: a health law perspective. Eur J Health Law 18(1):11ff.  https://doi.org/10.1163/157180911X546101 CrossRefGoogle Scholar
  67. 67.
    Rudolf E (2016) Medical age assessment in the case of a “doubtful” claim to being an unaccompanied minor as set forth in article 25 Para 5 sentences one to three of the recast asylum procedures directive 2013. The establishment of identity in the migration process. EMN-conference Vienna: https://www.emn.at/wp-content/uploads/2017/01/EMN-Tagungsbericht_web.pdf. Access date: 15.02.2019
  68. 68.
    Rudolf E, Kramer J, Winkler I, Schmeling A (2018) Technical note: utilization of 3D-rendering for CT-evaluation of extremitas sternalis claviculae within medical age assessment practice. Int J Legal Med. 133(3):931ff.  https://doi.org/10.1007/s00414-019-02025-0
  69. 69.
    Rudolf E, Kramer J, Schmidt S et al (2018) On the influence of hand-preference on the phenomenon of intraindividual differing appearances of the paired age marker ‘medial clavicular ossification’ in borderline-adults as seen from the sternoclavicular regions of 2,546 male persons by means of thin-slice CT-imaging. Arch Kriminol 241(5-6):183ffGoogle Scholar
  70. 70.
    Rudolf E, Kramer J, Schmidt S et al (2018) Intraindividual incongruences of medially ossifying clavicles in borderline adults as seen from thin-slice CT-studies of 2,595 male persons. Int J Legal Med 132(2):629ff.  https://doi.org/10.1007/s00414-017-1694-3 CrossRefGoogle Scholar
  71. 71.
    Scharte P, Vieth V, Schulz R et al (2017) Comparison of imaging planes during CT-based evaluation of clavicular ossification: a multi-center study. Int J Legal Med 131(5):1391ff.  https://doi.org/10.1007/s00414-017-1615-5 CrossRefGoogle Scholar
  72. 72.
    Schmeling A, Schulz R, Reisinger W et al (2004) Studies on the time frame for ossification of the medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 118(1):5ff.  https://doi.org/10.1007/s00414-003-0404-5 CrossRefGoogle Scholar
  73. 73.
    Schmeling A, Grundmann C, Fuhrmann A et al (2008) Criteria for age estimation in living individuals. Int J Legal Med 122(6):457ff.  https://doi.org/10.1007/s00414-008-0254-2 CrossRefGoogle Scholar
  74. 74.
    Schmeling A, Dettmeyer R, Rudolf E et al (2016) Forensic age estimation: methods, certainty, and the law. Dtsch Arztebl Int 113(4):44ff.  https://doi.org/10.3238/arztebl.2016.0044 CrossRefGoogle Scholar
  75. 75.
    Schmidt H, Freyschmidt J (1993) Köhler/Zimmer’s borderlands of normal and early pathological findings in skeletal radiography. Georg Thieme Verlag Stuttgart, New YorkGoogle Scholar
  76. 76.
    Schmidt S, Henke CA, Wittschieber D et al (2016) Optimising magnetic resonance imaging-based evaluation of the ossification of the medial clavicular epiphysis: a multi-centre study. Int J Legal Med 130(6):1615ff.  https://doi.org/10.1007/s00414-016-1442-0 CrossRefGoogle Scholar
  77. 77.
    Schmidt S, Ottow C, Pfeiffer H et al (2017) Magnetic resonance imaging-based evaluation of ossification of the medial clavicular epiphysis in forensic age assessment. Int J Legal Med 131(6):1665ff.  https://doi.org/10.1007/s00414-017-1676-5 CrossRefGoogle Scholar
  78. 78.
    Schulz R, Mühler M, Mutze S et al (2004) Studies on the time frame for ossification of the medial epiphysis of the clavicle as revealed by CT scans. Int J Legal Med 119(3):142ff.  https://doi.org/10.1007/s00414-005-0529-9 CrossRefGoogle Scholar
  79. 79.
    Schulz R, Schiborr M, Pfeiffer H et al (2013) Sonographic assessment of the ossification of the medial clavicular epiphysis in 616 individuals. Forensic Sci Med Pathol 9(3):351ff.  https://doi.org/10.1007/s12024-013-9440-8 CrossRefGoogle Scholar
  80. 80.
    Schulze D, Rother U, Fuhrmann A et al (2006) Correlation of age and ossification of the medial clavicular epiphysis using computed tomography. Forensic Sci Int 158(2-3):184ff.  https://doi.org/10.1016/j.forsciint.2005.05.033 CrossRefGoogle Scholar
  81. 81.
    Shaikh T, Ansari S, Mandhane N et al (2015) Bilateral total duplication of clavicle: 1st reported case. Int J Res Med Sci 3(7):1780f.  https://doi.org/10.18203/2320-6012.ijrms20150269 CrossRefGoogle Scholar
  82. 82.
    Skalski M (2013) From the case: forked clavicle: https://radiopaedia.org/images/2953544. Access date: 15.02.2019
  83. 83.
    Stevenson PH (1924) Age order of epiphyseal union in man. Am J Phys Anthropol 7(1):53ff.  https://doi.org/10.1002/ajpa.1330070115 CrossRefGoogle Scholar
  84. 84.
    Swiss Supreme Administrative Court 10.01.2017, D-6422/2016; 07.04.2016, D-859/2016Google Scholar
  85. 85.
    Tangmose S, Jensen KE, Lynnerup N (2013) Comparative study on developmental stages of the clavicle by postmortem MRI and CT imaging. JOFRI 1(3):102ff.  https://doi.org/10.1016/j.jofri.2013.05.008 CrossRefGoogle Scholar
  86. 86.
    Tangmose S, Jensen KE, Villa C, Lynnerup N (2014) Forensic age estimation from the clavicle using 1.0 T MRI—preliminary results. Forensic Sci Int 234:7ff.  https://doi.org/10.1016/j.forsciint.2013.10.027 CrossRefGoogle Scholar
  87. 87.
    Teplick JG, Eftekhari F, Haskin ME (1974) Erosion of the sternal ends of the clavicles. Radiology 113(2):323ff.  https://doi.org/10.1148/113.2.323 CrossRefGoogle Scholar
  88. 88.
    Todd TW, D’Errico J (1928) The clavicular epiphyses. Am J Phys Anthropol 41(1):25ff.  https://doi.org/10.1002/aja.1000410103 CrossRefGoogle Scholar
  89. 89.
    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(3):241ff.  https://doi.org/10.5152/dir.2016.15355 CrossRefGoogle Scholar
  90. 90.
    UNHCR (1997) Guidelines on policies and procedures in dealing with unaccompanied children seeking asylum, 5.11: http://www.refworld.org/docid/3ae6b3360.html. Access date: 15.02.2019
  91. 91.
    Viehweger G (1968) Schlüsselbein und Schultereckgelenk. In: Diethelm L et al (eds) Handbuch der Medizinischen Radiologie. Springer, Berlin HeidelbergGoogle Scholar
  92. 92.
    Viennese High Court 08.11.2017, 21 Bs 309/17wGoogle Scholar
  93. 93.
    Vieth V, Kellinghaus M, Schulz R et al (2010) Ossification stage of the medial clavicular epiphysis. Comparison of projectional radiography, computed tomography and magnetic resonance imaging. Rechtsmedizin 20(6):483ff.  https://doi.org/10.1007/s00194-010-0709-x CrossRefGoogle Scholar
  94. 94.
    Vieth V, Schulz R, Brinkmeier P et al (2014) Age estimation in U-20 football players using 3.0 tesla MRI of the clavicle. Forensic Sci Int 241:118ff.  https://doi.org/10.1016/j.forsciint.2014.05.008 CrossRefGoogle Scholar
  95. 95.
    Wei H, Zhu GY, Lei W et al (2015) Correlation between age and the parameters of medial epiphysis and metaphysis of the clavicle using CT volume rendering images. Forensic Sci Int 244:316.e1ff.  https://doi.org/10.1016/j.forsciint.2014.09.006 CrossRefGoogle Scholar
  96. 96.
    Wittschieber D, Schulz R, Vieth V et al (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(1):183ff.  https://doi.org/10.1007/s00414-013-0932-6 CrossRefGoogle Scholar
  97. 97.
    Wittschieber D, Schulz R, Vieth V et al (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):163ff.  https://doi.org/10.1007/s12024-013-9511-x CrossRefGoogle Scholar
  98. 98.
    Wittschieber D, Schmidt S, Vieth V et al (2014) Subclassification of clavicular substage 3a is useful for diagnosing the age of 17 years. Rechtsmedizin 24(6):485ff.  https://doi.org/10.1007/s00194-014-0990-1 CrossRefGoogle Scholar
  99. 99.
    Wittschieber D, Ottow C, Schulz R et al (2016) Forensic age diagnostics using projection radiography of the clavicle: a prospective multi-center validation study. Int J Legal Med 130(1):213ff.  https://doi.org/10.1007/s00414-015-1285-0 CrossRefGoogle Scholar
  100. 100.
    Wittschieber D, Schulz R, Pfeiffer H et al (2017) Systematic procedure for identifying the five main ossification stages of the medial clavicular epiphysis using computed tomography: a practical proposal for forensic age diagnostics. Int J Legal Med 131(1):217ff.  https://doi.org/10.1007/s00414-016-1444-y CrossRefGoogle Scholar
  101. 101.
    Wolff J (1870) Ueber die innere Architectur der Knochen und ihre Bedeutung für die Frage vom Knochenwachsthum. Virchows Arch Pathol Anat Physiol 50:389ffCrossRefGoogle Scholar
  102. 102.
    Yoon SH, Yoo HY, Yoo RE et al (2016) Ossification of the medial clavicular epiphysis on chest radiographs: utility and diagnostic accuracy in identifying Korean adolescents and young adults under the age of majority. J Korean Med Sci 31(10):1538ff.  https://doi.org/10.3346/jkms.2016.31.10.1538 CrossRefGoogle Scholar
  103. 103.
    Zhang K, Chen XG, Zhao H et al (2015) Forensic age estimation using thin-slice multidetector CT of the clavicular epiphyses among adolescent Western Chinese. J Forensic Sci 60(3):675ff.  https://doi.org/10.1111/1556-4029.12739 CrossRefGoogle Scholar
  104. 104.
    Zhao H, Dong XA, Zheng T et al (2011) Skeletal age estimation of sternal end of clavicle in Sichuan Han nationality youth using thin-section computed tomography. Fa Yi Xue Za Zhi 27(6):417ff.  https://doi.org/10.3969/j.issn.1004-5619.2011.06.005 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ernst Rudolf
    • 1
  • Josef Kramer
    • 2
  • Sven Schmidt
    • 3
  • Volker Vieth
    • 4
    • 5
  • Ingemar Winkler
    • 6
  • Andreas Schmeling
    • 3
  1. 1.Attnang-PuchheimAustria
  2. 2.Institute for CT and MRT DiagnosticsLinzAustria
  3. 3.Institute of Legal MedicineUniversity Hospital MünsterMünsterGermany
  4. 4.Department of Clinical RadiologyUniversity Hospital MünsterMünsterGermany
  5. 5.Clinic for RadiologyKlinikum IbbenbürenIbbenbürenGermany
  6. 6.Rax-Bergen 27JennersdorfAustria

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