Studies in use of the Greulich-Pyle skeletal age method to assess criminal liability

In recent years, skeletal age determination has become increasingly important for determining the age of live subjects as part of criminal investigation. The most widely used method worldwide to determine skeletal age is the Greulich-Pyle atlas method. The present study examines the suitability of the Greulich-Pyle method given the particular requirements of forensic age estimates. It is a retrospective analysis of 649 hand radiographs originally taken from persons aged between 1 and 18 years, separately for each sex. If the Greulich-Pyle method is used exclusively, it can be claimed with a probability of 95% that a young man has reached the age of 14 years and thus the age of criminal liability if his skeletal age is at least 15.5 years. In the case of female subjects, even if they are estimated as being 16.0 years old, it cannot be asserted with a probability of 95% that they have reached the age of 14. To reduce the margin of error of age estimates, determining the skeletal age should always go hand in hand with a physical examination to determine indications of sexual maturity and a dental examination to record dental status. The reference values given in the present study can be applied to members of all ethnic groups for age estimate purposes. If the person under examination has a different socio-economic status, the expert performing the age estimate should address this issue in his expert opinion and discuss the possible effects that might have on the age diagnosis.     

Accuracy of metric sex analysis of skeletal remains using Fordisc® based on a recent skull collection

It has been generally accepted in skeletal sex determination that the use of metric methods is limited due to the population dependence of the multivariate algorithms. The aim of the study was to verify the applicability of software-based sex estimations outside the reference population group for which discriminant equations have been developed. We examined 98 skulls from recent forensic cases of known age, sex, and Caucasian ancestry from cranium collections in Frankfurt and Mainz (Germany) to determine the accuracy of sex determination using the statistical software solution Fordisc which derives its database and functions from the US American Forensic Database. In a comparison between metric analysis using Fordisc and morphological determination of sex, average accuracy for both sexes was 86 vs 94%, respectively, and males were identified more accurately than females. The ratio of the true test result rate to the false test result rate was not statistically different for the two methodological approaches at a significance level of 0.05 but was statistically different at a level of 0.10 (p=0.06). Possible explanations for this difference comprise different ancestry, age distribution, and socio-economic status compared to the Fordisc reference sample. It is likely that a discriminant function analysis on the basis of more similar European reference samples will lead to more valid and reliable sexing results. The use of Fordisc as a single method for the estimation of sex of recent skeletal remains in Europe cannot be recommended without additional morphological assessment and without a built-in software update based on modern European reference samples.     

Ultrasound of femoral head cartilage: a new method of assessing bone age

This paper analyses the relationship between the thickness of the anterior femoral head cartilage (FHC), as measured by ultrasound, and some anthropometric parameters, such as height, weight, skeletal and chronological age. In addition, it provides standard norms for FHC thickness in a paediatric population. Both hips were examined in 213 consecutive subjects (99 boys and 114 girls), aged 1.9–14 years. Seventy-four subjects underwent hand and wrist X-rays for skeletal maturation: 32 of these were dropped from the study because a discrepancy as high as two standard deviations was found between their skeletal and their chronological age. The thickness of FHC correlated strongly with skeletal and chronological age, standing height and body weight. A side difference of 0.2 mm in FHC was considered to be abnormal. The study population was divided into 13 groups according to chronological age and values of FHC for boys and girls are provided for each group. It is suggested that the magnitude of hyaline FHC is a valuable feature in the evaluation of skeletal maturation in children.     

Der Einfluss der Ethnie auf die bei strafrechtlichen Altersschätzungen untersuchten Merkmale

The impact of ethnicity on characteristics examined for age estimation of living individuals is of major relevance to implementation of criminal law. In cases of significant interethnic differences, application of common reference studies to other ethnic groups would lead to erroneous and even false estimates. More than 500 publications were evaluated for ossification, dentition and sexual maturation in numerous populations and the results show that there are defined stages of development which occur in the same order in all major ethnic groups. While age-related ossification and mineralisation of third molars were obviously not significantly affected by ethnic origin, further research appears to be required with regard to the relative acceleration of third molar eruption and sexual maturation in Africans.     

Imaging features of thalassemia

Thalassemia is a kind of chronic, inherited, microcytic anemia characterized by defective hemoglobin synthesis and ineffective erythropoiesis. In all thalassemias clinical features that result from anemia, transfusional, and absorptive iron overload are similar but vary in severity. The radiographic features of β-thalassemia are due in large part to marrow hyperplasia. Markedly expanded marrow space lead to various skeletal manifestations including spine, skull, facial bones, and ribs. Extramedullary hematopoiesis (ExmH), hemosiderosis, and cholelithiasis are among the non-skeletal manifestations of thalassemia. The skeletal X-ray findings show characteristics of chronic overactivity of the marrow. In this article both skeletal and non-skeletal manifestations of thalassemia are discussed with an overview of X-ray findings, including MRI and CT findings. Received: 21 August 1999; Revision received: 22 December 1999; Accepted: 15 February 1999     

Age estimation: The state of the art in relation to the specific demands of forensic practise

Age estimation in cadavers, human remains and living individuals may clarify issues with significant legal and social ramifications for individuals as well as for the community. In such cases methods for estimating age should fulfil the following specific demands: (1) they must have been presented to the scientific community, as a rule by publication in peer-reviewed journals, (2) clear information concerning accuracy of age estimation by the method should be available, (3) the methods need to be sufficiently accurate and (4) in cases of age estimation in living individuals principles of medical ethics and legal regulations have to be considered. We have identified and summarized the methods that essentially fulfil these specific demands. In childhood and adolescence morphological methods based on the radiological examination of dental and skeletal development are to be recommended. In adulthood, the accuracy of most morphological methods is much reduced. Here a biochemical method based on aspartic acid racemization in dentine provides the most accurate estimates of age, followed by special morphological dental and skeletal methods. The choice of method has to take account of the individual circumstances of each case. Most methods require either the consultation of specialised and trained scientists or an adequate calibration by the “user”. Very few attempts have been made to find common standardisation, calibration and evaluation procedures or to develop means of quality assurance for methods of age estimation. Efforts in these directions are necessary to guarantee quality standards and adequate answers to the important legal and social issue of age estimation in forensic medicine. Received: 26 January 1999 / Received in revised form: 12 April 1999     

The ��blind age assessment��: applicability of Greulich and Pyle, Demirjian and Mincer aging methods to a population of unknown ethnic origin

Purpose

Age estimation is one of the most crucial issues in case of unknown deceased as well as in the living and is very frequently of radiological interest. Three methods for age estimation have been designated as the most reliable among the others: Greulich and Pyle, Demirjian and Mincer. The literature provides several studies concerning their applicability in different geographic contexts. However, not always can ancestry be ascertained, for example, in the case of badly preserved corpses. In these cases, age assessment must be performed without the corrections suggested by the literature for different ethnic groups. One may therefore wonder how reliable the result of age assessment performed without knowing the racial group to which the subject belongs may be. This study aimed at testing the applicability of the Greulich and Pyle Atlas, the Demirjian and the Mincer methods on a mixed population to compare skeletal and dental methods of age estimation.

Materials and methods

X-ray films of 167 subjects aged between 4 and 31 years from more than 18 countries were recruited. One hundred and nine orthopantomographs (OPG) of children aged between 4 and 15.5 years were evaluated by Demirjian??s method; whenever the highest Demirjian score was reached (31 cases), the Mincer method was applied. The skeletal maturation of 54 subjects aged between 7 and 19 years was determined by the Greulich and Pyle method.

Results

The lowest average variance from chronological age was shown by the Greulich and Pyle method, followed by Demirjian. The Mincer method showed very high mean variances.

Conclusions

Mean variances from the different methods do not significantly differ from data reported in the literature and demonstrate that the reliability of Demirjian, and Greulich and Pyle as they stand may be applied satisfactorily to remains or individuals of unknown ethnic origin.     

Maturity status of youth football players: a noninvasive estimate

PURPOSE: To estimate the biological maturity status of youth football players 9-14 yr old using a noninvasive method and to compare the body size of players of contrasting status. METHODS: Subjects were members of youth football teams in two central Michigan communities. Height and weight were measured on 653 boys 8.7-14.6 yr. Heights of biological parents of 582 boys were reported and subsequently adjusted for overestimation. Decimal age, height, and weight of the player and midparent height were used to predict mature (adult) height for the boy. Current height of each player was expressed as a percentage of his predicted mature height to provide an estimate of biological maturity status. Percentage of predicted mature height of each boy was expressed as a z-score to classify players into maturity groups. ANCOVA, controlling for age, was used to compare body size in contrasting maturity groups. RESULTS: Mean percentages of predicted mature height of the players matched those of longitudinal reference samples, but there was a trend for higher percentages among older players, suggesting advanced maturation. Overall, 405 boys were classified as on time/average in maturity status (69.6% [95%CI 65.7-73.3]), 154 were classified as early/advanced (25.5% [95%CI 23.0-30.3]), and only 23 were classified as late/delayed (3.9% [95%CI 2.6-6.0]). The gradient for height, weight, and BMI was as follows: early > on time > late, and differences were greater for weight and the BMI than for height. CONCLUSION: Percentage of predicted mature height attained at a given age appears to be a reasonable indicator of maturity status. The method needs to be validated with other more direct indicators (skeletal age, sexual maturation) and applied to other samples.     

Population genetics of the hypervariable locus D12S391 in Koreans

The hypervariable short tandem repeat (STR) locus D12S391 was investigated in a Korean population and 34 fragments were sequenced to confirm the structure of alleles. From these sequenced fragments an allelic ladder containing 13 sequenced alleles was constructed. From 595 unrelated Koreans, 14 alleles were detected and one variant allele 19.3 was observed. The observed heterozygosity was 0.795 and no deviation from Hardy-Weinberg equilibrium was observed in the Korean population (p = 0.606). The allele frequency distribution in the Korean population was not similar to other racial or ethnic groups except for Egyptians, Yemenis, Japanese and Caucasoids from the Rhine area. No mutations were observed in the 702 meioses from 144 Korean families. This study demonstrates that the STR locus D12S391 is a useful tool for forensic identification and parentage testing. Received: 15 September 1999 / Accepted: 18 December 1999     

Size and skeletal maturation of the hand in children with hypothyroidism and hypopituitarism.

Hypothyroidism affects linear growth less than it affects skeletal maturation, while hypopituitarism linear growth is more severely affected. By determining the mean age for the length of the second metacarpal and dividing by the skeletal age, a ratio R was obtained in 15 hypothyroid children and in 33 with hypopituitarism. R was more than 1 in most hypothyroids and less than 1 in most children with hypopituitarism. Thus, a distinction between these two entities can be made simply from a hand radiograph and appropriate reference sources for determining second metacarpal length age and skeletal age.     

D-2-hydroxyglutaric aciduria in association with spondyloenchondromatosis

D-2-hydroxyglutaric aciduria is a rare metabolic disorder, first reported in 1980, and does not yet have a clinically specific presentation pattern nor any specific treatment regime. We report a girl born with this uncommon metabolic disorder, who, at the age of 12 months, was also found to have a severe crippling form of skeletal dysplasia, spondyloenchondromatosis. Received: 19 February 1999 Revision requested: 20 May 1999 Revision received: 7 December 1999 Accepted: 8 December 1999     

Dental age estimation of Tibetan children and adolescents: Comparison of Demirjian,Willems methods and a newly modified Demirjian method

Tibetan ethnic group is one of the oldest ethnic groups in China and South Asia. This study set out to analyze the dental development and validate Demirjian method and Willems method in estimating dental age of Tibetan children and adolescents, and to modify Demirjian method based on Tibetan population to provide ethnic-specific reference data and a more reliable method for forensic age assessment in Tibetan ethnic group. In this study, 1951 samples aged between 4 and 15 years were retrospectively collected and analyzed. Multiple linear regression was used to establish relationship between chronological age (CA) and developmental stages of left mandibular permanent teeth. The accuracy of the modified method was tested and compared with that of Demirjian and Willems method. Results showed that dental maturity score (DMS) was significantly greater in girls than in boys in all age groups except for the 4-year age group (p < 0.05). Mean absolute error (MAE) was 0.96 years for both boys and girls by Demirjian method, and 1.06 and 1.16 years for boys and girls respectively by Willems method. Adjusted scores table was established and tested. The age of boys was overestimated by 0.13 years and the age of girls was underestimated by 0.06 years by the adjusted scores table. MAE was lower than that of the other two methods. In conclusion, Demirjian method and Willems method was not sufficiently accurate in estimating dental age of Tibetan population. The modified method was more suitable for dental age estimation of Tibetan population than Demirjian and Willems method.     

Skeletal maturation and growth rates are related to bone and growth plate injuries in adolescent athletics

Injuries are common in elite adolescent athletics, but few studies have addressed risk factors for injury. Growth and maturation are potential risk factors in this population; however, the current body of literature is both inconclusive and considered at high risk of bias. The aim of this study was therefore to examine whether growth rate, maturity status, and maturity tempo are associated with injury risk in an elite sports academy. Anthropometric, skeletal maturity and injury data collected prospectively over four seasons (117 athlete-seasons) were included in the analyses. Growth rate for stature was associated with greater risk of bone (incidence rate ratio (IRR): 1.5 per one standard deviation increase above the mean; 95% CI: 1.1-1.9) and growth plate injuries (IRR: 2.1; 1.5-3.1). Growth rate for leg length was associated with greater overall injury risk (IRR: 1.3; 1.0-1.7) as well as the risk of bone (IRR: 1.4; 1.0-1.9) and growth plate injuries (IRR: 2.1; 1.4-3.0). Athletes with greater skeletal maturity, expressed as skeletal age (IRR: 0.6 per year; 0.5-0.9) and percentage of predicted mature height (IRR: 0.8 per percent increase; 0.7-1.0), were less prone to growth plate injuries. Rate of change in skeletal age was associated with an increased risk of bone injuries (IRR: 1.5; 1.0-2.3). The results of this study suggest that rapid growth in stature and leg length, skeletal maturity status, and maturity tempo represent risk factors for certain injury types in adolescent athletics.     

A novel dimorphism in the human SRY gene: usefulness in human migration studies

A nucleotide polymorphism of C or T was detected at position 465 in the sex-determining region Y (SRY) gene. To evaluate the utility of this dimorphism in human population studies, the frequency and the frequency of the haplotype combined with the two polymorphic loci YAP and M9 were examined in a total of 130 unrelated Japanese and 130 unrelated German males. The T nucleotide was found in 24.6% (32/130) of the Japanese but not in any of the 130 German males. Accordingly, four of the eight possible combination haplotypes of SRY/YAP/M9 were identified in the Japanese population, but one of the four haplotypes comprising SRY(T) was absent in the German samples. This suggests that the C to T transition may be more recent than the YAP insertion or the M9 transversion and the change might have occurred in an ancestral Asian population. These results imply that the dimorphism at the SRY gene is one of the Y-linked markers useful for human population studies and also for ethnic identification of forensic samples. Received: 9 March 1999 / Accepted: 9 September 1999     

Ulnar variance and skeletal maturity of radius and ulna in female gymnasts.

It is has been suggested that repetitive loading on the distal end of the radius in elite gymnasts may lead to epiphyseal changes, a premature closure (union) of the radius growth plate, and ulnar overgrowth. PURPOSE: It is hypothesized that ulnar overgrowth in female gymnasts is associated with advanced maturity status and early onset of epiphyseal closure of the radius, and later maturity status and later onset of epiphyseal closure of the ulnar. METHODS: Posterior-anterior radiographs of 201 female gymnasts, participants of the 1987 World Championships Artistic Gymnastics, were used to measure ulnar overgrowth, to determine skeletal maturation of the hand and wrist with the Tanner-Whitehouse technique, and to determine the maturity status of the radius and ulna separately, particularly with regard to the onset of epiphyseal closure. To test the hypothesis, extreme quintiles for ulnar overgrowth were contrasted for skeletal maturation of the hand and wrist and for maturity stages of the radius and ulna as defined by the Tanner-Whitehouse criteria. RESULTS: Female gymnasts who demonstrate ulnar overgrowth are skeletally more advanced in maturity status of the entire hand-wrist compared with gymnasts who did not show ulnar overgrowth. There were, however, no differences between gymnasts in the extreme quintiles of ulnar overgrowth in the maturation of the radius, although gymnasts with ulnar overgrowth show more advanced maturity status of the ulna. CONCLUSIONS: Ulnar overgrowth is thus not apparently associated with advanced maturity of the distal radial epiphysis as defined in protocols for assessing skeletal maturity and does not apparently lead to premature epiphyseal closure of the distal radius.     

DXS10011: a hypervariable tetranucleotide STR polymorphism on the X chromosome

The locus DXS10011 is a polymorphic system with a tetranucleotide repeat sequence located on the human X chromosome. The distribution of allele frequencies was examined in 334 Japanese and 171 German individuals and a total of 36 alleles was detected in the two population groups. This STR polymorphism will be a useful marker for linkage analysis. Received: 8 March 1999 / Received in revised form: 14 July 1999     

Estimation of age from human sternum: an autopsy study on a sample from South India

Age estimation is one of the main parameters in the evaluation of skeletal remains in forensic anthropology casework. The present investigation is an attempt to study the fusion of manubrium and xiphoid process with mesosternum in 118 sterna (67 males and 51 females) of known age obtained during autopsy in South Indian population. The male samples were aged between 25 and 74?years and the females between 20 and 80?years. The fusion is studied to derive standards for the estimation of age from sternum. The results indicate that, with advancing age, the proportion of sternum with fusion of manubrio-mesosternal and mesosterno-xiphisternal junctions increases in males and females. A larger proportion of sterna showed fusion of mesosterno-xiphisternal junction than manubrio-mesosternal junction in different age groups. Fusion of manubrio-mesosternal and mesosterno-xiphisternal junctions was proportionately commoner in males than females. None of the sterna aged below 30?years showed fusion of mesosterno-xiphisternal junction. Nonfusion of mesosterno-xiphisternal junction was reported till the age of 48?years in males and 46?years in females. Manubrio-mesosternal junction was observed to be very variable with regard to fusion status as the joint remained unfused even in the elderly ages. Based on the variability of the fusion of manubrio-mesosternal and mesosterno-xiphisternal junctions observed in the study, it can be concluded that the sternum alone is not reliable for estimation of age in South Indian population.     

Growth and physical fitness of Polish youths in two successive decades

AIM: The aim of the study was to determine changes in somatic growth and physical fitness of Polish schoolchildren aged 7 to 19 years over the last 2 decades of the 20(th) century, during which Poland underwent a political and socio-economic transformation. Another objective has been to relate such changes to fathers' education, which is a comprehensive indicator of socio-economic status. METHODS: The study was conducted on representative random cohorts on 3 occasions: in 1979, 1989 and 1999, the numbers of subjects ranging from 73000 to 230000, i.e. about 1-3% of the total population of that age. Apart from determining basic somatic variables, all children were subjected to 8 tests of the International Committee on the Standardisation of Physical Fitness Tests (ICSPFT), 9 EUROFIT tests and Cooper's test. RESULTS: A clear-cut secular trend was observed for body height and mass, the former incrementing by about 2 cm per decade. Ponderal index increased which indicated a slightly excessive slimming tendency, especially in older girls. Physical fitness indices did not parallel the somatic trend, and in the last decade the results were even worse than at the beginning of the study. This was attributed to altered life styles induced by system transformation. When somatic and fitness variables were related to fathers' education, a markedly pronounced diversification was found the lower the education, the worse were all indices studied. CONCLUSION: It was concluded that special programmes should be designed to improve health-oriented attitudes and physical fitness, especially of children from the lowest social classes, in order to arrest and, possibly, to reverse the progressing decline in physical fitness.     

Bone age determination based on the study of the medial extremity of the clavicle

The development of the medial clavicular epiphysis and its fusion with the clavicular shaft have been a subject of medical research since the second decade of this century. Computed tomography provides the imaging modality of choice in analyzing the maturation process of the sternal end of the clavicle. In a retrospective study, we analyzed normal development in 380 individuals under the age of 30 years. The appearance of an epiphyseal ossification center occurred between ages 11 and 22 years. Partial union was found from age 16 until age 26 years. Complete union was first noted at age 22 years and in 100 % of the sample at age 27 years. Based on these data, age-related standardized age distributions and 95 % reference intervals were calculated. Compared to the experience recorded in the relevant literature, there are several landmarks that show no significant change between different ethnic groups and different periods of publication; these are the onset of ossification, the time span of partial union, and the appearance of complete union. Despite the relatively long time spans of the maturation stages, bone age estimation based on the study of the development of the medial clavicular epiphysis may be a useful tool in forensic age identification in living individuals, especially if the age of the subject is about the end of the second or the beginning of the third decade of life (e. g. in determining the applicability of adult or juvenile penal systems). Another possible use is in identifying human remains whose age is estimated at under 30 years. Received 31 December 1997; Revision received 11 February 1998; Accepted 23 February 1998     

Comparative analysis of the applicability of the skeletal age determination methods of Greulich–Pyle and Thiemann–Nitz for forensic age estimation in living subjects

Evaluation of hand ossification is a main pillar of radiological age diagnosis in living subjects. In the present study, we comparatively assessed the Greulich–Pyle and Thiemann–Nitz methods for accuracy of age estimation and degree of acceleration in the respective reference populations. For this, the skeletal age of 649 hand X-rays from German subjects aged 1–18 years was determined by both methods. Accuracy of the age estimates was determined based on regression and measures of certainty. In terms of accuracy, both methods seem to be equally well suited for forensic age diagnostics. The degree of acceleration in the reference populations for the two methods was calculated as the mean difference between the estimated skeletal age and the actual age of a test subject. Compared to the Greulich–Pyle population, the Thiemann–Nitz population was accelerated by 0.44 years in both male and female subjects. When an expert opinion is required and one cannot exclude the possibility that the investigated subject may come from a population with a high acceleration status, the Thiemann–Nitz method should preferably be used to prevent overestimation of age.