Identification of age and sex based on knee radiography

Aly, Sanaa M.; Shrestha, Biswas; Hong, Duan Jun; Omran, Ahmed; Wang, Wei

doi:10.1016/j.forsciint.2016.08.001

Cited by 10 publications

(4 citation statements)

References 15 publications

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“…In addition to distinct degrees of skeletal age predictability in each sex, there has been evidence of sex-specific patterns in the rate that each stage of fusion occurs—boys may complete stage 2 six months earlier than girls, but girls will complete epiphyseal union earlier. 1 Similar findings have been characterized in the pediatric elbow as well. 24 These sex-specific biological differences in ossification require more evaluation to understand how to optimize the evaluation of tibial tubercules to improve estimates of skeletal age in girls.…”

Section: Discussionsupporting

confidence: 73%

“…The lower correlation between tibial apophyseal staging in the present study may be a consequence of sex-specific differences in ossification center fusion in girls and boys. 1 In a large sample of Irish people, O’Connor et al 22 , 23 demonstrated sex differences in the estimation of skeletal age by tibial landmarks on knee radiographs, including lower precision of estimates in their female versus male participants (+2.0 to –1.9 years vs ±1.5 years of actual age, respectively). In addition to distinct degrees of skeletal age predictability in each sex, there has been evidence of sex-specific patterns in the rate that each stage of fusion occurs—boys may complete stage 2 six months earlier than girls, but girls will complete epiphyseal union earlier.…”

Section: Discussionmentioning

confidence: 99%

“…However, to our knowledge, no studies have examined the utility of knee radiographs for the same purpose, which have also been shown to capture ossification centers. 1 , 22 , 23 Because knee radiographs are routinely performed to diagnose knee injuries (eg, ACL tears), these radiographs may be able to serve a double role in both diagnosis and skeletal-age estimation, providing a feasible alternative to preoperative hand radiographs in certain contexts. As such, the purpose of this study was to evaluate the reliability and validity of a radiographic staging system using tibial tubercle apophyseal landmarks as hypothetical proxies for skeletal age.…”

mentioning

confidence: 99%

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Tibial Tubercle Apophyseal Stage to Determine Skeletal Age in Pediatric Patients Undergoing ACL Reconstruction: A Validation and Reliability Study

Dekhne

Kocher

Hussain

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Anterior cruciate ligament (ACL) injuries demand individualized treatments based on an accurate estimation of the child’s skeletal age. Wrist radiographs, which have traditionally been used to determine skeletal age, have a number of limitations, including cost, radiation exposure, and inconvenience. Purpose: To evaluate the reliability and validity of a radiographic staging system using tibial apophyseal landmarks as hypothetical proxies for skeletal age to use in the preoperative management of pediatric ACL tears. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The study included children younger than 16 years of age who underwent ACL reconstruction between July 2008 and July 2018 and received both skeletal age radiography and knee radiography within 3 months of each other. Skeletal age was calculated from hand and wrist radiographs using the Greulich and Pyle atlas. Tibial apophyseal staging was categorized into 4 stages: cartilaginous stage (stage 1), apophyseal stage (stage 2), epiphyseal stage (stage 3), and bony/fused stage (stage 4). Data were collected by 2 independent assessors. The analysis was repeated 1 month later with the same assessors. We calculated descriptive statistics, measures of agreement, and the correlation between skeletal age and apophyseal stage. Results: The mean chronological age of the 287 patients included in the analysis was 12.9 ± 1.9 years; 164 (57%) of the patients were male. The overall Spearman r between skeletal age and tibial apophyseal staging was 0.69 (0.77 in males; 0.60 in females). The interrater reliability for the tibial apophyseal staging was substantial (Cohen κ = 0.66), and the intrarater reliability was excellent (Cohen κ = 0.82). The interrater reliability for skeletal age was excellent (intraclass correlation coefficient [ICC] = 0.93), as was the intrarater reliability (ICC = 0.97). Conclusion: The observed correlation between skeletal age and tibial apophyseal staging as well as observed intra- and interrater reliabilities demonstrated that tibial apophyseal landmarks on knee radiographs may be used to estimate skeletal age. This study supports the validity of knee radiographs in determining skeletal age and provides early evidence in certain clinical presentations to simplify the diagnostic workup and operative management of pediatric knee injuries, including ACL tears.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Tibial Tubercle Apophyseal Stage to Determine Skeletal Age in Pediatric Patients Undergoing ACL Reconstruction: A Validation and Reliability Study

Dekhne

Kocher

Hussain

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…While the use of radiographs to detect cancerous lesions in skeletal material has received increased attention within the field of paleopathology (Brothwell, 2012;Marques, 2019;Ragsdale et al, 2018;Rothschild & Rothschild, 1995;Villa et al, 2019), radiographic imaging for the purpose of lesion detection has not become a prominent part of the published forensic anthropology literature. The use of radiographs in forensic anthropology has been increasingly employed when available; however, the published literature primarily has centered around using antemortem radiographs for establishing positive identification (Ross et al, 2016;Stephan et al, 2011;Watamaniuk & Rogers, 2010), the use of trabecular bone pattern as a means of identification (Kahana et al, 1998;Kahana & Hiss, 1994), development of methods for estimating measurements from radiographic images (Schroeder et al, 1997) or 3D reconstructions of the skull (Verhoff et al, 2008), methods of age or sex estimation based on radiographs (Aly et al, 2016;Dedouit et al, 2010;Garamendi et al, 2011;Wittschieber et al, 2013), and trauma analysis (Blau, 2017).…”

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confidence: 99%

Detection of cancerous lesions in skeletal remains using visual methods and radiographs

Fatula

2021

Intl J of Osteoarchaeology

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The recognition and diagnosis of pathological conditions can provide identifying characteristics that lead to the identification of unknown remains. While pathological lesions on dry bone are usually detected by gross visual examination, potentially individuating lesions may not be detected without radiographic analysis. Radiography may be especially important to diagnose metastatic cancer, where lesions may begin on the inner surface of the bone. The objective of this study was to determine if and on what skeletal elements metastatic cancerous lesions are detected more frequently when using radiographs compared to dry bone examination. Multiple skeletal elements from 30 individuals with reported soft tissue cancers were examined for the presence of visible lesions on dry bone and on radiographs. Results show that 63% of the sample with reported soft tissue cancers exhibited visible lesions. Of these, 42% of the lesions were identified solely on radiographs and 58% exhibited distinct lesions using both dry bone and radiographic analyses. A comparison of the two methods of lesion detection indicates that macroscopic analysis alone cannot capture the range of cancerous lesion manifestations. Here, I suggest a method for practitioners that minimizes time and expense in radiographing to prioritize skeletal elements that best exhibit cancerous lesions that would have otherwise been hidden on dry bone.

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Postmortem computed tomography assessment of skeletal and dental age in Polish children, adolescents, and young adults

Lopatin,

Barszcz,

Jurczak

et al. 2023

Forensic Sci Med Pathol

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This paper presents a retrospective analysis of postmortem computed tomography (PMCT) scans of secondary ossification centers in the medial clavicular epiphysis, iliac crest apophysis, proximal humeral epiphysis, distal femoral epiphysis, proximal tibial epiphysis, and distal tibial epiphysis. At the same time, we analyzed PMCT scans of the maxillary and mandibular incisors, canines, premolars, and molars. We assessed 203 corpses, whose age ranged from 2 to 30 years, including 156 males and 47 females. The purpose of our study was to compare the processes of secondary ossification center fusion and permanent tooth maturation. Our research hypothesis was that certain stages of skeletal and dental maturation occur along consistent timelines that can be related to the chronological age. Secondary ossification center fusion was evaluated based on Kreitner and also McKern and Steward’s classifications. The process of permanent tooth maturation was evaluated with Demirjian’s method. Spearman’s correlation coefficients (Rho) were positive in all analyses, which indicates that epiphyseal fusion progresses with age. The strongest relationship between the age and the stages of ossification was observed in the proximal tibial epiphysis (p < 0.001; Rho = 0.93) in females and in the medial clavicular epiphysis (p < 0.001; Rho = 0.77) in males. Studies show the importance of concomitant analysis of skeletal and dental maturation with a subsequent comparison of the results to achieve a greater precision in age estimation. A comparison of the results obtained in the study population of Polish children, adolescents, and young adults with the results of other studies in populations of similar ages showed a number of similarities in the time windows of dental and skeletal maturation. These similarities may help in age estimation.

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Identification of age and sex based on knee radiography

Cited by 10 publications

References 15 publications

Tibial Tubercle Apophyseal Stage to Determine Skeletal Age in Pediatric Patients Undergoing ACL Reconstruction: A Validation and Reliability Study

Tibial Tubercle Apophyseal Stage to Determine Skeletal Age in Pediatric Patients Undergoing ACL Reconstruction: A Validation and Reliability Study

Detection of cancerous lesions in skeletal remains using visual methods and radiographs

Postmortem computed tomography assessment of skeletal and dental age in Polish children, adolescents, and young adults

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