X-ray examination for determination of Age

Examination of X-Ray for the determination of age of an individual.

1. Demonstration class X-Ray Examination Dr. Salam Bitam singh Senior Resident

2. Bony Development Age (IU) Appearance Centre of ossification 1.5 Month (IU) Clavicle 2 Months Each half of Mandible 3 Months Ischuim 4 Month Sacral segment ( Upper, Mid), Middle Ear Bone 5 Month Calcaneum 6 Month Sternum 7 Month Talus 8 Month Sacral Segment (Lower) 9 Month Femur (Lower End) 10 Month Cuboid , Upper end Tibia

3. Thumb side

4. Carpel bones on X-Ray at the end of 1 yrs = 2 Carpel bones on X-Ray between 2-6yrs =Age in years.

5. Ossification centres of the foot Primary ossification centres present at birth Visible on x-ray from birth: calcaneus : 6 months in utero talus: 7 months in utero cuboid : 9 months in utero metatarsals: 9 weeks in utero phalanges: 3-10 months (proximal to distal) Primary ossification centres developing after birth Become visible on x-ray from: lateral cuneiform: 1 st  year medial cuneiform: 3 rd  year intermediate cuneiforms and navicular : 4 th  year Secondary ossification centres At the age of 3 years, secondary ossification centres of the navicular , metatarsals and phalanges should all be present. The last secondary ossification center to develop is the calcaneus appearing at 5 years.

6. TIPS Aging more accurate with the appearance of Ossification Centre than fusion Head of humerus : Last long bone epiphysis to be united. Upper limbs: elbow union earlier than wrist Lower limbs: Hip and Ankle union earlier than Knees. X-Ray union is 6 months earlier than the anatomical union.

7. Stages of union of Epiphysis with Diaphysis Stage 0 – Non-union: The diaphyseal and epiphyseal bones are adjacent to each other but not yet in intimate relationship. The epiphysis is separate from the diaphysis due to the presence of the cartilaginous growth plate . This should be apparent in at least one view on the radiograph, as a continuous radiolucent gap between the epiphysis and diaphysis . Stage 1 – Beginning union: The epiphyseal and diaphyseal surfaces closely move towards each other. There is a narrow radiolucent strip between adjacent surfaces of the epiphysis and diaphysis when compared to the state of non-union. There is a radiolucent gap which is not continuous from anterior to posterior or medial to lateral, indicating that union has begun centrally, but has not yet commenced on the remainder of the growth plate. In radiographic views, the later stage should be selected. Stage 2 – Active union: The epiphysis and diaphysis cap each other, the epiphysis overlapping the metaphysis . The terminal plate of the epiphysis can no longer be distinguished. A fusion line or zone of greater density than the adjacent bone replaces the epiphyseal cartilage . There is a radiodense region indicating that fusion is actively occurring.

8. Stage 3 Recent union: The epiphysis and diaphysis now form a single unit of bone; there is complete capping. The position of the former epiphysis and diaphysis can still be observed. There may be a fine line of fusion of greater density between the epiphysis and diaphysis , and a discontinuity of trabeculae between these. A slight notch at the margin of the growth plate (less than 2 mm) can be observed that is not yet completely calcified .These indicate that the bone has recently united. Stage 4 – Complete union: The epiphysis and diaphysis are united as a single unit of bone. There is continuity of trabeculae from shaft to former epiphysis. This is presented as a uniformity of internal bone pattern throughout the length of the long bone up to the articular surface. All traces of epiphyseal differentiation have been lost. The growth plate has now completely ossified and the bone is fused in its entirety; there are no radiolucent notches evident at the peripheral margin of the bone .

9. Appearance of the Ossification centres X-Ray between 6-12 years Elbow & Wrist ( Appearences of O.C) 6years 9years 9-11 years 10-11years 11years Ulna (Lower End) Medial Epicondyle of Humerus Olecranon Trochlea of Humerus Pissiform Lateral epicondyle of Humerus Between 13-16 years X-Ray Elbow and Pelvis 13 years 12-14 years 14 years 15 years 16 years TriRadiate cartilage of acetabulum Separate Centres Femur lesser trochanter Fussion of Medial Epicondyle , lateral epicondyle with Trochea Fusion of Triradiate cartilage of acetabulum Ischial tuberosity Fusion of lower end of Humerus Olecranon to ulna Fusion of upper end of radius

10. Fusion of the X-Ray joints 16 yrs 16-17 yrs 17-18 yrs 18-19 yrs 20-21 yrs Elbow Ankle Hip Knee Shoulder Wrist Iliac Crest Ischial tuberosity Inner end of Clavicle

11. GALSTAUN’S CHART Accepted in Calcutta High court Bone Male Female Appearance Fusion with Appearance Fusion Elbow joint Humerus M.EC L.EC Trochlear 7yrs 12yrs 11yrs 16yrs(Shaft) 14-16yrs( capitulum ) 11-15yrs( Capitulum ) 5yrs 10yrs 10yrs 14yrs 12yrs 10-13yrs( Capitulum ) Head of Radius 8yrs 16yrs 6yrs 14yrs Tip of olecranon 11-13 yrs 17yrs 9-12yrs 15yrs Wrist Joint Lower end of Radius 1yr 16-17yrs 1yr 17-18yrs Lower end of Ulna 10-11yrs 18yrs 8-10yrs 17yrs Pisiform 12-17yrs 9-12yrs

12. Bone Male Female Appearance Fusion with Appearance Fusion Pelvis joint Iliac Crest 17yrs 19-20yrs 14yrs 17-19yrs Ischial tuberosity 16-18yrs 20yrs 14-16yrs 20yrs Head of Femur 1yrs 16-17yrs 1yr 14-15yrs Greater Trochanter 17yrs 14yrs Lesser Trochanter 15-17yrs 15-17yrs Acetabulum Disappearnce of the triradiate cartilage 15-16yrs 14yrs Knee Joint Lower end of Femur At or just before birth 14-17yrs At or just before birth 14-17yrs Upper end of tibia At or just before birth 15-17yrs At or just before birth 14-15yrs Upper end of Fibula 11-16yrs 9-12yrs 14-16yrs Patella 3-7yrs 4yrs

13. Q. A.Determine the age of the individual from the X- Ray provide This is a Plane X-Ray of the Elbow joint in AP view showing the lower end of humerus and the upper end of radius and the ulna Findings: Fusion of the lower end of the humerus ( MEC with the shaft ,& LEC with the capitulum ) also the fusion of the epiphysis of the upper end of radius and ulna( tip of the Olecranon process) with the shaft. Impression : the person is above 14 years

14. 2. This is a plane X-Ray of the knee joint AP view showing the lower end of femur and the upper end of tibia and the fibula Findings : Epiphysis of the lower end of the femur is not fused with the shaft, also the epiphysis of the upper end of the Tibia and the Fibula is not fused with the shaft. Impression: the age of the person is below 16 years . Final impression: Female aged between 14-16years.

15. Medico legal Importance of 14-16yrs For 14 yrs: U/S 89 IPC , a child under 12 yrs of age can’t give valid consent to suffer any harms. Below 14 yrs can’t be employed in any form of work ( Factory Act) 2. For 16 yrs U/S 375 sexual intercourse by a man with a girl under 15 yrs evn if she is his own wife without her consent constitute rape. Having sexual intercourse with his own wife not being under 15 yrs of age is not rape .

16. Q. B.Determine the age of the individual from the X- Ray provide 1. This is a plane X-Ray of the knee joint AP view showing the lower end of femur and the upper end of tibia and the fibula Findings : Epiphysis of the lower end of the femur is fused with the shaft, also the epiphysis of the upper end of the Tibia and the Fibula are fused with the shaft. Impression: the age of the person is above 16 years

17. 2. This is a plane X-ray AP view of the wrist joint showing the lower end of the radius and the ulna along with the carpel bones and the metacarpal bones Findings : Epiphysis of the lower ends of the Ulna and the radius are not fused with the Shaft. All the carpel bones are present. Impression : The age of person is above 16 yrs but below 18 yrs.

18. Medico legal Importance of 18yrs Age of voting A person attains majority(Sec. 3 Indian Majority act) Adult as per the Indian factory Act. Age of marriage for female (Child marriage Restraint act 1978.) Employment in the government services Consent to suffer any harm.

19. Q.C. Determine the age of the individual from the X- Ray provide 1. This is a plane X-ray AP view of the wrist joint showing the lower end of the radius and the ulna along with the carpel bones and the metacarpal bones Findings : Epiphysis of the lower ends of the Ulna and the radius are fused with the Shaft. All the carpel bones are present. Base of the metacarpal bones are fused . Impression: The age of the person is above 18yrs.

20. 2. This is a plane X-Ray of the pelvis joint along with the upper end of femur Findings : Iliac Crest is not fused. Ischial tuberosity is not fused Head of the Femur is fused Greater and Lesser Trochanter is fused Triradiate cartilage is fused Impression : The age of the person is between 18-20 years.

21. Medico legal Importance of 20 yrs