The document discusses the estimation of bone age through radiography, outlining the process of ossification and the importance of understanding skeletal age for both clinical and forensic applications. Different methods of age estimation, including physical, dental, and radiological examinations, are highlighted, as well as specific criteria for evaluating bone ossification centers. It concludes that a combination of multiple criteria should be employed, and further research is necessary in the field.

1. ESTIMATION OF BONE
AGE BY RADIOGRAPHY
Dr. Somashekar C.
Department of Forensic Medicine and
Toxicology
AIMS, B G Nagara
1
March 8, 2014

2. Facts about Ossification:
• Bones are formed as mesodermal
condensations
• Formation of bone from these mesodermal
models is called Ossification
• Two centres of ossification for a bone
primary diaphysis
secondary epiphysis
• Embryonic period 806 centres, at birth 450
and in adults 206 2

3. • Sometimes confused for fractures esp. if
in association with joint.
3

4. • The process of appearance and fusion of
centers follow a sequence and time,
which is being utilized for age
estimation.
• On X-ray, fusion is seen 6 to 12 months
earlier than the actual bone fusion, as
the thin gap of non-union are not
noticed.
• Long bones ossify/fuse 1 year early in
females.
4

5. • The center which appears first, will
fuse with the diaphysis last usually.
• Ossification starts at the centre of
epiphysis and spreads to periphery.
5

6. Epiphysis grows in a typical fashion
(stages of progressive growth)
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7. 7

8. 8

9. 9

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11. 11

12. Age
Chronological age
Anatomical bone age
Radiological bone age
In normal subjects, bone age should be
roughly within 10% of chronological age.
Discordance may be seen if obese or early
attainment of puberty
12

13. • Appearance and fusion of centers vary
in different individuals depending on
environment, nutrition, endocrinal
factors.
• There may be maturity imbalance
between bones from different parts of
the same individual.
13

14. Why study skeletal age?
Clinical applications:
Diagnosis of growth disorders
-primary growth deficiency like bone
dysplasia
-sec. growth deficiencies like
nutritional, metabolic and unknown
(constitutional delay)
 Prediction of final adult height.
14

15. Forensic applications:
 criminal responsibility
 judicial punishment
 rape
 kidnapping
 consent and contract
 attainment of majority, marriage
 employment, joining govt. services
 sports etc.
15

16. Methods of age estimation:
• Physical examination (hair/sec sex ch./genital
development.)
• Dental examination (oral examination and dental X-ray esp
OPG)
• Radiological examination
 No single method is accurate in estimating age.
 In fact, multiple methods should be employed.
 Usually all the three methods are employed to estimate
the age of the individual.
16

17. Radiological methods of skeletal
age estimation:
a. Study of ossification centres
b. Other methods
1. Atlas technique
– Todd’s atlas
– Greulich and Pyle atlas
2. Scoring technique (preferred)
- Acheson’s method (Oxford method)
- Tanner and Whitehouse Method (TW1, TW2 &
TW3)
- FELS method
3. Individual Profile Maturity Technique
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18. Practical issues:
• For age estimation, usually standard right sided
X-rays are taken in AP view
-with few exceptions elbow (AP and Lat)
• Selection of regions/joints:
for age 6-12 years  elbow and wrist
for age 13-16 years  elbow and pelvis
• Wrist (& hand) is most studied region by
foreign authors/researchers.
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19. Ossification-age of appearance
and fusion:
• In Indian scenario, the following
estimates are being practiced currently,
though further research is needed in
this field.
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20. BONE OSSIFICATION CENTRE APPEARANCE CONJOINT
EPIPHYSIS
FUSION/UNION
Clavicle Medial end 18-19 yrs - 20-22 yrs
Sternum
Manubrium& 1st piece
2nd & 3rd piece
4th piece
xyphisternum
5th m of iul
7th m of iul
10th m of iul
3 yrs
-
All fuse
from below
upwards
between 14
and 25 yrs
Old age
40 yrs
Scapula Coracoid process
Acromion process
10-11 yrs
14-15 yrs
15-16 yrs
17-18 yrs
Humerus
Head
Greater tuberosity
Lesser tuberosity
1
3-4 yrs
5
5-6 yrs 18-19 yrs
20

21. 21

22. BONE OSSIFICATION
CENTRE
APPEARANCE CONJOINT
EPIPHYSIS
FUSION/UNION
Humerus
Capitulum
Trochlea
Lateral epicondyle
Medial epicondyle
1
9-11
11-12
5-6
14-16
-
16-17
15-16
Radius Head
Lower end
4-5
2
- 16-17
18-19
ulna Olecranon process
Lower end
8-9
5-6
- 16-17
17-18
Carpal
bones
Capitate
Hamate
Triquetral
Lunate
Scaphoid, trapezoid
Trapezium
pisiform
2m of iul
3 m of iul
3 yrs
4 yrs
5 yrs
6 yrs
10-12 yrs
- -
22

23. 23

24. 24

25. BONE
(hand)
OSSIFICATION
CENTRE
APPEARANC
E
CONJOINT
EPIPHYSIS
FUSION/U
NION
First Metacarpal 2-3 - 15-17
Proximal phalanges 1.5-2 - 15-18
Metacarpals 2-3 -
15-19
Middle phalanges 2-4 - 15-18
Distal phalanges 2-4 - 15-18
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27. 27

28. BONE OSSIFICATION
CENTRE
APPEARANCE C1ONJOIN
T
EPIPHYSIS
FUSION/UNI
ON
Hip bone Ischio-pubic rami
Tri-radiate cartilage
Iliac crest
Ischial tuberosity
-
-
14-16
16
- 6
13-15
18-21
20-22
Femur Head
Greater trochanter
Lesser trochanter
Lower end
1
4
12-14
At birth
- 17-18
17-18
17-18
18-19
Tibia Upper end
Lower end
At birth
1
- 18-19
16-17
Fibula Upper end
Lower end
4
1
- 18-19
16-17 28

29. 29

30. 30

31. BONE
(foot)
OSSIFICATION
CENTRE
APPEARANCE CONJOINT
EPIPHYSIS
FUSION/UNI
ON
Tarsal
bones
Primary
Calcaneum
Talus
cuboid
5th m of iul
7th
9th
- -
Calcaneum
Lateral cunieform
Medial cuniefoem
Middle cunieform
Navicular
6-8 yrs
1
2
3
3
- -
Phalanges Proximal phalanges 2-4 - 17-20
Metatarpals 3-4 - 17-20
Middle phalanges 3-6 - 18
Distal phalanges 6 -
18
31

32. 32

33. Conclusions:
• Multiple criteria have to be employed.
Opinion should be based on physical,
dental and radiological examination of
individual.
• It is advisable to give a range for the
age.
• There is a need for further research in
this field.
33

34. 34
THANK YOU

35. Elbow joint
• Secondary ossification Centres : (3 bones; 6 Ocs)
Capitulum (C) - appearance - 1 year of life
Head of Radius (R)– appearance -4 to 5 years
Medial Epicondyle (ME)
Appearance – 5 to 6 years
Fusion – 16 to 17 years
Trochlea (T) – appearance – 9 to 11 years
Olecranon Process of Ulna (OP)
Appearance - 8 to 9 years
Fusion- 16-17 years
Lateral Epicondyle(LE) – 11 to 12 years
Conjoint (Composite)Epiphysis (CE) [fusion of C+T+LE]
Formation – 14 to 16 years
Fusion – 16-17 years
Note: Fusion of O.Centres at elbow joint is 16-17 years in male, 15-16 years in female
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36. ELBOW JOINT
All OCs Appeared and fused (>16-17 years)
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37. No OC has appeared (< 1 year)
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38. Only Capitulum appeared (> 1 year)
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