International Journal of Legal Medicine

, Volume 124, Issue 2, pp 149–154 | Cite as

Forensic age estimation in living subjects based on the ossification status of the medial clavicular epiphysis as revealed by thin-slice multidetector computed tomography

  • Manuel Kellinghaus
  • Ronald Schulz
  • Volker Vieth
  • Sven Schmidt
  • Andreas Schmeling
Original Article


Determination of the stage of ossification of the medial clavicular epiphysis is a crucial part of age estimation in criminal proceedings when evaluating individuals with completed hand ossification. In order to ensure a maximum of accuracy in forensic age estimation practise, it is recommended to perform thin-slice CT scans; but to date there exist no reference data on the bone development of the region in question based on thin-slice computed tomography. In this retrospective study, the authors evaluated thin-slice multidetector CT images of 592 individuals aged between 10 and 35 years produced in the University Hospital of Münster. The ossification status of the medial epiphysis of the clavicle could be reliably determined in 502 cases using the classification of stages by Schmeling et al. In male individuals, stage 2 was first noted at age 14, in female individuals at age 13. Stage 3 was first achieved by male individuals at age 17, by female individuals at age 16. The occurrence of stage 4 was first found in both sexes at the age of 21. In either sex, the earliest observation of stage 5 was at age 26. The findings are basically in line with those from the only CT-based study on the subject in question using the same classification of five stages, except from the fact that in the present study, stage 5 first occurs at age 26, which is 4 or 5 years later than what was found in the CT study using 7 mm slices in the majority of cases. This vast difference may be explained through the partial volume effect occurring with thick-slice CT images by a visual deception of the epiphyseal scar occurring with stage 4.


Forensic age diagnosis Skeletal age Ossification Clavicle Computed tomography 


  1. 1.
    Cameriere R, Ferrante L, De Angelis D, Scarpino F, Galli F (2008) The comparison between measurement of open apices of third molars and Demirjian stages to test chronological age of over 18 year olds in living subjects. Int J Legal Med 122:493–497CrossRefPubMedGoogle Scholar
  2. 2.
    Knell B, Ruhstaller P, Prieels F, Schmeling A (2009) Dental age diagnostics by means of radiographical evaluation of the growth stages of lower wisdom teeth. Int J Legal Med 123:465–469Google Scholar
  3. 3.
    Landa MI, Garamendi PM, Botella MC, Alemán I (2009) Application of the method of Kvaal et al. to digital orthopantomograms. Int J Legal Med 123:123–128CrossRefPubMedGoogle Scholar
  4. 4.
    Quirmbach F, Ramsthaler F, Verhoff MA (2009) Evaluation of the ossification of the medial clavicular epiphysis with a digital ultrasonic system to determine the age threshold of 21 years. Int J Legal Med 123:241–245Google Scholar
  5. 5.
    Ramsthaler F, Proschek P, Betz W, Verhoff MA (2009) How reliable are the risk estimates for X-ray examinations in forensic age estimations? A safety update. Int J Legal Med 123:199–204CrossRefPubMedGoogle Scholar
  6. 6.
    Schmeling A, Grundmann C, Fuhrmann A, Kaatsch H-J, Knell B, Ramsthaler F, Reisinger W, Riepert T, Ritz-Timme S, Rösing FW, Rötzscher K, Geserick G (2008) Criteria for age estimation in living individuals. Int J Legal Med 122:457–460CrossRefPubMedGoogle Scholar
  7. 7.
    Schmidt S, Baumann U, Schulz R, Reisinger W, Schmeling A (2008) Study of age dependence of epiphyseal ossification of the hand skeleton. Int J Legal Med 122:51–54CrossRefPubMedGoogle Scholar
  8. 8.
    Schmidt S, Nitz I, Schulz R, Schmeling A (2008) Applicability of the skeletal age determination method of Tanner and Whitehouse for forensic age diagnostics. Int J Legal Med 122:309–314CrossRefPubMedGoogle Scholar
  9. 9.
    Schulz R, Mühler M, Reisinger W, Schmidt S, Schmeling A (2008) Radiographic staging of ossification of the medial clavicular epiphysis. Int J Legal Med 122:55–58CrossRefPubMedGoogle Scholar
  10. 10.
    Schulz R, Zwiesigk P, Schiborr M, Schmidt S, Schmeling A (2008) Ultrasound studies on the time course of clavicular ossification. Int J Legal Med 122:163–167CrossRefPubMedGoogle Scholar
  11. 11.
    Thevissen PW, Fieuws S, Willems G (2009) Human dental age estimation using third molar developmental stages: does a Bayesian approach outperform regression models to discriminate between juveniles and adults? Int J Legal Med [Epub ahead of print]Google Scholar
  12. 12.
    Kreitner K-F, Schweden F, Schild HH, Riepert T, Nafe B (1997) Die computertomographisch bestimmte Ausreifung der medialen Klavikulaepiphyse-Eine additive Methode zur Altersbestimmung im Adoleszentenalter und in der dritten Lebensdekade? Fortschr Röntgenstr 166:481–486CrossRefGoogle Scholar
  13. 13.
    Kreitner K-F, Schweden FJ, Riepert T, Nafe B, Thelen M (1998) Bone age determination based on the study of the medial extremity of the clavicle. Eur Radiol 8:1116–1122CrossRefPubMedGoogle Scholar
  14. 14.
    Schulz R, Mühler M, Mutze S, Schmidt S, Reisinger W, Schmeling A (2005) Studies on the time frame for ossification of the medial epiphysis of the clavicle as revealed by CT scans. Int J Legal Med 119:142–145CrossRefPubMedGoogle Scholar
  15. 15.
    Schmeling A, Schulz R, Reisinger W, Mühler M, Wernecke K-D, Geserick G (2004) Studies on the time frame for ossification of medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 118:5–8CrossRefPubMedGoogle Scholar
  16. 16.
    Mühler M, Schulz R, Schmidt S, Schmeling A, Reisinger W (2006) The influence of slice thickness on assessment of clavicle ossification in forensic age diagnostics. Int J Legal Med 120:15–17CrossRefPubMedGoogle Scholar
  17. 17.
    Black SM, Scheuer JL (1996) Age changes in the clavicle: from the early neonatal period to skeletal maturity. Int J Osteoarcheol 6:425–434CrossRefGoogle Scholar
  18. 18.
    Ji L, Terazawa K, Tsukamoto T, Haga K (1994) Estimation of age from epiphyseal union degrees of the sternal end of the clavicle. Hokkaido Igaku Zasshi 69:104–111PubMedGoogle Scholar
  19. 19.
    MacLaughlin SM (1990) Epiphyseal fusion at the sternal end of the clavicle in a modern Portuguese skeletal sample. Antropol Port 8:59–68Google Scholar
  20. 20.
    McKern TW, Stewart TD (1957) Skeletal age changes in young American males analysed from the standpoint of age identification. In: Technical report EP 45. Quartermaster Research and Development Center, Environmental Protection Research Division. Natick, Massachusetts, pp 89-97 Google Scholar
  21. 21.
    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 68:457–466CrossRefGoogle Scholar
  22. 22.
    Stevenson PH (1924) Age order of epiphyseal union in man. Am J Phys Anthropol 7:53–93CrossRefGoogle Scholar
  23. 23.
    Todd TW, D'Errico J (1928) The clavicular epiphyses. Am J Anat 41:25–50CrossRefGoogle Scholar
  24. 24.
    Flecker H (1933) Roentgenographic observations of the times of appearance of epiphyses and their fusion with the diaphyses. J Anat 67:118–164Google Scholar
  25. 25.
    Galstaun G (1937) A study of ossification as observed in Indian subjects. Indian J Med Res 25:267–324Google Scholar
  26. 26.
    Jit I, Kullkarni M (1976) Times of appearance and fusion of epiphysis at the medial end of the clavicle. Indian J Med Res 64:773–782PubMedGoogle Scholar
  27. 27.
    Schulze D, Rother U, Fuhrmann A, Richel S, Faulmann G, Heiland M (2006) Correlation of age and ossification of the medial clavicular epiphysis using computed tomography. Forensic Sci Int 158:184–189CrossRefPubMedGoogle Scholar
  28. 28.
    Schmidt S, Mühler M, Schmeling A, Reisinger W, Schulz R (2007) Magnetic resonance imaging of the clavicular ossification. Int J Legal Med 121:321–324CrossRefPubMedGoogle Scholar
  29. 29.
    Schmeling A, Reisinger W, Loreck D, Vendura K, Markus W, Geserick G (2000) Effects of ethnicity on skeletal maturation - consequences for forensic age estimations. Int J Legal Med 113:253–258CrossRefPubMedGoogle Scholar
  30. 30.
    Schmeling A, Schulz R, Danner B, Rösing FW (2006) The impact of economic progress and modernization in medicine on the ossification of hand and wrist. Int J Legal Med 120:121–126CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Manuel Kellinghaus
    • 1
  • Ronald Schulz
    • 1
  • Volker Vieth
    • 2
  • Sven Schmidt
    • 3
  • Andreas Schmeling
    • 1
  1. 1.Institut für RechtsmedizinMünsterGermany
  2. 2.Institut für Klinische RadiologieUniversitätsklinikum MünsterMünsterGermany
  3. 3.Institut für RechtsmedizinCharité—Universitätsmedizin BerlinBerlinGermany

Personalised recommendations