Advertisement

International Journal of Legal Medicine

, Volume 132, Issue 2, pp 629–636 | Cite as

Intraindividual incongruences of medially ossifying clavicles in borderline adults as seen from thin-slice CT studies of 2595 male persons

  • Ernst Rudolf
  • Josef Kramer
  • Sven Schmidt
  • Volker Vieth
  • Ingomar Winkler
  • Andreas Schmeling
Original Article

Abstract

In the past, numerous studies have documented the possibility of intraindividual differing appearances of the paired age-marker “medial clavicular ossification” in borderline adults. However, the extent of the divergences is rarely mentioned. Against that the article describes this phenomenon from a large sample of 2595 male persons by means of thin-slice CT imaging of the sternoclavicular regions. For determining the ossification stage of the medial clavicles, the two accepted classifications by Schmeling et al. (five main stages) and Kellinghaus et al. (six substages) were applied and buildings deviating from that labelled as atypical “norm variants”. The longstanding observation could be confirmed that intraindividual stage discrepancies of this age indicator are generally moderate and do not exceed one main stage or two substages of the respective classifications. It is concluded that stage determination should be scrutinized, if a dissimilarity seems to show larger differences.

Keywords

Medical age assessment Medial clavicular ossification Intraindividual incongruence 

References

  1. 1.
    Asylum procedure directive 2013/32/EU (26.06.2013): http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32013L0032&from=en
  2. 2.
  3. 3.
    Rudolf E (2016) Medical age assessment in the case of a ‘doubtful’ claim to being an unaccompanied minor as set forth in Article 25 para 5 sentences one to three Asylum Procedures Directive 2013. EMN-Conference The Establishment of Identity in the Migration Process, Conference Report, 50ff. http://www.emn.at/wp-content/uploads/2017/01/EMN-Tagungsbericht_web.pdf
  4. 4.
    United Nations (20.11.1989) Convention on the Rights of the Child: http://www.ohchr.org/EN/ProfessionalInterest/Pages/CRC.aspx
  5. 5.
    Schmeling A, Dettmeyer R, Rudolf E et al (2016) Forensic age estimation: methods, certainty, and the law. Dtsch Arztebl Int 113(4):44ff.  https://doi.org/10.3238/arztebl.2016.0044 https://www.aerzteblatt.de/pdf.asp?id=173619 Google Scholar
  6. 6.
    Schmeling A, Grundmann C, Fuhrmann A et al (2008) Criteria for age estimation in living individuals. Int J Legal Med 122(6):457ff.  https://doi.org/10.1007/s00414-008-0254-2 CrossRefGoogle Scholar
  7. 7.
    Wittschieber D, Ottow C, Vieth V et al (2015) Projection radiography of the clavicle: still recommendable for forensic age diagnostics in living individuals? Int J Legal Med 129(1):187ff.  https://doi.org/10.1007/s00414-014-1067-0 CrossRefGoogle Scholar
  8. 8.
    Buckley MB, Clark KR (2017) Forensic age estimation using the medial clavicular epiphysis: a study review. Radiol Technol 88(5):482ffGoogle Scholar
  9. 9.
    Scharte P, Vieth V, Schulz R et al (2017) Comparison of imaging planes during CT-based evaluation of clavicular ossification: a multi-center study. Int J Legal Med 131(5):1391ff.  https://doi.org/10.1007/s00414-017-1615-5 CrossRefGoogle Scholar
  10. 10.
    Schmeling A, Schmidt S, Schulz R et al (2014) Studienlage zum zeitlichen Verlauf der Schlüsselbeinossifikation. Rechtsmedizin 24(6):467ff.  https://doi.org/10.1007/s00194-014-0989-7 CrossRefGoogle Scholar
  11. 11.
    Schmeling A, Schulz R, Reisinger W et al (2004) Studies on the time frame for ossification of the medial clavicular epiphyseal cartilage in conventional radiography. Int J Legal Med 118(1):5ff.  https://doi.org/10.1007/s00414-003-0404-5 CrossRefGoogle Scholar
  12. 12.
    Schmidt S, Ottow C, Pfeiffer H et al (2017) Magnetic resonance imaging-based evaluation of ossification of the medial clavicular epiphysis in forensic age assessment. Int J Legal Med.  https://doi.org/10.1007/s00414-017-1676-5
  13. 13.
    Schulz R, Schiborr M, Pfeiffer H et al (2013) Sonographic assessment of the ossification of the medial clavicular epiphysis in 616 individuals. Forensic Sci Med Pathol 9(3):351ff.  https://doi.org/10.1007/s12024-013-9440-8 CrossRefGoogle Scholar
  14. 14.
    Vieth V, Schulz R, Brinkmeier P et al (2014) Age estimation in U-20 football players using 3.0 tesla MRI of the clavicle. Forensic Sci Int 241:118ff.  https://doi.org/10.1016/j.forsciint.2014.05.008 CrossRefGoogle Scholar
  15. 15.
    Wittschieber D, Schulz R, Pfeiffer H et al (2017) Systematic procedure for identifying the five main ossification stages of the medial clavicular epiphysis using computed tomography: a practical proposal for forensic age diagnostics. Int J Legal Med 131(1):217ff.  https://doi.org/10.1007/s00414-016-1444-y CrossRefGoogle Scholar
  16. 16.
    Wittschieber D, Ottow C, Schulz R et al (2016) Forensic age diagnostics using projection radiography of the clavicle: a prospective multi-center validation study. Int J Legal Med 130(1):213ff.  https://doi.org/10.1007/s00414-015-1285-0 CrossRefGoogle Scholar
  17. 17.
    Wittschieber D, Schulz R, Vieth V et al (2014) Influence of the examiner’s qualification and sources of error during stage determination of the medial clavicular epiphysis by means of computed tomography. Int J Legal Med 128(1):183ff.  https://doi.org/10.1007/s00414-013-0932-6 CrossRefGoogle Scholar
  18. 18.
    Wittschieber D, Schmidt S, Vieth V et al (2014) Subclassification of clavicular substage 3a is useful for diagnosing the age of 17 years. Rechtsmedizin 24(6):485ff.  https://doi.org/10.1007/s00194-014-0990-1 CrossRefGoogle Scholar
  19. 19.
    Ramadan SU, Gurses MS, Inanir NT et al (2017) Evaluation of the medial clavicular epiphysis according to the Schmeling and Kellinghaus method in living individuals: a retrospective CT study. Legal Med 25:16ff.  https://doi.org/10.1016/j.legalmed.2016.12.012 CrossRefGoogle Scholar
  20. 20.
    Gurses MS, Inanir NT, Soylu E et al (2017) Evaluation of the ossification of the medial clavicle according to the Kellinghaus substage system in identifying the 18-year-old age limit in the estimation of forensic age—is it necessary? Int J Legal Med 131(2):585ff.  https://doi.org/10.1007/s00414-016-1515-0 CrossRefGoogle Scholar
  21. 21.
    Gurses MS, Inanir NT, Gokalp E et al (2016) Evaluation of age estimation in forensic medicine by examination of medial clavicular ossification from thin-slice computed tomography images. Int J Legal Med 130(5):1343ff.  https://doi.org/10.1007/s00414-016-1408-2 CrossRefGoogle Scholar
  22. 22.
    Houpert T, Rérolle C, Saval F et al (2016) Is a CT-scan of the medial clavicle epiphysis a good exam to attest to the 18-year threshold in forensic age estimation? Forensic Sci Int 260:103.e1ff.  https://doi.org/10.1016/j.forsciint.2015.12.007 CrossRefGoogle Scholar
  23. 23.
    Ufuk F, Agladioglu K, Karabulut N (2016) CT evaluation of medial clavicular epiphysis as a method of bone age determination in adolescents and young adults. Diagn Interv Radiol 22(3):241ff.  https://doi.org/10.5152/dir.2016.15355 http://www.dirjournal.org/sayilar/83/buyuk/241-246.pdf CrossRefGoogle Scholar
  24. 24.
    Franklin D, Clavel A (2015) CT evaluation of timing for ossification of the medial clavicular epiphysis in a contemporary Western Australian population. Int J Legal Med 129(3):583ff.  https://doi.org/10.1007/s00414-014-1116-8 CrossRefGoogle Scholar
  25. 25.
    Rudolf E, Kramer J, Gebauer A et al (2015) Standardized medical age assessment of refugees with questionable minority claim—a summary of 591 case studies. Int J Legal Med 129(3):595ff.  https://doi.org/10.1007/s00414-014-1122-x CrossRefGoogle Scholar
  26. 26.
    Pattamapaspong N, Madla C, Mekjaidee K, Namwongprom S (2015) Age estimation of a Thai population based on maturation of the medial clavicular epiphysis using computed tomography. Forensic Sci Int 246:123.e1ff.  https://doi.org/10.1016/j.forsciint.2014.10.044 CrossRefGoogle Scholar
  27. 27.
    El Morsi DA, El-Atta HMA, El-Maadawy M et al (2015) Age estimation from ossification of the medial clavicular epiphysis by computed tomography. Int J Morphol 33(4):1419ff http://www.scielo.cl/pdf/ijmorphol/v33n4/art38.pdf CrossRefGoogle Scholar
  28. 28.
    Zhang K, Chen XG, Zhao H et al (2015) Forensic age estimation using thin-slice multidetector CT of the clavicular epiphyses among adolescent western Chinese. J Forensic Sci 60(3):675ff.  https://doi.org/10.1111/1556-4029.12739 CrossRefGoogle Scholar
  29. 29.
    Wei H, Zhu GY, Lei W et al (2015) Correlation between age and the parameters of medial epiphysis and metaphysis of the clavicle using CT volume rendering images. Forensic Sci Int 244:316.e1ff.  https://doi.org/10.1016/j.forsciint.2014.09.006 Google Scholar
  30. 30.
    Wittschieber et al (2014) The value of sub-stages and thin slices for the assessment of the medial clavicular epiphysis: a prospective multi-center CT study. Forensic Sci Med Pathol 10(2):163ff.  https://doi.org/10.1007/s12024-013-9511-x CrossRefGoogle Scholar
  31. 31.
    Ekizoglu O, Hoçaoglu E, Inci E et al (2015) Forensic age estimation by the Schmeling method: computed tomography analysis of the medial clavicular epiphysis. Int J Legal Med 129(1):203ff.  https://doi.org/10.1007/s00414-014-1121-y CrossRefGoogle Scholar
  32. 32.
    Ekizoglu O, Hoçaoglu E, Inci E et al (2015) Estimation of forensic age using substages of ossification of the medial clavicle in living individuals. Int J Legal Med 129(6):1259ff.  https://doi.org/10.1007/s00414-015-1234-y CrossRefGoogle Scholar
  33. 33.
    El-Gerby KM, Mohammad AS, Gomaa MS (2013) Using thin-slice multidetector computed tomography in forensic age estimation based on the ossification status of the medial clavicular epiphysis among Egyptian subjects. Med J Cairo Univ 81(2):221ff http://erepository.cu.edu.eg/index.php/MJCU/article/view/1371/1343 Google Scholar
  34. 34.
    Bassed RB, Briggs C, Drummer OH (2012) The incidence of asymmetrical left/right skeletal and dental development in an Australian population and the effect of this on forensic age estimations. Int J Legal Med 126(2):251ff.  https://doi.org/10.1007/s00414-011-0621-2 CrossRefGoogle Scholar
  35. 35.
    Bassed RB, Briggs C, Drummer OH, Valenzuela A (2011) Age estimation and the medial clavicular epiphysis: analysis of the age of majority in an Australian population using computed tomography. Forensic Sci Med Pathol 7(2):148ff.  https://doi.org/10.1007/s12024-010-9200-y CrossRefGoogle Scholar
  36. 36.
    Kellinghaus M, Schulz R, Vieth V et al (2010) Enhanced possibilities to make statements on the ossification status of the medial clavicular epiphysis using an amplified staging scheme in evaluating thin-slice CT scans. Int J Legal Med 124(4):321ff.  https://doi.org/10.1007/s00414-010-0448-2 CrossRefGoogle Scholar
  37. 37.
    Kellinghaus M, Schulz R, Vieth V et al (2010) Forensic age estimation in living subjects based on the ossification status of the medial clavicular epiphysis as revealed by thin-slice multidetector computed tomography. Int J Legal Med 124(2):149ff.  https://doi.org/10.1007/s00414-009-0398-8 CrossRefGoogle Scholar
  38. 38.
    Radiation protection directive 2013/59/EURATOM (05.12.2013): https://ec.europa.eu/energy/sites/ener/files/documents/CELEX-32013L0059-EN-TXT.pdf
  39. 39.
    European Asylum Support Office – EASO (2012–2017) Newsletters: https://www.easo.europa.eu/news-events/newsletters-archive
  40. 40.
    European Border and Coast Guard Agency - Frontex (2011–2017) Risk analysis network quarterly reports: http://frontex.europa.eu/publications/
  41. 41.
    Webb O, Suchey M (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 68:457ff.  https://doi.org/10.1002/ajpa.1330680402 http://references.260mb.com/Edad/Webb1985.pdf?i=1 CrossRefGoogle Scholar
  42. 42.
    MacLaughlin SM (1990) Epiphyseal fusion at the sternal end of the clavicle in a modern portuguese skeletal sample. Antropol Port 8:59ff https://digitalis-dsp.uc.pt/bitstream/10316.2/30601/1/AntropologiaPortuguesa8_artigo4.pdf?ln=pt-pt Google Scholar
  43. 43.
    Mays S, Steele J, Ford M (1999) Directional asymmetry in the human clavicle. Int J Osteoarch 9:18ffCrossRefGoogle Scholar
  44. 44.
    Kreitner KF, Schweden FJ, Riepert T et al (1998) Bone age determination based on the study of the medial extremity of the clavicle. Eur Radiol 8(7):1116ff.  https://doi.org/10.1007/s003300050518 CrossRefGoogle Scholar
  45. 45.
    Butting H (2008) Die Computertomographisch ermittelte Ausreifung der medialen Claviculaepiphyse als Untersuchungsmethode der Lebensaltersbestimmung. Thesis Hamburg/Germany: http://ediss.sub.uni-hamburg.de/volltexte/2008/3811/pdf/Diss_Holger_Butting.pdf
  46. 46.
    Schulz R, Mühler M, Mutze S et al (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(3):142ff.  https://doi.org/10.1007/s00414-005-0529-9 CrossRefGoogle Scholar
  47. 47.
    Schulze D, Rother U, Fuhrmann A et al (2006) Correlation of age and ossification of the medial clavicular epiphysis using computed tomography. Forensic Sci Int 158(2–3):184ff.  https://doi.org/10.1016/j.forsciint.2005.05.033 CrossRefGoogle Scholar
  48. 48.
    Tangmose S, Jensen KE, Lynnerup N (2013) Comparative study on developmental stages of the clavicle by postmortem MRI and CT imaging. J Forensic Radiol Imaging 1:102ff.  https://doi.org/10.1016/j.jofri.2013.05.008 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Ernst Rudolf
    • 1
  • Josef Kramer
    • 2
  • Sven Schmidt
    • 3
  • Volker Vieth
    • 4
    • 5
  • Ingomar Winkler
    • 6
  • Andreas Schmeling
    • 3
  1. 1.Attnang-PuchheimAustria
  2. 2.Institute for CT and MRT DiagnosticsLinzAustria
  3. 3.Institute of Legal MedicineUniversity Hospital MünsterMünsterGermany
  4. 4.Department of Clinical RadiologyUniversity Hospital MünsterMünsterGermany
  5. 5.Clinic for Radiology, Klinikum IbbenbürenIbbenbürenGermany
  6. 6.JennersdorfAustria

Personalised recommendations