Response to commentary on “Radiographic analysis of epiphyseal fusion at knee joint to assess likelihood of having attained 18 years of age”

Abstract

Dear Sir, We would first like to express our thanks for your valuable comments on our recently published article entitled “Radiographic analysis of epiphyseal fusion at knee joint to assess likelihood of having attained 18 years of age”. Second, we are very grateful to you for highlighting some evident errors in the published article. Unfortunately, one of them occurred in the way the figures have been presented. The Figs. 1 and 2 and their captions were inadvertently misplaced in the electronic version of the article. The right order of the figures and their corresponding captions appears as follows: In addition, in regard to the right number of studied subjects, a sample of 99 boys and 116 girls was analysed. The correct Table 1 is also as follows: Last but not least, we would like to answer your comments, to better clarify to readers the importance of this study in the relationship between age and forensic human identification. Regarding the use of a cumulative score for epiphyseal fusion at the knee joint, you state: “...it would have been more interesting and informative to present the scores for each epiphysis individually too as it could have shown the strength of each epiphysis in deciding the cut-off age and to note if any of the three epiphysis at the knee joint in particular shows delay in closure consistently.” From a clinical perspective, we agree that it would be of great interest to know whether there is a definite difference in the time at which the process of each epiphyseal union occurs. The age variation in the union of each separate epiphysis could provide important information aiding age estimation of adolescents and young adults, increasing information available in previously published works. However, such data have already been collected from several populations, by methods ranging from dry bone evaluation to medical imaging [1]. The radiological method also allows researchers to examine epiphyses at various ages in the same individual, but more important still is the facility with which large samples may be examined and accurate average dates arrived at [2]. The earliest appearance of the epiphyseal centre is easy to detect, when it is no bigger than a pinhead: its position can be recorded and its rate and direction of spread observed. Due to those mentioned above, the variation in the time of fusion of various knee bones has long been established. Countable differences have been noted in the appearance and fusion activities of ossification centres, showing that the process may be influenced by several factors such as geographic distribution, sex, nutritional status, infectious disease, hormonal and metabolic disorders and physical activity [2, 3]. Nevertheless, clinical and forensic approaches are based on different perspectives, and any comparison must take this fact into account. While clinical methods focus exclusively on establishing chronological age as accurately as possible, the forensic focus is on evaluating the needs of the individual. A proven identity with confirmation of chronological age is really important, since age determines how an individual will be treated by state authorities. Age defines access to services such as child protection, education and health care during childhood, and benefits, empowerments and citizen entitlements at adulthood, including employment legislation, banking services, driving licences and pensions. Age also often R. Cameriere : S. De Luca : L. Ferrante AgEstimation Project, Institute of Legal Medicine, University of Macerata, Macerata, Italy