The pattern of medical clavicular epiphyseal ossification: preliminary study of a Sri Lankan population

Abstract

Forensic Age Estimation (FAE) in living is required in many civil and criminal circumstances where documentary proof of age is unavailable. In Sri Lanka, 16-21 age range has many statutory age limits. Though international guidelines recommend CT scanning of medial clavicular epiphyses for forensic age estimations within this age range, Sri Lanka does not have any population-specific reference standards for this modality. The objective of this study was to describe the pattern of medial clavicular epiphyseal fusion among Sri Lankans aged 15-30 years. Chest, neck and pulmonary angiography CT scans of patients between 15-30 years performed in two tertiary hospitals were reported independently by two radiologists using the five-stage classification for medial clavicular ossification by Schmeling et al. (2004). Interobserver reliability was assessed using Cohen’s Kappa coefficient. A preliminary descriptive analysis of the first 46 cases was done using SPSS. There were 25 males and 21 females. Majority (80%) were 18 years and above. The oldest with stage 1 was 16 years. The youngest for stages 2 and 3 were both 17 years. Stages 4 and 5 were seen in 67% of cases and none were below 20 years. This trend was similar to previously published studies. From the preliminary results, it appears that only stages 4 and 5 can be used reliably to determine if a person is >18 years. Stages 2 and 3 are likely to indicate that the person is >16 years. Clavicular epiphyseal fusion shows good potential to be a reliable FAE method in Sri Lanka.