The age of the subject at death is usually more important than the stature and rivals the sex as the most vital indication TABLE3.7 Pearson’s (1899) regression tables for calculating stature
from dried long bones
S81.3061.880 Femur S72.8441.945 Femur S70.6512.894 Humerus S71.4752.754 Humerus S78.6643.378 Tibia S74.7742.352 Tibia S85.9253.271 Radius S81.2243.343 Radius S71.2721.159 (FT) S69.1541.126 (FT) S71.4411.220 F1.080 T S69.5611.117 F1.125 T S66.8551.730 (HR) S69.9111.628 (HR) S69.7882.769 H0.1958 S70.5422.582 H0.2818 S68.3971.030 F1.557 H S67.4351.339 F1.027 H S67.0490.913 F0.600 T S67.4670.782 F1.120 T
TABLE3.8 Dupertuis and Hadden’s (1951) tables for estimating stature from bones. The length of the bones (measured in centimetres according to the authors’ criteria) is multiplied by the factor in the table and added to the constant in the right hand column to give the body length (cm)
Men cm Women cm
2.238 (Femur) 69.089 2.317 (Femur) 61.412
2.392 (Tibia) 81.688 2.533 (Tibia) 72.572
2.970 (Humerus) 73.570 3.144 (Humerus) 64.977
3.650 (Radius) 80.405 3.876 (Radius) 73.502
1.225 (FemurTibia) 69.294 1.233 (FemurTibia) 65.213
1.728 (HumerusRadius) 71.429 1.984 (HumerusRadius) 55.729
1.422 (Femur)1.062 (Tibia) 66.544 1.657 (Femur)0.879 (Tibia) 59.259 1.789 (Humerus)1.841 (Radius) 66.400 2.164 (Humerus)1.525 (Radius) 60.344 1.928 (Femur) 0.568 (Humerus) 64.505 2.009 (Femur)0.566 (Humerus) 57.600
1.442 (Femur)0.931 (Tibia) 1.544 (Femur)0.764 (Tibia)
0.083 (Humerus)0.480 (Radius) 56.006 0.126 (Humerus)0.295 (Radius) 57.495
TABLE3.9 Telkkä’s table for calculating stature of Finnish men and women
Men SE Women SE
169.42.8 (Humerus32.9) 5.0 156.82.7 (Humerus30.7) 3.9 169.43.4 (Radius22.7) 5.0 156.83.1 (Radius20.8) 4.5 169.43.2 (Ulna23.1) 5.2 156.83.3 (Ulna21.3) 4.4 169.42.1 (Femur45.5) 4.9 156.81.8 (Femur41.8) 4.0 169.42.1 (Tibia36.6) 4.6 156.81.9 (Tibia33.1) 4.6 169.42.5 (Fibula36.1) 4.4 156.82.3 (Fibula32.7) 4.5
of identity. The estimation of skeletal age falls into various groups, which have marked differences in both method and accuracy. In general, the greater the personal age the less the confidence quotient. There are many publications on the subject, many of them arising from archaeological rather than forensic interest, as the age structure of a skeletal population is of great interest to social anthropologists and historians.
The fetus and young infant
It is more usual to have to estimate fetal and neonatal age on the intact dead body, rather than the skeleton, as the immature bones are so easily dispersed, lost and destroyed compared to the more robust bones of older subjects. Both in archaeology and forensic pathology, however, such fetal and immature remains are sometimes present.
The major dating indices are the appearance of ossifica- tion centres in growing cartilage but, as stated above, these are rarely available in dried bones as the cartilage disinte- grates within weeks or months and small ossification centres – both in diaphyses and epiphyses – rarely survive. The bones have to be examined with the cartilage still attached to offer much hope of ageing the remains. Radiology may provide more information than visual inspection.
Specialized books such as the classics by Fazekas and Kosa, Krogman and Iscan, and by Stewart and the numerous papers and monographs on the subject (a selection of which are listed at the end of this chapter) must be consulted where fetal issues are complex and important. Once again the help of interested anatomists and radiologists can be invaluable, especially as biological variation poses a constant trap for the inexperienced who slavishly follow printed tables without the knowledge to appreciate their limitations. Stewart has
Estimating the subject’s age from skeletal structures
Osteometric board
FIGURE3.14 Osteometric board for accurate measurement of bone length. There is a central slot in the headboard to accommodate the tibial head spines.
Femur (anterior upwards)
Medial condyle
Medial malleouls Tibia
Lateral condyle
Radius (posterior upwards) Humerus
Styloid
FIGURE3.15 Dimensions of dried bones for estimations of stature (Trotter and Gleser, Dupertuis and Hadden). The right side bone is used for preference. Femur:With the bone lying anterior surface upwards, the maximum length is measured from the medial condyle to the most proximal part of the head. Tibia:Maximum length between tip of medial malleolus and face of lateral condyle. The intercondylar eminence is not included. Humerus:Maximum overall length from the posterior margin of the trochlea to the upper edge of the head. Radius:From the tip of the styloid process to the head, lying with the posterior surface upwards. All bones should be measured either with an osteometric board or, if one is not available, on a flat bench with the maximum lengths taken between two vertical, parallel boards placed in contact with the bone ends. If the bones are not dry, but have articular cartilage in place, the following should be subtracted from the measured length before applying the formulae (Boyd and Trevor): radius and humerus 3 mm each, tibia 5 mm and femur 7 mm.
produced a useful nomogram that relates fetal femoral length to crown–rump length and hence to approximate gestational age. Teeth are discussed in Chapter 26. Fazeka and Kosa’s book is particularly useful to the pathologist (as bone lengths, etc. are directly related to fetal and infant age), as are the pro- fuse illustrations.
Skeletal age in the child and young adult
There is no break in the methods used for the fetus and small infant and the older child and young adult.
The appearance of ossification centres is complete by around 5 years and after this stage the fusion of epiphyses acts as a calendar up to the age of about 25, when the medial clavicular epiphysis is usually the last evidence of such fusion.
Lists and diagrams such as those shown here are the usual method of tracing the maturity of the skeleton.
Several cautionary points must be appreciated and where possible the advice of a radiologist be obtained if there are important issues at stake. The paper by McKern and Stewart gives a valuable commentary on personal variation in skeletal age determination (Table 3.10).
■ Maturity is not synonymous with calendar age. There are both sexual, racial, nutritional and other biological variations.
■ Females are almost always in advance of males, and maturity tends to be accelerated in hotter climates, though the latter may be tempered by nutritional disadvantages.
■ There is a marked range of closure dates in epiphyseal union, and the year suggested in some charts is merely the midpoint of that range.
■ Union is a process, not an event. It may be different radiologically from gross inspection; it may also be slow in completion, so that it may be difficult to pinpoint a date that is needed to refer to published data. An example is the one that is usually the last to fuse, the medial end of the clavicle, which may slowly close during any period from about 18 to 31 years. Finally, as emphasized by Krogman and Iscan, multiple criteria of skeletal age should be used, dependence not being placed upon any single measurement.
Skeletal ageing in later years
The eruption of the third molar teeth and the fusion of the last epiphysis occurs approximately in the middle of the third decade. This is a watershed in skeletal dating, as the more objective markers of age are almost all on the younger side of
this time. From around 25 years until old age, there are no dramatic events such as tooth eruption or the appearance of ossification centres. There are more subtle changes available for specialized interpretation, but the general decline through middle age to senility prevents assessment of age to within the nearest half-decade.
The major advances in this difficult period have been the use of the pubic symphysis and sternal ribs and the radiology of cancellous bone. However, dental technology may further refine the assessment of age.
Pubic symphysis and age
The opposing faces of the two pubic bones have been extensively studied by Todd (1920, 1921), by McKern and Stewart (1957) and by Gilbert and McKern (1973), who related the changing topography of the symphyseal faces to age. The technique is complex and requires bones that are free of cartilage, but not so eroded by drying and damage that the surface features are blurred.
ASSESSMENTOF AGE FROM THE MALE PUBIC SYMPHYSIS
As always, the details given in the original publications should be studied and practice gained by examining bones of known age. The method as originally devised by Todd has been radically modified by McKern and Stewart so that the technique is now the most useful in assessing the age of post-mature material. It must be noted that their method applies only to males and was not applied to female mater- ial until the work of Gilbert and McKern.
In summary, the face of the symphysis is analysed by reference to three ‘components’, each being scored on a scale of 6. In component I, the dorsal half of the face is assessed on a scale of 0–5; in component II, the ventral half is assessed; and in component III, the whole surface is con- sidered in relation to different criteria to the preceding two stages.
Component I (the dorsal plateau) is scored as follows:
■ 0: dorsal margin absent
■ 1: slight margin formation appears in the middle third of the dorsal border
■ 2: dorsal margin extends along whole dorsal border
■ 3: grooves filled in with resorption of ridges to form an early plateau in the middle third of the dorsal demiface
■ 4: te plateau, still with vestiges of billowing, extends over most of the dorsal demiface
■ 5: billowing vanishes and the surface of the demiface becomes flat and slightly granular.
Estimating the subject’s age from skeletal structures
TABLE3.10 Time of appearance of major ossification centres (a) Healthy Caucasian boys
(b) Healthy Caucasian girls
After Francis and Werle (1939).
Birth Calcaneus Talus Femur, distal Tibia, proximal Cuboid Humerus, head 2 months Capitate Hamate Lateral cuneiform 3 months Femur, head Capitulum Tibia, distal 6 months Fibula, distal 7 months
Humerus, greater tuberosity Radius, distal
10 months Triquetrum 11 months
Third finger–first phalanx First toe–second phalanx
12 months
Second finger–first phalanx Fourth finger–first phalanx First finger–second phalanx 13 months
Third toe–first phalanx Second metacarpal Medial cuneiform 14 months
Fourth toe–first phalanx Second toe–first phalanx Fifth toe–second phalanx 15 months
Third metacarpal
Second toe–second phalanx Fifth finger–first phalanx 16 months
Fourth toe second phalanx Fourth metacarpal 18 months
Second finger–second phalanx Third finger–second phalanx Fourth finger–second phalanx Fifth metacarpal
20 months First toe–first phalanx Middle cuneiform 21 months
Third finger–third phalanx Fourth finger–third phalanx Navicular of foot Fifth toe–first phalanx 22 months First metacarpal First metatarsal 23 months
First finger–first phalanx 2 years
Fifth finger–second phalanx Lunate
2 years, 2 months Second metatarsal 2 years, 5 months Second finger–third phalanx Fifth finger–third phalanx 2 years, 11 months Third metatarsal Fibula, proximal
3 years, 1 month Femur, great trochanter Patella
3 years, 3 months Fourth metatarsal 3 years, 4 months Fifth toe–third phalanx 3 years, 7 months Third toe–third phalanx Fourth toe–third phalanx 3 years, 8 months Fifth metatarsal
Second finger–third phalanx 3 years, 10 months Radius, proximal 4 years, 2 months Multangulate majus 4 years, 4 months Navicular, hand 4 years, 8 months Multangulate minus 5 years
Humerus, medial epicond Ulna, distal
Fifth toe–second phalanx
Birth Calcaneus Talus Femur, distal Tibia, proximal Cuboid Humerus, head 2 months Capitate Hamate Lateral cuneiform 3 months Femur, head Capitulum Tibia, distal 4 months
Humerus, greater tuberosity 6 months
Fibula, distal Radius, distal 7 months
First toe–second phalanx Third finger–first phalanx Fourth finger–first phalanx
8 months
Second finger–first phalanx First finger–second phalanx Third toe–first phalanx 9 months
Third toe–second phalanx Fourth toe–first phalanx Medial cuneiform 10 months Second metacarpal Second toe–second phalanx Fourth toe–second phalanx Third metacarpal Second toe–first phalanx Triquetrum
11 months Fourth metacarpal Fifth finger–first phalanx 12 months
Fourth finger–second phalanx Third finger–second phalanx 13 months
Fifth metacarpal
Second finger–second phalanx
14 months First metacarpal First toe–first phalanx Fifth finger–first phalanx Third finger–third phalanx Fourth finger–third phalanx Navicular of foot Middle cuneiform First metatarsal 15months
First finger–first phalanx Fifth finger–second phalanx 17 months
Second finger–third phalanx Fifth finger–third phalanx 19 months
Second metatarsal 21 months
Fifth toe–third phalanx 22 months
Third metatarsal 23 months Patella
2 years Lunate
Third toe–third phalanx Fourth toe–third phalanx Fibula, proximal Femur, greater trochanter 2 years, 2 months Second toe–third phalanx Fourth metatarsal 2 years, 5 months Fifth metatarsal 2 years, 8 months Multangulate majus 2 years, 9 months Humerus, medial epicon 3 years
Radius, proximal Multangulate minus 3 years, 2 months Navicular, hand 4 years, 6 months Ulna, distal 5 years
Fifth toe–second phalanx
Component II (the ventral rampart) is scored as follows:
■ 0: no ventral bevelling
■ 1: ventral bevelling only at the superior end of the ventral border
■ 2: bevelling extends along whole ventral border
■ 3: ventral rampant starts as bony extensions from either or both extremities
■ 4: extensive rampart, but still gaps, especially on the upper two thirds of the ventral border
■ 5: complete ventral rampart.
Component III (symphyseal rim) is scored as follows:
■ 0: no symphyseal rim
■ 1: partial dorsal rim visible, usually at the upper end of the border; it is round, smooth and elevated above the surface
■ 2: complete dorsal rim with beginnings of ventral rim, which starts at no particular site
■ 3: complete circumferential symphyseal rim, enclosing a finely grained, slightly undulating surface
■ 4: the rim begins to break down, no longer smooth but sharply defined. Some lipping on ventral edge
■ 5: further breakdown of rim, especially along superior ventral edge. Rarefaction of symphyseal face.
Disintegration and erratic ossification of ventral rim.
In practice, a three-figure score is made from evaluation of each component and added together. For example, com- ponent I3, component II4, component III1. Thus the score is 3418 and by reference to the tables, the age suggested is between 24 and 28.
Since the work of Gilbert and McKern, a method has been offered to assess age in both males and females. Stewart has pointed out that, although Todd felt that the same criteria could be applied to females, there was risk of overestimation of age in women because pelvic trauma during parturition could deform the dorsal border of the symphysis in a manner likely to mimic age changes.
The other limitation of the method is that the upper limit is 50 years, so that a large segment of the range is not considered. Also the scoring is naturally subjective, depend- ing on the experience and training of the observer. In spite of these drawbacks, the method remains the most useful ageing technique for post-mature males.
Gilbert and McKern established standards for females in 1973. The same three components are used, but the description of the symphyseal faces is different. Details must be sought in the original publications or in Krogman and Iscan’s invaluable book. Gilbert concluded that, if the male criteria were used for females, the age assessment would be underestimated by about a decade, as the female pubis reaches full maturity about 10 years later than the male.
Several tests of the accuracy of this method have been made by Suchey (1979) and Meindl et al.(1985). There have been many reports on the subject, but it would seem that Todd’s system remains the most accurate. Overall accuracy obtained by experienced observers lies in the range of 5–7 years around the true age.
The sternal rib methods
The costochondral junction has been studied by a number of physical anthropologists using different techniques.
Michelson (1934) found that calcification in the first costal cartilage did not occur under 11 years and that after 16 years, males calcified much more quickly until 66, when the sexes again became uniform. Iscan and Loth (1986) made detailed studies of the shape of the rib end adjacent to the cartilage and constructed complex criteria for age-related changes. The original publications must be consulted for details as well as more recent developments such as those by Loth, Iscan and Sheuerman (1994).
Skull sutures and age
The use of skull suture fusion as an index of age has had a chequered history, beginning in the first century ADwith a comment by Celsus. It is now generally discredited, except in the most broad terms.
It is common knowledge that most adults have at least part of their suture lines closed and that this tends to become more widespread as age increases. There are many exceptions and the rate of closure is not linear with time. This generality can be useful when skull fragments are found, as any visible fusion will at least indicate that the skull came from a mature individual, as it is unlikely below the age of 20 (Brothwell).
The claims of Dwight (1890), Parsons and Box (1905) and Todd and Lyon (1924, 1925) (who stated that sagittal fusion began at 22 and was complete by 35) for the use of fusion as an ageing tool, have been refuted by Singer (1953), Cobb (1952), McKern and Stewart (1957) and Genovés and Messmacher (1959). McKern and Stewart found that 25 per cent of 18-year-old males had begun closure of their sagittal sutures and that by 31–40 years, 90 per cent had some fusion. Yet many had no fusion at considerably older ages.
Since these criticisms were made, much further work has been carried out, recorded by Krogman and Iscan’s book in its 1986 edition. They concluded from the accumulated evi- dence of many publications that suture closure is not affected by sex, race or right/left differences. Only endocranial fusion must be studied, as that on the outer side is far more erratic.
Even so, determination of age from suture closure is unsafe:
they feel that in the 20–50 age range, it may be possible to
place a skull within the correct decade only, older material being even more variable.
The basisphenoid synchondrosis cannot be included in this class, as its fusion is a relatively reliable indicator of a minimum age of about 20 years. The metopic suture, between the two halves of the frontal bone, usually closes at about 2 years of age, but occasionally persists into adult life.
Radiology can also assist in the determination of age, from the internal structure of the cancellous bone and cortical thickness of the head of the humerus, for example.
Schranz (1959) developed a combination of external visual examination and radiographic features, indicating that the head of the humerus was a better determinator than the corresponding part of the femur. He produced a list of criteria that helped to age a skeleton from about 15 years of age up to one in excess of 75. This was pursued by Nemeskeri and later by him in conjunction with Acsadi (Acsadi and Nemeskeri 1970), to include the proximal parts of both humerus and femur, taking into account the radiological thinning of the cortex and the progressive rarefaction of the apex of the medullary cavity in the head of the bone. The original papers or their full synopsis in Krogman and Iscan’s book must be consulted for details.
Histological structure has also received attention and remodelling of Haversion systems seem potentially useful
Estimating the subject’s age from skeletal structures
23–28 18–21
14–17
Approximate dates (years) of epiphyseal union 15–17
16–19 16–19
16–21 17–19
17–20 18–21 16–19
18–22 14–17 13–16 15–17
16–23
FIGURE3.16 A guide to the age of epiphyseal union in the major centres. The commencement and completion of union takes several years. The table is only a guide for male subjects (female slightly earlier) in non-tropical climates; the two dates are partial and complete union (years).
Head of femur 16–19 Acromion 17–19
Greater trochanter 16–19 Distal femur 17–20
Lesser trochanter 16–19 Proximal tibia 17–19 Head of humerus 16–23 Proximal fibula 16–21 Distal humerus 13–16 Distal tibia 16–19 Medial epicondyle 16–17 Distal fibula 16–19 Proximal radius 14–17 Metatarsals 15–17
Proximal ulna 14–17 Iliac crest 18–22
Distal radius 18–21 Primary elements pelvis 14–16 Distal ulna 18–21 Sternal clavicle 23–28 Metacarpals 14–17 Acromial clavicle 18–21
FIGURE3.17 The interpretation of cranial suture closure as an index of age is fraught with error. This person was 23 of age and, as would be generally expected, no segments of fusion are shown on the exterior of the skull.