title: The value of sub-stages and thin slices for the assessment of the medial clavicular epiphysis: a prospective multi-center CT study.
abstract: The clavicle plays an important role for forensic age estimation in living individuals, particularly with regard to the age of majority. The present prospective study aims to evaluate the age-dependent ossification process of the medial clavicular epiphysis in order to establish the clavicular sub-stages introduced in 2010 as well as the advantages and possibilities of thin-slice computed tomography (CT). For this purpose, 0.6 mm thin-slice CT scans of sternoclavicular joints of 572 bodies aged between 10 and 40 years were evaluated by means of two complementary classification systems: a five-stage system and a sub-staging system for the main stages 2 and 3. Assessment was possible in 493 cases. The results for stages 4 and 5 are in line with previous studies that found the ages of 21 years and 26 years, respectively, as minimum ages for these stages. Sub-stage 3c was first found at the age of 19 years in both sexes, thereby corroborating the value of this sub-stage as to statements about the age of majority. In comparison to other CT studies, stage 3a was first observed ~1 year earlier (16.4 years in males and 15.5 years in females). Stage 2c only occurred in 3 cases. In conclusion, the data corroborate the significance of diagnosing sub-stages as well as the value of thin-slice CT. For forensic practice, the concomitant and complementary use of both classification systems applied in this study can be recommended.
authors.affiliation: Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany, daniel.wittschieber@ukmuenster.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wittschieber
authors.forename: Ronald
authors.initials: R
authors.lastname: Schulz
authors.forename: Volker
authors.initials: V
authors.lastname: Vieth
authors.forename: Martin
authors.initials: M
authors.lastname: Küppers
authors.forename: Thomas
authors.initials: T
authors.lastname: Bajanowski
authors.forename: Frank
authors.initials: F
authors.lastname: Ramsthaler
authors.forename: Klaus
authors.initials: K
authors.lastname: Püschel
authors.forename: Heidi
authors.initials: H
authors.lastname: Pfeiffer
authors.forename: Sven
authors.initials: S
authors.lastname: Schmidt
authors.forename: Andreas
authors.initials: A
authors.lastname: Schmeling
mesh_terms: D000293:Adolescent; D000328:Adult; D000365:Age Determination by Skeleton / Q000379:methods*; D002648:Child; D002968:Clavicle / Q000000981:diagnostic imaging* / Q000254:growth & development*; D004838:Epiphyses / Q000000981:diagnostic imaging / Q000254:growth & development; D005260:Female; D018732:Forensic Anthropology; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D010012:Osteogenesis; D011446:Prospective Studies; D054881:Sex Determination by Skeleton / Q000379:methods; D013247:Sternoclavicular Joint / Q000000981:diagnostic imaging / Q000254:growth & development; D055815:Young Adult