title: Systematic procedure for identifying the five main ossification stages of the medial clavicular epiphysis using computed tomography: a practical proposal for forensic age diagnostics.
abstract: In forensic age estimations of living individuals, computed tomography of the clavicle is widely used for determining the age of majority. To this end, the degree of ossification of the medial clavicular epiphysis can be determined by means of two classification systems complementing each other: a 5-stage system and an additional 6-stage system that further sub-classifies the stages 2 and 3. In recent years, practical experience and new data revealed that difficulties and even wrong stage determinations may occur especially when following the short descriptions of the fundamental 5-stage system only. Based on current literature, this article provides a systematic procedure for identifying the five main ossification stages by listing important preconditions and presenting an algorithm that is comprised of four specific questions. Each question is accompanied by comprehensive and detailed descriptions which specify the criteria used for differentiation. The information is subdivided into "single-slice view" and "multi-slice view." In addition, illustrative case examples and schematic drawings facilitate application of the procedure in forensic practice. The pitfalls associated with the criteria of stage determination will be discussed in detail. Eventually, two general rules will be inferred to assign correct ossification stages of the medial clavicular epiphysis by means of computed tomography.
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.affiliation: Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany.
authors.forename: Ronald
authors.initials: R
authors.lastname: Schulz
authors.affiliation: Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany.
authors.forename: Heidi
authors.initials: H
authors.lastname: Pfeiffer
authors.affiliation: Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schmeling
authors.affiliation: Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Schmidt
mesh_terms: D000365:Age Determination by Skeleton / Q000379:methods*; D000465:Algorithms; D002968:Clavicle / Q000000981:diagnostic imaging* / Q000254:growth & development*; D004838:Epiphyses / Q000000981:diagnostic imaging* / Q000254:growth & development*; D018732:Forensic Anthropology; D006801:Humans; D010012:Osteogenesis; D014057:Tomography, X-Ray Computed
keywords: Age estimation; Clavicle; Computed tomography; Forensic age diagnostics; Medial clavicular epiphysis; Ossification stages