A new analytical cut-off point for determining 18 years of age using MRI on medial clavicular epiphysis

Evaluation of the ossification of the medial clavicular epiphysis plays a key role in forensic age estimation. The purpose of the present study was to assess a new numerical cut-off at the age of 18 years, taking into consideration Magnetic Resonance (MR) images of the medial clavicular epiphysis. We analyzed 163 MR scans of Italian subjects aged between 14 and 25 years. Using the data obtained we calculated two ratios: REM-1 (ratio between the length of the whole epiphysis and the length of the metaphysis) and REM-2 (ratio between the length of epiphyseal-metaphyseal fusion and the length of the metaphysis). In 68 out of 163 cases it was not possible to measure REM-2. The reproducibility was demonstrated using the Intraclass Correlation Coefficient (ICC) (Cronbach's alpha > 0.80). REM-1 and REM-2 were compared in each category of age (adult and minor) by the Wilcoxon signed-rank test. The cut-off points for measurements of REM-1 and REM-2 were determined by logistic regression. For REM-1, the cut-off scores were 0.83 for all individuals (accuracy = 94.77%) and males (accuracy = 96.05%), and 0.86 for females (accuracy = 92.30%). For REM-2, the cut-off values were 0.40 for all individuals and males (accuracy = 100.00%), and 0.41 for females (accuracy = 100.00%). Finally, receiver operating characteristic (ROC) curves for age classification based on REM-1 and REM-2 were constructed, showing that REM-2 had the highest discriminative power. Thus, a new cut-off model for predicting the age of majority has been introduced, conducting a quantitative analysis thanks to the use of a high-resolution imaging tool.

Forensic age estimation using conventional radiography of the medial clavicular epiphysis: A systematic review

Of the many roles that forensic anthropologists and medico-legal professionals need to perform, forensic age estimation is one of the most frequent and important. Scoring medial clavicular epiphyseal (MCE) fusion is a method used to estimate age in young adults. The aim of this systematic review is to assess the reliability and reproducibility of MCE fusion visualised by conventional radiography and scored by Schmeling's grading system to determine whether an individual has attained the age of 18 years. Four articles were acquired after screening 4589 articles across four databases, and these were subjected to qualitative and quantitative synthesis. The risk of bias was calculated in the qualitative synthesis using the QUADAS-2 tool. Horizontal box plots were constructed to see whether MCE fusion as visualised by conventional radiography can be used to ascertain whether an individual has attained the age of maturity (18 years). It was observed that stages 4 and 5 of the Schmeling's method of age estimation from MCE fusion are observed only in individuals aged ≥18 years. This indicates that MCE fusion, when visualised using x-rays, which are associated with less ionisation radiation compared to computed tomography, can be used to verify the attainment of the age majority in individuals.

An Anatomic and Radiographic Study of the Distal Tibial Epiphysis

BACKGROUND

Although the undulating shape of the distal tibial epiphysis is well recognized, its anatomic features have not been well quantified in the literature. To guide the placement of surgical implants about the distal tibial physis, we investigated the topographical anatomy of the distal tibial epiphysis and explored the ability of standard radiographs to visualize the physis.

METHODS

We studied 30 cadaveric distal tibial epiphyses in specimens 3 to 14 years of age. Anteroposterior (AP) and lateral radiographs were obtained of each specimen and then repeated after flexible radiopaque markers were placed on the major undulations. All radiographs were analyzed to determine the height or depth of each landmark, and measurements with and without markers for each landmark were compared using intraclass correlation coefficients (ICC). In 9 specimens, similar measurements were obtained on high-resolution 3-dimensional (3D) surface scans.

RESULTS

There were 4 distinct physeal undulations usually present: an anteromedial peak (Kump's bump), a posterolateral peak, an anterior central valley, and a posterior central valley. On the 3D scans, Kump's bump averaged 5.0 mm (range, 3.0 to 6.4 mm), the posterolateral peak 2.4 mm (range, 1.2 to 5.0 mm), the anterior valley 1.3 mm (range, 0 to 3.6 mm), and the posterior valley 0.77 mm (range, 0 to 2.7 mm). Lateral radiographs with markers correlated with measurements from 3D scans better than those without markers (ICC=0.61 vs. 0.24). For AP radiographs, correlation was good to excellent regardless of marker use (ICC=0.76 vs. 0.66).

CONCLUSIONS

There are 4 major undulations of the distal tibial physis. Kump's bump is the largest. A centrally placed epiphyseal screw in the medial/lateral direction or screws from anterolateral to posteromedial and anteromedial to posterolateral would tend to avoid both valleys. Particular caution should be taken when placing metaphyseal screws in the anteromedial or posterolateral distal tibia. Physeal undulations were more difficult to visualize on the lateral view.

CLINICAL RELEVANCE

This study provides quantitative data on the topography of the distal tibial physis to aid hardware placement. Lateral views should be interpreted with caution, as the physeal undulations are not as visible, whereas AP views can be interpreted with more confidence.

Epiphyseal growth plate architecture is unaffected by early postnatal activation of the expression of R992C collagen II mutant

Spondyloepiphyseal dysplasia (SED) exemplifies a group of heritable diseases caused by mutations in collagenous proteins of the skeletal system. Its main feature is altered skeletal growth. Pathomechanisms of SED include: changes in the stability of collagen II molecules, inability to form proper collagen fibrils, excessive intracellular retention of mutant molecules, and endoplasmic reticulum stress. The complexity of this pathomechanism presents a challenge for designing therapies for SED. Our earlier research tested whether such therapies only succeed when applied during a limited window of development. Here, employing an inducible mouse model of SED caused by the R992C mutation in collagen II, we corroborate our earlier observations that a therapy must be applied at the prenatal or early postnatal stages of skeletal growth in order to be successful. Moreover, we demonstrate that blocking the expression of the R992C collagen II mutant at the early prenatal stages leads to long-term positive effects. Although, we could not precisely mark the start of the expression of the mutant, these effects are not significantly changed by switching on the mutant production at the early postnatal stages. By demonstrating the need for early therapeutic interventions, our study provides, for the first time, empirically-based directions for designing effective therapies for SED and, quite likely, for other skeletal dysplasias caused by mutations in key macromolecules of the skeletal system.

Morphology and morphometry of the ulnar head of the pronator teres muscle in relation to median nerve compression at the proximal forearm

INTRODUCTION

The pronator syndrome is a rare compression neuropathy of the median nerve. Ulnar head of the pronator teres muscle may cause compression at proximal forearm.

HYPOTHESIS

Detailed morphologic and morphometric studies on the anatomy of the ulnar head of pronator teres is scarce.

MATERIAL AND METHODS

We dissected 112 forearms of fresh cadavers. We evaluated the morphology and morphometry of the ulnar head of pronator teres muscle.

RESULTS

The average ulnar head width was 16.3±8.2mm. The median nerve passed anterior to the ulnar head at a distance of 50.4±10.7mm from the interepicondylar line. We classified the morphology of the ulnar head into 5 types. In type 1, the ulnar head was fibromuscular in 60 forearms (53.6%). In type 2, it was muscular in 23 forearms (20.5%). In type 3, it was just a fibrotic band in 18 forearms (16.1%). In type 4, it was absent in 9 forearms (8%). In type 5, the ulnar head had two arches in 2 forearms (1.8%). In 80 forearms (71.5%: types 1, 3, and 5), the ulnar head was either fibromuscular or a fibrotic band.

DISCUSSION

Although the pronator syndrome is a rare compression syndrome, the ulnar head of pronator teres is reported as the major cause of entrapment in the majority of the cases. The location of the compression of the median nerve in relation to the ulnar head of pronator teres muscle and the morphology of the ulnar head is important for open or minimally-invasive surgical treatment.

TYPE OF STUDY

Sectional study.

LEVEL OF EVIDENCE

Basic science study.

Anatomical variations of the trochlear notch angle: MRI analysis of 78 elbows

BACKGROUND

Little is known about the anatomical variations of the trochlear notch angle, nor do we know whether the cartilaginous layer modifies the trochlear bony contour. Our aim was to assess the variability of the bony and cartilaginous trochlear notch angles.

MATERIALS AND METHODS

We assessed 78 healthy elbows (39 patients, 19 females and 20 males) with a mean age of 28 years (range 21-32). High-definition MRI coronal scans at the level of the flexion-extension axis were performed. The cartilage thickness, the notch angle, and trochlear width were calculated at the level of the deepest point of the trochlear sulcus, the edge of the lateral and medial ridge. Patient height was used as indirect measurement of humerus length. Pearson correlation and Student's t tests were performed.

RESULTS

Mean cartilage thickness was 1.00 mm (range 0.62-1.83), with significant differences between the medial trochlear ridge and the other landmarks. The notch angle ranged from 124° to 156° (mean 142°) with no differences between the bony and cartilage layers. Trochlear width ranged from 1.57 to 2.75 cm (mean 2.24) and correlated with humerus length. No correlation emerged between the trochlear notch angle, trochlear width, or humerus length. The only significant difference between sexes was the width value, with a wider trochlea in males.

CONCLUSIONS

The trochlear notch angle varies considerably, determining anatomical variations in trochlear shape which ranges from less concave to more concave types. Moreover, the cartilaginous layer does not modify this angle at the level examined. These findings may be relevant to anatomical implant design for distal humerus hemiarthroplasty.

Ossification of the Medial Clavicular Epiphysis on Chest Radiographs: Utility and Diagnostic Accuracy in Identifying Korean Adolescents and Young Adults under the Age of Majority

The aim of our study was to evaluate the utility and diagnostic accuracy of the ossification grade of medial clavicular epiphysis on chest radiographs for identifying Korean adolescents and young adults under the age of majority. Overall, 1,151 patients (age, 16-30) without any systemic disease and who underwent chest radiography were included for ossification grading. Two radiologists independently classified the ossification of the medial clavicular epiphysis from chest radiographs into five grades. The age distribution and inter-observer agreement on the ossification grade were assessed. The diagnostic accuracy of the averaged ossification grades for determining whether the patient is under the age of majority was analyzed by using receiver operating characteristic (ROC) curves. Two separate inexperienced radiologists assessed the ossification grade in a subgroup of the patients after reviewing the detailed descriptions and image atlases developed for ossification grading. The median value of the ossification grades increased with increasing age (from 16 to 30 years), and the trend was best fitted by a quadratic function (R-square, 0.978). The inter-observer agreements on the ossification grade were 0.420 (right) and 0.404 (left). The area under the ROC curve (AUC) was 0.922 (95% CI, 0.902-0.942). The averaged ossification scores of 2.62 and 4.37 provided 95% specificity for a person < 19 years of age and a person ≥ 19 years of age, respectively. A preliminary assessment by inexperienced radiologists resulted in an AUC of 0.860 (95% CI, 0.740-0.981). The age of majority in Korean adolescents and young adults can be estimated using chest radiographs.

Sex Assessment Using the Femur and Tibia in Medieval Skeletal Remains from Ireland: Discriminant Function Analysis

Sex determination based on discriminant function analysis of skeletal measurements is probably the most effective method for assessment of sex in archaeological and contemporary populations due to various reasons, but it also suffers from limitations such as population specificity. In this paper standards for sex assessment from the femur and tibia in the medieval Irish population are presented. Six femoral and six tibial measurements obtained from 56 male and 45 female skeletons were subjected to discriminant function analysis. Average accuracies obtained by this study range between 87.1 and 97%. The highest level of accuracy (97%) was achieved when using combined variables of the femur and tibia (maximum diameter of femoral head and circumference at tibial nutrient foramen), as well as two variables of the tibia (proximal epiphyseal breadth and circumference at nutrient foramen). Discriminant functions using a single variable provided accuracies between 87.1 and 96% with the circumference at the level of the tibial nutrient foramen providing the best separation. High accuracy rates obtained by this research correspond to the data recorded in other studies thus confirming the importance of discriminant function analysis in assessment of sex in both archaeological and forensic contexts.

Histological analysis of the tibial anterior cruciate ligament insertion

PURPOSE

This study was performed to investigate the morphology of the tibial anterior cruciate ligament (ACL) by histological assessment.

METHODS

The native (undissected) tibial ACL insertion of six fresh-frozen cadaveric knees was cut into four sagittal sections parallel to the long axis of the medial tibial spine. For histological evaluation, the slices were stained with haematoxylin and eosin, Safranin O and Russell-Movat pentachrome. All slices were digitalized and analysed at a magnification of 20×.

RESULTS

The anterior tibial ACL insertion was bordered by a bony anterior ridge. The most medial ACL fibres inserted from the medial tibial spine and were adjacent to the articular cartilage of the medial tibial plateau. Parts of the bony insertions of the anterior and posterior horns of the lateral meniscus were in close contact with the lateral part of the tibial ACL insertion. A small fat pad was located just posterior to the functional ACL fibres. The anterior-posterior length of the medial ACL insertion was an average of 10.8 ± 1.1 mm compared with the lateral, which was only 6.2 ± 1.1 mm (p < 0.001). There were no central or posterolateral inserting ACL fibres.

CONCLUSIONS

The shape of the bony tibial ACL insertion was 'duck-foot-like'. In contrast to previous findings, the functional mid-substance fibres arose from the most posterior part of the 'duck-foot' in a flat and 'c-shaped' way. The most anterior part of the tibial ACL insertion was bordered by a bony anterior ridge and the most medial by the medial tibial spine. No posterolateral fibres nor ACL bundles have been found histologically. This histological investigation may improve our understanding of the tibial ACL insertion and may provide important information for anatomical ACL reconstruction.

The origin points of the knee collateral ligaments: an MRI study on paediatric patients during growth

PURPOSE

Different femoral origins for both the medial collateral ligament (MCL) and the lateral collateral ligament (LCL) have been reported in the growing skeleton (epiphyseal and metaphyseal). Knowledge about the exact attachment sites is mandatory for anatomically correct reconstruction. This study assesses the femoral origins of the knee collateral ligaments in skeletally immature individuals using magnetic resonance imaging (MRI).

METHODS

MRIs of 336 knee joints (median age 15 years (range 2-18 years), m = 209 and f = 127) were retrospectively analysed to assess the distances between the femoral origins of the MCL and LCL to the distal femoral growth plate. In 175 patients, the body sizes were additionally retrieved from medical records.

RESULTS

Both MCL and LCL ligament origins were invariably located on the epiphysis. Mean MCL origin-growth plate distance was 9.6 mm (SD 2.1 mm; range 2.2-13.6 mm) in boys and 8.6 mm (SD 1.5 mm; range 3.4-12.0 mm) in girls. Mean LCL origin-growth plate distance was 9.3 mm (SD 1.8 mm; range 4.3-13.0 mm) in boys and 8.2 mm (SD 1.5 mm; range 3.4-11.8 mm) in girls. The distance between the growth plate and both collateral ligaments as well as the length of the LCL correlated positively with patients' age and body size (MCL R(2) = 0.673 and 0.556, LCL R (2) = 0.734 and 0.645, LCL length R(2) = 0.589 and 0.741; all p < 0.001).

CONCLUSIONS

During growth, the femoral origins of the MCL and the LCL are constantly located on the distal femoral epiphysis. There is a linear increase in the distances from the ligaments' origins to the growth plate according to age and body size. This new information may be of clinical importance for reconstructive surgery of the knee's collateral ligaments.

Tactile and Kinesthetic Stimulation (TKS) intervention improves outcomes in weanling rat bone in a neonatal stress model

OBJECTIVES

Preterm infants are born with low bone mineral. Neonatal stress further impedes bone mineralization. Clinical evidence suggests that tactile and kinesthetic stimulation (TKS) improves bone phenotype and decreases stress response. Clinical and translational studies indicate the IGF-1 axis, responsible for postnatal growth and bone mineralization, is a key player. We hypothesized that TKS would attenuate the negative impact of neonatal stress on bone phenotype and the IGF-1 axis in weanling rats.

METHODS

Neonatal stress (STRESS) or TKS (STRESS + 10min TKS) was administered from D6 to D10. Control animals received standard care. Tissue was harvested on D21. Dual energy x-ray absorptiometry (DXA) and bone morphometry were performed and serum osteocalcin, type I procollagen N-terminal propeptide (PINP), tartrate-resistant acid phosphatase (TRAP), and bone and liver mRNA levels of IGF-1, IGF-1 receptor (IGF-1R), and growth hormone receptor (GHR) were measured.

RESULTS

Neonatal stress increased bone mineral content (BMC), area (BA), growth plate width, liver IGF-1 mRNA, and serum IGF-1. TKS maintained areal bone mineral density (aBMD) and bone specific IGF-1 and IGF-1R mRNA while STRESS decreased compared to controls.

CONCLUSIONS

Neonatal stress results in apparent accelerated growth response. TKS differed from STRESS with improved tibia aBMD and increased bone specific IGF-1 mRNA.

[The staging method of sternal end of clavicle epiphyseal growth by thin layer CT scan and imaging reconstruction]

OBJECTIVE

To establish a CT staging method of sternal end of clavicle epiphyseal growth for teenagers by thin layer CT scan, multiplanar reconstruction (MPR) and volume reconstruction (VR) technologies.

METHODS

The CT imaging characteristics, which collected from 460 teenagers (aged from 15 to 25) in East and South China, were studied through both sternal ends of clavicles' imagings by thin layer coronal CT scan and axial CT scan, MPR and VR technologies. The parameters of sternal end of clavicle including the longest diameter of epiphysis, the longest diameter of metaphysis, their length ratio, area of epiphysis, area of metaphysis, and their area ratio were measured and calculated in order to establish new classification.

RESULTS

Based on the staging method of Schmeling, integrating the CT imaging reconstruction information of sternal end of clavicle, the new classification of sternal end of clavicle epiphyseal growth were divided into 1 to 5 stages, and stage 2 and stage 3, respectively, contained a, b and c sub-classification.

CONCLUSION

This new classification has merits of large sample size, wide age range and easy operability. By using CT imaging reconstruction techniques and analyzing the data which closely related to sternal end of clavicle epiphyseal growth of teenagers, the feasibility of the staging method could be increased.

Micro-finite element analysis applied to high-resolution MRI reveals improved bone mechanical competence in the distal femur of female pre-professional dancers

Micro-finite element analysis applied to high-resolution (0.234-mm length scale) MRI reveals greater whole and cancellous bone stiffness, but not greater cortical bone stiffness, in the distal femur of female dancers compared to controls. Greater whole bone stiffness appears to be mediated by cancellous, rather than cortical bone adaptation.

INTRODUCTION

The purpose of this study was to compare bone mechanical competence (stiffness) in the distal femur of female dancers compared to healthy, relatively inactive female controls.

METHODS

This study had institutional review board approval. We recruited nine female modern dancers (25.7±5.8 years, 1.63±0.06 m, 57.1±4.6 kg) and ten relatively inactive, healthy female controls matched for age, height, and weight (32.1±4.8 years, 1.6±0.04 m, 55.8±5.9 kg). We scanned the distal femur using a 7-T MRI scanner and a three-dimensional fast low-angle shot sequence (TR/TE=31 ms/5.1 ms, 0.234 mm×0.234 mm×1 mm, 80 slices). We applied micro-finite element analysis to 10-mm-thick volumes of interest at the distal femoral diaphysis, metaphysis, and epiphysis to compute stiffness and cross-sectional area of whole, cortical, and cancellous bone, as well as cortical thickness. We applied two-tailed t-tests and ANCOVA to compare groups.

RESULTS

Dancers demonstrated greater whole and cancellous bone stiffness and cross-sectional area at all locations (p<0.05). Cortical bone stiffness, cross-sectional area, and thickness did not differ between groups (>0.08). At all locations, the percent of intact whole bone stiffness for cortical bone alone was lower in dancers (p<0.05). Adjustment for cancellous bone cross-sectional area eliminated significant differences in whole bone stiffness between groups (p>0.07), but adjustment for cortical bone cross-sectional area did not (p<0.03).

CONCLUSIONS

Modern dancers have greater whole and cancellous bone stiffness in the distal femur compared to controls. Elevated whole bone stiffness in dancers may be mediated via cancellous, rather than cortical bone adaptation.

[Skeletal age estimation by pelvic X-ray of Han teenagers in Sichuan]

OBJECTIVE

To estimate the chronological age of Han teenagers in Sichuan by the epiphyses development characteristics of iliac crest and ischial tuberosity in X-ray digital images.

METHODS

According to TW2 classification principle, combining with the age range of our subjects and epiphyses development regularity, the degree of epiphyses development of iliac crest and ischial tuberosity had been divided into 8 grades (0-7) and 7 grades (0-6), respectively. Based on the degrees, the pelvic X-rays digital images of 691 samples of 16-20 aged teenagers were read and statistically analyzed by SPSS 19.0 software. The multiple linear regression equation was established by skeletal age (Y), development degree of iliac crest epiphyses (X1) and ischial tuberosity epiphyses (X2).

RESULTS

There were no statistical differences between two sides of epiphyses development of iliac crest and ischial tuberosity (P>0.05). There were no statistical difference between genders (P>0.05). The re-substitution method of the samples showed that the accuracy of equation as Y=15.269+0.444X1+0.236 X2 was high. The result of the re-substitution method showed a high accuracy of the equation.

CONCLUSION

The multiple linear regression equation could be used to identify the skeletal age for providing the scientific basis to identify the 18-year-old Han population in Sichuan.

Long-term trend of bone development in the contemporary teenagers of Chinese Han nationality

OBJECTIVE

To further improve the accuracy of bone age identification using the time of secondary ossification center appearance and epiphyseal fusion of 7 joints to estimate the age of living individuals.

METHODS

DR films were taken from 7 parts including sternal end of clavical and the left side of shoulder, elbow, carpal, hip, knee and ankle joints of 1 709 individuals who came from eastern China, central China and southern China, whose ages were between 11.0 and 20.0 years. From those 7 joints 24 osteal loci were selected as bone age indexes, which could better reflect age growth of teenagers. The characteristics of secondary ossification center appearance and epiphyseal fusion were observed, and the mean and age range of secondary ossification center appearance and epiphyseal fusion were calculated.

RESULTS

The fusion time of the 24 epiphyses were advanced at different degrees, the most obvious epiphyses the sternal end of clavicle, scapular acromial end, distal end of the radius, distal end of the ulna, iliac crest, ischial tuberosity, the upper and lower end of tibia and fibula. The appearance time of sternal end of clavicle, scapular acromial end, iliac crest and ischial tuberosity epiphyses were all found to be after the age of 12, and the female's age, approximately 1 year ahead of schedule in comparison with the male's.

CONCLUSION

The relevant forensic information and data for bone age identification should be updated every 10-15 years so as to provide accurate and objective evidence for court testimony, conviction and sentencing.

Geometry of the femoral condyles in dogs

The stifle joint is one of the most important joints in dogs from the orthopaedic point of view. The aim of this study was to document the morphometric values of femoral condyles, given the close relationship between the shape and function of an anatomic structure. The left femora of 16 mid-sized dogs were used, and diameter and nine radii as well as cranial and caudal bow lengths from each condyle were measured. The photographs were taken of the distal femora from both sides. All measurements were obtained from these images by using software. Additionally, the rotation angle was calculated from the intercondylar distance and the difference between lateral and medial bow lengths. In addition to the rotation angle, the difference of diameter and nine radii between the lateral and medial condyles was determined. All radii except getting at 90° were significantly different between the medial and lateral condyles. The greatest values were determined in the caudal part of the medial condyle. This results the smaller contact area and a greater pressure on the underlying surface, and therefore the meniscus and articular cartilage of the caudal part of the medial side suggests the possibility of a risk of injury as the stifle joint flexes. The mean rotational angle of the femur was also calculated to be 2.18° laterally and 1.02° medially in the caudal and cranial parts of condyles, respectively. The result of this study showed that the lateral and medial condyles had different shapes in canine femur.

[The trend of epiphyseal development of knee and ankle joints in teenagers and age estimation]

OBJECTIVE

According to the features of epiphyseal development of knee and ankle joints in male and female teenagers, the trend of epiphyseal development was analyzed and the possibility of its application in age estimation was discussed.

METHODS

Firstly, radiographs of adem position were taken from both sides of knee and ankle joints from 1709 individuals from Eastern China, Central China, and Southern China (Age: 11-21 years old). Secondly, 5 osteal loci were selected as bone age markers from the two joints. Thirdly, characteristics of epiphyseal development were observed systematically and comprehensively. Fourthly, the proportions of "epiphyseal fusion" in different age groups were calculated, and confirmed the numbers of people which were included by epiphyseal fusion of knee and ankle joints. Finally, age range of each epiphyseal fusion was calculated by mathematical statistical analysis.

RESULTS

Compared with the data of 1960s', the age of 5 epiphyseal fusions was earlier about 2-3 years. However, the results were basically the same as the recent studies.

CONCLUSION

The data on the time of epiphyseal fusion were updated. It is important to determine the accuracy in age estimation in male and female teenagers.

Effects of age of cattle, turning technology and compost environment on disappearance of bone from mortality compost

As residual bones in mortality compost negatively impact subsequent tillage, two studies were performed. For the first study, windrows of mature cattle or calves were placed on a base of barley straw and covered with beef manure. Windrows were divided into two sections and turned at 3-month intervals. Approximately 5000 kg of finished compost per windrow was passed through a 6mm trommel screen, with bones collected and weighed. Bone weight was 0.66% of mature cattle compost and 0.38% of calf compost on a dry matter basis, but did not differ after adjustment for weights of compost ingredients. In a subsequent study, four windrows were constructed containing mortalities, straw and beef manure (STATC) or straw, manure and slaughter waste (STATW). Also, straw, beef manure and slaughter waste was added to an 850 L rolling drum composter (DRUMW). Fresh bovine long-bones from calves were collected, weighed and embedded in the compost. Bones were retrieved and weighed when windrows were turned, or with DRUMW, after 8 weeks. Temperatures achieved followed the order STATW>STATC>DRUMW (p<0.05). Rate of bone disappearance followed a pattern identical to temperature, with the weight of bones in STATW declining by 53.7% during 7 weeks of composting. For STATC, temperatures were uniform over three composting periods, but bone disappearance was improved (p<0.05) when compost dry matter was lower (46%), as compared to 58%. Using a ratio of five parts manure to one part mortalities, results of this study demonstrated that residual bone was <1% of cured cattle compost and may be reduced by maintaining a high compost temperature and moisture content.

Age estimation in children by measurement of carpals and epiphyses of radius and ulna and open apices in teeth: A pilot study

Estimation of skeletal age using radiographic images is widely used in assessing biological growth in clinical and auxological studies. The most frequently used areas for age estimation in children and adolescents are tooth and wrist/hand, both giving good results with only a low level of radiation. This pilot study of a sample of 150 Italian children and adolescents aged between 5 and 15 years focused on analyzing the possible applications of the proportion of carpal area (Ca) and teeth mineralization as a criterion of age estimation. The regression model, describing age as a linear function of gender (g), the ratio between carpal bones area and carpal area (Bo/Ca) and the measurement of open apices, yielded the following equation [Formula in text]. The model explained 93% of the total variance (R(2)=0.93), the median of the absolute values of residuals (observed age minus predicted age) was 0.465 years, with an inter-quartile range (IQR) equalling 0.529 years, and a standard error of estimate of 0.73 years.

Age estimation using carpals: Study of a Slovenian sample to test Cameriere's method

Carpals are often used as age indicators. In a recent study, Cameriere et al. studied the use of the ratio between the total area of carpal bones and epiphyses of the ulna and radius (Bo) and carpals (Ca) as age indicators. The present study, of a sample of 158 Slovenian children and adolescents aged between 6 and 16 years, focused on analysing the best regression for age estimation. The regression model yielded the following equation: age=-3.411+0.942 g+20.927(Bo/Ca), and explained 91.6% of total variance (R(2)=0.916). The median of the absolute values of residuals (observed age minus predicted age) was 0.09 years, with a quartile deviation of 0.786 years, and a standard error of estimate of 0.658 years. Comparisons between the previous equation referring to Slovenian children and the equivalent linear equation proposed by Cameriere et al. did not reveal any significant differences between the intercepts and slopes of the two linear models. These results suggested a common regression model for both Italian and Slovenian samples. The common regression model, describing age as a linear function of gender and Bo/Ca ratio, yielded the following linear regression formula: age=-2.907+0.408 g+20.757(Bo/Ca). This model explained 86% of total variance (R(2)=0.86). The median of the absolute values of residuals (observed age minus predicted age) was 0.02 years, with a quartile deviation of 1.02 years and a standard error of estimate of 0.96 years.

Morphology of the femoral intercondylar notch

BACKGROUND

During anterior cruciate ligament reconstruction, proper femoral tunnel placement is important. The purpose of the present study was to characterize the osseous anatomy of the femoral intercondylar notch.

METHODS

We studied the morphology of the femoral intercondylar notch in 200 human femora from skeletally mature donors, with specific attention being paid to the morphology of the ridge on the lateral wall of the intercondylar notch and the posterolateral rim of the intercondylar notch. The distances from the posterolateral rim of the intercondylar notch to the lateral intercondylar ridge and from the posterolateral rim of the intercondylar notch to the inlet of the intercondylar notch (notch depth) were measured at the nine, ten, and eleven o'clock positions for right knees and at the one, two and three o'clock positions for left knees.

RESULTS

The lateral intercondylar ridge was present in 194 femora and absent in six. The mean distance from the posterolateral rim of the intercondylar notch to the lateral intercondylar ridge was 9.0, 11.0, and 12.7 mm at the nine, ten, and eleven o'clock positions in right knees and the one, two, and three o'clock positions in left knees, respectively. We observed three different types of morphology of the posterolateral rim of the intercondylar notch. The morphology of the posterolateral rim of the intercondylar notch was distinct in 183 of 200 specimens. A distinct, straight border (type 1) was seen in 175 femora (87.5%); a distinct, V-shaped border (type 2) was seen in eight (4%); and an indistinct border (type 3) was seen in seventeen (8.5%).

CONCLUSIONS

The morphology of the femoral intercondylar notch varies little. Occasionally, the posterolateral rim of the intercondylar notch is not well-defined. In these knees, accurate placement of commercial femoral tunnel aiming guides may be difficult.

Stature Estimation of 3?10-Year-Old Children from Long Bone Lengths

Estimation of stature in adult forensic cases with available long bones of the limbs is routine, but such estimation is less common in subadult cases. Long bones from subadult cases are often used to estimate age, but in some instances stature may be helpful or even critical for identification. Few published regression equations exist for consultation in such cases. Data from the longitudinal growth study conducted by the Child Research Council in Denver in the mid-1900s are utilized to produce dual-sex and single-sex regression equations for the six long bones of the limbs (humerus, radius, ulna, femur, tibia, and fibula) and for the combined femur+tibia length. All measurements are from radiographs and are of diaphyseal length. Examples show that similar results can be obtained using a two-step process of "ballpark" estimation from published tables of the Denver data, but these new regressions allow a one-step standard error estimate for the means. Regressions are further compared with those previously published by Finnish researchers, which are generally broadly comparable. More routine stature estimation in subadult cases is encouraged both as an aid to possible identification and as a test of the available regression equations.

Is the assessment of bone age by the Greulich-Pyle method reliable at forensic age estimation for Turkish children?

BACKGROUND

Estimation of age is an important task for forensic experts especially in developing countries where birth records are often not well maintained. In this study, we investigated whether or not the Greulich-Pyle (G-P) method is sufficient at forensic age estimation for Turkish children.

METHODS

Plain radiographies of left hands and wrists of 492 (241 (49.0%) female, 251 (51.0%) male) healthy children between 11 and 18 years of age for girls and 11 and 19 years of age for boys were taken. Mean chronological ages (CA) were compared with mean skeletal ages according to G-P atlas for each gender and in the second step the differences those for each age group were determined. The children were Caucasian and had a low-middle socioeconomic status in this study population. The paired sample t test was used to indicate the difference between G-P (mean skeletal age according to G-P atlas) and CA (mean chronological age). In order to indicate the relation Pearson correlation coefficient was used. Modeling the relationship between G-P and CA linear regression was used. The analyses were done under SPSS 11.5.

RESULTS

The G-P compared to their CA. The CA was 14.52+/-2.18 S.D. years, S.E.: 0.14 (median: 14.47, range: 11.07-18.92 years) whereas G-P was 15.06+/-2.31 S.D. years, S.E.: 0.15 (median: 15.00, range: 10-18 years) for girls. The difference between the two parameters was statistically significant (p<0.001). The CA was 15.28+/-2.41 S.D. years, S.E.: 0.15 (median: 15.09, S.E. range 11.13-19.94 years) and G-P was 15.41+/-2.92 S.D. years, S.E.: 0.18 (median: 15.60, range 9-19 years) for boys. The difference was not statistically significant (p>0.05). There was a high correlation (Pearson r=0.882, p<0.001) for girls and (Pearson r=0.900, p<0.001) for boys. The determination coefficient (R2) is equal to 0.778 for girls and 0.81 for boys. The regression model also tested by ANOVA and it is found significant (p<0.01) for both genders. According to age groups G-P was advanced (0.17-1.1 year) almost for all ages and differences were significant at 11, 12, 14, 16 ages for girls. G-P was delayed at 11-14 ages (0.01-0.58 year) but not significant except for 13 years and G-P were significantly advanced in 15-17 ages (0.88-0.98 years) but then delayed in 18-19 years of age (0.02-0.48) for boys. The difference's standard deviation at 12, 13, 15, 16 years of ages for girls and between 12 and 16 and 18 years of ages for boys were more than 1 year.

CONCLUSION

When the results of the previous study and this study are compared, the test method could be used technically by pediatricians and other clinicians, but it is even more important for ethically unacceptable errors to disappear, especially in cases involving the possible criminal liability of the supposed minor. So standard deviation at 12, 15 years of ages for girls and 12, 15, 18 years of ages for boys were more than 1 year. But it is not known that the other methods whether more useful or not than this method. For the time being unless any other methods will be proved more useful, we have to use this method cautiously for possible criminal liability cases in forensic age diagnosis.

Epiphyseal Union Sequencing: Aiding in the Recognition and Sorting of Commingled Remains

The presence of accessory osseous material within a seemingly single individual assemblage has the potential to result in misidentification of the remains. Detection of nonrelated material relies on the anthropologist being able to recognize incongruities among the elements. Inconsistencies in developmental status provide evidence to suggest that commingling may have occurred. Analyzing the sequence in which the various epiphyses unite can help to identify outlying elements that do not match the predicted developmental pattern of the remaining skeleton, thus indicating that the element may not belong to that individual. This paper considers the sequence in which 21 various epiphyses of the body unite to serve as a reference for identifying incongruent fusing patterns within a commingled assemblage. Two hundred and fifty-eight male individuals of Bosniak (Bosnian Muslim) descent between the ages of 14 and 30 years were included for analysis. Sequence order was determined for both "beginning" and "complete" union by comparing the fusing status of each epiphysis with each of the other 21 epiphyses. Considering both sequence patterns provides a wider spectrum of evidence from which to recognize incongruities than either sequence pattern could provide in isolation. Variations to the majority sequence pattern were also included to ensure that skeletons displaying less popular but acceptable sequence patterns would not be mistakenly considered as two individuals when using this research as a reference. Although substantial variation in the order in which epiphyses initiate and complete union was discovered within the sample, most epiphyseal relationships did not display any variable patterns. These "unvaried" relationships will be most useful in recognizing the presence of incongruent material if the pattern within an assemblage does not conform to the pattern documented in this study. Figures demonstrating the two sequence patterns are provided for easy application in the field.

Brief communication: Infracranial maturation in the skeletal collection from Coimbra, Portugal: New aging standards for epiphyseal union

Age at death of a single skeletal individual or a group is essential information in archaeological, paleoanthropological, and forensic contexts. Dental remains are the most commonly used age indicators, but when the dentition is not available, or too few teeth are present for an accurate age assessment, other age indicators such as skeletal maturation must be used. Of particular utility in this regard is the fusion of the epiphyses of the infracranial skeleton. Here we present new aging standards based on the infracranial maturation of individuals from the known age and sex collection from Coimbra, Portugal. We scored infracranial epiphyseal fusion and spheno-occipital synchondrosis closure (64 loci of ossification in total) on 137 skeletons from individuals between 7 and 29 years old. We further discuss developmental differences between the sexes and similarities and differences between the Coimbra documented collection and other published aging standards.

Knee-Loading Modality Drives Molecular Transport in Mouse Femur

Mechanical loading is well known to stimulate bone remodeling. Load-driven interstitial fluid flow and molecular transport have been postulated to play a role in the enhancement of bone formation. In order to evaluate load-driven molecular transport in a lacunocanalicular network, we conducted fluorescence recovery after photobleaching (FRAP) experiments using lacunae stained with uranine (376 Da). Loads were applied to a mouse femur ex vivo with a novel knee-loading modality, where the distal epiphysis was loaded with a sinusoidal force at 2 Hz. The lacunae in the diaphysis located 25% (approximately 4 mm) proximal to the loading site were photobleached and sequentially imaged, and a time constant for fluorescence recovery was determined both with and without knee loading. The time constant was estimated as the period to recover 63% of fluorescent intensity using a best-fit exponential curve. The results reveal that the applied loads shortened the time constant from 33 +/- 9 s with non-loading control to 25 +/- 11 s with knee loading (p = 0.0014). The strain in the measurement site was <100 microstain along the femoral midshaft, which was an order of magnitude smaller than the minimum effective strain threshold for bone remodeling. Taken together, the current study supports the notion that molecular transport in cortical bone is enhanced by the loads applied to the epiphysis without inducing significant in situ strain in the diaphysis.

Morphological analysis of the proximal femur using quantitative computed tomography

The anatomy of the proximal femur was studied in 35 specimens using quantitative computed tomography (QCT) and compared with anatomical sections studied by plane radiography and gross dissection. We found the primary supporting structure of the femoral head to be the primary compressive strut, which is a dense column of trabecular bone projecting from the pressure buttress of the medial femoral neck to the epiphyseal scar. Trabecular bone mushroomed from the epiphyseal scar and terminated at right angles to the cortex of the femoral head. We believe the primary compressive strut is the predominant load-bearing structure connecting the femoral head to the femoral neck, as many specimens lacked continuity of the head cortex to the femoral neck. Based on the CT number, the primary compressive strut had similar bone density to cortical structures such as the lesser trochanter, calcar femorale and posterior lateral femoral cortex. Ward's triangle lacked structural integrity in many cases, and we doubt the significance of tensile trabculae for sharing load. Surgical techniques such as femoral fracture fixation, resurfacing hip arthroplasty and allograft transplantation may benefit from this knowledge.

Hand fractures and dislocations in the developing skeleton

Management of children's fractures requires a thorough knowledge of the developing skeleton, with recognition of the injury present and its potential course based on mechanism and anatomy, a dedication to complete and repeated clinical and radiologic examinations, and a willingness to intercede if unacceptable angulation or any rotation occurs in the course of treatment. The ability to remodel follows a well-defined course and may be anticipated within certain margins, but expectations of this ability should not be overemphasized or even contemplated outside the direction of joint motion. Growth arrest following injury, although a real concern, remains rare. Persistent stiffness, particularly at the PIP joint, occurs much more frequently than is perceived, particularly for phalangeal shaft, condylar, and neck fractures.

The relationship between alpha angle and resistive index of the femoral epiphysis in the normal and abnormal infant hip

BACKGROUND

The arterial vascularity of the hip has been investigated in normal infants using duplex Doppler sonography. This study addressed the differences in hip vascularity in infants with respect to gender and acetabular morphology.

OBJECTIVE

To determine whether there is a relationship between the resistive index of the vessels of the femoral chondroepiphysis and the alpha angle in normal infant hips and in those with developmental dysplasia of the hip.

MATERIALS AND METHODS

We studied 76 hips (38 patients) with gray-scale and power Doppler US. The patients were referred because of a possible abnormal clinical hip examination or had risk factors for developmental dysplasia of the hip. The infants ranged in age from 1 day to 6 weeks. There were 13 boys and 25 girls. Gray-scale images were initially performed in the coronal and transverse planes to evaluate acetabular morphology, alpha angle and position of the femoral chondroepiphysis relative to the acetabulum. The hips were then examined with power Doppler US, in both sagittal and transverse planes, to identify arterial vessels within the femoral epiphysis. Resistive indices were then recorded from the spectral analysis in each vessel identified. Each examination was performed by one of five pediatric radiologists. Mixed model regression was used to assess the relationship between resistive index and alpha angle, age and gender.

RESULTS

Of the 76 hips, 34 had an alpha angle of 60 degrees or greater and were classified as normal, 26 had an alpha angle between 50 degrees and 59 degrees and were classified as immature, and 13 had an alpha angle of less than 50 degrees and were either subluxed or dislocated at the time of examination. At least two vessels were documented in each femoral epiphysis except in three hips, in which no vessels could be documented because of technical factors. There was a statistically significant linear relationship between the alpha angle and resistive index, such that the resistive index tended to rise with increasing alpha angle (P=0.0022). In addition, female infants had a significantly higher average resistive index than the average resistive index in male infants with the same alpha angle (P=0.0005).

CONCLUSION

There is a direct linear relationship between alpha angle and resistive index in the infant hip. Female infants have a higher average resistive index than male infants. We believe that these results might serve as a model for predicting an infant hip at risk of ischemia. In addition, the fact that lower resistive indices of the femoral epiphysis are associated with acetabular dysplasia might help explain the documented low incidence of avascular necrosis in untreated hip dysplasia.

Correlation of age and ossification of the medial clavicular epiphysis using computed tomography

OBJECT

The aim of this study was the examination of relationship between the age and the ossification of medial epiphysis of the clavicle referred to CT examination.

MATERIALS AND METHODS

Concerning the epiphyseal ossification of the clavicle CT's of 100 patients (50 male and 50 female) between 16 and 25 years (10 patients for each year) were analyzed by three viewers.

RESULTS

In the legal relevant age segment (16-25a) we saw a turnover from stage 3 to stage 4 at the age of 21 years. The calculated empiric distribution function showed 95% of stage 4 over 21 years while 75% of the patients with stage 3 were under 21 years. A reconstruction kernel suitable for osseous structures should be used, images should be viewed or presented in a bone window.

CONCLUSION

According to these results it can be concluded that a person with stage 4 is probably 21 years or older, while a stage 3 leads to an estimated age under 21 years. On the other hand, a confidence level of 99.67% is not reached. Therefore, CT of the medial epiphysis of the clavicle will only be suitable for age estimation around the age of 21 years, if this relevant statistic obstacle is defeated. Bearing this in mind, further studies are needed to evaluate slice thickness as the most critical parameter.

Estimation of stature and determination of sex from radial and ulnar bone lengths in a Turkish corpse sample

Determination of sex and estimation of stature are important aspects of forensic identification of an unknown individual. In the absence of pelvis the sex is assessed from long bones and cranium as they both provide high accuracy in sexing. The present study is an attempt to assess sex and stature from long bones of the forearm using recently deceased forensic cases in Istanbul, Turkey. The sample is composed of 80 males and 47 females with an average age of 36 and 30 years, respectively. Length measurements from the radius and ulna were obtained by exposing the epiphyseal ends of the long bones in a fashion similar to dry long bones. Discriminant function statistics showed a sex determination accuracy as high as 96%. Regression analysis was used in stature estimation from these two bones. Ideally osteological remains are necessary to make standards for osteological identification. These materials are not always easy to obtain and those available seem to be less ideal when they do not represent a current population. Forensic anthropologists therefore should develop techniques that utilize autopsy remains.

[Difficulties and reproducibility of radiological measurement of the proximal tibial axis according to Lévigne]

PURPOSE OF THE STUDY

The angle between the anatomic axis of the tibia and the tangent to the superior borders of the tibial plateaus is, on average, tilted 3 degrees in the varus position. If there is no bone wear, this angle measures the constitutional epiphyseal axis of the proximal tibia. When degenerative joint disease modifies the aspect of the tibial plateaus, this angle measures the sum of the constitutional varus and the bone wear, without distinguishing between the two. It is known however that the respective contribution of these two deformations can have therapeutic implications, particularly when tibial osteotomy for valgus correction or implantation of a unicompartmental prosthesis is proposed. Lévigne proposed a radiographic measurement of the proximal tibial axis to distinguish between these two sources of tibial deformation. We studied the intra- and interobserver reproducibility of these measurements.

MATERIAL AND METHODS

Fifty volunteers free of knee disease were chosen at random among a population of patients undergoing upper limb surgery. All patients provided their informed consent for participation in the study. Full-limb radiographs of one lower limb (chosen at random) were obtained using a standardized technique. The proximal tibial axis was measured according to the Lévigne technique using a manual goniometer graduated in degrees. One operator performed two series of measures independently on the same films. Two other operators performed a series of measurements on each film. The intra- and inter-observer reproducibility was determined with the interclass coefficient of correlation (rho).

RESULTS

The proximal epiphyseal axis of the tibia could not be determined on 7 to 18 films, depending on the operator. All three operators were able to make the all measurements (four per film) for only 25 patients. The mean epiphyseal axis varied from 2.5 degrees to 4.7 degrees for the four series of measurements. Intra-observer reproducibility was considered good (rho=0.62). Inter-observer reproducibility was considered moderate (rho=0.41).

DISCUSSION

The Lévigne technique is to our knowledge the only method described in the literature distinguishing the relative contribution of constitutional varus and bone wear of the proximal tibia. According to the advocates of this method, the angle between the epiphyseal axis linking the center of the tibial plateaus and the center of the proximal growth cartilage scare, and the anatomic axis of the tibia is a measurement of constitutional varus. The average is 3 degrees . The angle between a line perpendicular to the epiphyseal axis and the tangent of the superior borders of the tibial plateaus measures the deformation related to bone wear. In the present work, we found that this technique enables acceptable intra-observer reproducibility but that inter-observer reproducibility is low. The differences observed are certainly related to uncertain identification of the growth cartilage scar. This illustrates the difficulty in generalizing this technique for measuring healthy knees. Such difficulties would be even greater for degenerative knees.

CONCLUSION

The Lévigne technique does not appear to be a reliable method for defining indications for different surgical procedures according to the morphology of the proximal tibia.

Ossification of the mouse metatarsal: differentiation and proliferation in the presence/absence of a defined growth plate

There is significant diversity in growth plate behavior among sites within an individual skeleton and between skeletons of different species. This variation within wild-type animals is an underutilized resource for studying skeletal development. One bone that potentially exhibits the most diverse behavior is the metatarsal. While one end forms a growth plate with an epiphyseal secondary center of ossification as in other long bones, the opposite end undergoes direct ossification in a manner more similar to short bones. Although descriptions of human metatarsal/metacarpal ossification are available, a detailed comparative analysis has yet to be conducted in an animal model amenable to biomolecular analysis. Here we report an analysis of proximal and distal ossification in an age series of mouse metatarsals. Safranin O staining was used for qualitative and quantitative histology, and chondrocyte differentiation and proliferation were analyzed using immunohistochemistry for type X collagen and proliferative cell nuclear antigen expression. We establish that, as in the human, both growth plate formation and direct ossification occur in the mouse metatarsal, with chondrocyte populations showing distinct differentiation patterns at opposite ends of the bone. In addition, growth plate formation is characterized by a peak of proliferation in reserve zone chondrocytes that distinguishes it from both established growth plates and direct ossification. Our analysis demonstrates that the mouse metatarsal is a productive model for investigating natural variation in ossification that can further understanding of vertebrate skeletal development and evolution.

Sports injuries in the pediatric and adolescent foot and ankle: common overuse and acute presentations

Care of the youth athlete requires knowledge of developmental anatomy and specific injury patterns, which are acute or chronic in nature. We may expect that the incidence of overuse and acute foot and ankle injuries in this population is likely to increase in proportion to the number and intensity of competitive youth teams with demanding training schedules. We, as physicians, must exercise our best judgment in regard to recognizing these patterns early and instituting appropriate treatments. Return to play decisions should be based on objective criteria when available and always keeping the best interest of the athlete's future health in the forefront of our minds.

Carpals and epiphyses of radius and ulna as age indicators

Estimation of skeletal age using radiographic images is widely used for assessing biological growth in clinical and auxological studies. The most frequent areas used for age estimation in children and adolescents are tooth and wrist/hand, both giving good results with only a low level of radiation. In particular, ossification of the carpals shows good agreement with chronological age. This study of a sample of 150 Italian children and adolescents aged between 5 and 17 years focused on analyzing the possible applications of the proportion of carpal area (Ca) mineralization as a criterion of age estimation. The ratio between the total area of carpal bones and epiphyses of the ulna and radius (Bo) and Ca was calculated. This ratio (Bo/Ca) was used for linear regression analysis. The regression model, describing age as a linear function of the ratio Bo/Ca, yielded the following equation: Age=-3.253+0.719 g+20.610 Bo/Ca, and explained 83% of the total variance (R (2)=0.83). The median of the absolute values of residuals (observed age minus predicted age) was 0.08 years, with a quartile deviation of 1.59 years, and a standard error of estimate of 1.19 years.

Age ranges of epiphyseal fusion in the distal tibia and fibula of contemporary males and females

The range of variation in epiphyseal fusion in North American populations has not been sufficiently established. This significant oversight can lead to exclusion of persons of interest in a forensic investigation. This study evaluates epiphyseal fusion of the distal tibia and fibula in 570 European-, African-, and Mexican-American children and young adults. Radiographs of 270 females aged 9 to 17 and 300 males aged 11 to 20 were analyzed to assess the range of variation of epiphyseal fusion at each age. Results indicate that complete fusion in females occurs as early as 12 years in the distal tibia and fibula. All females demonstrated complete fusion by 16 years with no significant differences between ancestral groups. Complete fusion in males occurs as early as 14 years in both epiphyses. All males demonstrated complete fusion by 19 years. Significant differences in the earliest age of complete fusion showed that African- and Mexican-American males demonstrate complete fusion as early as 14 years in both epiphyses while European-American males do not express complete fusion until 16 years.

An anatomical and biometrical study of the femoral trochlear groove in the human fetus

We performed a biometric analysis of the femoral trochlear groove in the fetus and compared our findings with those observed in adults. We studied 44 formalin-preserved fetuses (13-38 weeks) and used digitized images to obtain measurements (alpha angle of the groove, trochlear slopes thetaL and thetaM). A comparison of means between our series and adults was achieved. For each angle of the distal epiphysis (alpha, thetaL, thetaM) there was no significant difference between our fetal series and adults. This is the first biometric study of fetal trochlea. The morphology of the lower femur appears to be the same in the fetus and the adult.

Comparison of ages of epiphyseal union in North American and Bosnian skeletal material

The accurate determination of age at death is a critical component in the analysis of human skeletal remains. Population specific techniques are often used without due consideration of the provenance of the material being studied. This communication considers the ages at which epiphyseal union occur in young Bosnian males and compares those findings to data published by McKern and Stewart on young North American soldiers killed during the Korean War. Of the ten epiphyses considered in this study, all elements were observed to be at least two years in advance in the Bosnian sample compared to the American sample. This article demonstrates that whilst standards based on an American sample produce broadly applicable age ranges for use on forensic work in the Balkans, the age ranges generated produce an upper age limit that is often two or more years older than the chronological age. Therefore, it is desirable, that wherever possible, appropriate standards should be devised for more accurate aging reflecting population specific profiles.

Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 8. Quantitative back-scattered electron scanning electron microscopy and confocal fluorescence microscopy of the epiphysis of the third metacarpal bone

AIM

To characterise and explain the increase in density evident by computerised tomography (CT) and radiography in companion studies as a response to training, in bone in the palmar and dorsal regions of the condyles of the third metacarpal bone (Mc3) of 2-year-old Thoroughbred horses.

METHODS

Compositional back-scattered electron (BSE) imaging in scanning electron microscopy (SEM) and confocal scanning laser microscopy (CSLM) were conducted on polymethyl methacrylate (PMMA)-embedded mediolateral slices of the right distal Mc3 from seven 2-year-old Thoroughbred horses trained on a racetrack and seven untrained horses kept at pasture. One left Mc3 from each group was studied in transverse section planes. This study focussed on regions of Mc3 found to differ in density between the trained and untrained horses in companion studies using CT and radiography.

RESULTS

The increase of bone density in the condyles of Mc3 in trained horses compared with untrained horses occurred, without prior osteoclastic resorption, via the deposition of new bone on pre-existing internal surfaces. Within prior marrow spaces of cancellous bone, there was also rapid formation of immature strands and fronds of bone which were more cellular and mineralised, and more lamellar bone tissue was deposited on these new scaffolding elements in the trained horses. Both resulted in increased bone volume fraction (BVF). The microscopic mineralisation density of the bulk of the new tissue was lower than in pre-existing bone, and CT and radiography underestimated the increase in BVF. The new tissue was thus probably less stiff at the microscopic scale than pre-existing bone, though its addition would stiffen the global structure.

CONCLUSIONS

In Mc3 of all the trained horses, there were obvious differences in microscopic structure compared with those from the untrained horses. Moderate, industry-standard levels of exercise used to prepare young horses for racing induced the formation of new bone in non-bone spaces in bone tissue, such that the bone organ should better withstand later increased levels of exercise.

Development and growth of long bones in European water frogs (Amphibia: Anura: Ranidae), with remarks on age determination

Differentiation and development of long bones were studied in European water frogs: Rana lessonae, R. ridibunda, and R. esculenta. The study included premetamorphic larvae (Gosner Stage 40) to frogs that were 5 years old. Femora, metatarsal bones, and proximal phalanges of the hindlimb exhibit the same pattern of periosteal bone differentiation and the same pattern of growth. Longitudinal and radial growth of these bones was studied by examination of the diaphyses and epiphyses, particularly where the edge of periosteal bone is inserted into the epiphysis. The periosteum seems to be responsible for both longitudinal and radial growth. Investigation of the formation, length, and arrangement of lines of arrested growth reveals that the first line is present only in the middle 25-35% of the length of the diaphysis of an adult bone; therefore, only the central portion of the diaphysis should be used for age estimation in skeletochronological studies. Comparison of the shapes and histological structures of epiphyses in the femur, metatarsal bones, and phalanges revealed that epiphyseal cartilages are composed of an inner and outer part. The inner metaphyseal cartilage has distinct zones and plugs the end of the periosteal bone cylinder; its role in longitudinal growth is questioned. The outer epiphyseal cartilage is composed of articular cartilages proper, in addition to lateral articular cartilages. Differences in the symmetry of the lateral articular cartilages of distal epiphyses of the femur and toes may reflect adaptations to different kinds of movements at the knee and in the foot.

Gadolinium-enhanced MR imaging of epiphyseal and metaphyseal marrow in normal piglets

The purpose of this study is to define the appearance of normal epiphyseal and metaphyseal marrow and normal changes of marrow due to fatty conversion on Gadolinium (Gd)-enhanced MR Imaging. Unenhanced and enhanced T1-weighted MR imaging were performed in proximal and distal femoral ends of 8 healthy piglets at the ages of 2, 4, 6 and 8 weeks, respectively. The changes with age in signal intensity and enhancement ratio of the epiphyseal and metaphyseal marrow with age were examined. The correlation of MRI characteristics with histological findings was studied. Our study showed that marrow of the metaphysis and of periphery of the 2nd ossification center were well vascularized hematopoietic marrow and had great enhancements. The enhancement ratio of metaphysis was greater than that of epiphyseal marrow and both enhancement ratios degraded gradually with age. The central regions of the epiphyseal ossification center and of the diaphysis were of fatty marrow and had little enhancement. It is concluded that on Gd-enhanced MR imaging the hematopoietic marrow of metaphysis and of periphery of the 2nd ossification center had greater enhancement than that of fatty marrow of central region of the 2nd ossification center. All of their enhancements decreased gradually with age.

Contributions of bone maturation measurements to the differential diagnosis of neonatal transient hypothyroidism versus dyshormonogenetic congenital hypothyroidism

AIM

To a) evaluate the contribution of bone maturation in the diagnosis of neonatal transient hypothyroidism versus dyshormonogenetic congenital hypothyroidism in full-term newborns, and b) use bone maturation to test the hypothesis that neonatal transient hypothyroidism is perinatal in onset.

MATERIALS AND METHODS

The study included 20 patients with dyshormonogenetic and 43 with transient hypothyroidism. Thyroid function and measurements of the distal femoral epiphysis area, obtained at the time of first confirmatory diagnosis, were compared between the two groups. The epiphysis area in two control groups with normal thyroid function was also measured and compared with that in patients with transient hypothyroidism, at age 1-3 d (control A), or at the age when normal thyroid function was confirmed (control B).

RESULTS

Mean epiphysis area was 0.04 cm2 in patients with dyshormonogenetic versus 0.22 cm2 in patients with transient hypothyroidism (p < 0.0001). An area <0.05 cm2 was limited to patients with dyshormonogenetic hypothyroidism. Conversely, a normal area (>0.2 cm2) was only observed in patients with transient hypothyroidism. Mean epiphysis areas in control A (0.20 cm2) and in patients with transient hypothyroidism were similar (p = 0.37), consistent with perinatal onset of transient hypothyroidism. Mean epiphysis area in control B (0.31 cm2) was significantly greater than in patients with transient hypothyroidism (p < 0.01).

CONCLUSIONS

A short duration of hypothyroidism can significantly delay bone maturation. Examination of bone maturation at initial confirmatory evaluation yields important information pertaining to congenital hypothyroidism, not only to predict intellectual development, but also to evaluate the risk of dyshormonogenetic hypothyroidism.

Phenotypic features of the domestic pigs bred in the Roman settlements of Pompeii and Caralis

A reconstruction of the morphological features of domestic pigs from two Roman settlements is here suggested by means of the study of skeletal and dental remains, with the aim at evaluating their degree of selection in comparison with wild boars. Material was formed by 111 bone and tooth fragments and was uncovered during the excavations of Polybius' House in Pompeii and of Roman buildings in the neighbourhood of Caralis harbour (Sardinia). The remains underwent morphological examination. The eruption of permanent teeth and ossification of epiphyseal cartilages let us establish that most animals were over 18-20 months. When possible, the determination of sex was made by detecting tusk features. The presence of anthropic signs on the bone surface provides some information about slaughtering and cooking procedure in the Roman period and supports the hypothesis that the animal remnants were food remains. Osteometric analysis was carried out on long and short bones and teeth through suitable multiplicative parameters, leading to the assessment of the withers height and other main phenotypic features. Logarithmic deviation pointed out the significant osteometric differences between the domestic pigs from the two Roman settlements. These data were also compared with those from wild boars and modern crossbred wild boars X non-selected pigs. In conclusion, our data show that pigs from Caralis bear much resemblance to wild boars, whereas those from Pompeii appear to be improved, so sharing some phenotypic features of modem improved breeds.

Postnatal skeletal ontogeny in Callisaurus draconoides and Uta stansburiana (Iguania: Phrynosomatidae)

The mineralization of the skeleton from hatching to near maximum size in two phrynosomatid lizards, Callisaurus draconoides and Uta stansburiana, is described in detail. Observed patterns in the appearance of epiphyseal secondary centers, ossification centers, apophyseal ossifications, and calcifications, the distribution of sesamoids, and the timing of fusions, are compared and contrasted with observations of other squamates available in the literature. Overall, Callisaurus and Uta exhibit an advanced state of ossification in the hatchling relative to other squamate neonates and share a similar sequence of braincase fusions and appearance of secondary centers. Preliminary observations suggest that patterns of postnatal skeletal development are highly conserved and independent of patterns of prenatal morphogenesis, and thus a potentially rich source of character data for systematic investigations.

Articular area responses to mechanical loading: effects of exercise, age, and skeletal location

How reliable are reconstructions of body mass and joint function based on articular surface areas? While the dynamic relationship between mechanical loading and cross-sectional geometry in long bones is well-established, the effect of loading on the subchondral articular surface area of epiphyses (hereafter, articular surface area, or ASA) has not been experimentally tested. The degree to which ASA can change in size and shape is important, because articular dimensions are frequently used to estimate body mass and positional behavior in fossil species. This study tests the hypothesis that mechanical loading influences ASA by comparing epiphyses of exercised and sedentary sheep from three age categories: juvenile, subadult, and adult (n = 44). ASA was measured on latex molds of subchondral articular surfaces of 10 epiphyses from each sheep. Areas were standardized by body mass, and compared to diaphyseal cross-sectional geometrical data. Nonparametric statistical comparisons of exercised and control individuals found no increases in ASA in response to mechanical loading in any age group. In contrast, significant differences in diaphyseal cross-sectional geometry were detected between exercised and control groups, but mostly in juveniles. The conservatism of ASA supports the hypothesis that ASA is ontogenetically constrained, and related to locomotor behavior at the species level and to body mass at the individual level, while variations in diaphyseal cross-sectional geometry are more appropriate proxies for individual variations in activity level.

Growth hormone and insulin-like growth factor I receptors in the temporomandibular joint of the rat

While there are numerous investigations on hormonal control of long bone epiphyseal growth, corresponding knowledge is sparse concerning the condylar cartilage. We investigated the distribution of growth hormone (GH) and insulin-like growth factor I (IGF-I) receptors in the temporomandibular joint (TMJ), especially the condyle, and compared the findings with information of long bone epiphyseal plates. The localization of the receptors was examined in vivo by immunohistochemical methods in one- to 21-day-old rats. GH receptors were detected in various components of the TMJ, but not in the fibrous articular surface or in the cartilage layers of the condyle. IGF-I receptors were found in the fibrous articular surface of the condyle and particularly in the superior and posterosuperior regions of the condylar cartilage, the depth of the labeled cell layer increasing significantly with age. It is evident that the expression of GH and IGF-I receptors is area-specific in the TMJ. Early post-natal growth and development of the mandibular condylar cartilage seem to be IGF-I-dependent but not directly dependent on GH.

Additional manal and pedal epiphyseal centres

One hundred and thirty-six well-preserved medieval skeletons were excavated in advance of re-development in Norwich. Examination of sub-adult hand and feet bones indicated a high percentage of accessory epiphyses. The majority could be identified by traces of a fusion line. The distal first metacarpal and first metatarsal being the preferred sites. Such additional epiphyses have rarely been reported in archaeological samples and the findings are in strong contrast to the figures quoted in modern anatomical texts. The possible reasons for this apparent variation are discussed.