Analysis of Epiphyseal Fusion on Femur Bone Distal Parts For Identification of Age

Range 15 Years to 25 Years With Rontgen Photo Media

Muhammad Salsabeela Rusdi/ , Toetik Koesbardiati/ , Rosy Setiawati 9

1
Post-Graduate program, forensic science, Universitas Airlangga.
2
Radiology Department of RSUD Dr.Soetomo, Surabaya

The age identification aims to determine the approximate or age estimation of an unknown or doubtful person. The age
determining is expected to assist the authorities in completing legal proceesed of individuals involved in criminal procees.
One such method of age identification is the maturation of epiphyses or known as epiphyseal fusion by radiological
examination. Epiphyseal fusion is divided into four phases: begining union, active union, recent union and complete union.
Epiphyseal fusion may vary by individual because of genetic, gender, hormonal, nutritional, geographical, climatic, and
individual differences as well as bone differences. Radiological examinations or with femoral bone radiographs are used to
pinpoint epiphyseal fusion phases. This research used cross-sectionall descriptive research design. The conclusions in this
study of epiphyseal fusion in males lasted from the age of 15 to 22 years, epiphyseal fusion in women 15 to 19 years. There
is a difference in men and women that epiphyseal fusion occured more rapidly in women.

Keywords : Age, femur, epiphyseal fusion

Introduction
This research is originally developed for
the demand of occuracy for estimation age of an
unknown or doubtful person of authenticity.
Determination age is expected to assist the
authorities in completing legal proceedings of
individuals involved in criminal proccess.
(Dharmesh, et al 2011).
Age identification aims to determine the
approximate or age estimate of an unknown or
doubtful person. Determining age is expected to
assist the authorities in resolving the legal process
of individuals involved in criminal proceedings
(Dharmesh, et al 2011).
Age is principally divided into three
chronological age, mental age, and biological age.
Chronological age is the calculation of age that
begins at the birth of a person until the current
time. Mental age is the calculation of age is seen
based on the level of one's mental ability.
Biological age is the calculation of age based on
the biological maturity of a person, along with the
increasing stage of growth and development of
body structure in the form of physical changes and
maturation of organs so that each stage of the
process of change can be associated with the age
of an individual (Dharmesh, et al 2011).
A person's biological age can be
determined by epiphyseal fusion because the
maturation of epiphyses can show that the bone
has reached the end point of the growth period or
is still in its infancy. When the epiphyseal fusion
has reached the perfect then someone has reached
a certain age of 18 years for women and age 20 for
men (Bakthula & Agarwal 2014).
There are several methods of
determining biological age based on fusion of
epiphany by matching the standard table of
Greulich and Pyle in 1959, the Girdany and
Golden 1952 standard tables and the Tanner
Whitehouse 1962 method. Based on each method
using the X-ray method as media to see the
development of epiphyseal fusion . Tanner
Whitehouse's method is done by dividing the area
of the hand into 20 regions or Regions of Interest
(ROI). Each ROI location is then determined to be
in a certain phase based on the division by Tanner
Whitehouse and the estimated age is done by
summing the stage of each ROI then adjusted to
Tanner Whitehouse table (Bakthula & Agarwal
2014).
Regions of Interest (ROI) of epiphyses
are present in 20 regions and each region is spread
over the bones in the shoulders, elbows, hands,
hips, knees and legs. The epiphyses scattered in
human bones have at least two epiphyses and
sometimes more (the femur has four epiphyses).
The ribs each have two epiphisis. On the other
hand metacarpal and metatarsal each have only
one epifisis (Bakthula & Agarwal 2014,
Koesbardiati 2012).
Epiphyseal fusion is divided into four
phases: begining union, active union, recent union
and complete union. Each epiphyseal fusion phase
is seen by the union between bony parts such as
diaphisis, metaphysis and epiphyses that have
become a bone unity as a result of the ossification
process. Previous studies have suggested the
epiphyseal fusion of the femur begins in a person
16 years old for women and 18 years for men, and
in some other studies epiphyseal fusion occurs at
age 15 in the ulna, humerus and radius bones.
Epiphyseal fusion was different in every
individuals, because of different in gendre, in
population the individual is and the different in
bone location, that affects a person's biological age
difference and results in an evaluation of
epiphyseal closure (Bakthula & Agarwal 2014).
Generally to assess epiphyseal fusion is
done by using bone that has been cleared of soft
tissue, it will obviously take time in the
identification process if the victim is found in a
state of skeletal component still partially or
completely coated with soft tissue or in humans
still alive so that evaluation uses X-rays will
greatly assist the identification process under these
circumstances, where we can see the inside of the
body in humans who still have soft tissue or are
still alive (Dharmesh, et al 2011).
Method
The sample of research is patient in DR.
Soetomo Hospital with the femur bone traumatic,
man and women in 15 years to 25 years old.
Four stages of epiphyseal union were
identified as described by O’Connor et al.
Anterior, posterior and lateral radiographs were
used together when assessing the stage of
epiphyseal union. If there was a difference in the
stage of union between radiographic views, the
radi- ograph of the growth plate demonstrating the
least mature view was selected. For example, in
the case of the distal femur, fusion may appear to
have commenced in the anterior posterior view.
However, a radioluscent gap between epiphysis
and diaphysis may be observed in the lateral view,
indicating that union in fact has not com- menced.
The five stages of epiphyseal union as described
by O’Connor et al. are:
Stage 0 – Non-union: The diaphyseal
and epiphy- seal bones are adjacent to each other
figure 1 : Non Union
but not yet in inti- mate relationship. The epiphysis
is separate from the diaphysis due to the presence
of the cartilaginous growth plate. This should be
apparent in at least one view on the radiograph, as
a continuous radiolucent gap between the
epiphysis and diaphysis.
Stage 1 – Beginning union: The
epiphyseal and dia- physeal surfaces closely move
towards each other. There is a narrow radiolucent
strip between adjacent surfaces of the epiphysis
and diaphysis when compared to the state of non-
union. There is a radiolucent gap which is not
continuous from anterior to posterior or medial to
later- al, indicating that union has begun centrally,
but has not yet commenced on the remainder of the
growth plate. In radiographic views, the later stage
should be selected.
Stage 2 – Active union: The epiphysis
and diaphysis cap each other, the epiphysis
overlapping the metaph- ysis. The terminal plate
of the epiphysis can no longer be distinguished. A
fusion line or zone of greater density than the
adjacent bone replaces the epiphyseal cartilage.
There is a radiodense region indicating that fusion
is actively occurring.
Stage 3 – Recent union: The epiphysis and diaph-
ysis now form a single unit of bone; there is
complete capping. The position of the former
epiphysis and dia- physis can still be observed.
There may be a fine line of fusion of greater
density between the epiphysis and dia- physis, and
a discontinuity of trabeculae between these. A
slight notch at the margin of the growth plate (less
than 2 mm) can be observed that is not yet
completely calcified. These indicate that the bone
has recently united.
Stage 4 – Complete union: The
epiphysis and dia- physis are united as a single unit
of bone. There is con- tinuity of trabeculae from
shaft to former epiphysis. This is presented as a
uniformity of internal bone pattern throughout the
length of the long bone up to the articu- lar surface.
All traces of epiphyseal differentiation have been
lost. The growth plate has now completely ossified
and the bone is fused in its entirety; there are no
radi- olucent notches evident at the peripheral
margin of the bone.
This research is a non experimental
research with cross-sectional research design. All
data (mean±standard deviation) were analyzed
with SPSS Statistical Package for Social Sciences
(SPSS) software.
figure 2 : Active Union
 figure 3 : Recent Union figure 4 : Complete Union

Table 1
Number of male subjects (n) at each stage of union for the distal femur
No Age Number of Phase of Ephypiesal Fusion
(Years) Sample 1 2 3 4
1 15 3 3
2 16 4 3 1
3 17 4 1 3
4 18 1 1
5 19 1 1
6 20 4 2 2
7 21 3 1 2
8 22 1 1
9 23 3 3
10 24 6 6
11 25 3 3
Total 33 7 8 5 13
Table 2
Number of female subjects (n) at each stage of union for the distal femur
No Age Number of Phase of Ephypiesal Fusion
(Years) Sample 1 2 3 4
1 15
2 16 1 1
3 17 1 1
4 18 1 1
5 19 3 1 1 1
6 20 4 2 2
7 21 7 5 2
8 22
9 23 2 2
10 24 1 1
11 25 2 2
Total 22 1 2 11 8

Result constriction of male radiolucency occurred at the age of
16 years. radiolucency begins to disappear at the age of 18
Table 1 shows the number of male subjects at to 21 years (Table 1).
each stage with age. 33 men in all group. At the age of 15 An epiphyseal fusion of the male distal famur
years to 17 years is dominated by the first stage. early bone takes place from the age of 15 to the age of 22, which
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