Utility of bony fusion and molar eruption in determination of age

Introduction

Sports has become more competitive and lucrative these days, and the organizers have shown a keen interest in arranging tournaments for individuals of different age groups.

The categorization of sports according to its age helps sports aspirants to have a healthy and equal competition. However, the organizers often face the problem of ascertaining the exact age of the players. Such cases are often referred to the Clinicians. The present study was undertaken as a step in this direction.

Determination of age of an individual from the appearance and fusion of the ossification centre is a well-accepted feature in the field of medical and legal professions. The epiphysis of bones unites during certain age periods and it remains remarkably constant for a particular epiphysis. The determination of age is important for administration of justice. It is not possible to enunciate a hard and fast rule for age determination that is applicable for the entire country. The vast subcontinent like India is composed of areas which differ in climatic, in diet as well as in environmental factors that affect skeletal growth. The present study was carried out to determine roentgenographically the epiphyseal appearance and their union at elbow joint along with the dental age assessment and their physical appearance and biological evaluation in 165 youngsters who took part in cricket tournament.

Aims and objectives

To determine the age of a sportsperson based on clinical, dental and radiological features participating in the cricket tournament.

Material and methods

The study was carried out at Khaja Banda Nawaz Teaching and General Hospital, Kalaburagi on 165 sportspersons participating in the cricket tournament organized by Khaja Education Society, Kalaburagi during the month of November, 2017. Data of age was confirmed from history and record of birth date submitted by the team officials.

Data recorded included

1. Development of secondary sexual characters (Stage of pubic hair development and genital maturity).

2.   Dental age estimation based on third molar eruption.

3.   Fusion of ossification centers of long bones and wrist joint.

Medical evaluation was done to confirm the data submitted by the teams. Pubic hairs and genital maturity was examined according to the Tanner’s criteria^1,2. Mean age for development of different stages was taken according to a study conducted by Marshall and Tanner¹, and Susman et al².

X-ray of the elbow and wrist joint was taken in all the subjects at the Department of Radiodiagnosis. The epiphyses were observed for fusion by using classification methodology of Bhise et al3 and Mckern and Stewart4. X-ray of hip and knee joint was taken in individuals whose age appeared above 16 years. 

Dental age was determined on the basis of third molar eruption. Orthopantogram was studied for eight different stages (A-H) of development of 3rd molar by method adapted by Darji et al⁵, and Demirjian A et al⁶. Stage A, B and C corresponds to age less than 16 years. Stage D, E and F corresponds to age between 16-18 years. Stage G corresponds to age more than 18 years and Stage H corresponds to age more than 20 years.

Results

The study was conducted with the aim to establish exact age of 165 sportspersons participating in under-16 cricket tournament.

The clinical age was determined by using parameters of secondary sexual characters (Stage of pubic hair and genital maturity). Dental age and bone age were estimated by ascertaining orthopantogram, and ossification and fusion of epiphysis respectively.

Out of 165 sportsperson, 24 subjects had stage 4 and 141 subjects had stage 5 Tanner’s staging for pubic hair. 3 subjects had stage 3 and 31 sportspersons had stage 4 and 130 sports person had stage 5 Tanner’s staging for genital maturity (Table, 1).

The dental age was calculated under,

Stage A, B and C » approximately age less than 15 years » 103 sportspersons.

Stage D, E and F » approximately age more than 16 - 17 years » 41 sportspersons.

Stage G » age above 16-18 years » 15 sportspersons.

Stage H » age above 18 years » 06 sportspersons (Table, 2).

All 165 sportspersons were subjected to X-ray of elbow joint. 91 sportspersons were subjected to wrist X-ray whose age was found to be more than 15 years but less than 18 years. On wrist joint X-ray, 59 subjects were found to be below 16 years of age. The remaining 32 sportspersons were subjected to knee joint X-ray. Of them, 23 sports-person were found to be more than 18 years of age. These subjects were sent for X-ray of hip joint. Among them 13 were more than 20 years old (Table.3, 4).

Based on X-ray, 133 sports-persons were found to be below the age of 16 years, 10 sports-persons were found to be above 18 years and 13 sportspersons were found to be above 20 years and 9 sports-persons were found to be between 16-17 years.

Dental examination findings were used in these 9 sports-persons to correlate with the X-ray findings, 7 were found to be below 16 years of age.

Out of 9 sports-persons between 16-17 years, age of 2 sports-persons could not be ascertained by the current parameters. Hence, they were allowed based on the authenticity of the identity proof.

A total of 142 sportsperson were allowed to participate in the tournament based on current parameters. 23 sports-persons were declared to be above 18 years and were disqualified from participation.

Discussion

Bone age estimation^7,8:

Assessment of skeletal maturity is primarily based on degree of epiphyseal fusion of the distal phalanges of the hands. Fusion of the epiphysis to the metaphysis in the bones of the hand tends to occur in an orderly characteristic pattern as follows

Ossification of bones of wrist joint:

Appearance of hook of hamate occurs at the age of 1 year onwards and appearance of metaphalanx of thumb sesamoid bone occurs before the age of 13 years.

Proximal aspect of radial epiphyses extends to meet the maximum width of the distal metaphysis, but neither radial nor ulnar sided capping is completed till 13.5 years.

Completion of capping of distal radial epiphysis occurs by 14 years.

Closure of distal phalanx of thumb occurs by 15 years.

Closure of distal phalangeal epiphyses of the index finger and closure of thumb metacarpal epiphyses occurs by 15.5 years.

Closure of index finger proximal phalangeal epiphyses occurs by 16 years.

The distal epiphyses at wrist joint unite with the shaft by 17 years in females and 18 years in males.

Distal end epiphyses for radius fuses by 17 years in females and 18 years in males.

Ossification of bones of elbow:

External epicondyle appears by 10-12 years and fuses at 17-18 years.

Internal epicondyle appears by 5-8 years and fuses at 17-18 years.

Capitulum appears by 1-3 years and fuses at 17-18 years.

Head of radius appears by 5-6 years and fuses at 16-19 years.

Trochlea appears by 11th year and fuses at 18th year.

Olecranon appears by 10-13 years and fuses at 1620 years.

The ulnar proximal epiphyses of elbow joint fuses by 14 years in females and 16 years in males.

The proximal centre for radius at elbow joint fuses by 14 years in females and 17 years in males.

Ossification bones of knee joint:

Tibia: Upper end fuses by 16 years in females and 18 years in males.

Fibula: Upper end fuses by 17 years in females and 19 years in males.

Ossification of bones of hip joint⁹:

The fusion of epiphyses of head of femur and greater trochanter takes place by 14 years in females and 17 years in males.

The observation of the present study correlates with the observations made by Mehta10 and Bhise et al3 for medial epicondyle, head of radius and proximal end of ulna. At elbow the complete union of epiphysis is seen by 16-17 years in males.

The observation made in the present study was comparable to a study conducted by Flecker11 in Australia with respect to fusion of epiphysis in wrist, elbow, knee and hip joint.

It can be concluded that only bone ossification parameter is not sufficient to determine the exact age of a particular person. Other parameters such as dental age become crucial in determining the exact age of a person.

Conclusion

Age analysis of 165 sportspersons in the present study revealed that 23 were found to be above age of stipulated qualifying criterion of 16 years and were disqualified from participation.

Bony fusion remained the mainstay for age estimation. Addition of dental age estimation increased the efficacy and was more reliable than radiological diagnosis alone. Clinical examination was found to be not a useful tool for estimation of age in adolescent and in adult age group.