BONE AGE ESTIMATION USING THE MATURATION PROCESS OF THE LATERAL CLAVICULAR EPIPHYSIS AMONG THE BLACK SOUTH AFRICAN POPULATION: A RETROSPECTIVE RADIOLOGICAL STUDY

Abstract

Objective: To estimate the age of living individuals through radiological analysis of the ossification process of the lateral clavicular epiphysis, evaluate the sex dimorphism and population-specific variations within the Black South African population.
Materials and Methods: This was a cross-sectional study where 771 clear chest radiographs showing acromioclavicular joints were retrospectively collected from select radiological departments in KwaZulu Natal province of South Africa. The appearance of the maturation centers was examined and recorded in line with the 3 phases of maturation of the lateral clavicular epiphysis. The hospital radiologist was engaged as an inter-observer reviewer who cross examined and confirmed each of the stages of the maturation process. Regression analysis was employed to assess linearity by plotting the mean variation between chronological age and actual age for every respondent against their age distribution.
Results: It was observed that the age range for the total population was 14-24 years in stage 1, 14-26 years in stage 2, and 17-30 years in stage 3. Stages 2 and 3 were the most widely distributed along the age set. The ossification stages of the lateral clavicular epiphysis in this group were 32.7% (252/771) in stage 1, 24.3% (187/771) in stage 2, and 43.1% (332/771) in stage 3. The chronological age in the current cohort was approximated with a margin of error of ±1.46 years using linear regression analysis. Furthermore, it was observed that there was a greater tendency to overestimate the actual age by 0.19 years among the current population group using Bland Altman’s plot.
Conclusion: The fusion process of the lateral clavicular epiphysis may be used to approximate age, especially in individuals without birth records. To improve reliability, the lateral clavicular epiphysis may be used in combination with other skeletal indicators, such as the development of the iliac crest and the fusion of the distal femur, for forensic accuracy.