Radiological Anatomy Bone

Bone Age II
1
"BONE AGE" ESTIMATION
 The age of a growing skeleton may be reliably estimated
since the appearance and union of the centres of
ossification occur in a fairly definite pattern and time
sequence from birth to maturity.
 Radiologic study of bone development provides a
valuable guide for evaluation of normal and abnormal
growth.
2
 The skeletal maturity of any individual is known as the
'bone age'.
 A radiologist determines the bone age of a person by
assessing ossification centres.
3
 Two criteria are used.
1. The number and size of epiphyseal centres
demonstrable at a given chronological age.
2. The disappearance of the dark line representing the
epiphyseal cartilage plate which indicates that the
epiphysis has fused to the diaphysis. (Date of fusion)
4
 You are not required to memorize long lists of dates as
these can always be referred to in a book.
 It is important in radiographs of the young and adolescent
to be able to recognize the sites of epiphyseal lines in
order to distinguish them from fracture lines.
 For convenience, figures for the male are used.
 NB: In females, they are about one to two years earlier.
5
 The ossification centres which  Full-Term Child Has These
are normally present at birth Centres
are in three long bones and  The initial letters refer to
three short bones. They may  Femur (distal epiphysis)
be recalled by the following
 Tibia (proximal epiphysis)
mnemonic.
 Calcaneum
 Humerus (proximal epiphysis)
 Talus
 Cuboid
6
SUPERIOR EXTREMITY
 Sequence of Ossification and Union at
the Shoulder
 Appearance
 1st year - Head of humerus
 2nd year - Greater tuberosity
 5th year - Lesser tuberosity (not visible)
 6th year - Fusion of the epiphyses of
upper end of humerus into one mass.
 Fusion 20th year - Fusion of upper end
of humerus with shaft.
7
8
SEQUENCE OF OSSIFICATION AND
UNION AT THE ELBOW
 Appearance
 1st year - Capitulum and lateral part of
trochlea.
 5th year - Head of radius.
 6th year - Medial epicondyle of humerus.
 9th year - Medial part of trochlea.
 10th year - Top of olecranon process.
 12th year - Lateral epicondyle of
humerus.
9
UNION AT THE ELBOW
 Fusion
 15th year -Fusion of olecranon
epiphysis with upper end of ulna.
 16th year -Fusion of lateral epicondyle,
capitulum and trochlea into one mass.
 Fusion of capitulum, trochlea and
lateral epicondyle to shaft.
 17th year -Fusion of head of radius to
shaft.
 From 18th year -Fusion of medial
epicondyle of humerus to shaft.
10
11
UNION AT THE HAND AND THE WRIST
 Appearance
 1st year - Lower end of radius
 - Capitate
 - Hamate
 2nd year - Heads of second, third, fourth
and fifth metacarpals
 - Bases of the proximal phalanges
 3rd year - Triquetral
 - Base of the first metacarpal
 - Base of middle phalanges
 - Base of terminal phalanges
12
 Appearance
 4th year - Lunate
 5th year - Scaphoid
- Trapezium
 - Trapezoid
 6th year - Lower end

 12th year - Pisiform
13
 Fusion
 17th year- Fusion of the base of first
metacarpal
 18th year- Fusion of the epiphysis of
metacarpals and phalanges
 - Fusion of the lower end of ulna
 19th year- Fusion of the lower end of
radius
14
15
Sequence of Ossification and Union at the
Hip Region
 Appearance
 1st year—Head of femur.
 4th year—Greater trochanter.
 8th year—Fusion of the
inferior ramus of the pubis with
the ramus of ischium
 12th to 14th year—Lesser
trochanter.
16
Hip Region
 Fusion
 15th year—Lesser trochanter.
 16th year—Greater trochanter.
 17th year—Head of femur with
shaft.
 20th to 25th year—Disappearance
of acetabular triradiate cartilage to
fuse the three parts of hip bone.
17
Knee
 Appearance
 Present at birth—Lower end of femur
 1st year—Upper end of tibia (may be
present at birth)
 3rd to 6th year—Patella
 4th year—Upper end of fibula
 10th year—Tongue-like extension of tibial
epiphysis for tibial tubercle.
18
Knee
 Fusion
 18th year Lower end of femur
with shaft.
 Upper end of tibia with shaft.
 19th year Upper end of fibula
with shaft.
19
Ankle and Foot
 Appearance
 Present at birth Calcaneum
 Talus
 6th month Cuboid (may be

present at birth)
 1st year Lower end of tibia
 Lower end of fibula
 Lateral cuneiform
 2nd year Medial cuneiform

20
Ankle and Foot
 Appearance
 3rd year: Intermediate cuneiform
 Navicular
 Base of first metatarsal
 Heads of second, third, fourth and fifth
metatarsals
 Bases of phalanges
 7th year: Medial malleolus becomes bony
 8th year Epiphysis for the posterior part of
calcaneum
21
Ankle and Foot
 Fusion
 16th year: Fusion of epiphysis for
the posterior part of calcaneum.
 17th year: Fusion of lower end of
tibia with shaft.
 Fusion of lower end of fibula with
shaft.
 18th year: Fusion of the epiphyses
of metatarsals and phalanges.
22
23
 The ossification centres which  Full-Term Child Has These
are normally present at birth Centres
are in three long bones and  The initial letters refer to
three short bones. They may  Femur (distal epiphysis)
be recalled by the following
 Tibia (proximal epiphysis)
mnemonic.
 Calcaneum
 Humerus (proximal epiphysis)
 Talus
 Cuboid
24
“BONE AGE" ESTIMATION
 Ossification of the distal end of femur occurs during
the last two foetal months.
 Absence of the centre at birth is good presumptive
evidence of prematurity and appearance is
medicolegal evidence of full-term development.
25
BONE AGE" ESTIMATION
 In early childhood, the small bones of the foot undergo the most
rapid changes and, therefore, are most satisfactory for evaluation
of development in the early months.
 Note that the first three tarsals (calcaneum, talus and cuboid)
ossify in order of size.
 After six months of age, the wrist and hands are more useful.
 Usually the carpal centres are not present at birth, but the first
(capitate) appears at about two months of age.
26
 Note that the first three carpals (capitate, hamate and
triquetral) ossify in order of size.
 Note also the spiral sequence of ossification in the
carpus, starting with the largest and proceeding to the
next largest in the same row, but omitting the pisiform
capitate, hamate, triquetral, lunate, scaphoid, trapezium
and trapezoid.
27
 All the metacarpal and phalangeal epiphyseal centres normally are
demonstrable radiologically during the third year.
 The ossification of the distal radial epiphysis occurs at about 1 year
of age.
 The distal ulnar epiphysis is present at 6 to 8 years of age in girls
and at about 7 to 10 years of age in boys.
 In girls, the appearance of a sesamoid bone at the distal end of the
first metacarpal indicates menarche (age at which menses begin)
within one or two years.
28
 The postnatal ossification centres that have the highest statistical
"communality“ and hence the greatest predictive value in skeletal
assessment are located in the hand, foot and knee.
 Thus three radiographs can actually provide more diagnostically
useful in formation than the larger number often made.
 At puberty, however, more attention must be given to the centres
of the hip, iliac bones, and the sesamoids of the thumb and other
fingers.
29
Age & Cranial Sutures
At birth, our skull consists of 5 separate flat bones, separated by
fibrous material called sutures.
The sutures close in young to middle-aged adulthood, as our bones

grow together.
Skull Sutures In Estimation Of Age
 Posterior fontanelle closes b/w birth 1.5 months
 Anterior fontanelle closes by second year
 2 postero-lateral fontanelles closes within a short period after birth
& antero-lateral fontanelles within first 6 months.
 Metopic suture b/w 2 frontal bones closes b/w 2 yrs-8 yrs but
rarely may remain intact
 The basi-occiput fuses with basi-sphenoid by about 18-20 yrs in
Females & 20-22 in Males
31
What is the likely age range
Age & Cranial Sutures are of a male skeleton with
an open sagittal suture and
19-32
years
fused clavicle epiphyseal
Ages associated with cranial suture status plates?
Gender Sagittal suture Sagittal suture All sutures completely
completely open completely closed closed
Male Younger than 32 Older than 26 Older than 35
Female Younger than 35 Older than 29 Older than 50
Completely
Completely intact Partially closed closed sagittal
sagittal suture sagittal suture suture
What is the likely age range
Age & Cranial Sutures are of a female skeleton with
closed sagittal suture and
29-
35
unfused proximal clavicle
Ages associated with cranial suture status epiphyseal plates?
Gender Sagittal suture Sagittal suture All sutures
completely open completely closed completely closed
Male Younger than 32 Older than 26 Older than 35
Female Younger than 35 Older than 29 Older than 50
Completely closed
Completely intact Partially closed sagittal suture
sagittal suture sagittal suture
Suture Closure in the Skull
 Closure begins in inner table 5-10 years earlier than outer
table
 In contrast to others the fusion occurs earlier in Males
 Endocranially suture closure is more uniform & complete and
might not close ectocranially known as LAPSED UNION –
e.g. sagittal suture
 Estimation of age by sutural closure of skull is not reliable, it
can be given only in decades
 The order of reliability is sagittal, lambdoid & coronal
34
Order of suture closure in skull
 30-40 yrs:- Posterior 1/3rd of sagittal suture
 40-50 yrs:- Anterior 1/3rd of sagittal suture & lower half of coronal
suture
 50-60 yrs:- Middle sagittal and upper half of coronal suture
 In Lambdoid suture fusion activity occurs late and the progress is
also slow, the closure starts about 25-30 years near Asterion
maximum closure at about 55 years
 Squamous part of temporal bone with its surrounding after 60yrs
35
36
Symphyseal surface in Estimation of age
accuracy + 2 years
 Below 20yr Symphyseal surface has an even appearance with layer of
compact bone over its surface
 20-30 yrs It looks markedly ridged and irregular.- the ridges or billowing run
transversely and irregular across articular surface
37
accuracy + 2 years
 25- 35 yrs the billowing gradually disappears and the articular surface in
macerated bone presents granular appearance with well-defined anterior and
posterior margins
 35-45 yrs The articular surface looks smooth and oval with raised upper and
lower extremities
38
accuracy + 2 years
 45-50 yrs Narrow beaded rims develop in and around the margins of the
articular surface showing some erosion
 Above 50 yrs Symphyseal surface presents varying degrees of erosion with
varying degrees of erosion with breaking down of the ventral margins
39
40
41
After 25 years
 If all epiphysis of long bones are united the individual is most
probably >25 years.
 After 25 age estimation becomes more uncertain.
 Between 40-60 yrs
 The ossification of Hyoid bone.
 Fusion of greater cornu with body of hyoid bone
 Xiphisternum with body
 Lipping of vertebrae > 45 yrs
 Rarefaction of bones(osteoporosis) after 60 yrs
 Calcification of costal cartilage(30) yrs & Laryngeal cartilage 50+ 12.7 yrs
 Changes in Mandible with age
42
 Racial and sex variations must be taken into consideration in
bone maturation.
 Negroes show more rapid early maturation than Caucasians;
skeletal development of girls is advanced over that of boys slightly
so at birth but by as much as two years at puberty.
 In general osseous development correlates well with weight,
height, and sexual development.
 Correlation of bone age with age at menarche is closer than that
of chronological age and age at menarche.
43
Age & Teeth
Teeth are the best evidence for determining the age of children, as they have
regular patterns of eruption.
Dental records
can also be
extremely
useful in
identifying
individuals;
especially after
events like fire.
Age & Teeth
What is the likely
age of a baby
who has all four
central incisors,
but no other
teeth?
8 – 12 mos.
What is the likely
age of a baby
who has all its
baby teeth except
the second
molars?
17 – 31 mos.
Age & Teeth
What is the likely
age range of a child
who has lost their
central and lateral
incisors, but no
other baby teeth?
6 – 11 years.
What is the likely

age range of a
child who lost all its
baby teeth except
the second molars?
10 – 12 years

Radiological Anatomy Bone

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Radiological Anatomy Bone

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Bone Age II

 6th year - Lower end

 6th month Cuboid (may be

 2nd year Medial cuneiform

The sutures close in young to middle-aged adulthood, as our bones

What is the likely

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