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This initial study is the first to use eye-trackers as a tool in order to study gaze pattern strategies and decision making processes involved in the assessment of skeletal remains. Three experienced participants were asked to wear eye-tracking glasses (Tobii Pro Glasses 2) when estimating sex and age-at-death of one set of skeletal remains from a known archeological sample. The study assessed participants' fixation points (the features of the skeleton focused on), fixation duration (the total time spent on each assessment and feature) as well as visit count and duration (the total number of visits and the duration of visits to particular areas). The preliminary results of this study identified differences in gaze “strategies” with regards to fixation points, visit duration, and visit counts between the participants. The data generated provide a starting point for assessing how such technologies could be used in order to more fully understand the decision making processes involved in forensic anthropological interpretations and their role in forensic reconstructions.

Background The autonomous artificial intelligence (AI) system for bone age rating (BoneXpert) was designed to be used in clinical radiology practice as an AI-replace tool, replacing the radiologist completely. Objective The aim of this study was to investigate how the tool is used in clinical practice. Are radiologists more inclined to use BoneXpert to assist rather than replace themselves, and how much time is saved? Materials and methods We sent a survey consisting of eight multiple-choice questions to 282 radiologists in departments in Europe already using the software. Results The 97 (34%) respondents came from 18 countries. Their answers revealed that before installing the automated method, 83 (86%) of the respondents took more than 2 min per bone age rating; this fell to 20 (21%) respondents after installation. Only 17/97 (18%) respondents used BoneXpert to completely replace the radiologist; the rest used it to assist radiologists to varying degrees. For instance, 39/97 (40%) never overruled the automated reading, while 9/97 (9%) overruled more than 5% of the automated ratings. The majority 58/97 (60%) of respondents checked the radiographs themselves to exclude features of underlying disease. Conclusion BoneXpert significantly reduces reporting times for bone age determination. However, radiographic analysis involves more than just determining bone age. It also involves identification of abnormalities, and for this reason, radiologists cannot be completely replaced. AI systems originally developed to replace the radiologist might be more suitable as AI assist tools, particularly if they have not been validated to work autonomously, including the ability to omit ratings when the image is outside the range of validity.

As many other European countries, France has to deal with a growing number of migrants including some who contend age minority entitling them to benefits and privileges reserved for children within the context of legal proceedings. In case of doubtful minority, medical examinations may be carried out to assess skeletal and dental age. Our objective was to analyse the age assessments regarding individuals of doubtful minority assertion at the Medico-legal Institute of the University Hospital of Montpellier since 2018.Expert reports of forensic age assessments performed during the 2018-2021 period were reviewed. Demographic data and results from medical and radiological investigations based on AGFAD recommendations were recorded in each case. When available, conclusions of judicial investigations about the individuals' actual age were collected.A total of 265 reports were compiled. Age assessments predominantly concerned males (97.7%) and the main reported country of origin was sub-Saharan Africa (80.4%). The mean reported age was 16.3 ± 0.8 years. The individual's stated age was compatible with the age assessment in 31 cases (11.7%), while expert reports concluded that the age of majority had been reached in 131 cases (49.4%). In cases of discrepancies, the average difference between the stated and the assessed lowest possible age (= assessed minimum age) was 2.7 ± 2.3 years and 6.9 ± 3.8 years between the stated and the most probable age. Age assessments could be compared with actual ages determined by court proceedings in 27 cases, with established ages being systematically higher than the assessed minimum ages (mean difference = 4.4 ± 4.0 years). The difference between actual and stated ages ranged from 1.8 up to 18.9 years (mean difference = 6.4 ± 4.0 years). The used protocol never led to any age overestimation in this population.Our study reinforces the relevance of AGFAD recommendations for forensic age assessment and calls for the harmonization of practices based on this methodology in the European countries.

The paucity of early Pleistocene hominin fossils in Eurasia hinders an in-depth discussion on their paleobiology and paleoecology. Here we report on the earliest large-bodied hominin remains from the Levantine corridor: a juvenile vertebra (UB 10749) from the early Pleistocene site of ‘Ubeidiya, Israel, discovered during a reanalysis of the faunal remains. UB 10749 is a complete lower lumbar vertebral body, with morphological characteristics consistent with Homo sp. Our analysis indicates that UB-10749 was a 6- to 12-year-old child at death, displaying delayed ossification pattern compared with modern humans. Its predicted adult size is comparable to other early Pleistocene large-bodied hominins from Africa. Paleobiological differences between UB 10749 and other early Eurasian hominins supports at least two distinct out-of-Africa dispersal events. This observation corresponds with variants of lithic traditions (Oldowan; Acheulian) as well as various ecological niches across early Pleistocene sites in Eurasia., This study was funded the National Science Foundation to Miriam Belmaker (grant number 1851613) and by the Spanish Ministry of Science and Innovation to Markus Bastir (CGL2015-63648-P; Spanish Ministry of Economy and Competitivity, and PID2020-115854GB-I00; Spanish Ministry of Science and Innovation), and by The University of Tulsa Faculty Research Grant Program.

Bone and dental maturations are subject to physiological, environmental and pathological variables and are unique to each individual. Numerous methods for age estimation appeared to answer a new demand explained by the contemporary migratory movements and the increase of the crime rates. The objective of this study was to observe the relationships between skeletal and dental maturation stages to estimate which methods can be applied to a French population. This retrospective study was based on panoramic and cephalometric radiographs belonging to 192 (101 females and 91 males) orthodontic patients aged between 9 and 19 years, inhabitants of the Provence-Alpes-Côte d'Azur region. The Demirjian method based on dental calcification was used to estimate dental age. For the assessment of skeletal maturity and bone age, the Cervical Vertebral Maturation (CVM) method (Baccetti et al.) and its computerized version (Decocq et al.) were used. Spearman's correlation tests were performed to estimate the correlation between dental calcification stages and those of cervical vertebral maturation among the study population. The methods of Lin's concordance correlation coefficient and Bland and Altman were used to analyze the concordance between bone, dental and chronological ages. A moderate but statistically significant correlation was obtained between dental and skeletal developmental stages (R = 0.383-0.618). The tooth showing the highest correlation with vertebral stages was the second molar for both sexes. Earlier vertebral maturation stage affiliation was observed in girls. The results confirmed that bone and dental maturations can be assessed to estimate relevant biological ages for children in orthodontic or forensic contexts.

Artificial intelligence (AI) is increasingly being used in bone-age (BA) assessment due to its complicated and lengthy nature. We aimed to evaluate the clinical performance of a commercially available deep learning (DL)–based software for BA assessment using a real-world data. From Nov. 2018 to Feb. 2019, 474 children (35 boys, 439 girls, age 4–17 years) were enrolled. We compared the BA estimated by DL software (DL-BA) with that independently estimated by 3 reviewers (R1: Musculoskeletal radiologist, R2: Radiology resident, R3: Pediatric endocrinologist) using the traditional Greulich–Pyle atlas, then to his/her chronological age (CA). A paired t-test, Pearson’s correlation coefficient, Bland–Altman plot, mean absolute error (MAE) and root mean square error (RMSE) were used for the statistical analysis. The intraclass correlation coefficient (ICC) was used for inter-rater variation. There were significant differences between DL-BA and each reviewer’s BA (P P

The ability to make a continuous skeletal maturity estimate from a wrist radiograph would be useful in the treatment of adolescent forearm fractures, scoliosis, and other conditions. We attempted to create a reliable, rapid, and accurate method to do this.Many anteroposterior wrist radiographic parameters from 3 skeletal maturity systems were simplified to 23 based on relevance to the peripubertal age range, univariate correlation with skeletal maturity, and reliability. These 23 parameters were evaluated on serial peripubertal anteroposterior hand-wrist radiographs. We determined the Greulich and Pyle (GP) skeletal age and Sanders hand system (SHS) stage. We used stepwise linear regression and generalized estimating equation (GEE) procedures to identify important radiographic and demographic parameters for estimating skeletal maturity, creating the "Modified Fels wrist skeletal maturity system." Its accuracy predicting skeletal maturity was evaluated and compared with that of 4 other systems: (1) GP system, (2) SHS, (3) GP parameters along with age and sex, and (4) SHS parameters along with age and sex.Three hundred and seventy-two radiographs of 42 girls (age range, 7 to 15 years) and 38 boys (age range, 9 to 16 years) were included. Fifteen radiographic parameters were excluded from the Modified Fels wrist system by stepwise regression and GEE analyses, leaving age, sex, and 8 radiographic parameters in the final model. Use of the Modified Fels wrist system resulted in more accurate skeletal maturity estimations (0.34-year mean discrepancy with actual skeletal maturity) than all other systems (p0.001 for all). The Modified Fels wrist system had a similar rate of outlier skeletal maturity estimations as the age, sex, and SHS model (1.9% versus 3.5%, p = 0.11) and fewer outliers than all other systems (p0.05 for all).A system that included demographic factors and 8 anteroposterior wrist radiographic parameters estimates skeletal maturity more accurately than the 2 most-used skeletal maturity systems in the United States.The Modified Fels wrist skeletal maturity system may allow for more accurate, reliable, and rapid skeletal maturity estimation than current systems, and also may be used when treating adolescent forearm fractures as it does not require imaging past the metacarpals.Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Context Patients with classic congenital adrenal hyperplasia (CAH) often do not achieve their full growth potential. Adrenarche may accelerate bone maturation and thereby result in decreased growth in CAH. Objective The study aimed to analyze the impact of growth during adrenarche on final height of adequately treated classic CAH patients. Methods This retrospective, multicenter study (4 academic pediatric endocrinology centers) included 41 patients with classical CAH, born 1990-2012. We assessed skeletal maturation (bone age), growth velocity, and (projected) adult height outcomes, and analyzed potential influencing factors, such as sex, genotype, and glucocorticoid therapy. Results Patients with classic CAH were shorter than peers (−0.4 SDS ± 0.8 SD) and their parents (corrected final height −0.6 SDS ± 1.0 SD). Analysis of growth during adrenarche revealed 2 different growth patterns: patients with accelerating bone age (49%), and patients with nonaccelerating bone age relative to chronological age (BA-CA). Patients with accelerating BA-CA were taller than the normal population during adrenarche years (P = 0.001) and were predicted to achieve lower adult height SDS (−0.9 SDS [95% CI, −1.3; −0.5]) than nonaccelerating patients when assessed during adrenarche (0.2 SDS [95% CI, −0.3; 0.8]). Final adult height was similarly reduced in both accelerating and nonaccelerating BA-CA groups (−0.4 SDS [95% CI, −0.9; 0.1] vs −0.3 SDS [95% CI, [−0.8; 0.1]). Conclusion Patients with and without significant bone age advancement, and thus differing height prediction during adrenarche, showed similar (predicted) final height when reassessed during pubertal years. Bone age alone should not be used during adrenarche as clinical marker for metabolic control in CAH treatment.

Postmortem bone analysis is an essential part of forensic medicine. The goals are to determine whether the bones are human, the postmortem interval length, the number of people to whom the remains belong, the biological profile, and the existence of injuries., Obrada koštanih posmrtnih ostataka sastavni je dio posla sudskih medicinara. Ciljevi su odrediti radi li se o ljudskim posmrtnim ostatcima, duljinu postmortalnog intervala, broj osoba kojima posmrtni ostatci pripadaju, biološki profil osobe te postojanje ozljeda.

Background and purpose — Skeletal maturity is a crucial parameter when calculating remaining growth in children. We compared 3 different methods, 2 manual and 1 automated, in the radiological assessment of bone age with respect to precision and systematic difference. Material and methods — 66 simultaneous examinations of the left hand and left elbow from children treated for leg-length discrepancies were randomly selected for skeletal age assessment. The radiographs were anonymized and assessed twice with at least 3 weeks’ interval according to the Greulich and Pyle (GP) and Sauvegrain (SG) methods by 5 radiologists with different levels of experience. The hand radiographs were also assessed for GP bone age by use of the automated BoneXpert (BX) method for comparison. Results — The inter-observer intraclass correlation coefficient (ICC) was 0.96 for the GP and 0.98 for the SG method. The inter- and intra-observer standard error of the measurement (SEm) was 0.41 and 0.32 years for the GP method and 0.27 and 0.21 years for the SG method with a significant difference (p < 0.001) between the methods and between the experienced and the less experienced radiologists for both methods (p = 0.003 and p < 0.001). In 25% of the assessments the discrepancy between the GP and the SG methodwas > 1 year. There was no systematic difference comparing either manual method with the automatic BX method. Interpretation — With respect to the precision of skeletal age determination, we recommend using the SG method or preferably the automated BX method based on GP assessments in the calculation of remaining growth.

Objective: To determine potential associations between dental and skeletal maturation and palatally displaced canines (PDC) considering gender and chronological age. Material and methods: This study included pretreatment panoramic and lateral cephalometric radiographs of 43 subjects with PDCs and 203 randomly selected orthodontic subjects with normally erupted canines. Both groups were non syndromic patients. Chronological age of subjects was rounded and noted in years with decimal points and compared with chronological age according to Demirjian’s dental age assess-ment. Skeletal maturation was determined by cervical vertebrae changes on cephalometric radiographs. Results: Female subjects with PDC were more affected by left side canine displacement than males (p=0.027) with five times higher odds ratio (OR = 4.9; 95% CIL=1.2-19.7). A comparison of chronologic and skeletal age indicated that PDC subjects were skeletally younger than unaffected groups with statistically significant differences at the age of 10, 12 and 13. (p=0.05). Conclusion: Young subjects with PDCs showed skeletal maturation delay compared to control group, indicating that skeletal maturation assessment could be one of unexplored predicting factors of a PDC, especially at the age between 10 and 13 years in both genders. Subjects with PDC showed intensive growth spurt after the age of 12 years in females, and after the age of 13 in males. Dental maturation delay showed no statistical significance in PDC prediction., Cilj: Željelo se ustanoviti postoji li korelacija između dentalne i skeletne dobi te palatinalne impakcije očnjaka (PDC) s obzirom na spol i kronološku dob ispitanika. Materijali i metode: U ovoj studiji analizirani su ortopantomogrami i rendgenske kefalometrijske snimke 43 pacijenta s PDC-om i 203 nasumično odabrana ortodontska pacijenta s normalnim položajem očnjaka. Njihova kronološka dob zaokružena je i zabilježena kao decimalni broj izražen u godinama te uspoređena s dentalnom dobi koja je određena prema Demirjianovoj procjeni. Stupanj skeletne maturacije određen je prema morfološkim promjenama vratnih kralježaka na rendgenskim kefalometrijskim snimkama. Rezultati: Kod ispitanica s PDC-om češći je nalaz palatinalne impakcije lijevoga očnjaka u usporedbi s ispitanicima (p = 0,027), s pet puta većim omjerom izgleda (OR = 4,9; 95 % CIL = 1,2 – 19,7). Usporedba kronološke dobi i skeletne maturacije pokazala je da su ispitanici s PDC-om bili skeletno mlađi od onih s normalnim položajem očnjaka u dobi od 10, 12 i 13 godina (p = 0,05). Zaključak: Kod ispitanika s PDC-om zabilježeno je kašnjenje u skeletnoj maturaciji u odnosu prema kontrolnoj skupini, što upućuje na to da bi procjena stupnja skeletne maturacije mogla biti jedan od neistraženih čimbenika predviđanja PDC-a, posebno u dobi između 10 i 13 godina u oba spola. Djevojčicama s PDC-om intenzivno je ubrzan rast poslije 12. godine, a kod dječaka je zabilježen poslije 13. godine. Kašnjenje u dentalnoj zrelosti pacijenata nije pokazalo statističku značajnost u predviđanju PDC-a.

Objectives This feasibility study aimed to investigate the reliability of multi-factorial age estimation based on MR data of the hand, wisdom teeth and the clavicles with reduced acquisition time. Methods The raw MR data of 34 volunteers—acquired on a 3T system and using acquisition times (TA) of 3:46 min (hand), 5:29 min (clavicles) and 10:46 min (teeth)—were retrospectively undersampled applying the commercially available CAIPIRINHA technique. Automatic and radiological age estimation methods were applied to the original image data as well as undersampled data to investigate the reliability of age estimates with decreasing acquisition time. Reliability was investigated determining standard deviation (SSD) and mean (MSD) of signed differences, intra-class correlation (ICC) and by performing Bland-Altman analysis. Results Automatic age estimation generally showed very high reliability (SSD TA of 4 min). Radiological age estimation provided highly reliable results for images of the hand (ICC ≥ 0.96) and the teeth (ICC ≥ 0.79) for short acquisition times (TA = 16 s for the hand, TA = 2:21 min for the teeth), imaging data of the clavicles allowed for moderate acceleration (TA = 1:25 min, ICC ≥ 0.71). Conclusions The results demonstrate that reliable multi-factorial age estimation based on MRI of the hand, wisdom teeth and the clavicles can be performed using images acquired with a total acquisition time of 4 min.

Summary Objective This study aimed to evaluate the validity of using of digital dental X-ray for the thumb region in assessment of skeletal maturation stage around functional orthodontic treatment time. Materials and methods The sample consisted of 200 patients (100 males and 100 females) aged between (9.5–18) years. Each patient underwent a hand-wrist radiograph and a digital radiograph for the thumb region taken by a dental X-ray machine. Skeletal changes were studied in the sesamoid bone and first Metacarpophalangeal joint region, and compared to Bjork method. Results Good correlation was noted between our thumb method stages (Th index) and hand-wrist maturation stages, so Th index has a good validity and reliability in assessment of maturation stages, in addition to its simplicity, accuracy and advantages in saving time, cost and decreasing radiographic exposure compared with hand-wrist maturation stages.

Accurate age-at-death estimation is important for both paleodemographic studies and forensic casework. Although the auricular surface of the ilium is a well-validated skeletal indicator for aging studies, problems persist with identifying features that estimate age accurately in older individuals. This study tests the utility of one method, developed by Igarashi et al. (2005), which claims to estimate age more accurately in older individuals using a presence/absence scoring system for 13 auricular surface traits. Four hundred (400) individuals, aged 16-93 years, from the Hamann-Todd Collection were examined to test the performance of Igarashi et al.'s method in a North American sample. Pearson's product-moment correlation tests were performed for both the overall method and individual traits to assess correlation with chronological age. Eleven of the 13 traits showed statically significant correlations with chronological age, and nine were found to have higher correlations than originally reported. The method showed a tendency toward negative bias (i.e., a tendency to under-age individuals, particularly in the older age range). Models for both males and females and full and reduced models developed by Igarashi et al. were tested; the sex-pooled full model performed best, and the female full model performed most poorly. Although this method did not have significantly higher accuracy rates in a North American sample than other auricular surface methods, unique traits identified by Igarashi et al. did correlate with chronological age. In future studies, these traits should be investigated using different scoring systems (e.g., character states), as they show utility for aging research.

Determining majority plays a key role for forensic age diagnostics in living individuals. Recent data suggest that magnetic resonance imaging (MRI) of the proximal tibial epiphysis (PTE) may be a suitable alternative or at least an additional tool to clarify whether an individual has reached majority. However, the reference data situation is still sparse. Hence, the present dual center study retrospectively analyzed routine MRI of the knee in 413 cases (214 males and 199 females) of a Western Caucasian population aged between 12 and 25 years. MRI was performed at 1.5 and 3.0 T clinical scanners using T1- and T2-weighted sequences. The classification system by Vieth et al. (Eur Radiol 2018; 28:3255-3262) was applied for determining the ossification stages of the PTE. Intra-observer agreement was "very good" (κ = 0.931), and inter-observer agreement was "good" (κ = 0.798). Minimum ages above the age of 18 years were observed with the final stage (stage 6) in either sex (20.27 years in males and 18.55 years in females). The results are not in contradiction with the previous data and can be considered a strong and valuable support of the so far existing database. Therefore, the investigation of the PTE using routine MRI (either at 1.5 or 3.0 T) could be taken into consideration for application in forensic age estimation practice in near future.

We performed genome-wide association study meta-analysis to identify genetic determinants of skeletal age (SA) deviating in multiple growth disorders. The joint meta-analysis (N = 4557) in two multiethnic cohorts of school-aged children identified one locus, CYP11B1 (expression confined to the adrenal gland), robustly associated with SA (rs6471570-A; β = 0.14; P = 6.2 × 10−12). rs6410 (a synonymous variant in the first exon of CYP11B1 in high LD with rs6471570), was prioritized for functional follow-up being second most significant and the one closest to the first intron-exon boundary. In 208 adrenal RNA-seq samples from GTEx, C-allele of rs6410 was associated with intron 3 retention (P = 8.11 × 10−40), exon 4 inclusion (P = 4.29 × 10−34), and decreased exon 3 and 5 splicing (P = 7.85 × 10−43), replicated using RT-PCR in 15 adrenal samples. As CYP11B1 encodes 11-β-hydroxylase, involved in adrenal glucocorticoid and mineralocorticoid biosynthesis, our findings highlight the role of adrenal steroidogenesis in SA in healthy children, suggesting alternative splicing as a likely underlying mechanism., Olja Grgic, Matthew Gazzara, and Alessandra Chesi et al. perform a genome-wide association study meta-analysis for skeletal age in two pediatric cohorts. They observe that variation in the adrenal gene, CYP11B1, impacts its alternative splicing, suggesting that adrenal steroidogenesis may contribute toward variation in skeletal age in otherwise healthy children.

Conventional methods for artificial age determination of skeletal bones have several problems, such as strong subjectivity, large random errors, complex evaluation processes, and long evaluation cycles. In this study, an automated age determination of skeletal bones was performed based on Deep Learning. Two methods were used to evaluate bone age, one based on examining all bones in the palm and another based on the deep convolutional neural network (CNN) method. Both methods were evaluated using the same test dataset. Moreover, we can extend the dataset and increase the generalisation ability of the network by data expansion. Consequently, a more accurate bone age can be obtained. This method can reduce the average error of the final bone age evaluation and lower the upper limit of the absolute value of the error of the single bone age. The experiments show the effectiveness of the proposed method, which can provide doctors and users with more stable, efficient and convenient diagnosis support and decision support.

Objective: To evaluate dental age assessment reliability through Tooth Coronal Index (TCI) method . Material and Methods: The cone-beam computed tomography (CBCT) scans of 160 individuals aged between 20-70 years were analyzed in the present study. The height of the crown, i.e., coronal height, and the height of the coronal pulp cavity, i.e., coronal pulp cavity height, of mandibular second premolars and first molars were calculated and then TCI was measured. The actual age of a subject was compared with TCI of tooth and the acquired data were subjected to Pearson’s correlation and unpaired t - tests. Results: Negative correlation was observed between the real age and TCI of mandibular first molar (r = - 0.094, p=0.382) and second premolar (r = -0.176, p=0.0961. Statistically significant difference was observed between actual age and TCI for mandibular second premolar and first molar (p

In order to find a reliable method to correctly assess majority in both sexes by MRI, a study was conducted to evaluate the applicability of the recently presented Vieth classification in wrist MRI, after it had originally been proposed for knee MRI.After receiving a positive vote by the ethics committee, the left-hand wrists of 347 male and 348 female volunteers of German nationality in the age bracket 12-24 years were scanned. Before conducting the prospective, cross-sectional examinations, an informed consent was obtained from each volunteer. A 3.0 T MRI scanner was used, acquiring a T1 turbo spin-echo sequence (TSE) and a T2 TSE sequence with fat suppression by spectral presaturation with inversion recovery (SPIR). The images were assessed by applying the Vieth classification. Minimum, maximum, mean ± standard deviation, and median with lower and upper quartiles were defined. Intra- and interobserver agreements were determined by calculating the kappa coefficients. Differences between the sexes were analyzed using the Mann-Whitney U test.By applying the unmodified Vieth classification with corresponding schematics, it was possible to assess majority in both sexes via the epiphyseal-diaphyseal fusion of the distal radius and in males also via the epiphyseal-diaphyseal fusion of the distal ulna. The Mann-Whitney U test implied significant sex-related differences for all stages. For both epiphyses, the intra- and interobserver agreement levels were very good (κ0.8).If confirmed by further studies, it would be possible to determine the completion of the 18th year of life in both sexes by 3.0 T MRI of the wrist and using the Vieth classification.• The Vieth classification allows determining majority in males and females alike based on the distal radius' epiphysis by 3.0 T MRI of the wrist. • The Vieth classification also allows determining majority in males based on the distal ulna's epiphysis by 3.0 T MRI of the wrist, but not in females. • The presented data can be deemed referential within certain discussed boundaries.

Background Previous studies suggest that use of artificial intelligence (AI) algorithms as diagnostic aids may improve the quality of skeletal age assessment, though these studies lack evidence from clinical practice. Purpose To compare the accuracy and interpretation time of skeletal age assessment on hand radiograph examinations with and without the use of an AI algorithm as a diagnostic aid. Materials and Methods In this prospective randomized controlled trial, the accuracy of skeletal age assessment on hand radiograph examinations was performed with (

Objective: This study aimed to establish a correlation between the stages of tooth calcification of mandibular canines and second molars with the phases of skeletal development. Methods: In a consecutive series of panoramic, cephalometric and hand-wrist radiographs of 113 individuals (60 females and 53 males) with an average age of 12.24 ± 1.81 years, the stages of mandibular canine and second molar calcification, cervical vertebrae maturation indicators (CVMI) and skeletal maturity indicators (SMI) were classified. The variables were correlated by means of the Spearman’s Rank test: chronological age, SMI, CVMI and tooth calcification stages. In order to assess whether the CVMI and tooth calcification stages were significant predictors of the SMI, an ordinal regression analysis was carried out. Results: The stages of CVMI (OR = 16.92; CI 95% = 6.45-44.39; p< 0.001) and calcification of the second molars (OR = 3.22; CI 95% = 1.50-6.92; p= 0.003) were significant predictors of SMI, however similar result was not observed for canines (OR = 0.52, CI 95% = 0.18-1.54; p= 0.239). Calcification stage E for boys, and E and F for girls corresponded to the pre-peak phase of pubertal growth. Stages G and H for boys, and F and G for girls coincided with peak of growth. In the final growth phase, the majority of second molars presented with root apex closure (stage H). Conclusion: The stages of calcification of the second molar may be considered predictors of the stage of skeletal development in the population studied. RESUMO Objetivo: O presente estudo objetivou estabelecer uma correlação entre os estágios de calcificação dentária de caninos e segundos molares inferiores e as fases do desenvolvimento esquelético. Métodos: Em uma série consecutiva de radiografias panorâmicas, cefalométricas e de mão e punho de 113 indivíduos (60 meninas e 53 meninos) com idade média de 12,24 ± 1,81 anos, foram classificados os estágios de calcificação do canino e do segundo molar inferiores, indicadores de maturação das vértebras cervicais (IMVC) e indicadores de maturação esquelética (IME). As variáveis foram correlacionadas pelo teste de Correlação de Rank de Spearman: idade cronológica, IME, IMVC e estágios de calcificação dentária. A fim de avaliar se os estágios do IMVC e da calcificação dentária foram preditores significativos do IME, foi realizada uma análise de regressão ordinal. Resultados: Os estágios de IMVC (OR = 16,92; IC 95% = 6,45-44,39; p< 0,001) e calcificação dos segundos molares (OR = 3,22; IC 95% = 1,50-6,92; p= 0,003) foram preditores significativos de IME; no entanto, esse não foi o caso com dentes caninos (OR = 0,52, IC 95% = 0,18-1,54; p= 0,239). Os estágios de calcificação E para meninos e E e F para meninas corresponderam à fase pré-pico de crescimento puberal. Os estágios G e H para meninos e F e G para meninas coincidiram com o pico de crescimento. Na fase final de crescimento, a maioria dos segundos molares apresentou fechamento do ápice radicular (estágio H). Conclusão: Os estágios de calcificação do segundo molar podem ser considerados preditores do estágio de desenvolvimento esquelético na população estudada.

To assess the performance of knee MRI for forensic age prediction and classification for 12-, 14-, 16-, and 18-year thresholds.The ossification stages of distal femoral epiphyses and proximal tibial epiphyses were assessed using an integrated staging system by Schmeling et al. and Kellinghaus et al. for knee 3.0T MRI with T1-weighted turbo spin-echo (T1-TSE) in sagittal orientation among 852 Chinese Han individuals (483 males and 369 females) aged 7-30 years. Regression models for age prediction were constructed and their performances were evaluated based on mean absolute deviation (MAD) values. In addition, the performances of age classification were assessed using receiver operating characteristic (ROC) analyses.The intra- and inter-observer agreement levels were very good (κ0.80). The complete fusion of those two types of epiphyses took place before 18.0 years in our study participants. The minimum MAD values were 2.51 years (distal femur) and 2.69 years (proximal tibia) in males, and 2.75 years (distal femur) and 2.87 years (proximal tibia) in females. The specificity values of constructed prediction models were all above 90% for the 12-, 14-, and 16-year thresholds, compared to the 74.8-84.6% for the 18-year threshold. Better performances of age prediction and classification were observed in males by distal femoral epiphyses.Ossification stages via 3.0T MRI of the knee with T1-TSE sequence using an integrated staging system could be a reliable noninvasive method for age prediction or for age classification for 12-, 14-, and 16-year thresholds, especially in males by distal femoral epiphyses. However, assessments based on the full bony fusion of the distal femoral epiphysis and proximal tibial epiphysis seemed not reliable for age classification for the 18-year threshold in the Chinese Han population.

International audience; Introduction: The acetabulum has been reported as a reliable age estimation marker. However, analyzing its morphological changes can be challenging using computed tomography (CT) imaging. Newly introduced global illumination rendering (GIR) applied to CT can improve the visualization of the fine details and thus the method's performance. This study aimed to analyze age estimation using morphological features of the acetabulum using GIR applied to CT.Methods: We collected 200 postmortem CT scans. A segmentation of the acetabular joint was initially done. Then, three-dimensional (3D) reconstruction of the images was performed using GIR. These images were saved and then analyzed by two operators based on the three morphological criteria described in the Rougé-Maillart method. Reproducibility was assessed by intraclass correlation (ICC). Age estimation was assessed by multiple linear regression.Results: The sample was composed of 155 males and 45 females, with a mean age of 50 ± 18.3 years old. We observed high agreement in both the inter-observer and intra-observer reproducibility for the three variables (ICC of 75.6 to 90.8% and 89.3 to 95.8%, respectively) and the total score (ICC of 93.5% and 95%, respectively). The three variables, as well as the total score, were significantly correlated with age groups. The total score showed a prediction rate higher than 85% for ages under 40 and over 70 years old. We identified three models with two validated models with an adjusted R2 of 85.6% and 84.8%, respectively; a standard error of 0.688 and 0.706, respectively; and a good correlation of all variables and no inter-correlation. The first validated model included the three morphological criteria scores, and the second model was based on the total score.Conclusion: GIR applied to CT provides photorealistic images that can be useful for forensic imaging intended for age estimation based on morphological methods.

Age estimation is one of the prerequisites of human identification. Age-progressive changes in the pelvis offer useful evidence for forensic age estimation across all age groups. The acetabulum presents as a durable and taphonomic degradation resistant age marker, and, can be employed for analysing age-progressive changes described by Calce. The present study aimed at determining the applicability of the Calce method for age estimation in an Indian population based on a computed tomographic examination of the acetabulum. Additionally, different morphological features defined by Calce were evaluated to identify the feature which contributes most towards the process of age estimation. CT images obtained from clinically undertaken examinations of individuals aged 17 years and above were scrutinized according to the features defined within the Calce method. No statistically significant bilateral or sex differences were observed. An overall accuracy of 76.66% was observed on applying the Calce method to an Indian population, with lower accuracy percentages for individuals aged 40 years and above. The associated overall inaccuracy and bias were found to be 9.45 and 8.88 years, respectively. Within the various features, acetabular groove was found to contribute most towards the overall accuracy, and apex growth the least. Considering this weighted proportion, population specific models should be derived to render greater applicability to the method for age estimation.

Suchey-Brooks method has been studied many times with varying reports of accuracy and reliability. A systematic review and meta-analyses were utilized to quantitatively determine the accuracy and reliability of the Suchey-Brooks (S-B) method. A systematic search of PubMed and EBSCO health and medical databases was performed. Meta-analyses were performed to quantify the relationship between actual known age at death and the S-B method using Spearman's Rho and Pearson's r for (1) combined males and females estimates, (2) male-only estimates, and (3) female-only estimates. Overall correlation coefficient using Cohen's kappa, Spearman's Rho, and Pearson's r was also calculated to determine the interrater and intrarater reliability using the S-B method. Eighteen studies classified as moderate-to-high methodological quality met the inclusion criteria. The sample sizes were different for the combined male and female (n = 2620), male-only (n = 2602), and female-only (n = 1431) meta-analyses. The effect size of the age at death meta-analyses was large and significant for combined males and females (Spearman's Rho = 0.62; Pearson's r = 0.65), male-only (Spearman's Rho = 0.77; Pearson's r = 0.75), and female-only (Spearman's Rho = 0.71; Pearson's r = 0.71). The overall correlation coefficients of the interrater (Kappa = 0.76; Spearman's Rho = 0.73; Pearson's r = 0.80) and intrarater (Kappa = 0.81; Spearman's Rho = 0.91; Pearson's r = 0.83) reliability meta-analyses were large and significant. A significant degree of heterogeneity was present in all meta-analyses, with minimal evidence of publication bias. The meta-analyses results suggest the S-B method is highly reliable with a moderate-to-high degree of accuracy. Our results also identified sample size and accuracy differences between male and female individuals.

To assess the evidence on the relationship between dental and cervical vertebrae maturation.Searches were performed (up to December 2021) in seven databases, as well as in gray literature. Studies that included growing subjects, which evaluated the correlation between the stages of tooth formation and the maturation of cervical vertebrae, were eligible. The methodological quality of the selected reports was assessed using the JBI checklist for cross-sectional studies. Random-effects meta-analyses were implemented to calculate the pooled correlation coefficients between the maturation stages of cervical vertebrae and each tooth type. The GRADE approach was followed to assess the certainty of evidence.Seventy-seven studies were selected. Most of them had limitations related to sampling and reliability of the methods to evaluate maturation. The syntheses evidenced positive correlations between the maturation of cervical vertebrae and the formation/calcification stages of the following lower teeth: canine (n = 7318; r = 0.692; 95% CI: 0.656-0.724), first premolar (n = 6194; r = 0.689; 95% CI: 0.649-0.725), second premolar (n = 6194; r = 0.695; 95% CI: 0.659-0.729), and second molar (n = 7905; r = 0.698; 95% CI: 0.652-0.739). All estimates were affected by the risk of bias and the presence of unexplained statistical heterogeneity.The evidence points to an apparent positive correlation between dental and cervical vertebrae maturation. These results need to be carefully evaluated as the body of evidence is of very low quality.Dental maturation might be a potential indicator of skeletal craniofacial growth status. A routine dental x-ray could be sufficient, reducing radiation exposure by requesting additional radiographs.

Introduction In this study, we evaluated whether it is possible to perform forensic radiological skeletal age estimation via radiological examination of the ilioischial, ischiopubic, and iliopubic synchondrosis regions of the pelvis. Methods This study was conducted by retrospectively examining the abdominopelvic images of individuals aged 8–16 who had applied to the hospital for any reason without having a chronic disorder and who had undergone computed tomography. Two radiologists retrospectively reviewed the images. The BT images of the pelvis ilioischial, ischiopubic, and iliopubic synchondrosis regions were evaluated as follows: 0: open, 1: semiclosed, and 2: closed. The data were evaluated using the SPSS 17 program. Results Two hundred sixty-three children (118 girls and 145 boys) between the ages of 8 and 16 years without any health problems participated. There was a significant difference between the groups for all the evaluated synchondrosis joints in girls and boys (p Discussion Some studies have previously evaluated synchondrosis by using computed tomography. We showed that forensic radiological skeletal age estimation could be performed by examining ischiopubic-ilioischial-iliopubic synchondrosis in pelvis computed tomography images. The pelvis is more resistant to decay than other parts of the body. Furthermore, pelvis bones can withst and the effects of postmortem animal attacks for a longer period. Therefore, we believe that forensic age estimation can be made on corpses with no extremity, a damaged chest, or whose only pelvic bones are assessable through the method we use. Conclusion In our study, the ischiopubic-ilioischial-iliopubic joints were open in those aged nine and under and closed in those aged 15 and above. Ilioischial, ischiopubic, and iliopubic synchondrosis were observed to close earlier in girls than in boys. We consider that our study will be beneficial in the 8-16-year-old age group if used. In addition, our study can be used to determine the radiological bone age in cases with wrist bone abnormalities or wrist amputation.

Dual-energy x-ray absorptiometry (DXA) scans are frequently used in human biological research to study bone health and body composition. Hand-wrist scans for the assessment of skeletal maturity can also be easily obtained in immature research participants who are being scanned to assess bone health. Whilst assessment by an expert is the desired arrangement such expertise may not be available, and thus knowledge of the relative reproducibility of a trained novice and an acknowledged expert is pertinent. Here we compare the relative reproducibility of an expert and a trained novice on 41 DXA left-hand scans of adolescent males using the Tanner-Whitehouse 3 (TW3) RUS method. The trained novice showed almost perfect reproducibility when evaluating bone age from DXA hand scans compared to an expert in skeletal maturity assessment. Both observers demonstrated reproducibility good enough to suggest that the TW3 method is appropriate to use with DXA hand scans by a trained researcher.

BACKGROUND Recently, a skeletal maturity system using knee radiographs, named the modified Roche-Wainer-Thissen (RWT) system, has been developed using 7 discrete radiographic parameters. While the system has been shown to significantly outperform the Greulich and Pyle atlas, the effect of rotational variation of the knee radiograph on skeletal maturity determinations has not been studied. METHODS Normal knee computed tomography scans of 12 male children ages 10 to 16 years and 8 female children ages 8 to 14 years were obtained retrospectively, converted into 3-dimensional reconstructions, and then used to simulate knee radiographs in 5 different rotational positions. Images were graded using the modified RWT system, and 1-way repeated measures analysis of variance was used to compare skeletal age in the patella centered view versus the other positions. We next retrospectively found 85 pediatric patients with both bilateral standing anteroposterior hip to ankles and separate knee radiograph within 6 months of each other. The skeletal maturity values from the 2 different radiographs were compared in 39 males between the ages of 10 and 16 years and 46 females between 8 and 14 years of age using paired t test and Wilcoxon-signed rank test. RESULTS On the computed tomography scan-based images, there was no statistically significant effect of rotational position on the modified RWT score using repeat measures analysis of variance (P=0.210). Only the width ratio of the tibial epiphysis and metaphysis and the width ratio of the fibular epiphysis and metaphysis were statistically different between rotational positions (P

BACKGROUND Though skeletal maturity is most relevant during adolescence, it has utility in treatment of younger patients in some circumstances. Accurate estimation of skeletal maturity using knee radiographs would be useful when treating limb length discrepancy and other general medical conditions in preadolescent patients. Currently, a quick, accurate, and reproducible method of estimating skeletal maturity in preadolescents is lacking. METHODS Serial anteroposterior knee radiographs taken at historical growth study visits leading up to the chronological age associated with 90% of final height (an enhanced skeletal maturity standard as compared with peak height velocity) were analyzed in 75 children. Epiphyseal and metaphyseal widths of the distal femur, proximal tibia, and proximal fibula were measured and the epiphyseal:metaphyseal ratio was calculated. Greulich and Pyle (GP) bone ages were also assigned by an experienced pediatric endocrinologist using left hand radiographs. Stepwise linear regression and generalized estimating equation analyses were used to make a skeletal maturity model incorporating demographics (age+sex) and knee epiphyseal:metaphyseal ratios. RESULTS A total of 258 left knee radiographs from 39 girls (mean age 8.6 y, range: 2.9 to 13 y) and 36 boys (mean age 10.6 y, range: 3.8 to 15 y) were included. The demographics+ratios model had similar prediction accuracy (0.49 vs. 0.48 y, P=0.84) and rate of outliers (11% vs. 9%, P=0.11) as the demographics+GP model. The demographics+ratios model outperformed all other models evaluated, including a demographics-only model (P

The ability to estimate skeletal maturity using a hip radiograph does not yet exist, but may have utility in the treatment of scoliosis, slipped capital femoral epiphysis, and lower limb deformity. We sought to develop a fast, accurate, and reproducible method.Fourteen hip radiologic parameters were evaluated on serial anteroposterior hip radiographs from 3 years before to 2 years after the skeletal age associated with 90% of final height, a validated skeletal maturity definition which correlates with the timing of peak height velocity. The Greulich and Pyle (GP) left hand bone age was obtained for comparison. Stepwise linear regression and generalized estimating equation analyses were used to isolate key hip and demographic parameters, creating the "optimized Oxford" skeletal maturity system. The accuracy of the optimized Oxford system in predicting years from 90% of final height was evaluated and compared with systems of demographics only, the modified Oxford, demographics+modified Oxford, and demographics+GP.A total of 284 hip radiographs from 41 girls (range: 7 to 15 y) and 38 boys (range: 9 to 17 y) were included. Following multivariate analyses, 5 of the original 14 hip radiographic parameters remained significant. The predictions made by the optimized Oxford model had greater accuracy and fewer outlier predictions (predictions1 y off from actual years from 90% of final height) than the demographics only and modified Oxford only models (P0.05 for all). The optimized Oxford model had greater prediction accuracy than the demographics+modified Oxford model, but similar rates of outlier predictions (P=0.903). No differences in mean prediction accuracy or rate of outlier predictions were observed between the optimized Oxford and the demographics+GP model (P0.05).High precision in skeletal maturity estimation can be achieved by using chronological age, sex, and 5 hip radiographic parameters.We have developed a skeletal maturity system that utilizes anteroposterior hip radiographs and performs as accurately as GP.

Skeletal remains are often found on a crime scene in which a forensic anthropologist is then consulted to create a biological profile, which includes the estimation of age, sex, ancestry and stature. The viscerocranium plays an important role in the formation of a biological profile. However, to utilise the viscerocranium for age estimation, population specific normative data and knowledge of the development of the viscerocranium is required. Therefore, this study aimed to investigate the developmental changes from birth to 18 years of age of the facial skeleton of individuals from a South African cohort. This study comprised of 239 computed tomography (CT) scans (128 males; 111 females). The viscerocranium was subdivided into five regions viz.: orbital, nasal, midfacial, maxillary and mandibular. The linear parameters in each region were correlated to age to identify the developmental growth patterns of the viscerocranial regions according to male and female. The measurements which displayed the highest correlations with age were used to develop formulas which could be used for age estimation. The results of this study showed that the measurements in the orbital, midfacial, maxillary and mandibular regions experienced rapid growth between 0 and 5 years of age, with the nasal region increasing steadily over time. It was noted that males displayed overall larger measurements than females except for the anterior interorbital distance and both right and left zygomatic arch lengths (ZAL). Although only the left orbital height, nasal aperture height and mandible width displayed statistically significant size differences according to sex (p ≤ 0.05). The measurements which showed the highest correlations to age were the zygomatic arch distance (r = 0.8842, p 0.001), ZAL (right: r = 0.8929, p 0.001; left: r = 0.8656, p 0.001) and the mandible width (r = 0.8444, p 0.001). Formulas were derived for the measurements that could be used to forensically estimate age within a subadult cohort.

Objectives To validate adult height predictions (BX) using automated and Greulich–Pyle bone age determinations in children with chronic endocrine diseases. Methods Heights and near-adult heights were measured in 82 patients (48 females) with chronic endocrinopathies at the age of 10.45 ± 2.12 y and at time of transition to adult care (17.98 ± 3.02 y). Further, bone age (BA) was assessed using the conventional Greulich–Pyle (GP) method by three experts, and by BoneXpert™. PAH were calculated using conventional BP tables and BoneXpert™. Results The conventional and the automated BA determinations revealed a mean difference of 0.25 ± 0.72 y (p = 0.0027). The automated PAH by BoneXpert™ were 156.26 ± 0.86 cm (SDS − 2.01 ± 1.07) in females and 171.75 ± 1.6 cm (SDS − 1.29 ± 1.06) in males, compared to 153.95 ± 1.12 cm (SDS − 2.56 ± 1.5) in females and 169.31 ± 1.6 cm (SDS − 1.66 ± 1.56) in males by conventional BP, respectively and in comparison to near-adult heights 156.38 ± 5.84 cm (SDS − 1.91 ± 1.15) in females and 168.94 ± 8.18 cm (SDS − 1.72 ± 1.22) in males, respectively. Conclusion BA ratings and adult height predictions by BoneXpert™ in children with chronic endocrinopathies abolish rater-dependent variability and enhance reproducibility of estimates thereby refining care in growth disorders. Conventional methods may outperform automated analyses in specific cases.

The assessment of biological maturity status plays an important role in talent identification and development programs.To compare age at predicted adult height and BAUS skeletal age as indicators of biological maturity status in youth soccer players using a construct-validity approach.Participants were 114 players from the U12 to U17 age groups of a professional youth soccer academy. Maturity status was determined via percentage of predicted adult height based upon the Khamis-Roche method (somatic maturity) and assessed via the SonicBone BAUSAlthough maturity status indicators were largely interrelated (r = .94, 95%CL 0.91-0.96), concordance (κ = 0.31 to 0.39) and Spearman's rank-order correlations (ρ = 0.45-0.52) of classification methods were moderate. A selection bias towards early maturing players emerged in the U14 age group which remained relatively consistent through to the U17 age group.Results confirm the construct-validity of both methods to assess biological maturity status although further validation relative to established indicators of biological maturity is needed. Furthermore, caution is also warranted when interpreting maturity status classification methods interchangeably given the poor concordance between classification methods.

OBJECTIVE To predict the hand-wrist maturation stages based on the cervical vertebrae (CV) images, and to analyse the accuracy of the proposed algorithms. SETTINGS AND POPULATION A total of 499 pairs of hand-wrist radiographs and lateral cephalograms of 455 orthodontic patients aged 6-18 years were used for developing the prediction model for hand-wrist skeletal maturation stages. MATERIALS AND METHODS The hand-wrist radiographs and the lateral cephalograms were collected from two university hospitals and a paediatric dental clinic. After identifying the 13 anatomic landmarks of the CV, the width-height ratio, width-perpendicular height ratio and concavity ratio of the CV were used as the morphometric features of the CV. Patients' chronological age and sex were also included as input data. The ground truth data were the Fishman SMI based on the hand-wrist radiographs. Three specialists determined the ground truth SMI. An ensemble machine learning methods were used to predict the Fishman SMI. Five-fold cross-validation was performed. The mean absolute error (MAE), round MAE and root mean square error (RMSE) values were used to assess the performance of the final ensemble model. RESULTS The final ensemble model consisted of eight machine learning models. The MAE, round MAE and RMSE were 0.90, 0.87 and 1.20, respectively. CONCLUSION Prediction of hand-wrist SMI based on CV images is possible using machine learning methods. Chronological age and sex increased the prediction accuracy. An automated diagnosis of the skeletal maturation may aid as a decision-supporting tool for evaluating the optimal treatment timing for growing patients.

Introduction The reliability of the cervical vertebral maturation (CVM) method has been questioned. The objective of this research was to evaluate the diagnostic reliability of the CVM method to diagnose the mandibular growth spurt using longitudinal records from an alternative database (Iowa Facial Growth Study [IFGS]) using established diagnostic testing methods. Methods Cephalometric films from 43 subjects (males = 20, females = 23) with Class I or Class II skeletal pattern from the IFGS were scanned, digitized, and adjusted for magnification. At least 5 consecutive, annual films were digitized. For each subject, mandibular length (Co-Gn) was measured for each film, and the growth increment between films was calculated. The largest growth increment was the growth spurt. For each subject, the film displaying CVM stage 3 was identified by a blinded examiner viewing the films in random order. Interrater and intrarater repeatability for Co-Gn (intraclass correlation) and CVM staging (weighted kappa) were calculated. Diagnostic tests, including sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were carried out. The present data were compared with data previously derived from samples of the University of Michigan, Oregon, and Burlington Growth studies (UMGS, OGS, and BGS, respectively). A multilevel logistic regression analysis was also run with the mandibular growth peak as the response variable. Results Interrater repeatability for mandibular measurements (intraclass correlation coefficient [ICC] = 0.91) and CVM staging (k = 0.88) were excellent. Intrarater repeatability for mandibular measurements (ICC = 0.98) and CVM staging (kw = 0.55) were excellent to moderate. The UMGS data demonstrated higher sensitivity with comparable specificity. Accuracy was largely similar. Their PPV and NPV had larger ranges. The OGS and BGS data, compared with the IFGS data, showed that our sensitivity and PPVs were higher, that their specificity was higher, and that the NPV and accuracy were very similar. The regression analysis was applied to age groups 10-11 years through 13-14 years. Only chronological age was significant (P = 0.04). Conclusions Agreement between CVM stage 3 and the maximum mandibular growth spurt is inconsistent. The diagnostic capability of CVM for the mandibular growth spurt is questionable.

STUDY DESIGN: Prospective longitudinal study of novel growth modulation system for early adolescent idiopathic scoliosis (AIS), consecutive case series from first human use to study endpoint at skeletal maturity, fusion, or five years postoperation. OBJECTIVES: Determine adverse events and curvature changes to end of study; examine factors most likely to explain variability in curve changes. SUMMARY OF BACKGROUND DATA: Pilot clinical safety study was performed under US Food and Drug Administration (FDA) Investigational Device Exemption (IDE). Safety and radiographic results were previously reported to 24 months postoperation. METHODS: Subjects with early AIS underwent thoracoscopic placement of titanium clip-screw devices designed to modify growth asymmetrically. Eligibility was based on high risk of progression to 50°: single major thoracic curve 25°–40°, Risser 0, open triradiate cartilages, and premenarchal if female. Six subjects, the maximum allowed, enrolled. Adverse events (AEs), clinical outcomes, and curvatures were systematically collected. Disc heights, vertebral heights, and implant-bone contact areas were assessed. RESULTS: Consecutive subjects enrolled, aged 12.1 years (±1.7), three were female. AEs from two to five years postoperation included deformity changes leading to a second surgery in three patients: two for posterior spinal fusion, and one for thoracoscopic removal of half the implants for overcorrection. One patient, whose curve exceeded 50° at 18 years, did not choose fusion. Major thoracic curves were 34° (±3°) preoperatively and 42° (±20°) at end of study. CONCLUSIONS: In a study of spine growth modulation in patients with early AIS with high risk of progression, at skeletal maturity or five years postoperation, major thoracic curves of half progressed to >50°, whereas curves of the other half remained

The timing of skeletal maturation is one of the common indicators used to estimate age at death of juvenile skeletal remains. Skeletal maturation of the sternum has received less attention than other anatomical locations, and there is a general lack of detailed information about the fusion timing in the dry sternum that can be used for the estimation of age. The objective of this study is to document the age variation in the fusion of the body sternebrae, and both clavicular and intercostal notches. A three stage scale scheme was used (unfused elements, partial, and complete fusion) to quantify fusion of primary and secondary ossification centres in a sample of 68 individuals of both sexes from the identified skeletal collection housed at the National Museum of Natural History and Science in Lisbon, Portugal. Analysis was performed only for the pooled sex sample due to small sample size. Wide age intervals were obtained for fusion stages at all of the sternal centres. Primary ossification centres start to fuse between 1 and 27 years of age, with sternebrae 3 and 4 completing their fusion first. Secondary ossification centres fuse between 5 to 25 years of age. Results reflect considerable variability among individuals in the maturation of the sternum.