Eevir Akram Zain Aladdin, Saad Kadhum Kareem, Niran Mahmood Ahmed Al-Tameemi


Forensic Medicine Directorate, Ministry of Health. Baghdad, Iraq.


stimation of age is helpful in both civil and criminal cases. In the living individual age estimation is the most important issue to the court and the common citizens as well. The present study was carried out to study the estimation of age by epiphyses fusion at the knee joint, which is considered one of the modern and somewhat accurate methods of estimating age.

Purpose. To compare chronological age and age estimated according to the union from radiographic assessment of epiphyseal fusion at the knee joint in a sample of the Iraq population and to implement radiographic examination of the knee joint as an additional anatomical region for age estimation.

Materials and Methods. A prospective study was carried out on 55 medico-legal cases referred to the medico-legal directorate in Baghdad during 6-month period in 2022. The cases under study were classified into 2 groups: male (30) and female (25), their age ranged from (9-19 years). Radiographic  method (anteroposterior and lateral knee x-ray) was used to subdivide the continuum of development into 5 specific stages of union and scored as stage 0 – nonunion, stage 1 – beginning union, stage 2 – active union, stage 3 – recent union, stage 4 – complete union.

Results. The present study showed that out of the total of 55 cases, 30 cases were male and 25 were female. A maximum number of cases belong to the 18-19 years of age group in both genders. The chronological age (years) of the youngest and oldest subjects was recorded at each stage of union for each of the three epiphyses at the knee for males and females. The mean age and stander deviation for each stage of fusion were mentioned. The mean age in males; at stage 0 was about 10.5 for all three bones (distal end of femur and proximal end of tibia and fibula). Stage 1 was about 13 years for the proximal end of the femur, 13.5 years for the distal end of the tibia, and 14 years for the distal end of the fibula. Stage 2 was about 15.5 years for all three bones, while in stage 3; the mean age for all three bones was about 17.5 years and regarding stage 4; the mean age was 18.5 years for the proximal end of the femur and 19 for distal end for both tibia and fibula. Females were less than males by about 1.5 years.

Conclusion. The present study concluded that the stage of epiphyseal union is correlated with chronological age in both males and females. Mean age gradually increases with each stage of union and also varies between male and female cases. A statistically significant difference in mean age was recorded between stages when compared to the previous stage for three epiphyses. Fusion of various epiphyses has been reported earlier in females (about 1.5 years) in comparison to males of the present series. Epiphyseal fusion of the lower end of the femur was observed earlier than the tibia and fibula.


Keywords: epiphyseal fusion, epiphyseal union, chronological age, knee joint.


Corresponding author: Eevir Akram Zain alabdin, e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

For citation: Eevir Akram Zain Aladdin, Saad Kadhum Kareem, Niran Mahmood Ahmed Al-Tameemi. Radiological assessment of age from the epiphyseal fusion of the knee joint. REJR 2023; 13(3):83-96. DOI: 10.21569/2222-7415-2023-13-3-83-96.

Received:        04.05.23 Accepted:       11.07.23