Includes bibliographical references / Skeletal age is a measure of biological maturation and is based on the stages of formation of bones. As age increases, skeletal maturation progresses and the various hard tissue changes which take place are uniquely identifiable and defining to each stage of development. Age assessment using skeletal maturation is a diagnostic tool used clinically and in forensic investigations. Radiographs of the hand and wrist are frequently used to estimate age (Greulich and Pyle,1959); however studies conducted in South Africa have shown that these methods are not applicable to South Africans since the method over estimates age in the 17 - 22 year olds(Dembetembe and Morris, 2013) and both over and underestimates age in 0 - 13 year old individuals (Speed, 2012). There currently is a lack of comprehensive data and studies on the union of the major joints in South African children despite the need for population specific data in age estimations. The LODOX Statscan system, which emits low dose radiation and full body radiographs in thirteen seconds, was used to assess radiographs of1891 individuals between the ages of 6 - 24 years. Union was classified in four stages ranging from one (non-union) to stage four (complete union). Radiographs were obtained from the Red Cross War Memorial hospital and Groote Schuur hospital in Cape Town and Tygerberg and Salt River mortuaries in Cape Town as well as the Chris Hani Baragwanathand Milpark hospitals in Johannesburg. The standards developed on radiographs were later used to conduct gross analysis of skeletal material obtained from the Raymond Dart Collection. Complete union was classified as the age at which 95% of the both males and females showed stage 4 of union. Complete union of all joints in females occurs by age 21 years and 24 years in males with the iliac crest being the last epiphysis to fuse in both males and females. Ordinal logistic regression found significant differences between males and females in the stages of union and age (p < 0.05). There is however no significant differences in stage of union and age between different ethnic groups and individuals from various socio-economic status backgrounds (p > 0.05).Data for union times in South African children show that maturity in females at the elbow, hip and ankle are achieved at approximately 15 years of age followed by the knee at 16 years, wrist at 18 years, and shoulder at 20 years. The radiographically visible epiphyses the iliac crest are the last epiphyses to complete union at 21 years. Males progress through union in the same sequence with the exception that there is a two year delay in age at maturity. The elbow in males completes union at approximately 17 years followed by the hip and ankle at 18 years, knee at 19 years, wrist at 20 years, and shoulder at 21 years and finally the iliac crest at 22 years. The methodology derived on radiographs was successfully applied to gross observations of skeletal material. It therefore provides a useful diagnostic tool for use in skeletonised forensic cases in the absence of skeletal material from which to derive such standards. The current work provides an alternative to the Greulich and Pyle (1959) method and is specifically tailored toward South African children.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/16563 |
| Date | January 2015 |
| Creators | Lakha, Kavita Novinchandra |
| Contributors | Morris, Alan G |
| Publisher | University of Cape Town, Faculty of Health Sciences, Department of Human Biology |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Doctoral Thesis, Doctoral, PhD |
| Format | application/pdf |
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