FORENSIC AGE ESTIMATION BASED ON THE FUSION OF ILIAC CREST EPIPHYSIS ON PELVIC X-RAYS

Abstract

Background

Forensic age estimation plays a crucial role in medico-legal investigations, immigration cases, and criminal proceedings. Skeletal maturity indicators such as iliac crest ossification have been widely studied to assess chronological age. While conventional radiography has been frequently used for age estimation, variability in ossification timelines across populations necessitates further validation. The iliac crest apophysis follows a predictable maturation pattern, making it a valuable marker for forensic age determination. This study evaluates the reliability of iliac crest ossification staging in forensic age estimation using pelvic X-rays.

Objective

To assess the ossification status of the iliac crest apophysis in individuals aged 10 to 29 years using Kreitner’s four-stage classification and determine its applicability in forensic age estimation.

Methods

A retrospective cross-sectional study was conducted at Hayatabad Medical Complex, Peshawar, involving 549 individuals who underwent pelvic X-rays between January 2023 and August 2024. Participants included 277 females (50.5%) and 272 males (49.5%), aged 10–29 years. Digital pelvic radiographs were analyzed by an experienced radiologist blinded to patient age. Iliac crest ossification was classified into four stages: stage 1 (absence of ossification), stage 2 (ossification without apophyseal fusion), stage 3 (partial fusion), and stage 4 (complete fusion). Spearman’s correlation was used to assess the relationship between age and ossification stages, with P < 0.05 considered statistically significant.

Results

Stage 2 ossification was first observed at 12 years in females and 13 years in males. Stage 3 was first detected at 15 years in females and 17 years in males. Stage 4 ossification was identified at a minimum age of 17 years in males on both sides of the pelvis, while in females, it appeared at 20 years on the right iliac crest. The maximum observed age for stage 2 was 24 years in females and 25 years in males, while stage 3 and 4 ossification extended up to 28 years. A significant correlation was observed between age and iliac crest ossification (P = 0.0001), with correlation coefficients of r = 0.719 (right) and r = 0.716 (left) in males and r = 0.724 (right) and r = 0.700 (left) in females.

Conclusion

Iliac crest ossification assessed via conventional radiography provides a reliable skeletal marker for forensic age estimation. When used alongside other skeletal maturity indicators, this method enhances the accuracy of age determination. Further research with larger and diverse populations is needed to standardize age estimation criteria for forensic and clinical applications.