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A Comparison of 3 Established Skeletal Age Estimation Methods in an African Group From Benin and an Italian Group From Southern Italy

Santoro, Valeria, PhD; Marini, Chiara, PhD; Fuzio, Grazia, MD; Introna, Francesco, MD; De Donno, Antonio, PhD

The American Journal of Forensic Medicine and Pathology: June 2019 - Volume 40 - Issue 2 - p 125–128
doi: 10.1097/PAF.0000000000000472
Original Articles

Age estimation is a crucial matter in several forensic and legal instances. The literature recommends carrying out hand and wrist radiograph to assess skeletal age. Much research has been conducted to examine the application of various methods in different categories. Our study aims to evaluate the reliability of Greulich and Pyle, Tanner-Whitehouse 2, and FELS methods in Beninese and Italian samples, with a total of 204 subjects, 102 (51 were male and 51 were female) from Benin and 102 (51 were male and 51 were female) from Italy, aged between 4 and 19 years. Hand-wrist radiographs were carried out at Saint Luc Hospital in Cotonou for the African sample and in 2 hospitals in Southern Italy for Italian sample. Skeletal maturity was obtained, applying the 3 methodologies. The arithmetic mean of the 3 ages obtained was calculated, as well as the possible difference between the known chronological age and the estimated mean skeletal age. Data were analyzed statistically using the χ2 test, Student t test, and Bland-Altman plots. There are no significant statistical differences between real age and skeletal age calculated using the Greulich and Pyle and FELS methods. Comparison between Tanner-Whitehouse 2 and the average of the methods used results in statistically significant, but clinically insignificant, differences.

From the Section of Legal Medicine, DIM, University of Bari, Bari, Italy.

Manuscript received November 10, 2018; accepted January 18, 2019.

The authors report no conflict of interest.

Reprints: Grazia Fuzio, MD, Section of Legal Medicine, DIM, University of Bari, Bari, Italy. E-mail:

© 2019 by Lippincott Williams & Wilkins.