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Study of Pelvic X-Ray in Age Estimation

Bharat Bahadur Khatri1*,Bhogendra Bahadur KC1, Roshan Pangeni2 , Chandra Bahadur Mishra1,Bishwo Raj Bastakoti2 ,
1Department of Orthopedics, Western Regional Hospital, Pokhara Academy of Health Science, 2Department of Radiology,Western Regional Hospital, Pokhara Academy of Health Science
*Corresponding Author:
Dr Bharat Bahadur Khatri,
Senior consultant Orthopedic surgeon,
Department of Orthopedics,
Western Regional Hospital,
Pokhara Academy of Health Science, Pokhara-10, Nepal.
E-mail: [email protected]

Objective:To study usefulness of pelvis x-ray of growing individual for skeletal age (SA) estimation.
Materials and methods:
Pelvic x-rays of individuals with known chronological age (CA) upto 20 years of both sexes from Jan’16 to Mar’18 were collected, distributed to 20 groups for each year of age and sub-divided to male/female sub-group, each one containing at least 10 x-rays. The time/duration for appearance/presence, development and closure of epiphysis/apophysis for femoral head(CFE), greater trochanter(GTA), ilio-pubic (IPE) ramus,ischio-pubic(ISE) ramus and Iliac crest (Risser sign, RS) were studied.
Results:In new born, the ilium, ischium and pubis are separated and no head and tuberosities are visible. The CFE shows up at 4-6 months and closes by 12-14 in female and 13-16 in male. ISE fuses by 6 years. IPE fuses by 12-15 in female and 14-16 in male. GTA appears by 5-6 and fuses by 12-15 in female and 14-17 in male. RS appears at 13-16 in female and 13-18 in male and gets closed by 18-20 in both sexes. Conclusion:Pelvis X-ray seems to bea good tool for estimation of SA and this can be used in our set up as reference.
Key words: skeletal age estimation , pelvis growth, apophyses in pelvis

Age estimation of a growing individual is a frequent procedure in evaluating growth progress of a child, sport related activities and jurisdiction. Hand with wrist, pelvis and dental x-ray series are frequently used tools for the purpose. Appearance of the diaphysis, metaphysis, physis (growth plate)/epiphysis and appearance, progression and closure of growth plate of long bones as well as flat bones take place within a time frame. It is different for all individual bone and this uniqueness is used to estimate the age of a growing/fully grown individual. The chronological age(CA)related/compared with these factors in normal individual gives an idea of estimation of skeletal age (SA). This has been studied in different ethnic groupsand nationalitiesand an outline has been made for relating SA with chronological age. We are still using external resources to estimate SA in our country. Are these resources comparable to our children? still not answered by our own study. This suggested us to do a study in our child population and outline a data for skeletal age determination.Most of the individuals that need to have age estimation are for jurisdiction purposes in our institution. Both hand/wrist and Pelvic X-ray play good role in determining SA. We are studying pelvic x-rays here for the purpose.

Materials and Methods:
Pelvis x-rays of individuals who came for the consultation/treatment to Metrocity Hospital and Western Regional Hospital up to 20 years of CA has been collected from January 2016 to March, 2018.They are distributed to male(M)/female(F) group and to 20 clusters by age for every year of age. At least 10 x-rays, digital and films, are included for each age and sex group. For each year together with sex,altogether 40 clusters, the stage (appearance, growth, closure of physis) of capital femoral epiphysis (CFE), greater trochanterapophysis(GTA),ilio-pubic epiphysis(IPE), Ischio-pubicepiphysis (ISE)and Risser sign(RS) for iliac crest apophysis are recorded.Lesser trochanter(LT) and ischial apophyses are not included in the study as these are difficult to observe and other parameters serve the purpose. We use these findingsto estimate/correlate CA with SA.
The age is calculated by year and denotes entire 12 months after the completion of that particular year agei.e. Year 2 and onward means the individual has completed that year age. First year represents initial 24 months and different months are taken into account for estimation. Both males and females are representing separately.
The findings are being tabulated as follows: for easy tabulation abbreviations are used.
Sex: M=male, F=female;
CFE=capital femoral epiphysis: m=month, Y= presence of CFE, N=no appearance of CFE,
GTA=Greater trochanter apophysis: N=GTA not appeared, Y= GTA present
IPE=Ilio-pubic epiphysis: Y= presence of IPEISE= Ischio-pubic epiphysis: W= presence of IPE with wide separation, Na=narrow separation, A=approaching to fuse
RS= Risser sign: N=not appeared, Y=appeared, M=apophysis present at the middle, E= apophysis expanding towards periphery but not full, Fu=fully grown/full sized apophysis,
Fg=fusing, F=fused
*The number with alphabet indicates number of x-ray films studied.

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