Age estimation using ankle radiographic examination in a contemporary Thai population

Abstract

Background: Radiologic evaluation of skeletal maturity is one of the three practical methods to assess age in a living person. Objective: To assess the average age from the epiphyseal fusion of the distal tibia and fibula in Thai children and young adults. Methods: Ankle radiographs of 217 Thai patients aged 0 to 22 years who came to Siriraj Hospital from 1 January 2000 to 31 March 2020 were recruited for the study. The development of epiphyseal plate in the distal tibia and fibula was analyzed as a grading system. A composite score was also calculated. The relationship between age, the fusion stage and the composite score was explored. Results: The results showed that the complete fusion of the distal tibia and fibula in females and males was found as early as 12 and 13 years, respectively. All females exhibited complete fusion by 15 years old in both epiphyses. All males showed complete fusion of distal tibia and fibula by 15 and 16 years, respectively. The fusion stage tended to rise with the increasing age. There was a significant difference between male and female data. The reliability test showed excellent agreement. Conclusion: Ankle radiographs can essentially be used to assess distal tibia and fibula ossification. The reference values given in this study can be used in age estimation for the Thai population.