Age estimation on post-mortem CT based on pelvic bone mineral density measurement and the state of putrefaction: a multivariate method.

Age-at-death estimation is an important issue in forensic medicine and anthropology. Initially, methods relied on morphological criteria, but with the advancement of radiology, new techniques such as morphological studies on multi-slice computed tomography (CT) reconstructions have emerged. Recent studies have shown promising results by investigating the correlation between age and bone mineral density (BMD). However, there is currently a lack of data on post-mortem CTs (PMCT) involving decomposed bodies, and limited information exists regarding changes in Hounsfield Units measurement in a post-mortem context. In light of these gaps, our study aimed to examine the relationship between age at death and pubic and ilium BMD using a sample of forensic bodies. We also aimed to determine whether post-mortem processes, such as putrefaction, could interfere with this correlation. Our retrospective analysis encompassed 637 PMCTs conducted before medicolegal autopsies at Tours University Hospital. Utilizing simple and multiple linear regressions, we investigated the correlation between age and pubic and ilium BMD, as well as the relationship between BMD and the radiologic alteration index (RAI), a scale employed to quantify the degree of putrefaction. Our findings indicate promising outcomes in age-at-death estimation using pubic and/or ilium BMD for bodies exhibiting no or moderate decomposition (RAI < 80), particularly among individuals under 40 years old. However, for highly decomposed corpses (RAI ≥ 80), the presence of gas infiltration significantly influences the BMD of both the ilium and pubis. Consequently, we advocate for the incorporation of the RAI score into the age estimation equation to enhance the accuracy of our results in such cases. Further investigation involving a larger cohort of decomposed bodies could facilitate refinement and validation of our method within this specific population.

Death following cylindrical battery ingestion associated with toxic manganese levels.

Cases of battery ingestion are well documented in the scientific literature, especially concerning button cell battery ingestion in children. In this instance, the authors present an atypical case of a young man who voluntarily ingested a cylindrical alkaline battery containing manganese. The patient died approximately a week later, despite not exhibiting any specific symptoms. The battery was found in the cecum during the autopsy, showing deterioration at its positive pole. The cecal mucosa exhibited two ulcerations without perforation. Histological analysis revealed intestinal ischemia in the cecum, with no microscopic lesions in other organs. Toxicology reports indicated high levels of manganese in both cardiac and peripheral blood. Considering all the results from the additional analyses, the experts concluded that the death was likely of multifactorial origin, associated with a toxic blood concentration of manganese. To the best of our knowledge, this is the first recorded death following the ingestion of a cylindrical battery, and the first instance of manganese intoxication resulting from the ingestion of an alkaline battery. The authors will present the case and provide a literature review to assess the extent to which the presence of manganese may have contributed to the fatality.

Contribution of the use of clavicle bone density in age estimation.

Age estimation is an essential element in the field of forensics and is also of judicial interest in forensic medicine of the living. Despite all the methods, age estimation is often imprecise with many biases, especially in mature individuals. The main objective of our study is to assess the correlation between age and computed tomography bone mineral density of the medial end of the clavicle. A sample of 180 chest multi-slice computed tomography scans without contrast injection performed in living individuals, with suspected respiratory infection, aged 15 to 100 years was used. Bone density measurement was performed on the medial meta-epiphyseal region of the clavicles. A significant negative correlation was found between bone density and age of individuals (p-value < 0.05). The mean absolute error was calculated for men at 13.4 years and 13.1 years for women, which was associated with an absence of bias. Good precision of the estimate for both sexes was also calculated on a subgroup of individuals whose age was greater than 40 years, with average absolute errors of about 12 years, which was associated with an absence of relative error. In view of our preliminary results, the study of bone density of the medial end of the clavicle could be of interest in the estimation of age. Several studies will be necessary to evaluate the reproducibility of these results on independent bone samples and in the estimation of age in the living individual.

Comparison of different machine learning approaches to predict dental age using Demirjian's staging approach.

CONTEXT: Dental age, one of the indicators of biological age, is inferred by radiological methods. Two of the most commonly used methods are using Demirjian's radiographic stages of permanent teeth excluding the third molar (Demirjian's and Willems' method). The major drawbacks of these methods are that they are based on population-specific conversion tables and may tend to over- or underestimate dental age in other populations. Machine learning (ML) methods make it possible to create complex data schemas more simply while keeping the same annotation system. The objectives of this study are to compare (1) the capacity of ten machine learning algorithms to predict dental age in children using the seven left permanent mandibular teeth compared to reference methods and (2) the capacity of ten machine learning algorithms to predict dental age from childhood to young adulthood using the seven left permanent mandibular teeth and the four third molars. METHODS: Using a large radiological database of 3605 orthopantomograms (1734 females and 1871 males) of healthy French patients aged between 2 and 24 years, seven left permanent mandibular teeth and the 4 third molars were assessed using Demirjian's stages. Dental age estimation was then performed using Demirjian's reference method and various ML regression methods. Two analyses were performed: with the 7 left mandibular teeth without third molars for the under 16 age group and with the third molars for the entire study population. The different methods were compared using mean error, mean absolute error, root mean square error as metrics, and the Bland-Altman graph. RESULTS: All ML methods had a mean absolute error (MAE) under 0.811 years. With Demirjian's and Willems' methods, the MAE was 1.107 and 0.927 years, respectively. Except for the Bayesian ridge regression that gives poorer accuracy, there was no statistical difference between all ML tested. CONCLUSION: Compared to the two reference methods, all the ML methods based on the maturation stages defined by Demirjian were more accurate in estimating dental age. These results support the use of ML algorithms instead of using standard population tables.

Age estimation based on computed tomography exploration: a combined method.

Despite an extensive number of existing methods, age estimation of human remains is still an unsolved matter in the field of forensic anthropology, especially when it comes to mature adults. The specific aim of this work was to propose a combined method for age estimation, for forensic purposes, by coupling the Suchey-Brooks method and the measure of the pubic bone density. For this purpose, we used an independent test sample comprising 339 CT scans of living individuals aged 15 to 99 years old. Measurement of bone density and staging according to the Suchey-Brooks phases were performed, followed by estimation of ages based on a combined method and an existing virtual reference sample. Results highlighted a significant negative correlation between bone density and age. Good accuracy was obtained for the measurement of pubic bone density for age estimation of men and women, especially concerning mature adults, with an absolute error ranging from 9 to 16 years for all individuals. The authors propose a practical combined method consisting of, first, allocating phases according to the scannographic approach of the Suchey-Brooks method. For phases I to IV, the age estimation is given using the Suchey-Brooks method. For phases V to VI, the pubic bone density measurement is used. Further study will be needed to assess the reproducibility of these results on cadavers and dry bones, as the post-mortem process could interfere with the measurement of mineral bone density.

Technical note: age estimation by using pubic bone densitometry according to a twofold mode of CT measurement.

In forensic anthropology, age estimation is a major element in the determination of a biological profile and the identification of individuals. Thus, many anatomical structures have been studied, such as the pubic symphysis, which is a source of major interest due to its late maturation. One of the most well-known methods of assessment is the Suchey-Brooks (SB) system based on the morphological characteristics of the pubic symphysis. The aim of this study was to propose linear regression formulae in order to deduce chronological age from bone density, using both Hounsfield unit (HU), and mean bone density (mBD) values of the pubic symphysis. Moreover, we intended to test the reliability and then to explore the feasibility of using HU instead of mBD values for age estimation. We built retrospectively a reference sample of 400 pubic symphyses using computed tomography at a French hospital and a test sample of 120 pubic symphyses. Equations were created to establish linear regression models for age estimation. Inaccuracy and bias were calculated for individuals aged more or less than 40 years. We highlighted homogeneous mean absolute errors for both HU and mBD values, most of them being less than 10 years. Moreover, we reported a moderate overestimation for younger individuals and a very small underestimation for older individuals. This study proposes a correlation between the bone density and age of individuals with a valuable level of reliability. Finally, HU measurements seem to be suitable for linking bone density with the age of individuals in forensic practice.

Sex estimation in the cranium and mandible: a multislice computed tomography (MSCT) study using anthropometric and geometric morphometry methods.

INTRODUCTION: The purpose of this study was to analyze the respective contribution of the skull and mandible to sex estimation in an entire cranium using metric and geometric morphometric methods and multislice computed tomography (MSCT) analysis. MATERIALS: The study sample comprised 120 individuals aged 23 to 84 years and divided into three groups (whole sample and over or under 40 years of age). METHODS: Forty-eight osteometric landmarks were positioned using Osirix®, 34 for the cranium and 14 for the mandible. The data were analyzed using univariate analyses and logistic regression using backward stepwise selection with cross-validation of the classification results. Generalized procrustes analysis (GPA) was used, and Goodall's F test and Mahalanobis D2 matrices allowed an assessment of statistical significance. RESULTS: The classification accuracy of cranium models ranged from 87% to 88.3%, and from 68% to 81.4% for the mandibular models. With geometric morphometry, accuracy was of 94-100% for the cranium and 84.2% for the mandible. DISCUSSION: We conclude that the mandible had a higher accuracy rate for individuals over 40 years than individuals under 40 years of age, although the accuracy of geometric morphometry did not differ significantly between the age groups. The cranium, however, presented greater predictability for all the parameters assessed.

Sexual and ethnic polymorphism result in considerable mismatch between native trochlear geometry and off-the-shelf TKA prostheses.

PURPOSE: To determine if trochlear morphology in healthy knees depends on sex and ethnicity, and to compare it to off-the-shelf TKA prostheses. METHODS: Three retrospective series of CT angiograms from France (female, 124; male, 135), China (female, 122; male, 137) and South Africa (female, 21; male, 62) were used to digitize osseous landmarks at the level of the femoral epicondyles. Sulcus angle, trochlear rotation, lateral trochlear inclination, trochlear asymmetry ratio, and trochlear depth index were quantified for each knee and for 10 total knee arthroplasty (TKA) models. Univariable regression analyses were performed to determine associations of the five trochlear parameters with sex and ethnicity. Interquartile ranges (IQR) of native trochlear parameters were compared to the trochlear parameters of 10 off-the-shelf TKA prostheses. RESULTS: Compared to French knees, Chinese knees had greater sulcus angle (ß = 6.3°, p < 0.001), trochlear rotation (ß = 0.8°, p = 0.004) and trochlear depth index (ß = 1.60, p < 0.001). Conversely, South African knees had greater trochlear rotation (ß = 1.9°, p < 0.001) and lateral trochlear inclination (ß = 3.7°, p < 0.001). Female knees had smaller trochlear asymmetry ratios (ß = - 0.03, p = 0.05) but greater trochlear rotation angles (ß = 0.7, p = 0.005). Considerable mismatches in trochlear morphology were revealed between native knees and off-the-shelf TKA prostheses. CONCLUSIONS: The findings suggest that thresholds used in the diagnosis of patellofemoral instability should be adapted to patient sex and ethnicity, and that standard off-the-shelf TKA may not restore native trochlear parameters in all patients. LEVEL OF EVIDENCE: III, retrospective comparative.

Sexual and ethnic polymorphism render prosthetic overhang and under-coverage inevitable using off-the shelf TKA implants.

PURPOSE: Unexplained pain and stiffness after total knee arthroplasty (TKA) often result from mismatch between implant geometry and knee morphology, which depends on patient size, sex, and ethnicity. This study aimed to determine whether size, sex, or ethnicity are independently associated with distal femoral morphology in healthy Caucasian and Asian knees, and to compare anatomic ratios to those of commercially available TKA implants. METHODS: Two series of computed tomography (CT) angiograms from France (264 knees) and China (259 knees) were used to digitize osteometric landmarks at the level of the femoral epicondyles, to measure anteroposterior (AP) and mediolateral (ML) dimensions at the anterior, posterior, medial, and lateral zones. The aspect (ML/AP), trapezoidicity (MLp/MLa), and asymmetry (APl/APm) ratios, as well as the sulcus angle were calculated and compared to those of 9 TKA models. Multivariable analyses were performed to determine whether anatomic ratios were independently associated with sex, origin, or size. RESULTS: Multivariable analyses revealed that, independently from size, female knees were narrower (ß = - 0.03; p < 0.001) and more asymmetric (ß = 0.02; p < 0.001), while Chinese knees were more trapezoidal (ß = 0.04; p = 0.002) and asymmetric (ß = 0.02; p < 0.001) with shallower trochleae (ß = 6.4°; p < 0.001). Compared to native knees, most implants were too wide, and many of the recent models too 'trapezoidal'. Most prosthetic trochleae were too shallow compared to French knees, but within the third quartile of Chinese knees. CONCLUSIONS: The morphology of the distal femur depends on sex and ethnicity independently from size. The wide spectrum of morphotypes observed cannot be covered by 'off-the-shelf' TKA models, and until customized implants become more accessible, prosthetic overhang, and under-coverage remain inevitable. LEVEL OF EVIDENCE: III, Retrospective comparative study.

The contribution of Micro-CT to the evaluation of trabecular bone at the posterior part of the auricular surface in men.

AIM: Using multi-slice computed tomography (MSCT), Barrier et al. described the disappearance at the posterior auricular surface of a "central line" (CL) and "juxtalinear cells" (JLCs) belonging to a trabecular bundle, and a trabecular density gradient around the CL that decreased with age. The aim of our study was to use micro-CT to test these findings, referring to the concept of Ascadi and Nemeskeri. METHODOLOGY: The coxal bones of fifteen males were used; age was known. CLs were identified on MSCT-sections using Barrier's method (64 detectors, 0.6 mm slice thickness, 0.1 mm overlap) with two different software programs (Synapse®, Amira®). Then, CLs were researched on microCT slices (pixel size: 36 µm). Three volumes of interest were defined (around, above, and below CL), and 3D morphometric parameters of the trabecular microarchitecture (particularly BV/TV and DA) were calculated. Two-tailed statistical analyses were performed attempting to correlate these parameters with age at death. RESULTS: CLs and JLCs were observed on micro-CT slices, but with moderate agreement between both imaging techniques. Their presence was not correlated with the age of the subjects. Around the CL, BV/TV decreased significantly with age; DA was negatively correlated with BV/TV and had a tendency to increase with age. Between areas above and below the CL, there was a BV/TV gradient and both BV/TVs decreased in parallel with age. CONCLUSION: Our findings regarding the contribution of micro-CT to the evaluation of trabecular bone could be a promising research approach for application in a larger study population.

Sex determination of a Tunisian population by CT scan analysis of the skull.

It is widely accepted that the estimation of biological attributes in the human skeleton is more accurate when population-specific standards are applied. With the shortage of such data for contemporary North African populations, it is duly required to establish population-specific standards. We present here the first craniometric standards for sex determination of a contemporary Tunisian population. The aim of this study was to analyze the correlation between sex and metric parameters of the skull in this population using CT scan analysis and to generate proper reliable standards for sex determination of a complete or fragmented skull. The study sample comprised cranial multislice computed tomography scans of 510 individuals equally distributed by sex. ASIRTM software in a General ElectricTM workstation was used to position 37 landmarks along the volume-rendered images and the multiplanar slices, defining 27 inter-landmark distances. Frontal and parietal bone thickness was also measured for each case. The data were analyzed using basic descriptive statistics and logistic regression with cross-validation of classification results. All of the measurements were sexually dimorphic with male values being higher than female values. A nine-variable model achieved the maximum classification accuracy of 90% with -2.9% sex bias and a six-variable model yielded 85.9% sexing accuracy with -0.97% sex bias. We conclude that the skull is highly dimorphic and represents a reliable bone for sex determination in contemporary Tunisian individuals.

Age estimation at death using pubic bone analysis of a virtual reference sample.

Age at death estimation is a major part of forensic anthropology, but is often poor in the latter decades of life and should benefit from specific population standards. The aim of this study was to test a virtual reference sample with a uniform age distribution in order to improve the accuracy of age estimation for individuals over 40 years of age. We retrospectively built a random virtual reference sample of pubic symphyses from 1100 clinical cases using computed tomography at two French hospitals; this was compared with a test sample (pubic symphyses from 75 corpses undergoing post-mortem computed tomography at a French forensic department) and with the sample originally used in the Suchey-Brooks (SB) system. Inaccuracy and bias were calculated and the proportions of cases in which the real age fell within the estimated age ± 1 standard deviation were calculated. Compared to using the SB sample, using our French sample resulted in a lower inaccuracy for males over 55 years and bias showed that that for males aged 56 to 70 years were less underestimated. Compared to using the SB sample, using our French sample resulted in a lower inaccuracy for females over 70 years and bias showed that that for females aged 56 and older were less underestimated. This study presents a large data set of pubic symphyseal phases from a French virtual sample that allows for improving age estimation accuracy at death, particularly for individuals over 40 years. This kind of material can be useful to improve the age estimation accuracy in a specific region. However, the reliability remains poor and the variability of pubic symphysis morphology related to bone degeneration seems to be an unavoidable limit of the method.

Study of a seventeenth-century French artificial mummy: autopsical, native, and contrast-injected CT investigations.

BACKGROUND: A lead coffin was fortuitously discovered in a church called "Eglise des Toussaints" in Rennes (French Brittany). A collaborative taskforce investigated this extraordinary discovery. A multi-disciplinary team of experts from the National Institute for Preventive Archeological Research (INRAP) and Rangueil University Hospital of Toulouse was created, including anthropologists, archeologists, forensic pathologists, radiologists, and pathologists. The inscription on the lead coffin specified that the body belonged to "Messer Louys de Bruslon, Lord of Plessis," a nobleman who died on November 1, 1661. Multiple holes were visible in the lead coffin, and deterioration threatened the mummy. We opened the lead coffin and discovered an excellently preserved mummy, except for mostly skeletonized upper and lower limbs. The mummy was conserved in several layers of shrouds. Vegetal embalming material covered the head and filled the face, the thorax, and the abdomen. The embalmers had removed all thoracic and abdominal organs and conserved some pelvic organs (e.g., the bladder). METHODS: Multi-slice computed tomography (MSCT) scanner evaluated the mummy, at each step of our analysis. The excellent preservation of abdominal vascular axes led us to perform a CT angiography using Angiofil®, an oily contrast agent developed for postmortem imaging, before an autopsy. RESULTS: Sub-diaphragmatic arteries, including the abdominal aorta and iliac arteries, were excellently preserved. The vascular contrast agent filled all arteries. The native CT, CT angiography, and autopsy did not detect any vascular lesion. CONCLUSION: Our study, based on rare archeological material, allowed a complete examination of an excellently preserved seventeenth-century mummy, using MSCT, angiography, and an autopsy. We did not detect any arterial lesion and proposed a comprehensive description of the embalmment process.

Concerns About Lung Cancer Among Prisoners.

BACKGROUND: Few studies have looked at lung cancer in prisoners, despite this population is possibly at increased risk of malignancy. In a previous study, we found an early onset of lung cancer in prisoners. Thus, the present CARCAN study was aimed at assessing the epidemiological characteristics, management, prognosis, and incidence of lung cancer in prisoners compared to a sample of non-prisoner patients. METHOD: We performed a multi-center observational case-control study. Cases were prisoners diagnosed with lung cancer from 2005 to 2013. Controls were non-prisoner lung cancer patients selected from hospital databases and randomly matched to cases (targeted case-control ratio: 1:3). Incidence rates in both groups were calculated using national statistics. RESULTS: Seventy-two cases and 170 controls met inclusion criteria. Cases were mainly men (99%). Mean age at diagnosis was 52.9 (± 11.0) in cases and 64.3 (± 10.1) in controls (p < 0.0001). More case patients were current smokers compared to control patients (83% vs 53%; p < 0.0001). We found no significant differences between the two groups as concerns histologic types, TNM stages at diagnosis, initially-employed treatments, times to management or survival. Incidence rates (2008-2012) in male prisoners were higher than those in the general population in all concerned age groups. CONCLUSION: There is a shift of lung cancer toward young people in prisons. However, the presentation, management, and prognosis of lung cancer are similar between prisoners and non-prisoners. These finding could justify a specific screening policy for the incarcerated populations.

Bone age estimation based on multislice computed tomography study of the scapula.

Progress in medical imaging has opened new areas of research in forensic anthropology, especially in the context of the study of bone age assessment. The study of bone age has become a useful tool for age estimation at death or age of young adult migrants in an anthropological context. We retrospectively evaluated multislice computed tomography (MSCT) explorations focused on scapulae of 232 individuals (123 males; 109 females) aged between 8 and 30 years old. Computed tomography (CT) scans were viewed in axial and multiplanar reconstructed images using OsiriX 5.9 (64 bit)®. The ossification centers of the scapula studied were as follows: acromial, sub-coracoid, glenoid, coracoid, coracoid apex, and inferior angle epiphyses. Fusion status was scored based on a five-stage system (stage 1: no ossification, stage 2: visualization of an ossification center, stage 3: partial ossification, stage 4: full ossification associated to an epiphyseal scar, and stage 5: full ossification without epiphyseal scar). Intra-observer variability was excellent, and inter-observer variability was good, demonstrating the reliability of this MSCT staging system. The fusion of scapular ossification centers was statistically associated with age (p < 0.001) but not with sex (p > 0.05). In conclusion, MSCT of the scapula is an efficient method for age assessment, which is complementary to preexisting methods particularly for specifying the 18-year threshold. Further studies with larger groups are needed to support our results.

Detection of glass particles on bone lesions using SEM-EDS.

The problem of identifying the wounding agent in forensic cases is recurrent. Moreover, when several tools are involved, distinguishing the origin of lesions can be difficult. Scanning electron microscopy (SEM)/energy dispersive X-ray analysis (EDS) equipment is increasingly available to the scientific and medical community, and some studies have reported its use in forensic anthropology. However, at our knowledge, no study has reported the use of SEM-EDS in forensic cases involving glass tools, whether in case reports or experiments. We performed an experimental study on human rib fragments, on which we manually created wounds using fragments of window and mirror glass. SEM-EDS was executed on samples without any further preparation on low vacuum mode, then on the same samples after defleshing them completely by boiling them. Window and mirror glass particles were detected on experimental wounds. Both had silica in their spectra, and the opaque side of the mirror contained titanium, allowing for their identification. Boiling and defleshing the bone samples involved a loss of information in terms of the number of wounds detected as positive for glass particles and in the number of glass particles detected, for both window and mirror glass. We suggest the analysis of wounds with suspected glass particles using low vacuum mode and with no defleshment by boiling.

Peritraumatic Assessment of Autobiographical Memory After Exposure to a Traumatic Event.

Posttraumatic stress disorder (PTSD) is commonly acknowledged to be associated with reduced specificity of autobiographical memory (AM). However, very few studies have assessed AM in the peritraumatic phase. The aim of the present study was to examine whether the AM impairment reported in PTSD is present a few days after a traumatic event. We assessed AM in 41 participants who had recently been exposed to trauma, and 34 controls who had never experienced a traumatic situation. The trauma-exposed participants also completed the Impact of Event Scale-R (IES-R), the Inventory of Peritraumatic Distress, and the Peritraumatic Dissociative Experiences Questionnaire. Results showed that autobiographical memories cued by negative words were significantly less specific in the group of trauma-exposed participants than in the control group (p = .008; d = 0.40). Thus, mild AM impairment was already present three days after trauma exposure, long before acute PTSD set in.

Contribution of magnetic resonance imaging of the wrist and hand to forensic age assessment.

Forensic age estimation of living individuals is a controversial subject because of the imprecision of the available methods which leads to errors. Moreover, young persons are exposed to radiation, without diagnostic or therapeutic advantage. Recently, non-invasive imaging techniques such as magnetic resonance imaging (MRI) have been studied in this context. The aim of this work was to study if the analysis of wrist/hand MRI enabled determination of whether a subject was 18 years old. Two observers retrospectively analyzed metaphyseal-epiphyseal fusion of the distal epiphysis of the radius and the ulna and the base of the first metacarpus in wrist/hand MRI of living people between 9 and 25 years of age. A three-stage scoring system was applied to all epiphyses. Intra- and inter-observer variability was excellent. Staging of the distal radial epiphysis allowed the subjects to be correctly evaluated with regard to the 18-year-old threshold in more than 85 % of cases. Analysis of the radius alone was as good as the analysis of the three epiphyses together. Evaluation of the metaphyseal-epiphyseal fusion of the distal radius in wrist MRI gave good results in forensic age estimation. Wrist MRI could meet ethical expectations with regard to the link between the benefit and risk of practicing radiologic examination on individuals in this context.

Can the Greulich and Pyle method be used on French contemporary individuals?

Forensic age estimation of living individuals has become increasingly important in forensic practice with the constant increase of migration movements to developed countries. The method of Greulich and Pyle is one of the most frequently used methods for age determination. The aim of our study was to verify the reliability of this method on a French contemporary population. We retrospectively analyzed 190 frontal hand and wrist radiographs of living subjects aged between 10 and 19 years (100 males and 90 females) performed in the Radiology Department of the University Hospital of Tours. These radiographs were compared with the Greulich and Pyle atlas to determine the skeletal age (SA) and to compare it to the chronological age (CA). We calculated the coefficient of correlation and the coefficient of determination for each sex group. The SA of our subjects was also inserted in the graphs provided by Greulich and Pyle in their atlas. Intra- and inter-observer variabilities were good, demonstrating the reproducibility and repeatability of the method. The correlation coefficients were high (0.98 for males and 0.93 for females) and comparable with published data. The mean difference between CA and SA was -2.29 months for males and -6.44 months for females, showing an overestimation of CA for both sexes. No statistical difference was found between CA and SA for both male and female samples. We concluded that the method of Greulich and Pyle can be used on a contemporary French population but not without caution because of a tendency for this method to overestimate age. A fully developed hand and wrist does not allow to state that the 18th year of life is completed beyond a reasonable doubt. We recommend using it in association with other methods.