Assessment of Age From Sternal Fusion: A Radiographic Autopsy-Based Study in North India

Age estimation plays a crucial role in forensic identification, especially in cases involving dismembered or fragmented human remains. The sternum bone, often retrievable even in fragmented remains, holds potential value in age estimation. The present autopsy-based study aimed to estimate the age of fusion of the manubrio-sternal (M-S) and sterno-xiphoidal (S-X) junctions among males and females aged 14 years and above in the North Indian population using the radiographic (X-ray) method and to assess its applicability in forensic age estimation. A total of 195 sterna (165 males, 30 females) were examined for the fusion status of M-S and S-X junctions during medico-legal autopsies at AIIMS Rishikesh. Radiographic examination (X-ray) was performed, and the fusion was categorized as either fused or unfused. The age of the deceased was confirmed via official documents. Fusion at the M-S junction was observed in 23.6% (n=46) of cases and at the S-X junction in 34.4% (n=67) of cases. The earliest fusion at both junctions occurred at 19 years in males and 40 years in females. A moderate association was noted between age and M-S junction fusion in females (bias-corrected Cramer's V = 0.36), with receiver operating characteristic (ROC) analysis showing 100% sensitivity and 71% specificity at 40 years. In contrast, S-X junction fusion in males demonstrated a moderate association (bias-corrected Cramer's V = 0.35), with ROC analysis showing 81% sensitivity and 57% specificity at 34 years. No significant associations were observed between fusion of the M-S junction and age among males and between fusion of the S-X junction and age among females. These findings suggest that fusion of the M-S junction may help in age estimation in females, while fusion of the S-X junction could serve as a marker in males. However, due to inter-individual variability and limited female representation in our study sample, further studies with larger and more balanced samples are needed for confirmation of the findings of our study.