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102 Medico-Legal Update, July-December 2013, Vol. 13, No. 2
INTRODUCTION
Question of identification arises in every day
medico-legal practice both in civil cases such as
marriage, disputed sex, missing persons insurance
claims, person and inheritance claims as well as in
criminal cases such as persons accused of assault, rape,
murder, absconding prisoners etc. The methods of
identification depend upon, Available ante mortem
records and the degree of preservation of body remains
i.e. whether intact, decomposed, burned, fragmented,
semi skeletonized or skeletonized.
Since the bones resists putrefaction and destruction
by animals, skeletal remain contains an abundance of
information, which can lead to the reliable
determination of age, sex, race, stature of the
individual.
Use of ossification centers and dentition for
estimation of age is possible up to the age of about 25.
After the age of 25 years, skeletal age can be assessed
to within + 5 years by the state of cranial sutures and
of the bony surfaces of symphysis pubis. Sutures tend
to obliterate after mid-twenties onwards to told age
but the process begins from within and shows wide
individual variations.
A Comparative Study of Symphyseal Surface of Pubic
Bone at Autopsy for Age Estimation Using
Mckern- Stewart Criteria
Bajrang Kumar Singh1, Anil Aggrawal2, Anil Kumar Mittal3
1Assistant Professor, C.U. Shah Medical College, Gujarat, India, 2Director & Professor, Maulana Azad Medical
College, Lok Nayak and Associated Hospitals Delhi, 3Director, Professor & H.O.D., Forensic Medicine, Vardhman
Mahavir Medical College and Safdarjung Hospital Delhi
ABSTRACT
Determination of age after 25 years becomes very difficult as all teeth will be erupted and ossification
Centre of the bone will be fused till 25 years of the age. In all available bony changes, change in
morphological surface of symphysis pubis is the most reliable between 20 to 40 years of the age1.
Bony changes depend on climate, nutrition, geographical region, races etc. So we had done a
comparative study between Mckern- Stewart study and our study using Mckern- Stewart criteria for
scoring.
Keywords: Age Estimation, Forensic Medicine, Pubic Bone, Anthropology
It has been observed by various works that
developmental and regressive changes of bones in the
body are affected by various factors such as climatic,
dietetic, hereditary, nutritional, sociological, racial,
environmental and geographical etc. since most of
these factors are different in different countries and
also in different parts of India, no universal standard
can be devised for estimation of age from bones. The
same is true for pubic symphysis. Observation made
in western countries will not be same as observation
made in Indian population so we are presenting
comparative study. Delhi being a cosmopolitan city,
study of its population has, therefore, included all
important ethnic groups of the country. Anatomical
characters of symphysis pubis and pubic bone have
been studied for the above purpose.
REVIEW OF LITERATURE
Todd (1920) has made a substantial contribution in
evaluating the role of pubic symphysis as an age
indicator2. He called the symphyseal surface of pubis
as a modified diaphyso-epiphyseal plane and expected
it to show a metamorphosis as an ageing feature.
He evolved a system of assessing age from 10 stages
of pubic metamorphosis. Fundamentally, he
DOI Number: 10.5958/j.0974-1283.13.2.025
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Medico-Legal Update, July-December 2013, Vol. 13, No. 2 103
considered each pubic symphysis to have an oval
outline with supero-inferior long axis. Five main
features were studied:
1) A ventral (outer) border or “rampart”.
2) A dorsal (inner) border or “rampart”.
3) A superior extremity.
4) An inferior extremity.
Other features, seen mainly on the surface were
ridging billowing and ossific nodules. Varying and
progressive combination of these osteological features
was seen and this led to the establishment of 10 phases
of pubic symphysis ranging in age from 18-19 years to
50 + years.
In 1957, Mckern and Stewart worked on 450 pairs
of pubic symphysis for estimation of age in males
covering the age range (17-50 years) 3. This study was
based on Todd’s scoring method but they selected three
components, i.e. dorsal plateau, ventral rampart and
symphyseal rim. Five development stages were
described for each component.
Table 1. (Mckern-Stewart component with their respective scoring)
Component I Score Component II Score Component III Score
Dorsal margin Absent 0 Ventral Beveling Absent 0 Symphyseal rim Absent 0
Middle third 1 At superior extremity 1 Partial dorsal rim 1
Entire border 2 Extend inferiorly 2 Complete dorsal rim 2
Dorsal plateau Middle third 3 Ventral rampart Begins 3 Complete rim formation 3
Present Most of demiface 4 Extensive 4 Breakdown of rim begins 4
Complete 5 Complete 5 Rarefaction of symphyseal face 5
Mckern and Stewart noted that their system was
more reliable for age period between 17 and 30 years.
This method was easier and more accurate than the
Todd’s method because the scoring eliminated a
subjective bias in interpretation of bone
metamorphosis.
Glibert at al. in 1973 conducted studies on female
pubic symphysis based on the formula of Mckern and
Stewart4. This work was devoted to the development
of a standard for aging female pubic symphysis for
the age range 17-55 years.120 samples were collected
from female individuals of known ages and parity.
Besides, 60 more bones from Stewart collection were
also studied. The age of samples ranged between 17
and 55 years. He established 3 components namely
the dorsal demi-face, the ventral rampart and the
symphyseal rim. Each component was further divided
into six (0-5) stages of metamorphic change
It was observed that morphological development
of females is different from that of males, and females
are subject to trauma of child-birth. This may cause an
individual female os pubis to appear older than it
actually is. The dorsal surface of female symphysis was
seen to undergo flattening at faster rate as compared
to males. It was further noted that in females, the
ventral (demiface) is beveled away from dorsal
demiface whereas an imaginary line separated the two
demi-faces in males.
They concluded that female of the same age may
appear to be ten years younger based upon the ventral
rampart and ten years older based upon the dorsal
plateau.
Gllibert in 1973 carried out the comparison of age
estimates of female pelvis obtained by the new female
standard with those obtained by the male standard5.
15 females pelvis were aged by both the male standard
and a newly developed female standard. It was found
that the male standard significantly under aged
females 40 years or older in the test sample, although
it worked out very well for pubic between 17-40 years
of age. The female standard, however, yielded results
within useful limits in all age groups.
In 1979, J.M.Suchey carried out work to assess the
reliability of the Gllibert Mckern method for aging the
female os pubis6. He designed a study in which 23
forensic anthropologist were asked to an age & set of
11 female pubis of known age. There was a great deal
of variability in the responses of these 23 participants.
There, four and five different responses (out of a 6
scale system) were given for each component of each
pubic bone. Only 51% of the assessment showed age
ranges which included the known age of specimens.
It was concluded that it is difficult for an observer to
select the exact stage of development which is present
in any of the three components using the Gllibert-
Mckern method. Analysis of the errors showed that
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104 Medico-Legal Update, July-December 2013, Vol. 13, No. 2
one of the main problems of the Gllibert-Mckern
system was the difficulty in judging whether the
ventral rampart was building up or breaking down.
Same difficulty was experienced while assessing
component III (the symphyseal rim).
A study by Gaurav Sharma‘s demonstrated that
various stages of symphysial rim were found at a later
age in Indians as compared with American pubic
bones examined by Mckern and Stewart7. This study
confirms pubic symphysis as useful age indicator
especially for adult male. There were no differences in
the urban and rural populations to the metamorphic
changes in the symphyseal surface of pubic bone.
MATERIALS AND METHOD
The study was conducted on 50 cases coming for
medico-legal postmortem examination to the
Department of Forensic medicine, Maulana Azad
Medical College, New Delhi.
Study design: Descriptive cross-sectional study.
MATERIALS
Human pubic symphysis (body, part of superior
ramus and part of inferior ramus of pubis) belonging
to different known age groups and sexes had been used
for the study .The specimens were collected from
autopsies conducted by the Department of Forensic
Medicine at Maulana Azad Medical College New
Delhi.
Inclusion Criteria
1. The cases of known age coming for medico legal
postmortem examination. Age was confirmed by
documentary evidences.
2. Subjects above 12 years of age. According to
existing literature changes in symphysial surface
of pubic bone starts at 17 years of age, so we had
taken 12 years of the age for baseline morphology
of symphysial surface of pubic bone and to detect
changes before 17 years of the age in our study
population if any.
Exclusion Criteria
1. Unknown, unclaimed bodies.
2. Cases showing fracture of limb, pelvic
degenerative disease or fracture of pelvis.
Method of Removal of Pubic Symphysis At Autopsy
The soft tissue in the suprapubic region was
displaced and cleared in order to have workable space.
Soft tissue overlying pubic symphysis was retracted
as far as possible. Electric bone cutting saw was used
for cutting the bone. Two lateral cuts were made on
the superior pubic rami about 2 inches from midlines,
inferior pubic rami was cut in similar manner. Then
soft tissue was separated and the specimen had been
taken out from body. The specimens were further
dissected to remove soft tissue without damaging
underlying bone.
PROCESSING
The specimens were processed by chemical
method. After proper tagging with patient’s details,
the specimens were placed in bath of antiformin (150
grams of sodium bicarbonate and 100 grams of
bleaching powder with 1 litre of water mixed with 1
liter of 15% solution of sodium hydroxide) solution
using sufficient solution to cover the specimens. For
fresh tissue 1 part of antiformin to 8 to10 parts of water
was used. The solution was heated just short of boiling
and was maintained at this temperature. The
specimens were examined from time to time to see how
quickly it is being denuded. In most of the specimens
additional method like burying in sand was needed
to clean the soft tissue.
When the specimens were totally free of soft tissue
then the symphyseal surface was studied for
morphological changes using a hand lens. Age was
precisely recorded from police records (inquest
papers). The age was further verified from municipal
corporation records, i.e. birth certificate, election card
etc.
The Study materials were scored on the pattern as
described by Mckern – Stewart.
Statistical Evaluation
Assessment of age was made by study of various
morphological features of pubic symphysis. We had
used mean and correlation test.
OBSERVATION AND RESUT
The present study comprises a total of 53
individuals in the age group of 12-75 years, residence
of Delhi. All the individuals had never suffered from
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Medico-Legal Update, July-December 2013, Vol. 13, No. 2 105
any disease or deformity affecting the bone during
their life.
Table 2. (Mean age comparison for component I)
Score Mckern- Stewart Present Study
Study (Mean (Mean Age
Age In Years) In Years)
0 19.3 15.67
1 20.1 21.25
2 22.5 23.75
3 23.6 27
4 26.1 34.42
5 32.9 51.875
Table 3. (Mean age comparison for component II)
Score Mckern- Stewart Present Study
Study (Mean (Mean Age
Age In Years) In Years)
0 17.5 16.875
1 18.9 23
2 19.8 23.14
3 20.1 27.43
4 23.3 32.2
5 31.9 49.84
Table 4. (Mean age comparison for component III)
Score Mckern- Stewart Present Study
Study (Mean (Mean Age
Age In Years) In Years)
0 19.2 16.43
1 23.8 21.67
22725
3 28.1 28.08
4 35.9 38.2
5 41.1 53.57
DISCUSSION
In present study the examination of symphyseal
surface of os-pubis by Mckern-Stewart criteria in delhi
(India) population to determine the age showed
significant difference in all the 3 components as well
as in total scoring in both the sexes when compared
Mckern-Stewart study (study).
The dorsal margin appears late in the present study.
It begins at the mean age of 23 years in both sexes,
while in Mckern-Stewart study it begins at the mean
age of 18.9 years and it completes at the mean age of
of 23.14 in our study while it completed at the mean
age of 19.8 years in Mckern-Stewart study.
Dorsal plateau formation starts at the mean age of
27.43 years in our study, and it completes at the mean
age of 49.84, while in Mckern-Stewart study it started
at the mean age of 20.1 years and completed at the
mean age of 31.9 years.
CHART 1. (Showing comparison of mean age for component-I)
Ventral bevelling appears late in the present study.
It begins at the mean age of 21.25 years in both sexes,
while in Mckern-Stewart study it begins at the mean
age of 20.1 years and it completes at the mean age of
of 23.75 in our study while it completed at the mean
age of 22.5 years in Mckern-Stewart study.
Ventral rampart formation starts at the mean age
of 27 years in our study, and it completes at the mean
age of 51.875, while in Mckern-Stewart study it started
at the mean age of 23.6 years and completed at the
mean age of 32.9 years.
CHART 2. (Showing comparison of mean age for component-II)
Symphyseal rim formation appears early in the
present study. It begins at the mean age of 21.67 years
in both sexes, while in Mckern-Stewart study it begins
at the mean age of 23.8 years and it completes at the
mean age of of 28.08 in our study while it completed
at the mean age of 28.1 years in Mckern-Stewart study.
The rarefaction of symphyseal rim starts at the
mean age of 38.2 years in our study, while in Mckern-
Stewart study it started at the mean age of 35.9 years.
CHART 3. (Showing comparison of mean age for component-III)
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106 Medico-Legal Update, July-December 2013, Vol. 13, No. 2
CONCLUSION
For component I, II and III correlation between
Mckern-stewart study and present study is 0.99, 0.99
and o.98. Correlation for all 3 components is statically
significant, so in our study there was not much
differences in comparison to study done by Mckern
and stewart in 1957.
REFERENCES
1. Martrille L, Douglas H, Cattaneo C, Fabienne S,
Tremblay M, Baccino E . Comparison of 4 skeletal
methods for estimation of age on white and black
adults. J Forensic Sci 2007 ch;52(2):302-5
2. Todd, T.W. Age changes in pubic bone.Am J Phys
Anthrop 1920, 3(3):285-334
3. Mckern,T.W. & Stewart,T.D. Changes in Young
American Males: Analysis from the Standpoint
of Age Identification. Technical Report EP-45,
Quartermaster Research & Development Center,
Environmental Protection Research Division.)
Natick, Massachusetts: Headquarters
Quartermaster Research & Development
Command, 1957. viii, 179 pp., 87 figures, 52 tables.
4. Gilbert,B.M. and Mckern T.W. A method for aging
the female os pubis. Am J Phys Anthrop
1973;38:31-8
5. Gilbert,B.M- Misapplication to famales of the
standard for aging the male os pubis.Am J Phys
Anthrop 1973;38:39-40
6. Suchey,J.M. Problem in the aging of females using
the os pubis. Am J Phys Anthrop 1979;51:467-70
7. Sharma G. Determination of age from pubic
symphysis: an study. Med Sci and Law
2008;48(2):163-9
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