Effect of fusion status of sternum in stature estimation – A study from South India

Accepted Manuscript Effect of fusion status of sternum in stature estimation – A study from South India H.V. Chandrakanth, MD, Associate Professor, Tanuj Kanchan, MD, Dr.Associate Professor, Kewal Krishan, PhD, Sr. Assistant Professor PII:

S1752-928X(15)00171-7

DOI:

10.1016/j.jflm.2015.09.004

Reference:

YJFLM 1230

To appear in:

Journal of Forensic and Legal Medicine

Received Date: 31 January 2015 Revised Date:

26 August 2015

Accepted Date: 4 September 2015

Please cite this article as: Chandrakanth H, Kanchan T, Krishan K, Effect of fusion status of sternum in stature estimation – A study from South India, Journal of Forensic and Legal Medicine (2015), doi: 10.1016/j.jflm.2015.09.004. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Title: Effect of fusion status of sternum in stature estimation – A study from South India

HV Chandrakanth 1, MD (Associate Professor) Tanuj Kanchan2, MD (Associate Professor)

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Kewal Krishan3, PhD (Sr. Assistant Professor)

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Authors with Affiliations

1

Department of Forensic Medicine, JSS Medical College (JSS University), SS Nagar,

Mysore, India.

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2

Department of Forensic Medicine, Kasturba Medical College (Manipal University),

Mangalore, India 3

Department of Anthropology, Panjab University, Chandigarh, India

Corresponding Author:

Associate Professor

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Dr Tanuj Kanchan

Department of Forensic Medicine, Kasturba Medical College,

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Light House Hill Road,

Mangalore- 575 001, India

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E-mail: [email protected] , [email protected] Phone: 91-824-2444590 Ext 5565 (Office) 91-824-2444590 Ext 5731 (Residence) 91-9448252394 (Mobile)

Conflict of Interest: None to declare.

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ACCEPTED MANUSCRIPT Title: Effect of fusion status of sternum in stature estimation – A study from South India

ABSTRACT anthropologists

examine and

identify skeletal,

dismembered and

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Forensic

commingled remains in a legal context to establish the biological profile of the deceased. Stature estimation is one of the important parameters in establishing the

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biological profile. The present study is planned to derive regression models for stature estimation from sternal measurements. Various factors are likely to affect

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stature estimation in forensic investigations. Since, none of the previous researchers have studied the effect of fusion status on stature estimation from sternum and its segments, the present study attempts to find if the fusion status of the sternum affect its reliability and accuracy in stature estimation. The sample of the present study

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consisted of 117 sterna that were obtained from autopsied bodies. Five measurements i.e. Length of manubrium (M), length of mesosternum (B), combined length of manusbrium and mesosternum and the (M+B), width at first sternabrae

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(S1) and width of 3rd sternabrae (S3) were taken on the autopsied sterna. The

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sterna were classified as fused (both manubriosternal and xiphisternal joints were fused), partly fused (only one of the manubriosternal or xiphisternal joints was fused) and not fused (both manubriosternal and xiphisternal joints were not fused). Regression models were derived using statistical methods. All the sternal measurements show a positive however, a weak correlation with stature. Thus, it can be concluded that the accuracy and reliability of stature estimation from sternum and its segments is quite low in practical situations. Among the sterna classified based on the fusion status, the length measurements of completely fused sterna show

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ACCEPTED MANUSCRIPT significant correlation with the stature. None of the other sternal measurements on the non-fused or partly fused sterna show statistically significant correlation with stature. The present study concludes that the fusion status of the sternum is likely to affect the reliability and accuracy in estimation of stature. The findings of this study

studies based on larger samples from different populations.

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Keywords

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however, should be considered 'preliminary' until they are corroborated by similar

Forensic anthropology; Stature estimation; Sternum; Fusion of sternum; South Indian

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population

1. Introduction

One of the foremost tasks of a forensic anthropologist is to examine and

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identify the unknown skeletal, dismembered and commingled remains in a legal context. Emphasis is laid on the need to strengthen the methods of establishing biological profile of the deceased in these cases. Estimation of stature along with

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other parameters of identification such as sex, age and ancestry are the essential

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criteria in establishing the biological profile of an individual. This process facilitates in narrowing down the pool of possible victim matches during investigation process. An accurate estimation of stature is possible if whole skeleton is brought for

examination. The process of stature estimation becomes relatively complex in cases where a few/ individual bones are brought for examination. It has been shown that the reliability and accuracy of long bones is better than other human bones in stature estimation.1,2 In the absence of long bones; other bones such as skull,3-5 scapula,6

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ACCEPTED MANUSCRIPT sternum,7 vertebral column,8 pelvic bones9 and small bones of the body10-12 may be used for stature estimation. Sternum also known as the breast bone is a long, narrow, flat plate that is placed in the centre of the front of the chest. Sternum is divided into three parts- the

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manubrium on the upper side, the body of the sternum in the middle i.e. mesosternum and the xiphoid process in the distal or lower side. As the ossification takes place, the manubrium joins with the mesosternum and the mesosternum

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articulates with the xiphoid via either a primary or secondary cartilaginous joint13. The manubrium fuses with the mesosternum in the old age usually above 50 years,

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different segments of the sternal body fuse within the ages 14 to 25 years from below upwards and the fusion of the xiphoid process with the sternal body occurs between the ages 40 to 45 years.14 The three parts of the sternum develop from a variable number of centres of ossification and consequently, much of the variation

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seen in the sternum may be attributed to the number of patterns and ossification centers13. In mutilated and dismembered human remains, there are high chances of recovering the intact sternum. In this regard, previous researchers have published

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studies on the estimation of age15-17, sex18-22 and stature7,23 from sternum. Besides, there are a few discrete traits of the sternum that can be utilised for identification in

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forensic examinations.24

An individual attains adult stature at around 18 years of age25 which coincides

with the skeletal maturity. Hence, the studies on stature estimation are mostly conducted in adult populations for better reliability and accuracy of the derived models. This may not hold good for the process of stature estimation from sternum where fusion of it segments occur at a later age which is likely to effect the dimensions of the sternum. Moreover, the fusion of sternal segments per se does not

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ACCEPTED MANUSCRIPT follow a definite chronology. The present research was planned considering the fact that limited literature is available on stature estimation from sternal measurements and that none of the previous researchers have reported the effect of fusion status of sternum in stature estimation. The objective of the present study was to study the

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effect of fusion status on stature estimation and derive regression models for estimation of stature from the measurements of sternum in a modern autopsied

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sample.

2. Materials and Methods

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The samples used in the present study included 117 adult sterna (Males=67, Females=50) obtained from autopsied bodies at the Department of Forensic Medicine, JSS Medical College, Mysore in South India that has been previously utilised for estimation of age and sex in South Indian population.17-18 The age and sex distribution

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of the study sample is shown in Figure 1. A written informed consent was obtained from the legal heirs prior to the conduction of medico-legal autopsy explaining to them that the sternum will be preserved in the department for further analysis. The

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stature of the body was measured in centimeters on the autopsy table as length

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between head and heel. All the cases with evidence of injuries to the head, spine or lower limbs were excluded from the study. The sterna obtained after autopsy were subjected to a thorough maceration17 to ensure precision in measurements and fusion status. Sterna that were free from any apparent acquired or congenital abnormalities were included in the study. Visual inspection of the joints was done to comment on the fusion status. The sterna were classified as fused (both manubriosternal and xiphisternal joints were fused), partly fused (either of the manubriosternal or xiphisternal joints was fused) and not fused (both manubriosternal and xiphisternal

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ACCEPTED MANUSCRIPT joints were not fused). The following measurements were taken on each sternum using vernier calipers graduated to the nearest 0.01 mm. Length of manubrium (M): measured from jugular notch to manubriosternal joint. Length of mesosternum (B): measured from manubriosternal to xiphisternal joint.

notch to xiphisternal joint.

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Combined length of the manubrium and mesosternum (M+B): measured from jugular

for the third costal cartilage on both sides.

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Width at 1st Sternabrae (S1): Breadth of the sterna measured between the notches

Width at 3rd Sternabrae (S3): Breadth at the sterna measured between the notches

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for the fifth costal cartilage on both sides.

Landmarks on the sternum and measurements included in the study are described in Figure 2.

The data was analyzed using SPSS (Statistical Package for Social Sciences,

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version 11.0) computer software (SPSS, Inc., Chicago, IL, USA). The data was analyzed statistically for correlation and regression analysis. The descriptive analysis was done to obtain mean, standard deviation (S.D) and range of the sternal

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measurements. In the present research, the sterna were classified into three groups

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based on the fusion status (not fused, partly fused and fused). Pearson’s correlation was performed to determine the relationship between stature and sternal measurements in each of the aforementioned groups. Univariate regression models were derived for the measurements that showed statistically significant correlation with stature. Statistical significance (P-value) was defined as α = 0.05.

3. Results

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ACCEPTED MANUSCRIPT The stature of the study sample ranged between 140.0 and 181.0 cm, the mean stature being 162.4 cm (SD=9.7 cm). The mean stature among males and females was 167.4 (SD=7.7 cm) and 155.7 (SD=8.1 cm) respectively. Among the sternal measurements, total sternal length was observed to be the largest dimension

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and width at 1st Sternabrae as the smallest measurement. The descriptive statistics for stature and sternal measurements among males, females and total study sample are shown in Table 1.

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Following the descriptive analysis of the data, the sternal measurements were analyzed for their correlation with stature. The correlation between sternal

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measurements and stature were not observed to be statistically significant among males and females. In the total study sample, the correlation coefficient (r) varied between 0.173 for the width at 3rd Sternabrae and 0.337 for the length of manubrium. The correlation coefficients between stature and each sternal

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measurement included in the study were found to be positive and statistically significant, except for the width at 3rd Sternabrae in the total sample (Table 2). Linear regression models were derived for the measurements that showed

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significant correlation with stature. The stature was taken as the dependent variable

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and each sternal measurement as the independent variable. Univariate linear regression models thus derived for estimation of stature from the sternal measurements are shown in Table 3. The standard error of estimate for the regression models derived on the study sample varied between 9.21 cm (M) and 9.51 cm (B). The relation between stature and each sternal measurement are depicted in the scatter diagrams (Figure 3). Among the sterna classified based on the fusion status, only length measurements of completely fused sterna showed significant correlation with the

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ACCEPTED MANUSCRIPT stature. None of the sternal measurements on the non-fused or partly fused sterna showed statistically significant correlation with stature (Table 4). For the measurements on the completely fused sterna, the Pearson’s Correlation coefficient was maximum for the combined length of manubrium and mesosternum (r=0.649).

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Univariate linear regression models derived for the estimation of stature from the length measurements of the completely fused sterna are shown in Table 5. The predictive accuracy of stature estimation was found to be highest for the combined

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length of manubrium and mesosternum. The Standard Error of Estimate (SEE) was the least (8.27 cm) for the linear regression models derived for the combined length

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of manubrium and mesosternum of the fused sterna followed by length of manubrium and mesosternum individually (Table 5).

4. Discussion

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Sternum is an important bone in anthropological and forensic contexts. The sternum being safely placed in the chest has high degree of physical resistance and thus, is preserved as evidence in highly mutilated and decomposed cases. The

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literature search on PUBMED using keywords stature and sternum revealed a few

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studies on stature estimation from sternum. Menezes et al26,27 conducted studies on estimation of stature from sternum in males and females respectively on autopsied samples from south western coastal region of India. Singh et al28 used multivariate regression analysis on north western autopsied sample from India for estimation of stature from sternum and its parts. Tumram et al23 have computed linear regression equations from the total sternal length, manubrium and mesosternum length for estimation of stature in an autopsied sample from Central India. Yonguc et al29 carried out a study on Turkish autopsy sample and derived multiple regression

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ACCEPTED MANUSCRIPT equations for estimation of stature from sternum and its parts whereas Marinho et al7 tested the previously developed formulae for stature estimation on a Portugese sample. Macaluso Jr. and Lucena29 derived regression models for estimation of stature from radiographically measured sternal length in a modern Spanish

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population. Torimitsu et al31 conducted an investigation in the Japanese population on 107 males and 108 females using computed tomography. They found a correlation between stature and dimensions of sternal medullary cavity and derived

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regression equations for estimation of stature. On searching the Google data base, we found another study by Kumar et al32 on estimation of stature from sternal

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measurements based on digital X-rays where linear regression equations were derived from measurements of sternum for estimation of stature in a North Indian population. It is worth highlighting that the aforementioned studies on stature estimation from sternum have followed different methodologies and are either based

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on direct measurements on autopsied samples or radiological investigations including digital x-rays and computed tomography among different population groups. The literature available on estimation of stature from sternal lengths in

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autopsied samples is compared and summarised in Table 6. Most of the previous researchers, except for the studies by Yonguc et al29 and

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Menezes et al26,27 have reported a low correlation between sternal measurements and stature, and a high standard error of estimate (SEE). The present investigation likewise shows a low correlation and high SEEs indicating that the estimation of stature from sternum and its parts may not be very accurate7. Thus, sternum should not be considered as a very reliable bone in stature estimation. The lower accuracy and lesser reliability of sternum in estimation of stature may be primarily attributed to the fact that the sternum does not directly contribute to the anatomical stature of an

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ACCEPTED MANUSCRIPT individual. Long bones in this regard are known to show strong correlation with stature and provide more accurate results in stature estimation. Long bones of the lower limb provide better results than the upper limb bones as the lower limb directly contributes to the stature of the person. It also needs to be highlighted that though

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the sternum is a curved structure; its measurements included in the studies are the linear distances and not the exact ones along the curved surface that may also influence the correlation of sternal measurements and stature. The differences in the

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observations of different studies thus, can be attributed to population differences and variability in methodology and measurement techniques. Variations in measurement

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can be due to differences in spotting the limit between manubrium and mesosternum or xiphoid and mesosternum. Here the anatomical impact on the length of the sternum after fusion also needs to be explored.

Usually sex specific regression models are derived for estimation of stature

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owing to the sex differences in the growth spurt and fusion of bones during adulthood. However, sexing of bones and dismembered remains accurately may itself be a difficult task even for the trained anthropologists; especially in cases of

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bones and body parts that do not exhibit reliable sexually dimorphic traits. It implies

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that the application of sex specific regression models would depend on an accurate estimation of sex, without which there are chances of erroneous results. In such scenario, universal regression formulae are proposed for effective estimation of stature than the sex specific regression models.33 Previous studies on estimation of sex from sternum and its segments have shown that the sexing from sternum is not very accurate, thus, limiting the utility of sex specific models in estimation of stature from sternal measurements. Hence, in the present study, universal regression

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ACCEPTED MANUSCRIPT formulae have been derived for pooled sample of males and females together (mixed sample). The present research further studies the effect of fusion status of the sternal segments on estimation of stature which has not been investigated in the previous

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studies. The present study shows that the correlation of stature with different parts of the sterna depends upon its fusion status. A significant correlation of stature and sternal length measurements were demonstrated for the fused sterna only. The

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measurements of the unfused and partly fused sterna did not show any significant correlation with stature. Amongst the fused sterna, the length of Manubrium and

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Mesosternum together showed highest correlation coefficient (r= 0.649) and thus, shows better reliability and accuracy in stature estimation (SEE = 8.67cm). The study thus observes that while the sternal measurements showed a statistically significant correlation with stature in the total sample, it was only the fused sterna that showed

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a significant correlation with stature after these were classified based on fusion status. The correlation between stature and sternal lengths was higher for the fused sterna than for the total sample irrespective of the fusion status. However, it is

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observed that the overall utility of sterna in stature estimation is very low based on

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high SEE observed in the study.

5. Conclusion

The present study concludes that the sternum and its measurements show a

positive however, a weak correlation with stature in individuals. The accuracy and reliability of stature estimation from sternum and its segments is quite low in practical situations. Thus, sternum should be utilized for stature estimation only when other

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ACCEPTED MANUSCRIPT bones are not available for examination. When required, the length measurements provide a better estimate of stature than the width measurements. The present study accomplishes that the fusion status of the sternum affects the reliability and accuracy in estimation of stature. Length of manubrium and

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mesosternum together for the fused sterna provide better estimates of stature. The fusion stage of the sternum directly points at the development of the bone, and there is likelihood of getting erroneous results if the state of fusion of the sternum is not

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taken into consideration while estimating stature from its various measurements. It is thus, hypothesised that the lower accuracy of sternum in stature estimation as

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reported by the previous researchers may be due to the fact that the earlier studies have attempted to estimate the stature irrespective of the fusion status of the sterna. The limitation of the present research on the effect of fusion status on stature estimation may be its small sample size. The findings of this study hence, should be

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considered 'preliminary' until they are corroborated by similar studies based on larger samples from different populations.

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Conflict of Interest: The authors declare that there is no conflict of interest

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regarding this manuscript and research.

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Table 1: Descriptive statistics of the sternal dimensions among males, females and total sample

B

MB

S1

Range

28.2-64.2

62.6-124.2

104.8-186.4 13.1-39.1

18.9-40.5

Mean ± S.D.

48.9±06.7

90.7±15.3

139.8±17.2 27.8±04.7

28.8±04.8

Range

32.1-54.1

56.6-124.2

95.3-178.3

16.2-36.2

16.2-41.2

Mean ± S.D.

43.7±04.2

78.8±14.3

122.4±16.2 23.2±04.0

25.4±04.1

Range

28.2-64.2

56.6-124.2

95.3-186.4

13.1-39.1

16.2-41.2

Mean ± S.D.

46.7±06.3

85.7±15.9

132.4±18.8 25.8±04.9

27.3±04.8

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Total (n=117)

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Males (n=67)

Females (n=50)

S3

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M

M – Length of Manubrium (mm), B – Length of Mesosternum (mm), MB – Length of Manubrium and Mesosternum (mm), S1 –

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Width at 1st Sternabrae (mm), S3 – Width at 3rd Sternabrae (mm), S.D. – Standard Deviation

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ACCEPTED MANUSCRIPT Table 2: Pearson Correlation (r) between stature and dimensions of sternum

Females (n=50)

Total (n=117)

r

r

r

P-value

P-value

Stature

P-value

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Variable

Males (n=67)

M

0.119 0.339

0.148 0.305

0.337* <0.001

B

0.091 0.462

0.243 0.089

MB

0.069 0.578

0.259 0.069

S1

0.016 0.899

0.112 0.400

0.244* =0.008

S3

0.003 0.981

0.113 0.435

0.173 =0.063

0.234* =0.011

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0.322* <0.001

M – Length of Manubrium (mm), B – Length of Mesosternum (mm), MB – Length of Manubrium and Mesosternum (mm), S1 –

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Width at 1st Sternabrae (mm), S3 – Width at 3rd Sternabrae (mm)

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ACCEPTED MANUSCRIPT Table 3: Univariate linear regression models for reconstruction of stature from sternum in the study sample

Equation

R

R2

S.E.E.

M

138.129 + 0.519 (M)

0.337

0.114

9.21

B

150.146 + 0.143 (B)

0.234

0.055

9.51

MB

140.315 + 0.167 (MB)

0.322

0.103

9.26

S1

149.997 + 0.480 (S1)

0.244

0.059

9.49

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Variable

M – Length of Manubrium (mm), B – Length of Mesosternum (mm), MB – Length of Manubrium and Mesosternum (mm), S1 –

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EP

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M AN U

Width at 1st Sternabrae (mm), SEE – Standard Error of Estimate (cm)

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ACCEPTED MANUSCRIPT Table 4: Pearson Correlation (r) between stature and different dimensions of sternum based on the fusion status

Partly fused (n=49)

Fused (n=33)

r

r

r

P-value

Stature 0.217 0.210

0.194 0.182

B

0.102 0.559

0.075 0.608

MB

0.004 0.983

0.154 0.290

S1

0.143 0.413

0.179 0.219

S3

0.096 0.582

0.048 0.742

0.517* 0.002

M AN U

M

P-value

RI PT

P-value

0.437* 0.011

SC

Variable

Not fused (n=35)

0.649* <0.001

0.342

0.051

0.301

0.089

M – Length of Manubrium (mm), B – Length of Mesosternum (mm), MB – Length of Manubrium and Mesosternum (mm), S1 –

AC C

EP

TE D

Width at 1st Sternabrae (mm), S3 – Width at 3rd Sternabrae (mm)

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ACCEPTED MANUSCRIPT Table 5: Univariate linear regression models derived for reconstruction of stature from completely fused sternum

Equation

R

R2

S.E.E.

M

121.879 + 0.519 (M)

0.517

0.268

9.75

B

141.686 + 0.243 (B)

0.437

0.191

10.25

MB

112.796 + 0.368 (MB)

0.649

0.421

8.67

RI PT

Variable

SC

M – Length of Manubrium (mm), B – Length of Mesosternum (mm), MB – Length of Manubrium and Mesosternum (mm), SEE –

AC C

EP

TE D

M AN U

Standard Error of Estimate (cm)

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ACCEPTED MANUSCRIPT Table 6: Comparison of the literature on estimation of stature from sternal length using autopsied samples

Population

Sample

N

Max. Correlation (r)

Yonguc et al29

Turkish

Autopsy

95

M=0.721, F=0.740

Marinho et al7

Portugese

Autopsy

45

0.329

Singh et al28

Indian (North-west)

Autopsy

343

0.575

Tumram et al23

Indian (Central)

Autopsy

92

0.550

SC

RI PT

Studies

Autopsy

40

M=0.693

Menezes et al27 Indian (South-west coastal)

Autopsy

36

F=0.638

Present Study

Autopsy

117

0.322

M AN U

Menezes et al26 Indian (South-west coastal)

Indian (South-central)

AC C

EP

TE D

Max. – Maximum; M – Male; F – Female

21

ACCEPTED MANUSCRIPT

AC C

EP

TE D

M AN U

SC

RI PT

Figure 1: Age and sex distribution of the study sample (Males=67, Females=50)

22

ACCEPTED MANUSCRIPT

AC C

EP

TE D

M AN U

SC

RI PT

Figure 2: Landmarks and measurements on the sternum

23

ACCEPTED MANUSCRIPT

AC C

EP

TE D

M AN U

SC

RI PT

Figure 3: Scatter diagrams for stature and measurements of the sternum

24

ACCEPTED MANUSCRIPT

Highlights •

The study aims to derive regression models for stature estimation from sternal measurements.

•

The study also attempts to study the effect of fusion status on stature estimation from

RI PT

sternum. •

All the sternal measurements show a positive however, a weak correlation with stature.

•

Based on the fusion status, the length of completely fused sterna show significant correlation

EP

TE D

accuracy in estimation of stature.

M AN U

The study concludes that the fusion status of the sternum is likely to affect the reliability and

AC C

•

SC

with stature.