From cartilage to bone: the utility of ultrasonography in age estimation using forearm bones: a novel scoring system approach.

Forensic age estimation is of critical legal importance. This study aimed to assess the utility of ultrasonography (US) as an alternative, safe, non-invasive technique that could replace other roentgenographic modalities in forensic age estimation. Epiphyseal maturation staging of the upper and lower ends of the radius and ulna using US was conducted for 155 Egyptian juveniles and adolescents, showing a mean age of 15.8 ± 3.7 years. Above the age of 17, all females demonstrated complete epiphyseal closure of the proximal bone ends, and above the age of 18, the distal end of ulna was completely united. All males demonstrated complete epiphyseal union of the proximal ulna above 17 years, the proximal radius above 18 years, and distal ulnas above 20 years. A proposed model. [Formula: see text] using a novel total score assessing epiphyseal maturation of all forearm bones could significantly explain 85.6% of age variations, with very low error, where the predicted age deviates from the real age by approximately 1.0 to 1.2 years. We observed a substantial to near-perfect agreement between the estimated and chronological age (coefficients>0.879). The overall score has the highest accuracy in predicting the ages of 15, 16, 17, and 18 years (p < 0.001). Females showed accelerated epiphyseal maturation compared to males, and the proximal forearm bones approached full maturation before the distal ends. Using the proposed novel score assessing the proximal and distal ends of the ulna and radius through US offers a simple and radiation-free approach that could predict age with precision.