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Determination of Crown-Rump length from fetal long bones Humerus and femur.

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Determination of Crown-Rump Length from Fetal Long
Bones: Humerus and Femur
LALIT MEHTA AND H. M. SINGH
D e p n r t m e n t of A n a t o m y , R. N . T . M e d i c n l College, U d a i p u r , Indici
KEY WORDS Fetus . CR Length . Humerus
Diaphysis . Age.
. Femur . Growth .
ABSTRACT
Lengths of the ossified diaphysis of the humerus and femur
were measured in 50 fetuses ranging from 65 to 290 mm Crown-Rump length.
A significant correlation was found between the diaphyseal length and the
CR length. No appreciable difference was noted in diaphyseal lengths of the
humerus and femur i n fetuses of 85 mm CR length or below. Various growth
phases were observed. The difference i n length of the femur and humerus is
due to a comparative slow growth of the humerus during the later period of
prenatal life. Diaphyseal growth rates of the humerus and femur are 0.18 mm
and 0.21 m m respectively for every 1 mm increase in CR length. Regression
coefficients for the lengths of the ossified shaft of the humerus and femur are
5.35 and 5.00 respectively. With the help of these coefficients, CR length of
the fetus was estimated within a range of k 1 5 mm. From the estimated CR
length, age of the fetus was determined with the help of a standard age and
size curve with reasonable accuracy.
Study of the correlation between linear
growth of long bones and the CR (CrownRump) length of the fetus assumes importance in medicolegal practice, since
the correlation can be used to estimate
the age of the fetus from its available
long bones.
Growth of long bones during prenatal
life has been studied in detail (Nishizuka,
'26; Streeter, '49; Felts, '54). Radiographic studies on the prenatal ossification of
human long bones recording the ratio of
the lengths of the ossified shaft relative
to the corresponding CR length have been
undertaken (Bade, '00; Halonen, '29;
ORahilly and Meyer, '56). Various phases
of linear growth of long bones have been
reported (Depreux and Fontaine, '51 ;
Moss et al., '55) and a linear correlation
between diaphyseal length and fetal
height has been observed (Smith, '39;
Saettle, '51; Olivier and Pineau, '60). Recently, Gray and Gardner ('69) and Gardner and Gray ('70) in their reports on the
prenatal development of the humerus
and femur published tables showing the
lengths of the ossified shaft and the corresponding CR length in fetal specimens
of 37 to 342 mm CR length.
AM, J . PHYS. ANTHROP.. 36: 165-168.
In the present study the lengths of the
ossified diaphysis of the humerus and
femur were measured in fetal specimens
of 65 to 290 mm CR length and a formula
derived to estimate the age of the fetus
based on the correlation of the diaphyseal
growth with the CR length.
MATERIALS AND METHODS
We studied 50 apparently normal fetuses, 30 male and 20 female, delivered
by normal women and having a CR length
ranging from 65 to 290 mm. The CR
length was measured, after fixation of
fetuses i n 10% formaline for four to six
months, with a specially prepared osteometric board to the exactness of 1 mm.
Values were verified by recording several
times. The limbs were detached and
placed in 5% KOH solution at room temperature for about two weeks. After thorough washing in running tap water, the
humerus and femur were dissected out
and cleaned. The cartilaginous ends were
removed gently. The remaining ossified
part of the shaft of each bone was dried
at room temperature for 48 hours. The
maximum length of the ossified shaft of
165
166
LALIT MEHTA AND H. M. SINGH
TABLE 1
M e m i length oftlie oss$ed shaft of the Izumenis
c c n d f e m u r for fetuses grouped by C R leitgth
Lengths of the
ossified shaft
CR length
No. of
fetuses
Humerus
11LnZ
?nm
2
3
2
2
3
3
2
2
5
4
2
6
4
3
3
2
2
11.5
16.0
18.0
20.7
21.5
26.5
26.7
26.7
29.1
29.5
33.5
35.3
37.8
38.8
43.3
48.5
51.5
11.5
16.0
19.0
21.5
22.5
27.0
28.0
28.0
30.4
31.2
34.5
37.5
40.5
41.5
47.3
52.2
59.0
iiinz
65
85
95
120
125
135
145
150
155
160
170
180
190
200
230
245
290
Femur
each bone was measured with a sliding
gauge. In order to exclude a possible
crossed asymmetry, only the right bones
were measured. The exactness of measuring was within 0.25 mm. Personal error
was eliminated by random controls measured by a second person. The fetal specimens were grouped by CR length to the
nearest 5 mm and the length of the ossified shaft of each was recorded.
OBSERVATIONS AND RESULTS
The CR length of fetuses in different
groups and the corresponding lengths of
the ossified shaft of the humerus and the
femur are recorded in table 1. No appreciable difference occurs in the diaphyseal
length of the humerus and femur i n fetuses of CR length 8 5 m m or below. The
ossified diaphyseal length of both humerus
and femur are plotted against CR length
in figure 1. The correlation coefficient
(r) is 0.9893 for the humerus and 0.9956
for the femur. The growth in length of
both bones was rapid and regular in fetuses with CR length up to 99 mrn followed by a phase of slow growth lasting
up to 150 m m CR length. Thereafter
again there was a phase of regular growth
in both bones up to 245 mm CR length.
This was followed by a phase of slow
60
100
i40
f80
,220
CROWN-RUMP
LENGTH
260
300
IN mm.
1 Curve showing the growth of the ossified diaphyses of the humerus and femur and
their correlation with the CR length
growth, especially in the humerus. The
difference in the diaphyseal lengths of
the humerus and femur became greater
during the later period of prenatal life.
The diaphyseal growth, as observed graphically, was 0.18 m m and 0.21 mm for the
humerus and femur respectively for every
1 mm increase in CR length. Regression
formulae were used to find the regression
coefficients for estimating the CR length
from the measured length of the ossified
diaphysis of the humerus and femur:
Y (CR
Y (CR
&
*
15 mm) = 5.35 x humerus
15 mm) = 5.00 X femur
DISCUSSION
As only the ossified portions of the
bones are usually available for determination of age, only the length of the ossified
portion of the diaphysis was studied.
These lengths of the humerus and femur
were equal in specimens of 85 m m or less
CR length. Depreux and Fontaine ('51)
recorded slow growth in both the bones
of fetuses of four to six months, but in
the present study such a slow growth
phase was found during four to six months
only. The lengths of the humerus and
femur increased regularly from the fifth
month onwards. However, the growth of
AGE DETERMINATION OF FETUS FROM LONG BONES
the humerus during this period was slow
compared to the femur, resulting in the
marked difference in length of both the
bones a t the time of birth. Bade (‘00)
found no correlation of growth in length
of long bones with the body length, but
Olivier and Pineau (‘60) showed linear
correlation between the diaphyseal lengths
and the fetal height. A similar correlation
was observed in the present study between
the lengths of the ossified shafts of the
humerus and the CR length. Felts’ (‘54)
observation that the length of the femur
increased by 0.21 mm for every 1 m m increase in CR length was confirmed by the
present study. Gardner and Gray (‘70)
reported a n increase of 0.285 mm in the
shaft of the femur for every 1 mm increase in CR length. Saettle (‘51), in his
studies on determination of size of the
human fetus based on linear measurements of bones, plotted growth curves of
shafts against fetal height and reported
that estimation of height on the basis of
the growth curve is more accurate. A
similar curve was obtained in the present
study for the growth of the ossified shaft
of the humerus and femur against the
CR length. Scammon’s (‘37) nomogram
showing maximum dried length of the
femur i n fetuses of 180 to 375 mm CR
length gives lower values when compared
with those obtained in the present study.
Due to different growth phases, a definite
multiplying factor for a given diaphyseal
length to estimate the exact CR length
is difficult to derive. Smith (’39) reported
multiplying factors of 7.60 and 6.71 for
the diaphyseal lengths of the humerus
and femur respectively to estimate the
Crown-Heel (CH) length of the fetus. In
the present study multiplying factors were
derived to find the CR length. The values
(5.35 and 5.00 for humerus and femur
respectively) are a little higher than those
of Smith’s observations after converting
the values for CH length determination
(CR:CH ratio taken as 1:1.45). The regression line of femur length on CR length
is similar to but slightly lower than that
found by Stewart (‘54) after maximum
drying in the range for which they can
be compared, 40-59 mm.
Once the Crown-Rump length is estimated from the lengths of the ossified
shaft of the humerus or femur, the age
167
of the fetus can be estimated with a reasonable accuracy from a standard age
and size curve such as that published by
Boyd (’41).
ACKNOWLEDGMENTS
We are thankful to Dr. R. P. Chaturvedi, Principal and Professor of Anatomy,
R.N.T. Medical College, Udaipur, for permission to carry out this study and for
his guidance. We are also thankful to
Dr. K. C. Jain for his help and to Mr.
D. K. Shrivastava for the statistical calculations.
LITERATURE CITED
Bade, P. 1900 Die Entwicklung des menschlichen skelets bis zur Geburt. Arch. mikr. Anat.
Entw., 55: 245-290.
Boyd, E. 1941 Outline of Physical Growth and
Development. Burgess, Minneapolis.
Depreux, R., and R. Fontaine 1951 Pousses et
crises de croissance de l’humerus et du femur
foetaux. Etude Bull. SOC.Anthrop., 2: 182-188.
Felts, W. J. L. 1954 The prenatal development
of the human femur. Am. J. Anat., 9: 1 4 4 ,
Gardner, E., and D. J. Gray 1970 The prenatal development of the human femur. Am.
J. Anat., 129: 121-140.
Gray, D. J., and E. Gardner 1969 The prenatal
development of the human humerus. Am. J.
Anat., 124: 431-446.
Halonen, L. 1929 Rontgenlogisch-Anatomische
Untersuchungen uber die Entwicklung der
Knochen der freien Extremiteten beim Menschen. I . Die extremitenknochen der Feten.
Acta Societatis Medicorum Fennicae “Doudecim.” Sounalaisen Laakariseur a n Duodecim
’in Toimituksia, Tom XI, Fase. 3 : 1-151,
Helsinki.
Moss, M. L., C. R. Noback and G. G. Robertson
1955 Critical developmental horizons i n hum a n fetal long bones. Am. J. Anat., 97: 155175.
Nishizuka, T. 1926 Beitrage zur Osteologie der
Foten, Neugeborenen, und Kinder nebst Erwachsenen (Japoner). Knochen der Extremitaten samt Schulter und Backen. 2. Morph.
Anthr., 25: 1-90,
Olivier, G., a n d H. Pineau 1960 Noubelle determination de la tailla foetale d’apres les longures diaphysaires des 0s longs. Ann. Med.
Leg., 40:2 141-144.
ORahilly, R., and D. B. Meyer 1956 Roentgenographic investigation of the h u m a n skeleton during early fetal life. Am. J. Roentgen.,
76: 4 5 5 4 6 8 .
Saettle, R.
1951
Korpergroszenbestimmung
menschlicher Fruchte and Hand der Langemasze einzelner Skeletteile oder der en Dia-
168
LALIT MEHTA AND H. M. SINGH
physen. Dtsch. Z . Ges. gerichtl. Med., 40: 567577.
Scammon, R. E. 1937 Two simple nomographs
for estimating t h e age and some of the major
external dimensions of the h u m a n fetus. Anat.
Rec., 68: 221-225.
Smith, S. 1939 Quoted by W. M. Krogman.
In: The Human Skeleton i n Forensic Medicine.
Charles C Thomas, Springfield, 1962, p. 177.
Stewart, T. D. 1954 Evaluation of evidence
from the skeleton. In: Legal Medicine. Chap. 17.
R. B. H. Gradwohl, ed. C. V. Mosby Co., St.
Louis, pp. 420-421.
Streeter, G. L. 1949 Developmental horizons i n
h u m a n embryos (fourth issue). A review of the
histogenesis of cartilage a n d bone. Contrib.
Embryol., 33. 149-167. Publication No. 583,
Carnegie Institution of Washington.
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