For medicolegal estimation of age near the upper limit of skeletal maturation, an examiner studies the knee region. Among the epiphyses of the lower limb, which one is the last to unite with its diaphysis?

• A Proximal tibial epiphysis
• B Distal tibial epiphysis
• C Proximal femoral (greater trochanter) epiphysis
• D Distal femoral epiphysis ✓

Explanation

The distal femoral epiphysis unites with the shaft at approximately 19 to 20 years, slightly later than the proximal tibial epiphysis at 17 to 19 years, making it the last lower limb epiphysis to fuse. The greater trochanter fuses around 16 to 18 years and the distal tibia around 16 to 18 years. Because the distal femoral centre is present at birth yet fuses last, this single epiphysis brackets nearly the whole span of postnatal skeletal maturation used in age assessment.

Reference: Cunningham's Manual of Practical Anatomy, Volume 1: Upper and Lower Limbs, 16th ed.

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