A wrist radiograph of a boy whose age is disputed shows all carpal bones clearly ossified except the pisiform. The distal radial epiphysis is present but unfused. What is the most reasonable conclusion?

• A The radiograph is technically inadequate because the pisiform is always visible by five years
• B The boy is between 14 and 16 years
• C The boy is older than 18 years
• D The boy is younger than 10 to 12 years ✓

Explanation

The pisiform ossifies at about 10 to 12 years, so its absence places the boy below that range. An unfused distal radial epiphysis is consistent with this, since that epiphysis fuses around 17 to 19 years. Option C is impossible because an individual over 18 would have a fused distal radial epiphysis. Option A is wrong because the pisiform is characteristically absent in younger children, so its absence is a normal developmental finding rather than a technical failure.

Reference: Parikh's Textbook of Medical Jurisprudence and Toxicology, 7th ed.

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