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Body height estimation from post-mortem CT


femoral F1 measurements in a contemporary
Swiss population

Article in Legal Medicine February 2016


DOI: 10.1016/j.legalmed.2016.02.004

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Legal Medicine 19 (2016) 6166

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Legal Medicine
journal homepage: www.elsevier.com/locate/legalmed

Body height estimation from post-mortem CT femoral F1 measurements


in a contemporary Swiss population
Wolf-Dieter Zech a,, Maya Nf a, Frank Siegmund b, Christian Jackowski a, Sandra Lsch c
a
Department of Forensic Medicine and Imaging, Institute of Forensic Medicine Bern, University of Bern, Switzerland
b
Institute of History, Heinrich Heine University Dsseldorf, Germany
c
Department of Physical Anthropology, Institute of Forensic Medicine, University of Bern, Switzerland

a r t i c l e i n f o a b s t r a c t

Article history: Purpose: The present study aimed at the comparison of body height estimations from cadaver length
Received 28 November 2015 with body height estimations according to Trotter and Gleser (1952) and Penning and Riepert (2003)
Received in revised form 15 February 2016 on the basis of femoral F1 section measurements in post-mortem computed tomography (PMCT) images.
Accepted 16 February 2016
Methods: In a post-mortem study in a contemporary Swiss population (226 corpses: 143 males (mean
Available online 16 February 2016
age: 53 17 years) and 83 females (mean age: 61 20 years)) femoral F1 measurements (403 femora:
199 right and 204 left; 177 pairs) were conducted in PMCT images and F1 was used for body height esti-
Keywords:
mation using the equations after Trotter and Gleser (1952, American Whites), and Penning and Riepert
Stature
Forensic anthropology
(2003).
Post-mortem computed tomography Results: The mean observed cadaver length was 176.6 cm in males and 163.6 cm in females. Mean mea-
(PMCT) sured femoral length F1 was 47.5 cm (males) and 44.1 cm (females) respectively. Comparison of body
Femur height estimated from PMCT F1 measurements with body height calculated from cadaver length showed
Body height estimation a close congruence (mean difference less than 0.95 cm in males and less than 1.99 cm in females) for
equations both applied after Penning and Riepert and Trotter and Gleser.
Conclusions: Femoral F1 measurements in PMCT images are very accurate, reproducible and feasible for
body height estimation of a contemporary Swiss population when using the equations after Penning and
Riepert (2003) or Trotter and Gleser (1952).
2016 Elsevier Ireland Ltd. All rights reserved.

1. Introduction elements and their linear proportionality to the stature can be used
for body height estimation or estimation of sex. In settings, such as
Over the last 10 years post-mortem CT (PMCT) scanning has mass disasters the use of PMCT imaging can be very helpful
become a useful tool in forensic practice [13]. Since CT images because metric bone measurements of any body part can be exe-
can depict osseous structures well, CT imaging is also applied in cuted quickly, are easily to be reproduced and avoid elaborate
forensic anthropology for tasks such as determination of sex, age maceration procedures [3,6,8,9,1417]. Moreover CT data offer
and body height [49]. Body height estimation remains one of the advantage of population studies and enable for bone recon-
the key parameters to identify unknown individuals [10,11]. Body struction as a means of providing metrical data of skeletal struc-
height can be estimated by the anatomical method or mathemat- tures in victim identification. CT measurements may also be
ically by the use of regression equations. The anatomical method conducted for determination of sex [18,19]. Several previous stud-
provides more accurate estimates, but requires the entire skeleton ies investigated the feasibility of CT bone measurements such as
by summing up measuring lines from the skull to the foot [12,13]. pelvic measurements or radial and ulnar length measurements
In forensic practice decomposed, burned or incompletely pre- for body height estimation in Japanese and Chinese populations
served corpses may be presented as the only available source to [2023]. Other studies used the metatarsal bones in a Spanish pop-
establish identity. In such cases measurement of single skeletal ulation or the first cervical bones in a Portuguese population for
body height estimation from CT measurements [18,19]. Since
femur length is closely correlated with stature, metric femoral
Corresponding author at: Department of Forensic Medicine and Imaging, parameters can be used to determine the body height of an individ-
Institute of Forensic Medicine Bern, University of Bern, Bhlstrasse 20, 3012 CH ual [2431]. Hence PMCT measurements of metric femoral param-
Bern, Switzerland.
eters can be used to determine body height as well [23,32]. Several
E-mail address: wolf-dieter.zech@irm.unibe.ch (W.-D. Zech).

http://dx.doi.org/10.1016/j.legalmed.2016.02.004
1344-6223/ 2016 Elsevier Ireland Ltd. All rights reserved.
62 W.-D. Zech et al. / Legal Medicine 19 (2016) 6166

equations for body height estimation from the femur have already According to Martin [38] the metric F1 parameter (distance
been established. Only few of them have been re-evaluated since between the highest point of the caput femoris and the lowest
[11,13,33,34]. Trotter and Gleser [35] developed different equa- point of the medial condyle on a conventional osteometric board)
tions for White, Negroid and Mongoloid populations. The was measured in PMCT images (Fig. 1). The mean, standard devia-
equations generated by Penning and Riepert [36] were established tion and interquartile range of measured femoral length F1 in
on a large southern German population sample. However, evalua- PMCT images were calculated for all subjects. When both femora
tion of these equations has shown regional and temporal bias [11]. were measured in the same individual, the arithmetic mean of
The present study aimed at the comparison of body height estima- both measurements was used. KolmogorovSmirnov goodness of
tions from cadaver length with body height estimations according fit test was used to test for normality of the distribution of F1 mea-
to Trotter and Gleser [35] and Penning and Riepert [36] on the surements [37].
basis of measurements of the anthropologically standardized
femoral F1 section in PMCT images. Furthermore, accuracy of body 2.4. Intra-observer error
height estimation between the regression equations after Trotter
and Gleser [35] and the regression equations after Penning and Intra-observer error of PMCT F1 measurements in corpses of the
Riepert [36] for a contemporary Swiss population sample should study population was estimated using randomly selected PMCT
be assessed. images of 20 right femora (of 10 male and 10 female bodies). After
a two month period F1 was measured again in the same PMCT
2. Materials and methods images by the same observer. The intra-observer error was esti-
mated calculating the difference and the absolute difference
2.1. Study subjects between the two measurement series of F1. A t-test for paired sam-
ples was applied to test the significance of the differences [37].
The study was performed retrospectively on PMCT images of
226 corpses (143 males and 83 females). Information about the liv- 2.5. Inter-observer error
ing height of the individuals e.g. from passport or medical docu-
ments was not available. The sample consisted of total 403 Inter-observer error of PMCT F1 measurements in corpses of the
femora (199 right and 204 left, thereof 177 pairs). Study cases were study population was estimated using randomly selected PMCT
chosen by the following criteria (as stated in the autopsy reports): images of 20 right femora (of 10 male and 10 female bodies).
(1) confirmed age between 20 and 95 years, (2) skeletal system: no Two observers measured F1 of the same individuals in PMCT
fractures of lower extremities, no fractures of vertebral column, no images. The inter-observer error was estimated calculating the dif-
severe head fractures, (3) Caucasian origin, (4) no signs of relevant ference and the absolute difference between the measurements of
decomposition according to autopsy reports. In cases with one the two observers. A t-test for paired samples was applied to test
sided hip replacements and/or knee replacements the counterpart the significance of the differences [37].
femur was measured. The mean age of the men was 53 17 years
and that of the women 61 20 years. The post mortem interval 2.6. Accuracy of PMCT F1 measurements vs osteometric board
between death and CT scan/autopsy ranged from one day to
10 days. To test the accuracy of F1 measurements taken from PMCT, five
observers independently measured F1 values at archeological
femoral bones (8 femora per observer: 4 left, 4 right) with a con-
2.2. Measurement of cadaver length and estimation of body height
ventional osteometric board. Afterwards the same femora were
CT-scanned with their dorsal side on the plane CT examination
After PMCT scanning the cadaver length (CL) was measured in
table and F1 was measured in PMCT images by the same observers
whole centimeters using a stiff yardstick. CL was defined as maxi-
(Fig. 2). The arithmetic mean of all F1 measurements conducted
mum distance between skull vertex and the sole of the heels in 90
angle to the anterior part of the lower limbs. Bodies were
unclothed and in supine position on a plane metal table. According
to Trotter and Gleser [35] measured cadaver length was converted
into body height (BH/CL) by subtracting 2.5 cm. The mean, stan-
dard deviation and interquartile range of measured cadaver length
were calculated for all subjects. KolmogorovSmirnov test (KS
test) for goodness of fit was used to test for normality of the distri-
bution of cadaver length and femur length within the study popu-
lation [37].

2.3. PMCT imaging and image analysis

All corpses underwent PMCT scan (6-slice Somatom Emotion 6,


Siemens Medical Solution, Forchheim, Germany) prior to forensic
autopsy. The interval between CT scan and forensic autopsy was
Fig. 1. F1 measurements in PMCT images: The Femur was positioned in the sagittal
maximum one day. The scan parameters for raw data acquisition
plane. The coronal axis (green line) was adjusted to the most dorsal points
were as follows: beam energy 130 kilovolt (kV); rotation time (Trochanter major and condyles) of the Femur (a). By adjusting the sagittal plane,
1500 ms. Image reconstruction was performed as follows: kernel the highest point of the Caput was determined and marked with a line (blue axial
B70; slice thickness 1.25 mm; increment: 0.7 mm; the field of view axis) (b). At the coronal plane, the sagittal axis (red line) was drawn between the
was adapted to the size of the object. lowest point of the medial condyle and the highest point of the caput femoris (c).
Then, F1 was vertically measured in the sagittal oblique plane between the lowest
Measurements in PMCT images were conducted on a Leonardo point of the medial condyle and the highest point of the caput femoris (d). (For
Workstation (Siemens, Forchheim, Germany) by one observer. interpretation of the references to colour in this figure legend, the reader is referred
PMCT images of the femora were examined in multi-planar mode. to the web version of this article.)
W.-D. Zech et al. / Legal Medicine 19 (2016) 6166 63

3. Results

3.1. Cadaver length and femur length F1 of the population

Table 1 shows the mean of the individuals cadaver length (CL).


Table 2 shows the mean femoral F1 values of the population mea-
sured in PMCT images. CL and F1 were normally distributed in both
sexes (KS test). Therefore, parametric statistics and tests were
used.

3.2. Intra-observer error

The measurements for intra-observer error at the PMCT images


showed a mean difference between the first and the second mea-
surement of 0.5 mm, indicating that there is no relevant differ-
ence between the two series of measurements. The absolute
difference between the first and second measured value of F1
was 0.7 mm (Table 3). A t-test for paired values shows that the
small differences between the first and the second measurement
are statistically significant (t 2.932, sign. 0.009). Applied to the
Fig. 2. To test for accuracy of PMCT F1 measurements F1 was measured on
material and estimation methods, a difference of 0.5 mm at F1
defleshed femoral bones on a conventional osteometric board (a) and afterwards in
CT images (b). would cause a difference in body height estimation of approx.
1 mm.

with the osteometric board was calculated and defined as real


femoral length (RFL). Afterwards the differences (d) of the real 3.3. Inter-observer error
femoral length and each single measured PMCT F1 value were cal-
culated for each observer. Significant differences of d between the The measurements for inter-observer error at the PMCT images
five observers were estimated using the KruskalWallis-H-Test. showed a mean difference between the first and the second obser-
Significant differences between the observations on the osteomet- ver of 0.4 mm, indicating that there is no relevant difference
ric board and the PMCT-Images were estimated using the t-test for between the two series of measurements. The absolute difference
paired samples [37]. between the first and second observer was 1.3 mm (Table 4). A t-
test for paired values confirms that the differences between the
2.7. Estimation of body height from PMCT F1 measurements two observers are not significant (t 0.709, sign. 0.487). Applied
to the material and estimation methods, a difference of 1.3 mm
Body height of the study subjects which underwent PMCT scans at F1 would cause a difference in body height estimation of approx.
was estimated on the basis of the F1 data from femoral measure- 3 mm.
ments in PMCT images (BH/F1). Estimations were performed by
means of regression equations by Penning and Riepert [36] and
Trotter and Gleser [35] (see Supplementary material: estimation
3.4. Accuracy of PMCT F1 measurements vs osteometric board
equations). Equations were applied with and without age
correction.
The F1 measurements of 8 archaeological femora on an osteo-
metric board showed an arithmetic mean of 465.2 mm 32.8
2.8. Comparison between BH/F1 and BH/CL (real femoral length). There were no significant differences of
the measured PMCT F1 values between the five different observers
The mean differences between BH/CL and BH/F1 were calcu- (KruskalWallis-H-Test: chi-square 2.727, significance 0.604).
lated. Calculations were applied for BH/F1 with and without age Compared to the osteometric board the PMCT measurements
correction according to the regression equations by Penning and exhibited a slightly decreased F1 mean value of 0.6 mm with a
Riepert [36] and Trotter and Gleser [35]. A t-test for paired samples slightly increased standard deviation (Table 5). T-test for paired
was applied for the evaluation of significant differences between samples between F1 measurements conducted on the 8 archaeo-
BH/CL and BH/F1 values. logical femora (with an osteometric board) compared to the F1
measurements obtained from PMCT images of the same bones
2.9. Statistical analysis showed, that these differences although small were statistically
significant (t = 3.041, significance 0.004). Applied to the material
Statistical analyses were performed using SPSS version 22 and estimation methods, a difference of 0.6 mm at F1 would cause
computer software (IBM Corp., Armonk, NY). a difference in body height estimation of approx. 1.5 mm.

Table 1
Mean cadaver length (CL, in cm) of the study population. IQR = interquartile range. Cadaver length is not significantly deviant from normal distribution in both sexes (KS test).

CL mean SD Minmax Median IQR KS test


Males (n = 143) 176.6 7.2 158199 176.0 173181 0.072, sign. 0.433
females (n = 83) 163.6 7.8 143182 163.0 159169 0.059, sign. 0.920
64 W.-D. Zech et al. / Legal Medicine 19 (2016) 6166

Table 2
Femoral length F1 (in cm) of the study population. IQR = interquartile range. F1 is not significantly deviant from normal distribution in both sexes (KS test).

F1 mean SD Minmax Median IQR KS test


Males (n = 143) 47.5 2.19 41.753.4 47.6 46.049.2 0.042, sign. 0.957
Females (n = 83) 44.1 2.37 38.950.3 44.0 42.445.8 0.035, sign. 1.000

Table 3
Results for intra-observer error estimation (n = 20). The mean difference between the first and second measured value of F1 was 0.5 mm (column 2), and the mean absolute
difference was 0.7 mm (column 4); the maximum aberration was 1 mm (column 5).

d mean SD (mm) Minmax (mm) d absolute mean SD (mm) Minmax (mm)


PMCT F1 0.5 0.7 1 to 1 0.7 0.5 01

Table 4
Results for inter-observer error estimation (n = 20). The mean difference between the first and second observer measuring F1 was 0.4 mm (column 2), and the mean absolute
difference was 1.3 mm (column 4); the maximum aberration was 6 mm (column 5).

d mean SD (mm) Minmax (mm) d absolute mean SD (mm) Minmax (mm)


PMCT F1 0.4 2.2 6 to 5 1.3 1.8 06

Table 5
Accuracy of F1 measurements in CT images of archeological femoral bones compared to osteometric board F1 measurements (n = 40): The mean difference (board minus CT) was
+0.6 mm (column 2) and the mean absolute difference was 1.1 mm (column 4), the maximum aberration was 3 mm (column 5).

d mean SD (mm) Minmax (mm) d absolute mean SD (mm) Minmax (mm)


BoardCT 0.6 1.2 3 to 3 1.1 0.8 03

Table 6
Relation between the mean body height calculated from measurements of cadaver length and the mean body height estimated from PMCT F1 measurements after Trotter/Gleser
(1952) and Penning/Riepert (2003) for the males (n = 143). Difference = estimated BH/F1 minus calculated BH/CL. For all estimation equations, the difference between BH/CL and
BH/F1 is not significant (t-test for paired samples). All values are in centimeter with standard deviation.

Mean body height (cm) estimated from F1 Mean difference (cm) to BH


measurements in PMCT (BH/F1) calculated from CL (BH/CL)
Trotter/Gleser 1952 white, not age corrected 174.5 5.2 +0.47 4.95
Trotter/Gleser 1952 white, age corrected 173.1 5.5 0.95 4.68
Penning/Riepert 2003, without age 173.8 5.8 0.26 4.98
Penning/Riepert 2003, 10-years-model 174.2 6.2 +0.12 4.64
Penning/Riepert 2003, 20-years-model 173.3 6.1 0.77 4.67

Table 7
Relation between the mean body height calculated from measurements of cadaver length and the mean body height estimated from PMCT F1 measurements after Trotter/Gleser
(1952) and Penning/Riepert (2003) for the females (n = 83). Difference = estimated BH/F1 minus calculated BH/CL. For all estimation equations with age correction, the difference
between BH/CL and BH/F1 is not significant (t-test for paired samples); for both estimation equations without age correction, the small differences between BH/CL and BH/F1 are
significant (t-test for paired samples). All values are in centimeter with standard deviation.

Mean body height (cm) estimated from F1 Mean difference (cm) to BH


measurements in PMCT (BH/F1) calculated from CL (BH/CL)
Trotter/Gleser 1952 white, not age corrected 163.0 5.8 +1.98 4.81
Trotter/Gleser 1952 white, age corrected 161.2 6.2 +0.12 4.36
Penning/Riepert 2003, without age 162.7 5.8 +1.62 4.82
Penning/Riepert 2003, 10-years-model 161.5 6.3 +0.39 4.41
Penning/Riepert 2003, 20-years-model 161.3 5.9 +0.26 4.51

3.5. Comparison of body height estimated from PMCT F1 test for paired samples indicates that these differences are not sig-
measurements (BH/F1) with cadaver length measurements (BH/CL) nificant. Both equations without age correction show smaller devi-
ations of less than a half centimeter, while Trotter and Gleser [35]
Tables 6 and 7 show the mean difference between body height with age correction and the 20-years-model of Penning and Riepert
calculated from the observed cadaver length (i.e. BH/CL = CL minus [36] show higher deviations. For females (Table 7), both estima-
2.5 cm; males 174.1 7.2, females 161.1 7.8 cm) and the esti- tions without age correction show an overestimation of body
mated BH from F1 after the five regression approaches (BH/F1). height of 1.98 resp. 1.62 cm, these differences are statistically sig-
For males (Table 6), all estimations (BH/F1) are close to the calcu- nificant (t-test for paired samples). On the contrary, the estima-
lated body height (BH/CL), with deviations lesser than 1 cm. A t- tions with age correction show very small deviations from
W.-D. Zech et al. / Legal Medicine 19 (2016) 6166 65

calculated body height (BH/CL), with differences less than a half Imaging methods (e.g. ultrasound measurement in order to
centimeter. assess fetal growth) have been used for anthropometry since the
late 1950s already [42]. Recently in vivo CT and MRI studies con-
ducted femoral bone measurements in CT and MRI images in order
4. Discussion to determine bone lengths and to develop new regression equa-
tions for body height estimation in different populations
In the present study, metric data F1 data of the femur were [40,43,44]. However none of these studies manually validated the
obtained from post-mortem CT images for estimation of body accuracy of their measurement techniques for femoral bone
height. The study proved that the applied metric femoral F1 mea- lengths. It has to be taken into account that accuracy and repro-
surements in PMCT images were very accurate and reproducible ducibility of bone measurements not only depends on image qual-
between different observers. There is a small, but statistically sig- ity but also on precise definition of landmarks [2530]. The results
nificant difference between manual measurements of F1 on from the present study showed that the PMCT F1 measurement
archaeological femoral bones on a conventional osteometric board technique as conducted in the present study was as accurate as
compared to F1 measurements in PMCT. When applied to the esti- measurements on a conventional osteometric board. The so far
mation equations used here, this systematic difference of ca. conducted in vivo CT and MRI studies which used femoral length
0.6 mm would cause an underestimation of body height of about for body height estimation did not use anthropologically standard-
1.5 mm by PMCT images in comparison to the osteometric board, ized measurement sections [40,43,44]. Therefore inaccurate bone
a difference, which could be neglected. Therefore, it can be con- measurements may be the source of errors in calibrating regres-
cluded that PMCT femoral F1 measurements as conducted in this sion equations and estimating body height. In the present study
study provide reproducible and valid metric results which can be the metric parameter F1 after Martin [38] as clearly defined mea-
used for body height estimation with appropriate regression equa- surement section was measured in PMCT images and showed a
tions. It is noteworthy determination of height in corpses in gen- close congruence with body height. Recent work from Giurazza
eral is not limited to the use of femoral measurements. Forensic et al. and Hishmat et al. conducted femoral CT measurements
anthropologists rely on several other bones of the human body without using standardized anthropological sections of the femur
for body height estimation. Several studies for the determination with results that showed a strong correlation between body height
of body height from bone measurements in CT images have been and femoral measurements [23,40]. This indicates that body height
conducted not for the femur but several other bones of the human estimation from femoral measurements in CT images is also feasi-
body such as scapula, forearm bones, first and second cervical ver- ble when using none anthropologically standardized measurement
tebra or metatarsal bones. It had been shown that metric measure- sections. However Hishmat et al. conducted measurements on a
ments of these bones are feasible for the determination of body post-mortem Japanese population and Giurazza et al. conducted
height. In many cases measurements of such smaller bones may measurements on living persons exclusively which limits the com-
even be more feasible since long bones are often missing or frag- parability with these studies. In comparison to the other studies
mented [1824]. However the results of the present study as well the PMCT F1 femoral bone measurement in the present study is
as previous studies demonstrate that femoral measurements in CT more elaborate than measurement of anthropologically not stan-
images can play an important role in body height estimation of dardized sections. However the F1 measurements as conducted
corpses or skeletal remains [23]. Moreover, the usage of CT imaging in this study are relatively easy to perform with a common radio-
data bears the advantage for elimination of soft tissue surrounding logical workstation and can be assumed to be accurate.
the bone which can make CT measurements even more accurate
than direct bone measurements [19]. As demonstrated by Rodri-
4.1. Limitations of the study
guez et al. the method of highly accurate bone measurements in
CT images may also be conducted on CT images of living persons
Since cadaveric measurements are known to be imprecise the
and being used for contemporary population studies [18].
corrected body heights evaluated from cadaver length remain an
Since there are globally observed changes in secularization, the
uncertainty factor [41]. Other studies however found no significant
issue of outdated regression equations for body height estimation
difference between cadaver length and previous heights records
has repeatedly been raised [11,13,15,31,38,39]. Equations cali-
[45]. In the present study 2.5 cm were subtracted from cadaver
brated for traits such as body height or sex are usually applicable
length to assess real body height according to Trotter and Gleser
to subjects from the same ethnic group [11,15,27,39]. This is one
[35] which led to results that showed a close congruence between
of the reasons why recent research partially concentrated on
body height estimated from PMCT F1 measurements and body
development of new regression equations from femoral measure-
height calculated from cadaver length. However other recent
ments for selected populations [40,41]. However, few of the exist-
works suggest that this correction should not be applied [46].
ing equations for body height estimation using femoral
It has to be taken into account that slice thickness of CT images
measurements have been re-evaluated for other populations.
was 1.25 mm. Due to the thickness of the first and last slice of the
Therefore, in the present study instead of developing new equa-
measured femora an error range from 1.25 mm to 2.5 mm may be
tions, the already existing equations after Penning and Riepert
considered. Such error range was not considered for calculations of
[36] and Trotter and Gleser [35] which were developed on a Ger-
body height from F1 measurements. However the body height esti-
man population and on north American populations respectively
mations in the present study on the basis of the conducted F1 mea-
were evaluated for their feasibility for a contemporary Swiss pop-
surements led to very similar and comparable results. Therefore
ulation [35,36]. The body height estimations according to Penning
errors in F1 resulting from CT slice thickness may be neglected
and Riepert [36] and Trotter and Gleser [35] on the basis of the F1
when used for body height estimation.
measurements conducted in PMCT images led to very similar and
comparable results. Thus, on the one hand the equations after Trot-
ter and Gleser [35] could be confirmed to be accurate for the con- 5. Conclusion
temporary Swiss population. On the other hand the lesser known
equations after Penning and Riepert [36] could be validated on this It can be concluded that femoral F1 measurements in PMCT
contemporary Swiss population as well. The results indicate that if images are very accurate, reproducible and feasible for body height
possible the estimations with age correction should be preferred. estimation of a contemporary Swiss population when using the
66 W.-D. Zech et al. / Legal Medicine 19 (2016) 6166

equations after Penning and Riepert (2003) or Trotter and Gleser radial and ulnar lengths using three-dimensional images from multidetector
computed tomography in a Japanese population, Leg Med. (Tokyo) 16 (4)
(1952). In the contemporary Swiss population sample of this study
(2014) 181186.
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