AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 140:143148 (2009)

Sex Determination of Adolescent Skeletons Using the

Distal Humerus
Tracy L. Rogers*
University of Toronto Mississauga, Mississauga, ON, Canada L5L 1C6
KEY WORDS

human remains; morphological; sex assessment

ABSTRACT
Accurate determination of the sex of
immature skeletal remains is difcult in the absence of
DNA, due to the fact that most sexually dimorphic features of the human skeleton develop as secondary sex
characteristics during adolescence. Methods of assessment of adult skeletons cannot reliably be applied to adolescent skeletons because of the transitional nature of
the skeleton at puberty and the variability of the adolescent growth spurt. The purpose of this work was to evaluate the accuracy of Rogerss method of morphological
sex determination using the distal humerus (Rogers: J
Forensic Sci 44 (1999) 5559) to assess the sex of adoles-

cent skeletons. The sample consists of 7 documented adolescent skeletons from the Christ Church Spitalelds collection at the British Museum of Natural History and 35
from the Luis Lopes skeletal collection housed in the
National History Museum (Museu Bocage) of the University of Lisbon, Portugal. Ages range from 11 to 20 years.
The technique achieved an accuracy of 81% on the combined sample of 42. This method can be applied to adolescent skeletons once the trochlea begins fusing to the
humeral diaphysis, which occurred by age 11 years in
the test samples. Am J Phys Anthropol 140:143148,
2009. V 2009 Wiley-Liss, Inc.

From sociocultural, developmental, and evolutionary

perspectives, adolescence is a key period in the human
life cycle (Bogin and Smith, 2000; Bucholtz, 2002;
Cameron and Demerath, 2002). Negotiation of new roles,
agency, and participation in initiation ceremonies; the
inuences of developmental stages on long term health;
and the adaptive signicance of human adolescence are
only a few of the anthropologically signicant facets of
puberty and the transition to adulthood. To fully explore
the implications of adolescence in past populations, it is
necessary to draw comparisons between male and female
cultural experiences and biological expressions of adolescence, which raises the problem of determining the sex
of subadult skeletal remains.
In the absence of DNA, methods of subadult skeletal
sex assessment have produced mixed results, often demonstrating signicantly greater success for males than
females (Sutter, 2003). Developing and testing methods
of subadult sex determination has proven problematic
for a number of reasons, most of which can be traced to
the lack of suitable skeletal samples of known sex, and
of ages that are equally distributed throughout fetal,
infant, childhood, and adolescent periods. Most methods
of subadult skeletal sex assessment have been developed
for application on fetal and juvenile remains (Weaver,
1980; Schutkowski, 1993; Molleson et al., 1998; Loth and
Henneberg, 2001) Independent tests of these methods on
similarly young skeletons achieved results that were less
accurate than those obtained by the original authors
(Mittler and Sheridan, 1992; Scheuer, 2002; Sutter,
2003). Tests of the same techniques using older juvenile
and adolescent skeletons also met with limited success.
Sutters (2003) test of Weavers (1980) method
included 7 females and 17 males estimated to be 1015
years of age. In the 1115-year category, Sutter (2003)
found that a higher percentage of males than females
exhibited elevated auricular surfaces, conrming Mittler
and Sheridans (1992) conclusion that auricular surface

elevation is a poor indicator of sex after age 10. Sutter

(2003) also evaluated Schutkowskis (1993) mandibular
and iliac traits using a Chilean mummy sample and
found a comparable pattern of higher accuracy for males
than females, but was able to conclude that Schutkowskis (1993) greater sciatic notch depth, greater sciatic
notch angle, the arch criterion, and mandibular arcade
shape can tentatively be applied to forensic cases involving children aged 615 years (Sutter, 2003). Similarly,
when Vlak et al. (2008) tested the sciatic notch criteria
from Schutkowskis (1993) article using the Lisbon Skeletal Collection, they found the method incapable of
achieving 75% accuracy in any age group below 11 years
of age and concluded neither metric nor morphological
analysis of the sciatic notch revealed statistically signicant levels of sexual dimorphism. They did, however,
note a strong correlation between pelvic shape and age
at death (Vlak et al., 2008).
A metric dental technique proposed by De Vito and
Saunders (1990) is the exception to the trend of focusing
on infant and early childhood skeletons. This method
can be applied to children with deciduous and mixed
dentition, which includes the period from early childhood
through early adolescence. The authors report an accuracy of 8385% depending on the combinations of teeth
measured. A review of the literature has revealed no

C 2009
V

WILEY-LISS, INC.

*Correspondence to: Dr. Tracy Rogers, Department of Anthropology, University of Toronto Mississauga, 3359 Mississauga Rd. N.,
Mississauga, Ontario, Canada L5L 1C6.
E-mail: tracy.rogers@utoronto.ca
Received 21 June 2008; accepted 27 January 2009
DOI 10.1002/ajpa.21060
Published online 8 April 2009 in Wiley InterScience
(www.interscience.wiley.com).

144

T.L. ROGERS

additional testing of this technique on independent samples, but a recent presentation at the Canadian Association for Physical Anthropology detailed the results of
testing the De Vito and Saunders subadult dental formulae using a geographically and temporally distinct population - the Lisbon Skeletal Collection. Cardoso (2008)
tested 39 juveniles, aged birth to 9 years, who were born
between the years 1910 and 1971. He found that the
mean absolute percentage of sexual dimorphism was
2.03 compared to De Vito and Saunderss (1990) 3.67.
The accuracy of the equations ranged from 45.5% to
75%. In the latter case, accuracy for females (66.7%) was
considerably lower than that for males (83.3%).
Discriminant function formulae derived from the permanent dentition (e.g., Ditch and Rose, 1972) should
also prove useful during adolescence, as most of the permanent dentition is in place by early adolescence. It is
difcult, however, to nd research to support this hypothesis. Dental functions have been shown to be population specic, with some groups exhibiting relatively
low accuracy, e.g., 7377% in a modern Turkish sample
_ can and Kedici, 2003). The majority of proposed meth(Is
ods of subadult sex determination simply do not address
adolescent skeletal remains.
The second problem with current approaches to subadult sex assessment is a misplaced emphasis on regions
of the skeleton that are effective in adult sex determination, namely, the pelvis and skull. Most of the observable
sex differences of the pelvis and skull develop during puberty in conjunction with the adolescent growth spurt
(La Velle, 1995; Rissech and Malgosa, 2005); sexual
dimorphism of such traits is minimal during childhood.
One notable exception may be the lateral angle of the
petrous portion of the temporal bone. While testing the
lateral angle to determine adult skeletal sex, Noren
et al. (2005) noted sex differences in four subadult bones,
suggesting the lateral angle may prove effective for subadult sex determination. The lateral angle is formed
early in the process of development and is not dependent
upon puberty to achieve its peak discriminatory power.
Seeking additional morphological traits in regions of the
skeleton that do not rely on the adolescent growth spurt
is a more theoretically sound approach to developing
new methods of subadult sex determination than revisiting and modifying traits that are only fully expressed in
adulthood.
A suitable site for such predictive characteristics can
be found in the carrying angle of the arm. The carrying
angle refers to the normal, lateral angulation of the radius and ulna relative to the main axis of the humerus.
It ranges from approximately 10158 in males, to 20258
in females (Grabiner, 1989). The nature and signicance
of the carrying angle is contentious. Sex differences have
been reported for children as young as three years of age
(Smith, 1960); yet, some researchers claim the carrying
angle is a secondary sex characteristic, differentiating
only at puberty (Atkinson and Elftman, 1945). Several
other authors observed no signicant sex differences,
even in adults (Steel and Tomlinson, 1958; Keats et al.,
1966; Beals, 1976). Instead, Beals (1976) reports a significant association with age, concluding the carrying angle
increases with skeletal maturation.
Paraskevas et al. (2004) conrm an increase in the
angle with age, but also detected statistically signicant
differences between males and females in their sample
of individuals aged 1228 years. Tukenmez et al. (2004)
observed a similar increase in angle with age and
American Journal of Physical Anthropology

detected sex differences in children as young as 6 years,

although the distinction was not statistically signicant.
Khare et al. (1999) offer a slightly different perspective
on the issue. They believe the carrying angle is a function of shorter arm length in response to pronation of
the forearm, and is not directly related to sex; the
shorter the forearm, in particular the ulna, the larger
the carrying angle. Such a relationship would suggest
that the carrying angle should decrease with age, as the
length of the ulna increases. This pattern is supported
by the results of Paraskevas et al. (2004), who observed
a greater carrying angle in their adolescent cohort than
their adult cohort, but is contradicted by the ndings of
Tukenmez et al. (2004) and Beals (1976) who found an
increase in angle with age.
The debate over the timing and degree of carrying
angle differentiation may be a by-product of the methods
used to evaluate the angle. Studies that measure the
carrying angle on radiographs are less likely to nd signicant sex differences than those taking measurements
directly from the arm of the subject. Disagreement and
misunderstanding over the correct method of dening
the angle radiographically also occur (Acton and
McNally, 2001). The most convincing evidence to support
the use of the carrying angle as a means of evaluating
the sex of subadult skeletons is, however, Baughman
et al.s (1974) nding that the carrying angle varies in
degree along a continuum that is statistically signicantly correlated with the presence of the Y chromosome
and with supernumerary sex chromosomes. The fact that
the carrying angle has a sex-linked genetic basis makes
it an ideal indicator for subadult skeletal sex determination.
The purpose of this work was to evaluate the accuracy
of Rogerss (1999) method of skeletal sex assessment for
use on adolescent skeletons. The technique is derived
from four features of the distal posterior humerus that
contribute to the carrying angle of the arm. Valgus (lateral) angulation of the forearm is prevented in the living
by the anterior bres of the ulnar collateral ligament,
which originate on the medial epicondyle of the humerus
and insert on the medial aspect of the coronoid process of
the ulna (Fuss, 1991). The eccentric shape of the trochlea
and screw axis of the humero-ulnar joint is reported to
change the carrying angle during elbow exion so that
the misalignment between the arm and forearm is
decreased (Grabiner, 1989; Fuss, 1991). Thus, the shape
of the trochlea, shape and depth of olecranon fossa, and
angulation of the medial epicondyle are all directly
related to the degree of lateral angulation (carrying angle)
permitted at the elbow. Following Cameron and Demerath (2002), the term adolescence is used in this study to
reect somatic skeletal growth and is dened by the period beginning with fusion of the trochlea and ending
with full fusion of the humeral head. By the point of
fusion, the shape of the trochlea is clearly dened. For
the study samples this denition of adolescence equates
to individuals with a chronological age of 1120 years.

MATERIALS AND METHODS

The sample consists of 7 documented adolescent skeletons (n 5 5 females, n 5 2 males) from the Christ
Church Spitalelds Collection at the British Museum of
Natural History and 35 (n 5 17 females, n 5 18 males)
from the Luis Lopes skeletal collection housed in the
National History Museum (Museu Bocage) of the University

SEX DETERMINATION OF ADOLESCENT SKELETONS

145

TABLE 1. Sex and age distribution of sample

1115 yr
Collection
Spitalelds
Lisbon
TOTAL
Correct
1,

1620 yr
M

Total

0
3
3
33% 5,

1
2
4
2
5
5
15
12
18
17
6
17
16
20
22
83% 15, 88% 13, 81% 16, 80% 18, 82%

Fig. 2. Visualizing the medial epicondyle trait. This image

was taken to demonstrate the correct position for the bone,
while making it possible to see the descriptive tags. For best
visualization of the medial epicondyle angulation, your eyes
should be at table level. Note that the trait can be scored even
if the epicondyle is unfused, as is the case for the male humerus
on the left. Angulation, where present, will begin at the base of
the epicondyle. Observe the posterior surface (seen as superior
with the bone in this position; use position and angle of white
lines on this image for guidance) as the inferior surfaces of both
males and females are somewhat rounded and may appear to
angle upward.
Fig. 1. Male and female humeri characteristics. The white
arc on the male image demonstrates its less pinched trochlea,
resulting from a gradual curvature along the distal border. The
female trochlea is more pinched, as the distal border slopes toward a distinct apex. The trochlea is asymmetrical in males and
more symmetrical in females (compare slopes of black lines).
Usually the male olecranon fossa is shallow and more triangular, while the female forms a deep oval.

of Lisbon, Portugal. The Spitalelds Collection includes

individuals buried at Christ Church in Londons East
End, who died between 1729 and 1852. Many were
French Huguenots, while the remainder were British.
Further details about this collection are available in Molleson and Cox (1993). The Lisbon Collection consists of a
sample of individuals buried at cemeteries in Lisbon,
who died between 1880 and 1972. Additional details of
the Luis Lopes collection are available from Cardoso
(2006). The Spitalelds sample was analyzed in 2000
and the Museu Bocage sample in 2004. Ages range from
11 to 20 years, corresponding to the period dened by
initial fusion of the trochlea and nal fusion of the humeral head. See Table 1 for sex and age distributions of
the samples.
Left humeri were used in this analysis, with the right
being substituted if poor preservation precluded analysis
of the left. All four of Rogerss (1999) distal humerus criteria were scored to produce an overall determination of
sex. The features are located on the posterior surface of
the bone. The traits comprise trochlear constriction
(markedly constricted and bow-tie shaped in females,
slight in males); trochlear symmetry (more symmetrical
in females, more asymmetrical in males); olecranon fossa
depth and shape (deep oval in females, shallow triangle
in males); and angle of the medial epicondyle (raised in
females, parallel to the table in males). The medial epicondyle can be scored even if fusion is incomplete
because angulation, where present, is evident beginning
immediately at the base of the epicondyle. Observe the

posterior edge of the epicondyle (which is superior with

the bone placed in the correct position), not the anterior
edge. All traits are dichotomous. If a feature is not
clearly one form or the other, the trait is scored as
indeterminate. Examples of the traits can be seen in
Figures 1 and 2.
The traits are scored by placing the anterior surface of
the left humerus on a table and looking directly down at
the posterior surface (see Fig. 1). The medial epicondyle
is observed with the bone in the same position, but is
viewed from the distal end with the eye at table height
(see Fig. 2). Sex is determined by scoring each trait and
using majority rule to reach a nal decision. As there
are four traits it is possible for two features to score
male and two features to score female. In such cases,
the olecranon fossa shape and depth is used as the deciding factor because this trait proved most accurate in
adult samples (Rogers 1999).
The humeri were randomly selected by an assistant to
prevent the observers assessment from being biased by
other skeletal elements. Humeri were observed in no
particular order. For more details about the technique
and gures illustrating the male and female forms of the
traits, see Rogers, 1999, 2006.

RESULTS
Two of the 7 adolescent skeletons from Spitalelds
(29%) and 5 of the 35 adolescents from Lisbon (14%)
were assessed incorrectly and one was scored as indeterminate, producing an overall accuracy of 81%. Four of
the incorrectly assigned individuals were male and three
were female (the indeterminate case was also female),
producing an accuracy of 80% for males and 82% for
females. Three of the incorrect assessments were for
individuals aged 15 years (1 with trochlea only fused, 2
with trochlea and medial epicondyle fused), three were
16 years old, and one was 17 years (Table 1). All four
American Journal of Physical Anthropology

146

T.L. ROGERS

individuals under 15 years of age (1 male and 3 females)

were correctly assessed.
An additional six individuals 1115 years of age were
evaluated during the development phase of the technique. These individuals were not utilized in the nal
accuracy tests because the low number of adolescent
skeletons made it easy to remember the sex, making it
impossible to verify the results through blind testing. To
provide perspective on the potential success of the distal
humerus method in early adolescence, the results of the
developmental cases are as follows. There were four individuals aged 11 years (2 males and 2 females). Both
males were correctly assessed, while one female was correctly assigned and the other was not. A 13-year-old
male was incorrectly assessed as female, while a 14year-old male was correctly assigned to the male category. The accuracy for this group was 67%.

DISCUSSION AND CONCLUSIONS

Rogers (1999) rst proposed a method of sex determination based on the carrying angle of the arm for use on
adult skeletons. The accuracy of the method for a modern population was high (92% on University of Tennessee at Knoxville and University of New Mexico combined
samples). When applied to historic populations the accuracy of the technique dropped. Wanek (2002) reports an
overall accuracy of 84% for individuals of diverse ancestry (European, African, Indigenous North American,
Eskimo, Aleutian, Chinese, and Japanese) from the
Hamann-Todd and Smithsonian collections. Rogers
(2006) established accuracy rates of 80% for 49 adults
from the Spitalelds Collection and 83% accuracy for
101 adults from the Lisbon Collection, while Falys et al.
(2005) report an accuracy of 79% for the St. Brides skeletal assemblage.
Accuracy results for adolescent skeletons from the Spitalelds (71%, n 5 7) and Lisbon (83%, n 5 35) collections were similar in their combined accuracy (81%, n 5
42) to the results obtained for adults in the combined
samples (81.5%, n 5 150). Rogers (2006) suggests the
drop in accuracy from modern to historic samples may
relate to activity patterns. This possibility is indirectly
supported by Paraskevas et al. (2004) and Tukenmez
et al. (2004), who reported signicantly higher mean
angles for both sexes on their dominant arm versus the
contralateral side. If increased activity in one arm relative to the other produces signicantly greater carrying
angles, then increased activity by one group of individuals may increase their angle relative to the less active
group. This may have been the case for the Spitalelds
and Lisbon Collections relative to the modern samples.
A greater carrying angle in the historic collections of
both males and females would translate to potentially
more males being incorrectly scored as female, as
greater carrying angles are typically female. Rogers
(2006) notes a higher proportion of incorrect male evaluations than female (14%, 21/150 errors were with males;
4%, 6/150 errors were with females). It is difcult to
assess such a pattern in the adolescent skeletons as only
seven errors were made, four male and three female.
The difference, although minor, is in the anticipated
direction. Similarly, if activity does affect the carrying
angle, it is possible that bilateral asymmetry could occur
in the traits of the distal humerus. The current study
was limited to the left humerus where possible for the
sake of consistency. It was not possible to compare left
American Journal of Physical Anthropology

and right humeri in the adolescent sample due to poor

preservation and limited numbers of adolescent skeletons of known age and sex.
One of the benets of the distal humerus method is its
applicability to adolescents. A review of traditional pelvic
traits suggests that growth and development of the pelvis will limit the accuracy and precision of both metric
and morphological means of assessing sex from the pelvis. Measurements and indices, such as those based on
ischiopubic dimensions and indices, could prove problematic for use in adolescent sex determination because
union of the ilium, ischium, and pubis at the acetabulum
usually occurs between 14 and 16 years and as late as
18 years (Schwartz, 1995). Continued growth through
adolescence will also impact the appearance of morphological characteristics.
The Phenice criteria (Phenice, 1969) (developed on
mature skeletons) have proved among the most accurate
and precise morphological traits for skeletal sex assessment (Rogers and Saunders 1994). Unfortunately, few
empirical studies of these criteria have focused on adolescent skeletons, making it difcult to evaluate their
applicability to this demographic group. The ventral arc
is the only pelvic trait that has been specically tested
on adolescents. Based on a sample of 66 females between
the ages of 1119, Sutherland and Suchey (1991) noted
the ventral arc is missing in most females less than 21
years of age, but that a precursor condition is evident as
early as 14 years of age. They also determined that the
precursor arc does not become the most frequent condition until 20 years of age. Similarly, Budinoff and Tague
(1990), who examined the anatomical and developmental
bases for the ventral arc through the dissection of four
female and three male adult pelves, determined that the
sexes share identical muscular and ligamentous attachments to the ridge of bone that is known as the ventral
arc in females. The lateral placement of the ridge in
females and subsequent appearance of the ventral arc is
related to the amount of growth that occurs at the symphyseal border of the pubis during adolescence, and is
highly correlated to pubic length (Budinoff and Tague,
1990).
The sciatic notch has proven problematic for both
adult and subadult skeletal sex assessment. Rogers and
Saunders (1994) found the sciatic notch to be one of the
least accurate traits for sex determination of the adult
skeleton and results for children have been mixed. Holcomb and Konigsberg (1995) examined sexual dimorphism of the fetal sciatic notch by tting a convex hull
to digitized photographs to locate landmarks. They
determined that the position of greatest sciatic notch
depth differed between males and females, but concluded
that there is too much overlap between the sexes for the
sciatic notch to prove useful as an indicator of sex in the
fetal skeleton. Schutkowski (1993) reported sex-specic
trait frequencies ranging from 62.1% for girls using iliac
crest curvature to 95% for boys using sciatic notch angle,
but did not conduct actual tests of accuracy and precision of sex assessment based on these features. Sutter
(2003) found three of Schutkowskis (1990) traits useful
for sex determination: angle of the sciatic notch (80.7%);
depth of the sciatic notch (79%); and arch criterion
(82.3%), but accuracy varied considerably between males
and females. For all three traits males were more often
evaluated correctly than were females, and accuracy was
better for older individuals ([2 years). Vlak et al. (2008)
included some adolescent skeletons in their assessment

SEX DETERMINATION OF ADOLESCENT SKELETONS

of Schutkowskis (1993) sciatic notch criteria (10 individuals aged 1115 years). Although their sample size was
small and the sex ratio skewed (7 males ages 1115, 3
females ages 1112), the early adolescent age group was
the only cohort to approach 75% accuracy. A closer examination of the data reveals a serious sex bias, with all
of the correct assessments being male. The fact that
none of the three females were correctly evaluated suggests that sciatic notch morphology may retain a male
conguration through early adolescence, or that sciatic
notch shape is not a particularly effective means of
assessing skeletal sex.
The current study demonstrates the Rogerss distal
humerus method for determining skeletal sex can be
accurately applied to adolescent skeletons. The results
for later adolescence are robust with accuracy of 84.8%,
but greater sample sizes are needed to demonstrate the
efcacy of the technique to younger adolescents (n 5
9.67% accuracy). The distal humerus method of skeletal
sex assessment offers the potential to provide new
insight to several areas of biological anthropology. In bioarchaeological contexts the technique will allow
researchers to assess the roles and interactions of adolescents in the larger community. Studying the evolution
of the human growth spurt will be facilitated by skeletal
determinations of sex that are not dependent on comparisons of dental and skeletal maturation, as utilizing variations in growth to assess the potential for an adolescent growth spurt could potentially bias results. Finally,
skeletal sex determination of adolescents will prove useful in forensic contexts, where a large proportion of missing persons are teens (Sutherland and Suchey, 1991).
The study of human adolescence is an exciting area of
research that will benet from an accurate method of adolescent skeletal sex determination.

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