Siriraj Medical Journal

Minimum Ischiopubic Ramus Width as a Single Metric for Sex Estimation: A Pilot Study

Robert W. Mann — 2025-12-02

Objective: The present study assesses the effectiveness of the minimum width of the ischiopubic ramus as a single measurement for sex estimation.

Materials and Methods: Visual and metrical examination of 135 known-identity male and female os coxae was investigated by measuring the minimum mediolateral width of the ischiopubic ramus, a novel and simple measurement of the narrowest part of the ischiopubic ramus.

Results: The results revealed females typically have a narrow (“pinched”) ischiopubic ramus in comparison to males, with a statistically significant difference in the minimum mediolateral width of the ischiopubic ramus between sexes. Logistic regression, which delivered the best sex estimation model among traditional statistical analysis and machine learning approaches, provided an accuracy of 77.8%, a sensitivity of 83.33% and a specificity of 73.33% with a demarking point of 11.977 mm.

Conclusion: Although the method yields moderate accuracy, the minimum width of the ischiopubic ramus provides a straightforward and practical approach that may assist in sex estimation when only a fragment of the ischiopubic ramus is available. Further validation using larger and more diverse samples is recommended to confirm its applicability.

Standardized Medical Photographic Imaging of Patients: A Proposed Guideline

Kawitsara Eambunnapong — 2025-11-01

Medical photographic imaging plays an essential role in the diagnosis, treatment planning, and follow-up care of patients. Medical photographic imaging also plays a vital role in supporting academic/instructional and research documentation and materials. Therefore, to ensure high-quality, reliable, and consistent medical photographic imaging, standardized guidelines for photographing medical patients are needed. Based on a synthesis of relevant published documents, we hypothesized that medical photographic imaging standards can be divided into the following three key domains: 1) characteristics of; 2) essential elements of; and, 3) standardized process of producing good medical photographic imaging. Establishing and consolidating these standards into a medical photographic
imaging guideline for medical clinicians, researchers, and educators will improve the usefulness and consistency of photographic communication of medical patient information. Accordingly, the aim of this study was to establish a medical photographic imaging guideline for use by any subset involved in human patient healthcare, including clinicians, medical imaging specialists, researchers, teachers/students, human healthcare manufacturers/publishers, and government health policy organizations. Moreover, acceptance and establishment of the proposed medical photographic imaging guideline will facilitate and promote improved communication of medical information internationally, making comparisons of treatment and research outcomes more accurate, consistent, and systematic.
The proposed medical photographic imaging guideline represents an important advancement in medical knowledge, including how medical photographic imaging is learned, used, and communicated in clinical practice.

Calcaneal Articular Talar Facets, Stieda’s Process, and Calcaneus Secundarius: Variations Found in Thai Population

Areeya Marie B. Wongla — 2025-12-02

Objective: The calcaneus and talus have been studied in anatomy and pathology, but research is limited compared to its forensic use. This study examines the prevalence of three types of variants (calcaneal talar facet types, Stieda’s process, and calcaneus secundarius) to find correlations with sex and siding of the calcaneus and talus in a Thai
population.

Materials and Methods: A total of 250 specimens from the bone collection of Siriraj Anatomical and Anthropological Bone Research Centre (Si-AABRC), Thailand, were used. The calcaneus was classified into three types based on its articular talar facets, and the talus was categorized based on the presence of Stieda’s process and four types of posterolateral tubercles. Presence of a calcaneus secundarius was checked for a crescent-shaped notch and an accessory ossicle.

Results: Pattern I, the most common facet type, accounted for 60.23% of calcanei, with a 45.2% average of “fullshaped” facets. Pattern III was the least common, averaging 4.4%. The flat posterior processes of the talus were the most frequent trait (41.4%), while the hook type was the least common (2.4%). Calcaneus secundarius (CS) and Stieda’s process (SP) were the rarest traits.

Conclusion: The aforementioned calcaneal and talar traits can aid in investigating sides, as left or right, but not as a specific sex characteristic. The calcaneus secundarius has no correlation to either sex or siding due to limited samples. The outcomes of prevalence align with prior studies.

Sexual Dimorphism in Cranial and Post-Cranial Skeletal Elements: Forensic Implications for Sex Estimation in a Contemporary Thai Population

Napakorn Sangchay — 2025-12-02

Objective: The analysis of human skeletal remains is instrumental in forensic and anthropological contexts, particularly for establishing biological profiles of unidentified individuals. Determining sex via skeletal examination is a fundamental component of this process and traditionally involves morphological assessment and metric analysis of pelvic and cranial bones. Nevertheless, the precision and reliability of these methodologies—whether through morphological evaluation or morphometric analysis—remain subjects of ongoing debate and scrutiny. This research set forth to investigate the efficacy of morphological and morphometric analysis in sex estimation by focusing on cranial and post-cranial long bones within contemporary Thai population.

Materials and Methods: The study sample comprised 204 skulls (105 from males, and 99 from females) and 200 sets of long bones of upper (humerus, radius, and ulna) and lower extremities (femur and tibia). Multiple measurements were systematically obtained from various anatomical regions of each bone, and measurements of extremity long bones were compared between the left and right sides.

Results: The analysis revealed statistically significant differences in these metrics between sexes, indicating the potential utility of this approach for sex classification. However, despite achieving high levels of accuracy, the studied methodology yielded some classification errors, which suggests some potential limitations.

Conclusion: The findings suggest that both inherent skeletal variability in cranial and post-cranial morphology within contemporary Thai population and the specific analytical techniques employed can markedly influence the accuracy of sex determination. These factors harbor and confer important implications for forensic and anthropological applications.

Endovascular Versus Open Repair for Symptomatic, Non-Ruptured Abdominal Aortic Aneurysms: A Retrospective Cohort Study

Wanchai Chinchalongporn — 2025-11-01

Objective: To compare perioperative organ morbidity, 30-day mortality, and 5-year overall survival following endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) for symptomatic, non-ruptured abdominal aortic aneurysm (SnAAA).

Materials and Methods: We retrospectively reviewed 140 consecutive patients treated for SnAAA between 2010 and 2020 (EVAR n=111, OSR n=29). The primary endpoint was 30-day all-cause mortality; secondary endpoints included perioperative complications and 5-year survival. Due to extreme baseline imbalances (62.2% unfit in EVAR vs 6.9% in OSR) and limited sample size, multivariable adjustment was used instead of propensity score methods.

Results: Thirty-day mortality was 1.8% in the EVAR group and 3.4% in the OSR group (p=0.504, Fisher’s exact test). EVAR was associated with an 88% reduction in perioperative organ complications (adjusted OR 0.12, 95% CI 0.03-0.47, p=0.003), including a significant reduction in respiratory failure (2.7% vs 13.8%, OR 0.17, 95% CI 0.04-0.83, p=0.034). EVAR also resulted in shorter operative time (median 150 vs 265 minutes, p<0.001), reduced blood loss (200 vs 1,800 mL, p<0.001), and shorter hospital stay (7 vs 11 days, p<0.001). Five-year survival analysis revealed no significant difference between groups (log-rank p=0.193; adjusted HR 1.09, 95% CI 0.42-2.85, p=0.857).

Conclusions: Despite being performed in a higher-risk cohort, EVAR provided significant protection against organ complications without compromising long-term survival compared to OSR. These findings support EVAR as the preferred approach for unfit patients with SnAAA, while both strategies remain appropriate options for fit patients.