

ORIGINAL ARTICLE 

Year : 2018  Volume
: 1
 Issue : 1  Page : 1927 

Estimation of stature from hand dimensions in North Saudi population, medicolegal view
Mahrous Abdelbasset Ibrahim^{1}, Athar Mohamed Khalifa^{2}, Hassan Abdelraheem Hassan^{3}, Hany Goda Tamam^{4}, Abeer Mohamed Hagras^{5}
^{1} Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt; Department of Forensic Medicine and Clinical Toxicology, Jouf University, Sakaka, Saudi Arabia ^{2} Department of Pathology, College of Medicine, Jouf University, Sakaka, Saudi Arabia ^{3} Department of Anatomy, College of Medicine, Beni Suef University, Beni Suef, Egypt; Department of Anatomy, College of Medicine, Jouf University, Sakaka, Saudi Arabia ^{4} Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, AlAzhar University, Cairo, Egypt ^{5} Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Date of Web Publication  25May2018 
Correspondence Address: Mahrous Abdelbasset Ibrahim Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. Department of Forensic Medicine and Clinical Toxicology, College of Medicine, Jouf University, Sakaka
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/sjfms.sjfms_10_17
Introduction: Estimation of individual's stature is an important parameter in the field of forensic anthropology. There is a scarcity of literature on the estimation of stature from hand dimensions among Saudi populations. Aim: To setup standard formulae to estimate stature from hand dimensions in Saudi population. Subjects and Methods: Three hundred and fifty participants in 20–30 years' age group were incorporated into a crosssectional study. The research population included 150 males and 150 females as a study group, and 50 participants as a control group to test the accuracy of the formulae. Nine measurements of different hand dimensions (hand length, palm length, handbreadth, maximum handbreadth, and five phalanges lengths) and statures were taken. The simple linear regression equations and multiple linear regression equations with the explanatory variables were suggested as a statistical model to clarify the total variation in stature. Results: Statistical analysis indicated that the bilateral variations were insignificant for all the measurements (P > 0.05). The correlation between the stature and different parameters studied in males and females were found to be positive and statistically highly significant (P < 0.001). The highest correlation with stature was observed with hand length and palm length than the other variables. Linear and multiple regression equation for stature estimation were calculated separately for males and females. The derived equations were applied to the control group, and it was noticed that the percentage difference between true stature of the control and the estimated stature ranged from 0.01% to 0.12%. The multiple linear regression equation was more reliable than the simple linear regression equations. Conclusion: The findings of the present study have provided the regression equations from hand dimensions that can be used for predicting stature of adult Saudi population.
Keywords: Anthropometry, hand dimensions, identification, stature estimation
How to cite this article: Ibrahim MA, Khalifa AM, Hassan HA, Tamam HG, Hagras AM. Estimation of stature from hand dimensions in North Saudi population, medicolegal view. Saudi J Forensic Med Sci 2018;1:1927 
How to cite this URL: Ibrahim MA, Khalifa AM, Hassan HA, Tamam HG, Hagras AM. Estimation of stature from hand dimensions in North Saudi population, medicolegal view. Saudi J Forensic Med Sci [serial online] 2018 [cited 2019 Oct 15];1:1927. Available from: http://www.sjfms.org/text.asp?2018/1/1/19/233184 
Introduction   
Identification of persons in dead unknown bodies and in mass disaster, where only parts of bodies might be available, is very important. Furthermore, stature measurement is required for the assessment of children's growth.^{[1]} The relationship of dimensions between the segments of the body allows the reconstruction of its original stature which can be effectively estimated from linear dimensions of the hand.^{[2]}
The dimensions of hand have been used for determination of sex, age, and stature of an individual in forensic investigation.^{[3],[4]} However, due to the difference in body proportions between populations such as the relative lengths of the limbs and trunk, populationspecific regression formula and multiplication factor should be used for this purpose.^{[5],[6]}
The relationship of dimensions between the segments of the body and the whole body has been the focus of anthropologists, scientists, and anatomists for many years. Furthermore, the relationship between body segments has been used to compare and highlight variations between different ethnic groups and to relate them to locomotor patterns, energy expenditure, and lifestyle.^{[7]}
The stature is, anatomically, includes the dimensions of legs, pelvis, vertebral column, and skull. The contribution of each of these to the total varies in different individuals and populations.^{[8]} In addition, stature can be defined as the natural height of a person in erect position, and it is determined by many factors such as genetic and environmental factors.^{[9]}
The stature can be measured by anatomical and mathematical methods. However, mathematical method derives regression formula and multiplication factor to determine stature from the bone or body part and is more useful in medicolegal cases as it can be applied even when only part of the body is available.^{[10]}
Moreover, stature reconstruction is important as it provides a forensic anthropological estimate of the height of a person in the living state; playing a vital role in the identification of individuals.^{[11]} Furthermore, it is important for the physical assessment of nutritional status by nutritionists and physicians.^{[12]}
Hand length measurement is coming up as a basic tool in estimating agerelated loss of stature, in individuals where direct height cannot be measured due to physical deformities such as kyphosis, scoliosis, contractures, and missing limbs.^{[13]} On the other hand, hand length is easier to measure than other anthropometrical indicators used to estimate body height such as ulna length or knee height. Furthermore, the hand is more accessible as its measurement requires a minimum of motion and cooperation by the individual and can be obtained without the necessity of mobilizing the patient, causing practically no discomfort.^{[14]}
In their study, Pal et al.^{[15]} suggested that there is a significant positive correlation between the stature and the hand length. They mentioned, also, that there is no significance in the difference in the length of right and left hand in either sex. These observations are confirmed by Varu et al.^{[10]} who mentioned that handbreadth of the right side was significantly higher than the left side Thus, the use of either hand would be satisfactory for the analysis, whereas the study conducted by Laila et al.^{[16]} found a different multiplication factor for both the hands. In addition, Moorthy and Zulkifly ^{[17]} found that a more accurate stature could be estimated based on hand length than handbreadth. The lefthand length shows higher correlation coefficient, while the right handbreadth shows higher correlation in both genders.
The present study was designed to develop an anthropometry for the right and left hands in both sex and stature in North Saudi people. Furthermore, to detect the correlation between hand dimensions and stature.
Subjects and Methods   
This study was carried out in the Department of Forensic Medicine and Clinical Toxicology, College of Medicine, Jouf University over 6 months (AprilSeptember, 2015) in accordance with the standard ethics laid down by the Jouf University Ethical Committee for Human Experimentations. A crosssectional descriptive study was carried out randomly on 350 righthanded normal healthy adults between the age group of 20–30 years and those who were born and brought up in Al Jouf Province. The research population included 150 males and 150 females as a study group and 50 participants as a control group to test the accuracy of the formulae. Nine measurements of different hand dimensions (hand length, palm length, handbreadth, maximum handbreadth, and five phalanges lengths) were taken from each participant. All the measurements were taken at a fixed period between 2 and 4 pm to avoid any diurnal variations. Participants without visible pathology or history of any surgical procedures on the hand were included in our study. Participants from different region, those with poorly defined wrist creases, physical deformities – acquired or congenital, injuries, fractures, amputations or history of surgical intervention of the hands were excluded from the study. All the participants are individuals whose parents and grandparents have been living in the Northern part of Saudi Arabia to characterize ethnic peculiarities of this part of the country. After taking informed written consent, physical parameters were recorded. While collecting data, the instruments were regularly checked for their accuracy.
Stature measurement
Stature was measured by a standard stadiometer (Seca 216 Stadiometer, Scales Galore, USA). The individual was asked to stand barefoot on the horizontal flat base in an erect position with their back in contact with the vertical board of the stadiometer and head oriented in the eye–ear– eye plane (Frankfurt plane). Then, the measurement was taken in centimeters as the distance between the heel and the highest point on the head (vertex) by bringing the sliding bar to the vertex.
Hand measurements
Hand measurements were taken in centimeters to the nearest millimeter by a sliding caliper in accordance with the conventional technique.^{[18]} Intraobserver error was determined to be within accepted standards for all measurements (R > 0.9; r technical error of the measurement [TEM] <5%). The palm was placed in a supinate position with fingers extended and close to each other. The long axis of the forearm was kept parallel to the axis of the hand. Then, the following linear dimensions were measured on both hands [Figure 1]:  Figure 1: Human hand illustrating the landmarks of different hand dimensions. HL: Hand length, PL: Palm length, D1: 1^{st} digit length, D2: 2^{nd} digit length, D3: 3^{rd} digit length, D4: 4^{th} digit length, D5: 5^{th} digit length, HB: Handbreadth, MHB: Maximum handbreadth
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 Hand length (HL): maximum distance between the distal crease of the wrist joint and the tip of the 3^{rd} finger
 Palm length (PL): maximum distance from the midpoint of the distal crease of the wrist and the palmar digital crease of the 3^{rd} fingers
 Handbreadth (HB): distance between the most remote points on the heads of the 2^{nd} and 5^{th} metacarpal bones
 Maximum handbreadth (MHB): distance between the most remote points on the heads of the 1^{st} and 5^{th} metacarpal bones
 Five finger lengths: It is the distance between the palmar digital creases of the finger to the tip of the corresponding finger.
Each participant was measured twice. When the two initial measures did not satisfy the 0.4 cm criterion, two additional measurements were taken, and the mean of the closest records was used as the best estimate to minimize interobserver errors. All participants were wearing light clothes and were barefooted during measurements.
Statistical analysis
The obtained data were computed and analyzed with SPSS computer software (SPSS, Inc., Chicago, IL, USA) version 22.0. While conducting the present study, the TEM was taken into consideration. The technical error of measurement is an accuracy index for anthropometrical measurements and represents the measurement accuracy. It is the most common way to express the error margin in anthropometry. When performing repeating anthropometrical measurements, the TEM index allows anthropometrics to verify the degree of accuracy. TEM is inversely proportional to the examiners' accuracy in performing the anthropometrical measurement. Before begging data collection, all measurements were taken from 30 participants twice and TEM, the relative TEM (%TEM) and coefficient of reliability (R) was calculated.^{[19]} The value of reliability coefficient ranged from 0 to 1. A coefficient of below 0 indicates “no reliability”, >0–<0.2 is slight reliability, 0.2–<0.4 is fair reliability, 0.4–<0.6 is moderate, 0.6–<0.8 is substantial, and 0.8–1.0 is almost perfect reliability. The coefficient of variation (%CV) of each measurement was also calculated. Kolmogorov–Smirnov test was carried out to examine the normality distribution of data.
After the calculation of descriptive statistics, sexspecific and bilateral differences of hand measurements were evaluated using a paired samples ttest. The hand dimensions showing substantial correlation with stature were incorporated into a regression model to calculate constant “a” and regression coefficient “b” for the following estimation of stature as S = a + bx, where “x” is a known “independent variable” that is one of the hand dimensions. The magnitude of the relationship between the dependent variable (stature) and explanatory variables (hand dimensions) was obtained by calculating the simple (Pearson) correlation. The simple linear regression equations and multiple linear regression equations with the explanatory variables were proposed as a statistical model to explain the total variation in stature, the dependent variable. The model with the highest value of coefficient of determination, “R^{2}”, was considered as the most appropriate one for determining stature. The standard error of estimate (SEE) was calculated by calculating the difference between measured stature and stature estimated with the regression equation. The regression equations derived from the study group were applied in the control group to test the accuracy of the formulae. Statistical significance was set at P < 0.05.
Results   
The results of the present study showed that the stature of both groups was approximately normally distributed. The coefficients of skewness and kurtosis were − 0.043 and 0.139 for the study group, and 0.216 and − 0.056 for the control group, respectively. The Kolmogorov–Smirnov test of normality also confirmed these findings (P< 0.001 for both groups) (data were not shown).
In the current study, the control of the precision and accuracy of the measurements will result in more reliable data, so, the TEM, %TEM, and percentage of coefficient of reliability (R) were used as accuracy index to express the error margin in anthropometric measurements and the lower the obtained TEM, the better the accuracy the anthropometrical measurement. The results for the TEM, %TEM, and R are tabulated in [Table 1] and [Table 2]. In the present study, the TEM and %TEM for measurements were low and it was below the acceptable relative TEM. The acceptable relative TEM for intraobserver is 1.5% for anthropometric measures.^{[20]} The reliability coefficient was high. This indicated that the observer error for measurements in the present study was small and the measurements were reproducible without significant technical error.  Table 1: Intraobserver technical error of the measurement, relative technical error of the measurement, and percentage of coefficient of reliability of different male hand (right and left) dimensions
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 Table 2: Intraobserver technical error of the measurement, relative technical error of the measurement, and percentage of coefficient of reliability of different female hand (right and left) dimensions
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[Table 3] presents the descriptive statistics and comparison of mean values ± standard deviations (SD) of stature and measured parameters of right hands and the differences of these parameters in both sexes. Hence, it can be deduced that there is a highly significant difference between these parameters in both sexes (P< 0.001).  Table 3: Comparison between descriptive statistics of righthand measurements for both sexes
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Similarly, [Table 4] presents the descriptive statistics and comparison of mean values ± SD measured parameters of the left hands and the differences of these parameters in both sexes. According to these results, there is a highly significant difference between these parameters in both sexes (P< 0.001).  Table 4: Comparison between descriptive statistics of lefthand measurements for both sexes
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However, the data in [Table 5] showed that there are insignificant differences between measured parameters in both the hands of the same sex (P > 0.05).  Table 5: Comparison between bilateral difference for right and lefthand measurements in both sexes
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In the current study, there is a positive correlation between measured hand dimensions in both sexes and stature which is highly significant. The hand length and palm length showed stronger correlation with stature [Table 6].  Table 6: Correlation between stature and hand measurements in both sexes
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The obtained data of this study shows simple and multiple linear regression formulas to estimate the stature from the measured hand dimensions in males. A low value of SEE implies greater reliability in the estimated stature. Here, SEE is less for both hand length and palm length compared to SEE of the other hand parameters. For coefficient of determination (R), it is reverse. At the same time, the multiple linear regression equation for stature estimation from different hand dimensions (HL, PL, HB, and MHB) revealed the lower value of SEE and higher value of determination coefficient as compared to the values given by the simple linear regression equations [Table 7].  Table 7: Simple and multiple linear regression equations for stature estimation from hand dimensions in male
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Similarly, in [Table 8], simple and multiple linear regression formulae to estimate the stature from the measured hand dimensions in females are designed. As in males, the SEE is less for both hand length and palm length compared to SEE of the other hand parameters. For coefficient of determination (R), it is reverse. It is evident from the above data that regression formula predicts stature more accurately from hand length and palm length from the other hand parameters in females. At the same time, the multiple linear regression equation for stature estimation from different hand dimensions (HL, PL, HB, and MHB) revealed the lower value of SEE and higher value of determination coefficient as compared to the values given by the simple linear regression equations.  Table 8: Simple and multiple linear regression equations for stature estimation from hand dimensions in females
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The comparison between estimated stature computed from the equations derived in the present study, from the right and left hand, respectively, and true stature of the control group in males are designed. The obtained results revealed that there is no significant difference between the true stature and estimated stature by simple and multiple linear regression equations. The percentage difference between true stature and the estimated stature ranged from 0.01% to 0.12% [Table 9] and [Table 10].  Table 9: Comparison between differences of true and estimated statures by righthand dimensions in control group of Saudi male population
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 Table 10: Comparison between differences of true and estimated statures by lefthand dimensions in control group of Saudi male population
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Similarly, [Table 11] and [Table 12] showed the comparison between estimated stature computed from the equations derived in the present study, from the right and left hand, respectively, and true stature of the control group in females. There was no significant difference between the true stature and estimated stature by simple and multiple linear regression equations. The percentage difference between true stature and the estimated stature ranged from 0.02% to 0.09% in the right hand and from 0.01% to 0.08% in the left hand.  Table 11: Comparison between differences of true and estimated statures by righthand dimensions in control group of Saudi female population
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 Table 12: Comparison between differences of true and estimated statures by lefthand dimensions in control group of Saudi female population
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Discussion   
Prediction of the stature of a person has an important function in forensic investigations and anthropological researches. Stature is a particular characteristic that is based on many factors such as sex, genetic makeup, ethnic and geographical radix, social stratum, and physical activity.^{[21]}
Formerly, many authors attempt to determine the correlation between stature and length of different long bones.^{[22]} Most of these researches have done on Caucasians. The regression equations obtained from them cannot be used for Saudi population because of ethnic variations.
The present study was carried out to detect the stature from the different hand dimensions and establish regression equations between the stature and these dimensions for males and females in North Saudi people.
In this study, hand dimensions and stature of Saudi population were statistically larger in males than females. These results are in agreement with Ahmed ^{[23]} and Kanchan et al.^{[24]} Furthermore, Numan et al.^{[25]} found significant gender difference in stature for Nigeria population. Sex differences can be explained by the fact that females are genetically shorter than males and by earlier maturity associated with earlier cessation of growth of girls than boys.^{[26]} This suggests that sexspecific regression equations need to be used when estimating stature from measurements of body parts.
Regarding bilateral differences for the right and lefthand measurements in both sexes, there are no statistically significance, and these findings are in agreement with Zeybek et al.^{[27]} and Uhrová et al.^{[28]} Conversely, Rastogi et al.^{[29]} and Ishak et al.^{[2]} reported that there were statistical significance bilateral differences in hand and foot breadth, this may be due to that, more intense physical activity of one side over the other. Frequent use of dominant side results in muscle strengthening and greater muscle and bone development of the respective side.^{[30]} The lack of bilateral asymmetry of hands in this study can be explained by the fact that the participants were young adult students, who would not be exposed to hard manual work.
In this study, we have found a significant positive correlation between the stature and the hand length. This result is in agreement with Shah et al.^{[22]} who tried to use foot and hand lengths simultaneously to correctly estimate the stature in Gujarat region, India, the correlation coefficient was found to be statistically significant suggesting a strong relationship between foot and hand lengths with stature for both males and females.
The present study does not depict any significant difference in the dimensions of the right and left hand in the same sex. Thus, use of either hand would be satisfactory for the analysis. Similarly, Uhrová et al.^{[28]} stated that there is no statistically significant bilateral differences were found in their study. However, other studies reported that there are statistically significant bilateral differences mostly in handbreadth.^{[2]} This bilateral asymmetry of hands can be explained by more intense physical activity of one side over the other. Frequent use of dominant side results in muscle strengthening and greater muscle and bone development of the respective side more intense physical activity of one side over the other.^{[30]}
The current study cleared a significant positive correlation between the stature and the measured hand dimensions. This correlation is stronger in both hand length and palm length than other parameters. Similar findings obtained by Varu et al.^{[10]} and Kornieieva and Elelemi ^{[21]} who confirmed that there is a highly positive and statistically significant correlation of stature with hand and palm lengths in both sexes.
On the other hand, this study found the lower value of the Pearson's correlation (r) for the measurement of handbreadth indicates that the length parameters are more valuable for the stature estimation, these results agree with the result of Tang et al.^{[31]} who showed less correlation of stature with handbreath (R = 36.8) than with hand length (R = 66.4).
In the current study, the correlation coefficient was found be statistically significant indicating a strong relationship between hand dimensions and stature for males and females. The same results obtained by Pal et al.^{[12]} who reported that the hand length and palm length can give the most accurate estimation of stature by linear regression analysis Blessing et al.^{[32]} reported that regression equation provides the greater reliability in the estimation of stature.
In addition, this study revealed low value of SEE implies greater reliability in the estimated stature. Here, SEE is less for both hand length and palm length compared to SEE of the other hand parameters. For coefficient of determination (R), it is reverse. Thus, regression formula predicts stature more accurately from hand length and palm length than the other hand parameters in both sexes.
Moreover, the multiple linear regression equation in male and female revealed the lower value of SEE and higher value of determination coefficient as compared to the values given by the simple linear regression equations. This indicated that the multiple linear regression equation was the better indicator of stature estimation than simple linear regression equations.
These results are in agreement with Uhrová et al.^{[33]} who found that the results of the stepwise linear regression show the lowest SEE for a model including foot and hand length. From the statistical and theoretical point of view, this model will result in the most accurate stature estimation. However, in victims with dismembered bodies where only hands are found multiple regression equations were presented and gave better predicting results more than simple linear regression equation.
In contrast, Pal et al.^{[15]} who studied anthropometric measurements of hand length and their correlation with the stature in the Eastern Indian population found that multiplication factor of 9.12 in female of Delhi state and multiplication factor of 9.16 for males are more reliable than a linear equations, while Kaur et al.^{[8]} who study anthropometric measurements of hand length for estimation of stature in North Indians found that linear equation with positive “y” intercept to be better than multiplication factors.
Varu et al.^{[10]} found that though regression equations and multiplication factors, both are useful to determine stature from hand dimensions, regression equations measure stature more precisely than multiplication factors. Such finding was also observed by Krishan et al.^{[34]} for Rajput (India) population.
Regarding comparison between estimated statures computed from the equations derived in the present study, from the right and left hand, respectively, and true stature of the control group in males. There was no significant difference between the true and estimated statures by simple and multiple linear regression equations. Furthermore, comparison between estimated statures from the right and left hand, respectively, and true stature of the control group in females represents that there was no significant difference between the true and estimated statures by simple and multiple linear regression equations.
These results are in agreement with Oria et al.^{[35]} who studied the extent of reliability of regression equations that they obtained from matching the estimated and true measured statures and reported that, all values of the true and estimated stature were all so close in both sexes.
Conclusion   
Estimation of stature of a person is a substantial parameter in forensic inspection and anthropological studies, and the morphometry of the hand affords remarkable evidence in crime scene examination which helps in criminal stature' estimation.
This study represents an ultimate and powerful correlation between the stature and hand length; it will assist in medicolegal situations in establishing personal identification while only some remains of the body are found. The formula arrived at in the study can be absolutely used for Saudi population. With the assistance of simple and multiple linear regression equations, stature can be predicted. We attempted to determine the normal range while one parameter is known. The study can be further explored by growing the sample size and widen the geographic region.
Acknowledgment
We are sincerely grateful to all the study participants for their kind cooperation. We would like to extend our gratitude to the Community Department, College of Medicine, Jouf University, for helping out with the statistical analysis.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12]
