European Journal of Cardiovascular Medicine

The identification of human remains is a critical concern in situations involving explosions, mass casualties, and assaults where the victim's body is dissected to hide their identity, when forensically identifying human remains, sex assessment is crucial. Sexing the remains accurately mostly reduces the number of potential victim matches. Additionally, it is significant since male and female stature estimation formulas differ, as does the age at which epiphyseal fusion occurs. When a hand is recovered and brought in for analysis, it can reveal important details about the person's age, sex, and stature. Using statistical formulas and equations, the stature has been determined from various hand dimensions and little hand bones [1-7]. Even though scientists have tried to determine sex from the hand's tiny bones [8–12], the data on sex determination from hand soft tissue measures is currently equivocal. Numerous studies have been conducted to evaluate anthropometric measures of various body areas for identification reasons, to determine stature, sex, race, etc. All these investigations have demonstrated gender dimorphism. Anthropometric methods of many kinds are applied to ascertain the sex from such severed body pieces. These anthropometric methods seek to determine how measurements of different body parts or bones that differentiate between boys and females are cut off [13]. Because of sex hormones, men are often taller and more muscular than women. Numerous environmental and genetic factors, as well as their interactions, affect the degrees of such sexual dimorphism [14]. Since both hereditary and environmental variables impact skeletal growth, anthropometric measurements would differ amongst populations. There have been prior studies on hand dimensions and hand index, but the findings are limited to that specific study population. We assessed the value of hand dimensions, hand index, and palm index in sex discrimination among the Indian population because the foot measurements, foot index, and footprint ratio are frequently proposed as sex discriminators in many population groups [15-18]. The current study aimed to determine the sexual dimorphism in hand measurements among the North Indian population.

The study was conducted at the Department of Forensic Medicine & Toxicology, at Indira Gandhi Institute of Medical Sciences in Patna, Bihar. This included 100 healthy MBBS students (50 males and 50 females) aged between 20-30 years, from the first year to the final year, who gave their informed consent to participate in the study.

The inclusion criteria were as follows:

• Only right-handed medical students above 20 years but below 30 years of age studying at Indira Gandhi Institute of Medical Sciences, Patna, Bihar.

The exclusion criteria were as follows:

Students with any disease, deformity, injury, fracture, amputation, or history of surgical procedures of either hand and poorly defined flexion creases were excluded from the study. Left-handed students were also excluded since the effect of hand dominance on measurements has been suggested

This study recorded three morphometric parameters (Fig. 1) for each hand in cm, using vernier calipers, as described previously in the literature [20]:

1. Length of the hand (HL): The distance between the mid-point of the inter-styloid line (line joining the most distal point on the styloid processes of radius and ulna) to the most anterior projection of the middle finger (A to B).
2. Breadth of the hand (HB): The distance between the radial side of the second metacarpophalyngeal joint and the ulnar side of the fifth metacarpophalyngeal joint (C to D). The length of the participant's hands and palms was measured after they were instructed to rest their hands supine on a hard, horizontal surface with their fingers extended and adducted. The individuals were then instructed to stand with their hands prone on a level, hard horizontal surface, with the thumb abducted and the other fingers, extended and adducted, to measure the breadth of their hands. To prevent inter-observer bias, only one observer took all of the measurements. To ensure that the forearm and middle finger were in perfect alignment, care was taken to ensure that there was no adduction or abduction at the wrist joint.
3. Hand Index: It was calculated individually for both hands in males and females by using the following formulas:

Hand Index = (Hand Breadth ⁄ Hand Length) X 100.

For all hand dimensions and indices, the average of mean values in males and females was taken as the cut-off value for sex determination and termed as the ‘‘sectioning point or cut-off point’’.

Sectioning point = [Mean male value + Mean female value] / 2.

The value more than cut off point suggests male and the value less than that suggests female.

The accuracy of cut-off points was calculated as follows:

Accuracy (%) = (Correctly assigned male cases + correctly assigned female cases x 100) / Total cases

The data was analyzed using Statistical Package for Social Sciences (SPSS, version 24.0) software. Descriptive statistics were generated using the software. The data was statistically analyzed to determine gender by measuring the hand dimensions. An independent samples T-test was conducted to determine the statistical significance of bilateral differences, as well as to determine the statistical significance of gender differences in hand dimensions. The p-value less than 0.05 was considered significant.

We observed that the dimensions and indices in both hands were higher in males as compared to females. Statistically, we did not find any significant difference (p>0.05) in the dimension of the hand and the hand indices on the right and left sides (Table No. 1).

Table 1: Showing the comparison of right and left-sided hand dimensions and hand index

We observed that the mean values of bilateral hand lengths, breadths, and indices were higher in males as compared to females. We found a statistically significant difference (p<0.05) in the hand dimensions and indices amongst males and females (Table No. 2).

Table 2: Showing the comparison of male and female hand dimensions and hand index

[All values measured in cm]

Table 3: Showing the calculation of the cut-off points using combined right and left-hand measurements

[All values measured in cm]

Our study has estimated the cut-off points for hand length, hand breadth, and hand index to be 18.31 cm, 7.79 cm, and 42.58 cm, respectively. If the values are more than these figures, they could suggest the male sex, and if the values are less than these figures, they could suggest the female sex. In differentiating sex, hand breadth (91%) has the highest accuracy, followed by hand length and hand index (Table No. 3).

One of the key responsibilities of forensic experts has always been to identify mangled and dismembered human remains. In these kinds of situations, identifying the sex is essential to determining the precise identification and lowers the quantity of matched IDs. Numerous investigations have been carried out to evaluate sex based on anthropometric measurements. In certain cases, human hands alone may be salvaged from large-scale incidents such as bomb blasts and airline crashes. The proportions of the hand would aid in identification in this situation by revealing the sex. Therefore, the purpose of this study was to investigate the sexual dimorphism in hand index, length, and width. In this study, it was observed that males tend to have longer and broader hands, as well as higher hand index values than females. This finding is consistent with many other similar studies. Some small bilateral variations were noted in previous studies by Bindurani et al [21] and Varu et al. [13]. Danborno [22] found that both hand and foot indices were significantly higher in males than in females. However, within the same sex, males did not show significant differences in the hand index. For females, both hand and foot indices were significantly different. However, Asha et al and Agnihotri et al observed that there was no statistically significant bilateral difference [23, 24]. Sexual dimorphism was observed in mean hand lengths, breadths, and indices, with a statistically significant difference of p < 0.05. Similar observations were made by Ishak et al [25] and Danborno et al. [26]. The cut-off points were derived for hand length, hand breadth, and hand index, with values of 18.31 cm, 7.79 cm, and 42.58 cm, respectively. These cut-off points were found to have an accuracy of 87%, 91%, and 66% for hand length, hand breadth, and hand index, respectively. Hand dimensions were found to have more accuracy than hand index. However, Varu et al [13] estimated the cut-off points for hand length, breadth, and index as 17.2, 7.7, and 44.6, respectively. The estimated accuracy to differentiate sex was 73.25%, 82%, and 69.5% for hand length, hand breadth, and hand index, respectively. Hand breadth showed the highest accuracy in determining sex, followed by hand length and hand index [13]. A study by Krishan K et al [26] reported that hand and foot dimensions showed higher accuracy when compared to hand and foot index. In a study done by Ishak, the cut-off points calculated were 18.57 cm and 8.48 cm for hand length and hand breadth, respectively [25]. Hand breadth was able to differentiate sex with higher accuracy (93.3%), followed by hand length (91.3%). The breadth and length of the hand contribute most significantly to sex discrimination; cross-validated sex classification accuracies range between 82.6% and 96.5% with a sex bias of ≤5% [25]. These cut-off points differ from one population to another as environmental and genetic factors affect the growth and development of the human skeleton. We recommend such anthropometric studies need to be done on various populations and thereby the data can be utilized in forensic practice.

Hand dimensions and indices show sexual dimorphism. It was observed that there were minor variations in both sides of the same sex. Cut-off points were determined regardless of the side. A measurement above the cut-off point indicates male sex, while a measurement below the cut-off point indicates female sex. These cut-off points are specific to a particular population and their accuracy has also been calculated. Hand breadth is a more reliable indicator than hand length and index to differentiate between sexes. The results of this study may be helpful in identifying the gender of a severed hand during a medicolegal examination. Even in cases where a portion of the hand is retrieved and brought in for analysis, the study has consequences for medicine and law.

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