Knee joint injuries as a reconstructive factors in car-to-pedestrian accidents.

Knee joint injuries were found in 214 out of 357 fatal pedestrian victims of traffic accidents (60%). The cross-sections of tibial and femoral epiphyses revealed bone bruises (due to compression and avulsion) and the percentage of victims with knee injuries increased to 80% (in the group of lateral impacts - 94%). The bone bruises in the central tibial and femoral condyles were observed only in victims hit in an upright position. There was a strong correlation between the side of impact on the extremities in medium sized pedestrians (from the front, back, lateral and medial side) caused by passenger cars and the mechanism of knee injuries (hyperextension, anterior dislocation of the proximal tibial epiphysis in relation to the femoral condyles, valgus and varus flexion). In the cases of very low impacts (e.g. in very tall victims hit by rapidly breaking wedge-shaped cars) or very high impact (e.g. in very short victims or truck hits) the "reversed" complexes of injuries were found (lever principle). These findings showed that knee joint injuries are useful for determining the car-pedestrian location on collision and the type of vehicle (in hit-and-run accidents).     

Behavior of expelled glass fragments during projectile penetration and perforation of glass

Bullets striking common forms of flat glass with an orthogonal intercept angle result in a cloud of ejected glass fragments that are in concert with the exiting bullet's flight path. This is not the case with strikes at angles other than orthogonal. In these situations, the expelled glass fragments follow a very different course from that of the exiting projectile. This is both counterintuitive and a potential source of serious error in the evaluation and reconstruction of a shooting victim's position and orientation at the moment the victim was struck by a bullet that has passed through a nearby source of glass such as a vehicle side window or a window in a building. The flight path of the ejected glass fragments is, however, predictable and is dictated by the orientation of the plane of the glass opposite the projectile's impact site.In all cases, these expelled glass particles have considerable velocity and can produce pseudostippling of the skin in individuals located downrange of bullet-struck glass and near the projectile's exit site. The distribution and location of such pseudostippling and its relationship to the associated bullet hole in glass have important reconstructive value. A proper and reliable reconstruction of the victim's position in such cases will require the integration of scene information with the autopsy findings.     

Fatal pedestrian-bicycle collisions

Although, fatal collisions between pedestrians and bicycles are relatively rare, they are still of forensic relevance because of the need to explore the circumstances of the accident. Based on three reconstructed cases, situation and injury patterns are presented that might prove useful in future cases: usually the person causing the accident is the cyclist while the pedestrian generally suffers more severe injuries; the situation at the site of accident is important for its reconstruction: end location of the persons involved in the accident, injuries and traces on pedestrians and cyclists, traces at the site of accident and on the bicycle; because of the lack of pre-crash traces and any eyewitness accounts, the pedestrian's injuries are the best starting point for the reconstruction of the accident; a characteristic wound on the lower leg of the pedestrian that reveals the initial impact between the front wheel and the leg is crucial not because of its seriousness, but because of its external morphology; the injuries that can be expected by the following impact between body and handlebar are unspecific and only minor; the most severe injuries to the pedestrian as a result of the accident are caused secondarily by falling and hitting the head on the road; the fall of the cyclist, however, corresponds to a throw-off followed by a sliding phase with less impact load when the head hits the ground [maximum abbreviated injury scale 1 (MAIS 1)]; the cyclists involved are mainly younger persons on fashionable bicycles (here: mountain bikes); in the great majority of cases, the injured pedestrians are frail, elderly people with a lower tolerance of trauma.     

Severity of vehicle bumper location in vehicle-to-pedestrian impact accidents

Pedestrian protection is one of the key topics for safety measures in traffic accidents all over the world. To analyze the relation between the collision site of the vehicle bumper and the severity of the lower extremity injuries, we performed biomechanical experiments. We compared the applied external force and the risks of subsequent injuries between the impact of the center and side positions of the front bumper. These comparisons were performed by practical impact tests with eight typical different types of cars which were typical of the current vehicle fleets. The tests were made using the TRL legform impactor which was a mechanical substitute of a pedestrian lower extremity. The TRL impactor is used all over the world for assessing the safety of car bumpers. It was found that the risks of lower extremity injuries in the impacts at the side positions, in front of the vehicle's side member, were significantly higher than those at the center. In the tests, we found that foam materials around the rigid front cross member had a significant effect on reducing the lower extremity injury risks and especially tibia fracture risk against vehicle bumper center collisions, but had little effect at the sides of the bumper over the vehicle's side members where the foam was thinner. We also found that the front shape of the vehicle affected the risk of ligaments injuries. According to these results, the information of impact locations of cars in vehicle-to-pedestrian traffic accidents is valuable for clinicians to diagnose patients with lower extremity injuries in traffic accidents and for forensic pathologists to analyze the accident reconstruction. Furthermore, the results suggest that testing of the bumper area in front of the main longitudinal beams should be included in the car safety legislation to require pedestrian safety.     

Ankle joint injuries as a reconstruction parameter in car-to-pedestrian accidents

The study has assessed the usefulness of ankle joint injuries for deducing about the presumable location of a pedestrian in relation to a motor vehicle at the moment of collision. A statistically significant correlation was found between the direction of impact and the mechanism of ankle joint injuries. Such injuries were found in 113 of 317 pedestrian, fatal victims of road traffic accidents (36%). In the cases of impacts on the medial surface of the lower limb, the injuries associated with the supination mechanism were six times more frequent than the injuries associated with the pronation mechanism, while in the group of impacts on the limbs from the lateral side those connected with the pronation mechanism were four times more frequent. In victims hit from the back, the injuries connected with the plantarflexion mechanism were found almost four times more frequent than the dorsiflexion mechanism and in victims hit from the front in three of the five damaged joints the dorsiflexion component was observed (without any plantarflexion case). Less frequent "pronation injuries" in the limbs hit from the medial side and "supination injuries" in the limbs hit from the lateral side as well as "dorsiflexion injuries" in victims hit from the back predominantly occurred in impacts to the pelvic area, i.e. resulting from collisions with a van or lorry. Injuries of upper ankle joints are, thus, useful for reconstructing the presumable location of the pedestrian in relation to the vehicle at the moment of collision, especially, when the vehicle involved in the accident is known.     

Pelvis and hip joint injuries as a reconstructive factors in car-to-pedestrian accidents.

The pelvic girdles of 371 pedestrian victims of road traffic accidents were evaluated during postmortem examinations. Additionally, 144 hip joints were opened. The pelvic injuries were found in 28% of the pedestrians hit exclusively in their upright position and 52% of the victims run over by a vehicle. The side of the body hit by a car was determined on the basis of the location of blood suffusions within the subcutaneous tissues and muscles of lower limbs as well as the character of injuries found in the knee and upper ankle joints. The findings were verified with the data from court records. It was shown that the injuries of the sacroiliac joints or vertical fractures of the posterior parts of iliac bones were useful parameters for determining the side (left or right) of the body hit by a vehicle. Moreover, it was found that a direct impact on the hip region was evidenced by the ipsilaterally localized fractures of the iliac ala, central hip fractures and intraosseous blood suffusions within the greater trochanter of the femur. The external dislocations of the hip joints (always) and bilateral injuries to the sacroiliac joints (usually) were observed in the victims run over by vehicles.     

The modern holy shroud

Testimonies disclosed that a 44-year-old pedestrian was struck head-on by a truck while she was roaming on the motorway; at the time of collision, the truck was travelling at a speed of about 90 km/h. In the second phase of the collision, the pedestrian was projected about 100 m before her body was run over by the truck and then by a car. The autopsy revealed extensive mutilations, making it impossible to verify the testimonies of witnesses to the collision as regards the pedestrian's position at the moment of the first impact. However, the reports produced by the technical expert and the forensic pathologist were able to confirm the testimonies, based on an impact zone on the front panel of the cab of the truck, where part of the pedestrian's face was reproduced like a "modern holy shroud".     

Reconstruction of a real car-pedestrian-accident. Part I: Generating an individual digital topographic image of the victim

The aim of forensic biomechanics is the reconstruction of traumatic events based on the pathological findings in the victim's morphology, the accident traces and the car damages. The use of forensic documentation tools (e.g. Streifenlichttopometrie) enables 3-dimensional and proportional accurate documentation of the victim's body, of its injuries and of the car damages with submillimeter precision. The generated topographic image serves as input for a multi-body system model of the victim. It allows further to determine exactly the contact points between car and victim for a computer simulated dynamical reconstruction of the impact situation. In the case of an accident involving a car and a pedestrian the generation and application of computer aided 3-dimensional reconstruction models are shown.     

In the Line of Fire—21st-Century Approach to an Ancient War Injury

Abstract:  Authentic black-powder muzzle-loader weapons or replicas are used today primarily for re-enactments of historic battles. A lay actor playing the role of a Prussian infantryman sustained life-threatening gunshot injuries during a recent re-enactment of a historic battle of the Sixth Coalition. As only blank historic muzzle-loading weaponry was used, the origin of the missile causing the wounding was initially unclear. Further investigation revealed a ramrod that had been propelled out of the barrel of another gunner's smooth-bore gun as cause of injury. The ramrod was hurled on a trajectory of more than 20 m, breaking the victim's shouldered barrel and hitting the victim resulting in severe abdominal, thoracic, and upper limb injuries. The critical incidents while handling muzzle-loading weaponry leading to premature discharge are elucidated. Furthermore, this report demonstrates how actual diagnostics and subsequent surgical treatment enabled this infantryman to survive an injury to which his comrades-in-arms would have succumbed 200 years ago.     

Fatal craniocerebral trauma in a young child. I: Forensic documentation,model generation and geometric impact conditions

The aim of forensic biomechanics is the reconstruction of traumatic events based on the pathological findings in the victim's morphology and on the traces and shapes of the traumatizing tools. The introduction of Streifenlichttopometrie into forensic science enables 3-dimensional and proportionally accurate documentation of the victim's body and injuring agent with submillimeter precision. The advantages of this method of documentation are the possibilities of producing animated models which correspond exactly to the body's shape and injury topography, and of ascertaining the physical parameters (centers of mass, moments of inertia) of the various body parts and the geometrical impact conditions for the reconstruction of the injury dynamics. This way of proceeding thus enables more precise models than hitherto possible for kinetic and dynamic reconstruction. In the case of an infant who was fatally injured by a wooden sculpture the generation and application of computer aided 3-dimensional reconstruction models are shown.     

Hyperpigmentation in the long bones of the lower limbs as a basis for vehicle identification and traffic accident reconstruction

Following the earlier studies on the identification of injuries in unbroken cranial bones, the described method was adapted for the examination of the long bones in fatal casualties of traffic accidents.Two types of bumper injuries might occur: the bumper was found to cause fracturing of limbs [1], and femoral muscle contusions and microtraumas within compact and spongiose parts in the femoral with subsequent maculate hyperpigmentation [2].The authors show that the correlation of above mentioned traces of the trauma, facilitates the reconstruction of the accident and also the identification of the vehicle.     

Signs of injury in bone findings--analysis and evaluation

Recent bone finds examined under forensic aspects as well as historic skeletons (mainly dating from the Middle Ages) with a known history as to the cause of death and the place where they were found were studied to develop basic criteria for the assessment of the cause and time of origin of bony defects. With regard to the time of origin it was found that the closer an injury occurs before or after death, the harder it is to distinguish from a perimortal injury. A schematic pattern was worked out for the kind of origin classifying the injuries as to "type of force", "mechanism", "weapon/object" and "effect to the bone", which helps in the forensic assessment of the causes of injuries found on bones.     

车外人员撞击伤特点分析

目的以真实案例为基础,研究汽车碰撞事故中,不同机动车车型、不同交通方式等因素造成车外人员撞击伤的特征。方法选取上海地区发生的汽车与车外人员碰撞事故案例200例,通过对事故中的人、车等检验对比,分析车外人员撞击伤的特点。结果车外人员撞击伤主要出现在下肢,其次为胸部和头部;行人（含推车人）撞击伤出现频次与骑车人（含自行车或摩托车后座乘员）无明显差异;小轿车和小客车事故中撞击伤多见于下肢,大客车多见于胸部;车外人员被撞击后发生抛甩频率随车速的加大而增高,且通过车体痕迹检验,人体与车辆挡风玻璃发生（二次）撞击伤匹配程度最高。结论分析汽车与车外人员碰撞事故人体撞击伤特点,对于交通伤法医学鉴定及深化交通伤机制研究具有参考价值。     

论被害人同意的体系性地位——一个中国语境下的“德国问题”

关于被害人同意在犯罪论体系中的地位,德国刑法学界历来有"二元论"和"一元论"之争。对于我国主张全面引入大陆法系犯罪论体系的"革命派"而言,需要审慎思考"一元论"对刑法学理论发展的深度影响;对于主张维持"四要件"基本格局的"改良派"而言,也可以从"一元论"中汲取资源,将被害人同意纳入"四要件"框架内予以重新解释。此外,笔者认为以同意的体系性地位之争为辐射源,可以从中引申出关于法益概念以及问题性思考等具有一般性意义、需要各种立场共同回应的深层次问题。     

Injury pattern on the hand after slipping onto the blade during a knife attack--a contribution to the differential diagnostic classification of sharp force injuries of the upper extremities

Differential diagnosis of injuries caused by accidental slipping of the hand onto the blade of a knife includes self-inflicted injuries (e.g. to simulate an offense) as well as active and passive defense injuries indicative of the involvement of another party. The injury pattern on the hands of five perpetrators who suffered accidental cuts during knife attacks, as seen by the authors during the clinical forensic examination, is presented. The injuries were localized on the ulnar aspect of the thumb facing the index finger, the radial aspect of the index finger facing the thumb and variable sites on the flexor or extensor side of the middle and ring fingers. Especially in those cases in which the injuries of the victim (e.g. involvement of bony structures) and the dominant hand of the perpetrator are known, additional information for the reconstruction of the course of events may be derived from the cut wounds occurring during the knife attack as the hand slipped onto the blade.     

Practical application of the Injury Severity Score (ISS) in expert forensic testimony

The retrospective analysis of the autopsy records of 50 homicides showed that the Injury Severity Score (ISS), a numerical scoring system initially developed to quantify the severity of injuries sustained in road traffic accidents, can also be useful for objectively describing and ranking the overall severity of trauma with regard to forensic issues. The present case report illustrates to what extent the ISS can help to assess the contribution of each assailant in homicides committed by several perpetrators. In the case presented the court was convinced that one perpetrator had inflicted four deep stab wounds to the victim's face (each with bony lesions), 2 stabs to the chest piercing the right lower pulmonary lobe and causing a haemothorax of 200 ml, an abdominal stab wound without involvement of a parenchymatous organ as well as multiple defence wounds of the arms. Thereafter, a second perpetrator was thought to have inflicted several heavy blows with a full water bottle causing severe contusions on the right side of the forehead, the chin, the left side of the face and a spider's web fracture of the frontal bone. Using the ISS an injury severity score of 24 was assigned to the first complex of injuries and a score of 10 to the second complex. The forensic conclusions with regard to prognosis and lethal outcome are discussed.     

The use of the laser for determining the direction of the shots and the position of the victim's body in gunshot wounds

In this article a practical case is described when gunshot directions and position of a victim's body at the moment of each shot were determined by natural simulation using an LG-78 laser (made in the form of a gun).     

Avulsion of the distal tibial shaft in aircraft crashes: a pathological feature of extreme decelerative injury

A pilot and his passenger were killed on impact with the ground when their light aircraft crashed. Both deaths were caused by extensive injuries involving severe craniocerebral, skeletal, soft tissue, and organ trauma. In both victims, the legs were shortened, with stripping of muscle and soft tissues from the shafts of the lower limb long bones. In addition, fragments of distal tibial shaft had been forced through the soles of the victims' shoes. This sign indicated a fall from height and showed that the direction of the decelerative forces had been along the axis of the legs and that the force of impact was severe enough to cause fracturing of the lower limb bones, with subsequent extrusion of bone fragments downwards through the shoes. When present, this observation represents another feature at autopsy that can add to the understanding of the circumstances of a fatal air crash and the position of the victims immediately prior to impact.     

About morphological findings in fatal railway collisions

The autopsy findings in fatal cases of railway collisions of the Bonn Institute of Legal Medicine in 1992-1999 were investigated and compared to the statements in the investigation files of the public prosecutor with regard to classification as accident or suicide as well as with regard to type and speed of collision. Of the 38 deaths, 10 were hit in an upright position, 11 fatal collisions affected persons lying outside the track and 13 were hit and overrun lying inside the track. According to the investigation classification 21 persons committed suicide (56%), while 10 died in an accident (26%). Our survey confirmed the leading role of being over-rolled in a lying position as an indication for suicides, while in accidents the upright hit was most important. With exception of the persons primarily affected between the rails in upright position and over-rolled consecutively an unequivocal assignment of injury patterns to the hit categories was possible. In cases of persons being primarily over-rolled in a lying position especially the criteria (i) opening of body cavities, (ii) organ injuries and (iii) loss of parts of the body allowed for careful conclusion on hit, respectively, overrunning speed.     

Reconstruction of the angle of shot by using computed radiography of the head

In a case of murder by a single .22 caliber bullet fragmented in the head, determination of the trajectory was a key issue in identifying which of 2 windows, 1 of which was associated with 2 suspects, was the site of fire. For this purpose, we processed the computed tomography of the victim's head by using a radiation therapy planning system called Plato, which is routinely used in radiation oncology. This tool provided a 3-dimensional reconstruction of the cranio-cerebral lesions and a spatial location of bullet and bone fragments. In this article is described the more intuitive relationship with forensic and ballistic data obtained from the 3-dimensional visualization and the physical and mathematical analysis used to calculate the angle of shot.