Some aspects of forensic-medical studies of dog bite injuries

The incidence of dog attacks of humans has increased, but no publications or methodological recommendations on this problem appeared. The history of the problem and statistical data reflecting distribution of injuries with regard to sex and age, location of injuries, and time of the day are presented. Signs which help differentiate injuries inflicted by dog and human teeth or injuries with blunt objects are defined. Further investigation of the problem is needed.     

Fatal and Nonfatal Rip Saw Injuries

This paper deals with a fatal stab wound suffered by a 29-year-old man and nonfatal injuries of 35-year-old and 67-year-old saw operators. Rip saw is a machine that is specially designed for making a rip cut, a cut made parallel to the direction of the wood grain. Rip-saw-related injuries mostly occur when a person is struck by the cutting material, which usually involves splinters of irregular shape and diameter. When the splinter strikes the body diagonally, the injuries may include abrasions, lacerations, and cut wounds; in situations where the victim is struck directly, the most common injuries are oval- or star-shaped stab wounds with a varying width of abrasions around the wounds. Therefore, such injuries may come across as injuries produced by a knife-like instrument, which is an added difficulty in the interpretation of such injuries.     

腹部穿透创致腹腔积血的法医学鉴定

在法医学鉴定中,当暴力所致的原发损害与医疗过失行为造成的继发损害并存时,应区别“不可避免的”继发损害和“可以避免的”继发损害,并将原发损害与“不可避免的”继发损害一起,作为损伤程度鉴定的依据,而不能将“可以避免的”继发损害也作为损伤程度鉴定的依据。《人体重伤鉴定标准》第七十二条规定了外伤后腹部积血的鉴定原则,如何应用该条款评定损伤程度,需对原发损害与继发损害加以区别,同时,有必要对这一条款进行必要的修改。     

Criteria for homicide and suicide on victims of extended suicide due to sharp force injury

This report is about the findings in association with the extended suicides of nine victims killed by sharp force. All victims were killed by sharp force. The perpetrators were predominantly the parents, the victims their children. Regarding the criteria for differentiating self-inflicted injuries from injuries inflicted by another person, the victims' injuries presented patterns usually found solely in suicides. Thus eight of nine cases presented tentative and hesitation injuries, in three of five cases areas of injury covered by clothing had been exposed beforehand. Despite extremely narrow intercostal spaces in children, injuries to the bones in thoracic stabbing were avoided more often than not (four of seven cases). Only the criterion "defence injury" occurred nearly as often as in homicide victims (three of nine cases). The psychopathology of extended suicide can explain this pattern. The perpetrator's motive is characterised by his pseudoaltruistic belief to save the loved ones from a world that is in his opinion unacceptable. A fusion or integration of the victim into the perpetrator's own self is based on an identity problem. Physical interrelation of forces between perpetrator and victim restricts the victim in his defence and presents an important prerequisite for acquiring the patterns of described injuries.     

船舶螺旋桨损伤特点及成伤机制

目的总结船舶螺旋桨损伤的主要特点,探讨螺旋桨损伤的特点及形成机制,探索螺旋桨损伤与碎尸的鉴别方法。方法收集浙江省湖州地区1994─2005年尸检的100余例船舶螺旋桨损伤案例,对螺旋桨造成的损伤（擦划伤、表皮剥脱、创、骨折和全部离断创）的特点,以及衣着特征,进行回顾性分析。并与常见碎尸案中使用的工具造成的断面特征进行比较。结果船舶螺旋桨损伤是高速旋转螺旋桨的巨大劈力和机械切削所造成的损伤;碎尸是人为使用锐器切割或砍击尸体。两者由于形成机理、作用力及反作用力大小不同,导致损伤断面呈现不同的特征。结论船舶螺旋桨损伤具有独特的特征,可与碎尸损伤进行鉴别。     

An alleged assault by police

A case is presented of self-inflicted injuries alleged to have been sustained during an assault by police. A summary is given of the factors in this case differentiating between self-inflicted injuries and those due to an assault. The desirability of taking photographs of injuries in cases of alleged assault and the importance of keeping an open mind when assessing injuries are emphasised. The need for greater awareness in the medical and legal professions of the advantages of a forensic medical opinion in the assessment of injuries is mentioned.     

Comparison of injuries sustained by drivers and pillion passengers in fatal head-on motorcycle collision accidents

This study aimed to compare injuries sustained by motorcycle drivers with those sustained by pillion passengers in fatal head-on motorcycle collision accidents. We examined 84 cases of fatal head-on motorcycle collision accidents, causing 79 deaths of drivers and 19 deaths of pillion passengers, using medical and medico-legal examination records. The distribution of superficial injuries, characteristic injuries, injury severity as well as fatal causes was evaluated and compared using χ(2) tests. The results revealed a significant difference in the distribution of superficial injuries between drivers and passengers. The proportions of injuries in the hand and perineum regions were significantly higher in drivers than passengers. Some characteristic superficial injuries on the palms, chest, abdomen as well as the perineum areas were observed in drivers, while none of these characteristic injuries were observed in pillion passengers. Drivers were found to have suffered more severe chest and abdomen injuries than passengers. In addition, there was a higher incidence of fatalities involving run-over injuries for drivers compared with pillion passengers. The proportion of fatal injuries related to tumbling was higher for passengers than for drivers. Overall, our results revealed a difference in injury severity, superficial injury distribution and characteristic injuries between drivers and passengers. Few characteristic injuries were found in pillion passengers. These findings could help to guide medico-legal examinations, particularly in identifying drivers among victims involved in traffic accidents.     

Characteristics of child abuse by anteroposterior manual compression versus cardiopulmonary resuscitation: case reports

Lethal and sublethal injuries to infants caused by anteroposterior manual compression can be accompanied by lateral rib fractures, hemorrhage into the viscera, and when severe, rupture of large vessels and solid organs. Abusers may claim that these injuries were sustained in an attempt to perform cardiopulmonary resuscitation (CPR). The difference between injuries caused by CPR and injuries caused by inflicted anteroposterior compression is examined in one sublethal and two lethal cases.     

Fatal and non-fatal injuries caused by crossbows

Today in modern times, traumatic injuries caused by crossbows are a rarity. The largest collection of cases so far is presented in this study, consisting of four fatalities (two homicides and two suicides) and two non-fatal injuries (grievous bodily harm and an accident). All the victims were male having an age between 31 and 54. The weapons, which were used, were mainly high-performance precision crossbows with telescopic sights and hunting bolts. The parts of the body involved were the facial/head area in three of the cases and the thorax in three of them. There were either deep or total penetration injuries to the cranium and thorax with the bolt remaining in the wound in four out of six cases. The persons with non-fatal crossbow injuries exhibited comparatively few symptoms, despite the sometimes extensive involvement of the interior of the cranium (cerebrocranial penetration, in one instance). The two cases of suicide favoured the body areas often found with gun-users. The aetiological classification of crossbow injuries may be difficult after the removal of the bolt. The external morphology is strongly dependent on the type of tip used. Multiple-bladed hunting broadheads produce radiating incised wounds, whereas conical field tips produce circular to slitlike defects. Correspondingly, the external injuries can be reminiscent of the effects of a violent attack by sharp force or of a gunshot wound. The possibility, supported by clinical data, that the victim might have the ability to act or even to survive for a period of time, even with penetration of the brain, should be taken into account when the cause of death is being investigated.     

The sensitivity and specificity of control surface injuries in aircraft accident fatalities

Among the important determinations that aircraft crash investigators try to make is which occupant of an aircraft was attempting to control the aircraft at the time of the crash. The presence or absence of certain injuries of the extremities is used to help make this determination. These "control surface injuries" reportedly occur when crash forces are applied to a pilot's hands and feet through the aircraft's controls. We sought to clarify the significance of these injuries and the frequency with which their presence indicates that the decedent was the person that might have been trying to control the aircraft, questions that are frequently asked of the examining pathologist. We studied sequential fatalities of airplane and helicopter crashes in which autopsies were performed by the Office of the Armed Forces Medical Examiner, excluding those that were known to have been incapacitated before the crash and those that were known to have attempted to escape from the aircraft, collecting 100 "qualified" crash decedents. The incidence of control surface injuries was determined for both pilots and passengers. The sensitivity and specificity of control surface injuries were calculated by classifying the decedents into a 4-cell diagnostic matrix. The positive and negative predictive values for control surface injuries were also calculated. Injuries that met the published definitions of control surface injuries had high incidences in passengers, as well as pilots, giving the term control surface injury a diagnostically unacceptable sensitivity and specificity for indicating "a pilot attempting to control an aircraft." We offer caveats and refinements to the definition of these injuries that help to increase the sensitivity and specificity of this term.     

Cardiopulmonary resuscitation-related injuries and homicidal blunt abdominal trauma in children

Defendants accused of inflicting fatal abdominal injuries to children occasionally raise the defense that the injuries were caused by cardiopulmonary resuscitation (CPR). The purpose of this study is to answer the question: Does closed chest CPR result in fatal blunt abdominal injuries that can be mistaken for homicidal assault? To that end, a retrospective study was conducted of all homicidal blunt abdominal injuries in children 10 years and younger from the Dade, Broward, and Palm Beach Medical Examiner's Offices from 1981 through 1997. These were compared to cases of children who died of natural causes during the same time period in Broward County who had CPR (control group 1) and to children who died of nonvehicular accidental blunt abdominal trauma (control group 2). Children with life-threatening head injuries were excluded. Medical examiner records, autopsy reports, documenting photographs, and clinical records were reviewed. The data analyzed included subject demographics, whether CPR was performed and by whom, and autopsy findings. Thirty-three child homicides with fatal abdominal injuries were reviewed. Twenty-four (73%) of the homicides received CPR. There was no difference in the nature and severity of injuries between the 24 children who received CPR and the 9 who did not. Three hundred and twenty-four cases of pediatric natural deaths were reviewed, all of which had CPR. No traumatic abdominal injuries were found in any of the children who died of natural causes. Only four children who died of natural causes had evidence of extraabdominal trauma related to CPR. No cases of nonvehicular accidental blunt abdominal trauma were identified during the 17-year period, although there were nonvehicular accidental fatalities due to extraabdominal injuries. The likelihood of CPR-related primary abdominal trauma in child homicides is very low.     

Severe Cardiac Rupture by Only One Blow to the Chest in a Young Boy: An Autopsy Case

Cardiac rupture by blunt chest trauma is commonly seen after motor vehicle accidents and falls; however, it is rarely caused by a blow to the chest. We herein report an autopsy case of a high school boy who sustained severe right ventricular rupture by only one knee kick to the chest during a quarrel. He was hospitalized and developed cardiopulmonary arrest. Emergency surgery was performed, but the patient died. The autopsy revealed no external severe trauma or deformation, but the side wall of the right ventricle contained a large V‐shaped laceration. The other thoracic organs had no injuries. This case illustrates that severe cardiac rupture can occur by only one blow to the chest. Blunt cardiac injuries can occur even if no severe injuries are present on the body surface. We should consider the possibility of severe cardiac injuries regardless of the presence of external injuries.     

Death by chainsaw: fatal kickback injuries to the neck

Each year over 3 million new chainsaws are sold in the United States. The operation of these newer saws combined with the millions of older chainsaws in circulation results in over 28,000 chainsaw-related injures annually. The majority of the injuries involve the hands and lower extremities with less than 10% involving injuries to the head and neck regions. Deaths while operating a chainsaw are extremely rare. The most common hazards associated with chainsaws are injuries caused by kickback, pushback, and pull-in. Kickback is the most common and poses the greatest hazard. Kickback occurs when the rotating chain is stopped suddenly by contact with a more solid area throwing the saw rapidly backward toward the operator. The cause of most injuries can be traced to improper use of the saw or poor judgment on part of the operator. We present two fatal chainsaw deaths; one with an older style saw, and the other with a modern type. In both cases the victims died from fatal injuries received to the neck region from a chainsaw kickback. The first case involved a 49-year-old white male operating an older style chainsaw with limited safety features. The second case involved a 38-year old white male who was operating a newer model chainsaw equipped with a low kickback chain in an unsafe manner.     

Fatal Wounds by “Manja” to a Motorbike Rider in Motion

“Kite fights” are quite popular throughout Asia. Most kite variations, including the fighter kites of India, Pakistan, and Japan, are small, flat, roughly diamond‐shaped kites composed of paper, with a tapered bamboo spine and a balanced bow. They are flown with the help of a “Manja,” which is a thread made of cotton or nylon, and coated with fine glass powder using glue and other chemical adhesives to cut down opponent's kite string. The nylon “Manja” is particularly more dangerous, as it not only cuts down opponent's kite string but also causes bodily injuries to humans, which may be at times fatal. The pattern of injuries by Manja is underreported in literature. In the present case, the deceased had encountered fatal injuries by “Manja” while riding on his motorbike. This case discusses the pattern of injuries caused by Manja when the victims are in motion on their two‐wheelers.     

汽车安全气囊的使用与损伤

交通事故已经成为导致死亡和致残的首要原因,气囊的产生和使用明显的降低了交通事故中的死亡率和致残率。虽然气囊可以降低交通事故中人员的死亡率和损伤程度,但同时也引起很多非致命性的损伤。本文主要阐述了气囊的作用机制,引起的损伤类型以及机制,并提出减少和降低与气囊相关的损伤和死亡的建议。     

Forensic medical expertise of injuries in the anorectal region and rectum unrelated to attempts at sexual abuse

The results of analysis of 46 commission forensic medical expertises are presented based on the materials concerning injuries and changes in the anorectal region and rectum unrelated to attempts at sexual abuse. The materials were collected and stored by the Primorskoye territorial Bureau of forensic medical expertise during 5 years, from 2005 to 2009. All injuries and changes were categorized into several groups in terms of their origin, viz. car accidents, inadequate medical care, insertion of foreign bodies, falls on sharp and protruding objects, gunshot wounds, chemical and thermal burns, sports training, etc. The occurrence of the injuries is illustrated by the examples from forensic medical practice. It is concluded that experts describing injuries and changes in the anorectal region and rectum must act in conformity with the order of the Russian Ministry of Health No 346 dated October 21, 2010) and use instrumental methods and terminology accepted in modern proctology. The severity of harm to health in subjects presenting with injuries and changes in the anorectal region and rectum should be evaluated in terms of both the degree of the threat to life and the outcome of the treatment with special reference to the duration of health impairment, severity of the trauma, and its consequences (anorectal dysfunction).     

A review of blunt force injury homicides of children aged 0 to 5 years in bexar county, Texas, from 1988 to 2009

ABSTRACT: It is essential that clinical physicians, medical personnel, medical examiners, and law enforcement agencies understand the types of injuries seen and demographics of children affected by intentional blunt force as this understanding can be crucial to the death and/or criminal investigations. An understanding of the injuries can also assist in drawing conclusions regarding how those injuries could have been sustained. This study discusses the types and patterns of injuries seen in blunt force homicides in children younger than 6 years. The study found that male infants are more often intentionally injured than are female infants and that fatal head injuries most frequently occur in the first year of life, whereas most fatal thoracoabdominal injuries occur in the first 3 years of life. In children with head injuries, subdural hemorrhage was the most common finding, followed by subarachnoid hemorrhage. In 2.5% of deaths due to head injury, concurrent neck injury was seen, a percentage far lower than previous literature would suggest if shaking was the primary mechanism of injury. Twelve legal confessions were also reviewed, none of which disclosed a pure mechanism of shaking the infant.     

Position paper on fatal abusive head injuries in infants and young children

This article represents the work of the National Association of Medical Examiners Ad Hoc Committee on shaken baby syndrome. Abusive head injuries include injuries caused by shaking as well as impact to the head, either by directly striking the head or by causing the head to strike another object or surface. Because of anatomic and developmental differences in the brain and skull of the young child, the mechanisms and types of injuries that affect the head differ from those that affect the older child or adult. The mechanism of injury produced by inflicted head injuries in these children is most often rotational movement of the brain within the cranial cavity. Rotational movement of the brain damages the nervous system by creating shearing forces, which cause diffuse axonal injury with disruption of axons and tearing of bridging veins, which causes subdural and subarachnoid hemorrhages, and is very commonly associated with retinal schisis and hemorrhages. Recognition of this mechanism of injury may be helpful in severe acute rotational brain injuries because it facilitates understanding of such clinical features as the decrease in the level of consciousness and respiratory distress seen in these injured children. The pathologic findings of subdural hemorrhage, subarachnoid hemorrhage, and retinal hemorrhages are offered as "markers" to assist in the recognition of the presence of shearing brain injury in young children.     

Neck injuries caused by automatic two-point seat belts: an analysis of four cases

Although seat belts significantly reduce the extent and severity of injuries sustained by motor vehicle occupants, seat belts are known to be associated with chest and abdominal trauma. Less commonly understood are severe neck injuries caused by the use of two-point automatic shoulder harnesses without concurrent use of a manual lap belt. Such injuries may include cervical spine fractures, craniocervical dislocations and rarely decapitation. Recognizing patterned injuries caused by seat belts and the ability to correlate autopsy findings with the circumstances surrounding the death will allow for correct interpretation of seat-belt related trauma. The four cases described detail fatal neck injuries as a result of improper seat belt use in which an automatic two-point shoulder harness was used without a manual lap restraint. In two of the cases, the victims were decapitated.     

骑跨伤在机动车碰撞自行车事故中的特征及生物力学分析

目的以真实案例为基础,研究自行车与机动车碰撞交通事故中,不同机动车型、交通方式等因子造成自行车骑车人下肢内侧骑跨伤的特征,分析其生物力学机制。方法选取上海地区发生的自行车与机动车碰撞交通事故案例140例,全面收集现场、自行车、机动车、人体、交通方向等信息,运用回顾性研究方法分析,同时,选取其中典型案例,通过计算机仿真技术模拟事故发生过程,提取人体各受伤部位的动力学响应数值,如加速度、力和力矩等,与案例研究结果对比。结果全部事故中出现骑跨伤与无骑跨伤案例频数相等;侧面撞击与前后方向撞击骑跨伤的发生情况无显著性差别;大型车辆撞击事故中出现骑跨伤频率较低;骑跨伤的发生频率随车速加大而增高;就骑跨伤的分布来说,撞击侧下肢骑跨伤位置低(链条、脚蹬管等损伤),而对侧骑跨伤位置高(鞍座损伤),在小型车辆撞击时该特点更明显。结论分析自行车骑车人的骑跨伤特征和生物力学机制有望对道路交通行为方式鉴定提供新依据。