Sharp force injuries in clinical forensic medicine--findings in victims and perpetrators

The injury findings in 58 perpetrators and 158 victims surviving bodily injuries due to sharp force are presented here. Defence injuries were found in 45.9% of the victims without any significant differences between males and females. There was no clear predominance of defence injuries on the left forearm and hand, as is known from autopsy studies; the right and the left hands were affected with an almost identical frequency. Regarding other parts of the victims' bodies, the topographic distribution of injuries showed a marked concentration on the left side (63.7%). The thorax, head and neck were frequently affected (45.9%, 15.3% and 15.3%, respectively), and less often the abdomen (11.1%), the lumbar and gluteal region (6.3%) and the lower extremities (6.1%). In surviving victims with only one singular stab apart from the upper limbs, the incidence of additional defence injuries on the hands and/or forearms was significantly higher (28.3%) than in fatalities. When the perpetrators had unintentionally cut their own hands, the frequency of these injuries on the right and left hands was almost equal.     

Sharp Force Homicide in Denmark 1992–2016

Sharp force trauma is a common homicide method. The weapon is typically a knife, which is easily accessible and does not require special skills. We have analyzed all 471 sharp force homicides in Denmark during 1992–2016 with special focus on aspects that are relevant to forensic pathologists, including the distribution of wounds and organ injuries. Most homicides were committed inside with a kitchen knife. The front left thorax was the most common area to be affected by sharp force trauma. In 18.9% of the victims, there was only one sharp injury, the majority on the thorax. The most common trajectory for stab wounds was directly posterior with no deviation to the sides or up/down followed by directly anterior. The heart (including pericardium) and lungs (including hemo- and pneumothorax) had injuries in more than 75% of the victims. 67% of victims were males. Female victims had more sharp force injuries and defense wounds than male victims. Most females were killed in domestic homicides (73.7%), most commonly in partner killings (56.4%). In contrast, many male victims were killed in a setting of nightlife/intoxication (34.0%) most by a friend/acquaintance delivering a few stab wounds. The results clearly show strong sex differences in both victims and offenders. This could be useful for shaping policies and public opinion, and as a route for understanding the developments in interpersonal violence. In the narrow setting of death investigation, our results will provide an evidence-based approach to understanding the injury patterns in sharp force homicide.     

Weapon Use in Korean Homicide: Differences Between Homicides Involving Sharp and Blunt Instruments

On the basis of information regarding 276 homicides committed in South Korea between 1987 and 2008, we compared offenders’ and victims’ characteristics, injury locations, weapon‐related behavior, and offending behavior between homicides involving sharp and blunt instruments. The victims of sharp‐force homicide were much younger relative to those of blunt‐force homicide. In addition, homicides involving blunt instruments were more likely to be committed by offenders who lived with the victims. Most sharp‐force homicides involved injuries to the torso, while blunt‐force homicides involved mainly head injuries. Furthermore, perpetrators of sharp‐force homicides tended to preselect their weapons, while those of blunt‐force homicides were likely to use weapons of opportunity. Logistic regression analysis identified a number of factors, including injury location and body transportation, which significantly predicted weapon type. As this was the first South Korean study to compare sharp‐ and blunt‐force homicides, the results have practical implications for homicide investigations.     

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。     

159例家庭暴力损伤的法医学鉴定分析

目的　探讨家庭暴力损伤的特点及其有关的法医学鉴定问题。方法　对 1 998年 4月～ 1 999年 1 2月间来诊的 1 59例家庭暴力损伤鉴定案件进行回顾研究。结果　家庭暴力的受害者绝大多数为妇女(占 93 1 % ) ,主要发生在配偶间 ( 85 5% ) ,其次为虐老 ( 7 5% )和虐儿 ( 5% )。家庭暴力一般发生在家中 ,以晚上为发生高峰。致伤方式以拳脚为主 ,其次为随手可得的钝器或锐器。损伤多为软组织损伤 ;有4 0 %的受害人投诉前未去医院就诊 ;损伤程度多为轻微伤 ,达轻伤标准占 1 0 %。结论　家庭暴力损伤具有隐藏性和复杂性 ,准确及时地进行法医学鉴定可为受害人主张权利提供有力的证据和帮助 ,对揭露家庭犯罪有着重要意义     

交通意外事故尸体剖验37例

本文作者报告陆上交通意外尸体剖验37例。事故类型分路人车撞、汽车相撞、汽车撞静物及摩托车事故四种。路人被车撞致死者,损伤分布广,种类多,有5种不同的损伤。摩托车事故死亡者胸腹部损伤多,突出的是胸主动脉横裂。汽车驾驶员的损伤以胸腹部为多。其中因车撞车驾驶员死亡者,头部损伤常不严重。各种不同的损伤各有一定的特征。作者强调了要注意酒精与车祸的关系。     

Fall from height--surprising autopsy diagnosis in primarily unclear initial situations

External post-mortem examination and first police assessments are often not consistent with subsequent autopsy results. This is all the more surprising the more serious the injuries found at autopsy are. Such discrepancies result especially from an absence of gross external injuries, as demonstrated by four examples. A 42-year-old, externally uninjured male was found at night time in a helpless condition in the street and died in spite of resuscitation. Autopsy showed severe polytrauma with traumatic brain injury and lesions of the thoracic and abdominal organs. A jump from the third floor was identified as the cause. At dawn, a twenty-year-old male was found dead on the grounds of the adjacent house. Because of the blood-covered head the police assumed a traumatic head injury by strike impact. The external examination revealed only abrasions on the forehead and to a minor extent on the back. At autopsy a midfacial fracture, a trauma of the thorax and abdomen and fractures of the spine and pelvis were detected. Afterwards investigations showed that the man, intoxicated by alcohol, had fallen from the flat roof of a multistoried house. A 77-year-old man was found unconscious on his terrace at day time; a cerebral seizure was assumed. He was transferred to emergency care where he died. The corpse was externally inconspicuous. Autopsy revealed serious traumatic injuries of the brain, thorax, abdomen and pelvis, which could be explained by a fall from the balcony. A 47-year-old homeless person without any external injuries was found dead in a barn. An alcohol intoxication was assumed. At autopsy severe injuries of the brain and cervical spine were found which were the result of a fall from a height of 5 m. Conclusion: On the basis of an external post-mortem examination alone gross blunt force trauma cannot be reliably excluded.     

西安“六.六”空难的法医学鉴定

本文报告了１９９４年６月６日，中国西北民航Ｂ—２１６０号客机在西安失事的法医学鉴定。机上乘员１６０人全部遇难、死难中，以撞击伤为主，主要死因为多脏器严重损伤、创伤休克、大出血。１６０名遇难者中，１３９人经体貌特征和遗物被确认，６例通过血型被认定，３例通过指纹被认定，其余通过牙齿被确认。本文还讨论了如死亡时间等空难中的法医学处理问题。     

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.     

An Analysis of the Characteristics of Thoracic and Abdominal Injuries Due to Gunshot Homicides in Israel

De‐identified wound data from 197 homicidal gunshot postmortems were obtained between 2000 and 2008. Forensic ballistics data were only available for cases between 2004 and 2008. Males represent 91% of gunshot victims and were struck in the thorax/abdomen with an average of 2.3 bullets. The type of firearms involved were semi‐automatic pistols in the predominant caliber 9‐mm Luger and assault rifles in caliber 5.56 × 45 mm and caliber 7.62 × 39 mm Soviet, using full metal jacket bullets. The majority of shootings occurred at ranges of 1 m or greater. The most common bullet path was front to back in 66% of cases. Entry wounds occurred more often on the left side of the thorax, abdomen, and back. The most common critical organs/tissues to sustain bullet trauma in descending order were as follows: heart, lungs, liver, aorta, spleen, kidneys, and vena cava. Ribs were struck by most bullets that entered the thorax.     

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.     

机动车外后视镜对人体损伤的研究

目的探讨机动车外后视镜对人体损伤的特点。方法对10例于1990-2005年间在华西医科大学法医学院鉴定的案例进行回顾性的调查,所有研究对象均为机动车外后视镜损伤患者。结果在车内驾驶员为左眼损伤,前排乘客为右眼损伤,均被同则外后视镜碎片所致,而在车外分为两类,一类为骑自行车的中学生,被外后视镜撞伤,以颅脑损伤居多,另一类为行走老年人,被后视镜撞伤,表现为四肢骨折。结论根据其受伤特征,提出相应的预防措施。     

1110例汽车驾驶员及乘员交通伤特点分析

目的比较道路交通事故中汽车驾驶员及乘员的损伤特点,为汽车安全设计及事故预防提供参考。方法选择2006～2009年受理的交通伤害案件中373例汽车驾驶员及737例汽车乘员的伤残评定资料进行回顾性分析,对损伤部位的分布,多发伤的数量以及伤残等级进行比较。结果驾驶员损伤部位明显较乘员多,肢体、胸腹损伤发生率明显较乘员高,脊柱损伤的发生率明显较乘员低;驾驶员身体左侧受伤的几率较右侧高,而乘员左右损伤差异不显著;两类人员损伤所致伤残等级腹部、盆部分布显著不同,而其他部位无显著差异,但胸部、脊柱部位高等级伤残构成比乘员略多于驾驶员。结论汽车驾驶员与乘员损伤部位、数量及部分部位的损伤致残程度有差异,值得汽车安全设计及交通管理部门参考。     

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.     

Suicides by fall from height in Geneva,Switzerland, from 1991 to 2000

Suicides due to fall from height in Geneva from 1991 to 2000 were reviewed. Scene investigations, autopsy findings, psychiatric histories, and toxicology results were examined. There were 197 of these suicides, an incidence of five cases per 100,000 inhabitants per year or one fourth of all suicides in Geneva per year. Autopsies were performed on 33%, the rest had external examinations. Of the victims, 56% were female and 44% were male. The age distribution peaked at 20-29 years in men and 60-69 years in women. Most of the victims jumped from their home, the range of 2 to 7 stories being the most frequent height. Major injury sites, in decreasing frequency, were the thorax, abdomen, skull, vertebrae, pelvis and limbs. Psychiatric illness was reported in 38% of the cases. Toxicological analysis was performed in 25% of the cases and showed that the main drugs present were benzodiazepines, cannabis and antidepressant.     

Fatal penetrating abdominal injury by a metallic projectile

Penetrating abdominal injury is often a life-threatening condition, which is mainly associated with inflicted injuries. Fatal self-inflicted sharp force abdominal injuries too have been reported in the literature. Inadvertent penetrating abdominal injuries are a rarity and are caused by sharp objects of low-velocity and often nonmissile-type. A 27-year-old male factory worker was brought dead to the emergency department with an alleged history of sustaining abdominal injury by a sharp metal projectile while working on a metal cutting grinder. Autopsy observations were consistent with the history of inadvertent penetrating injury. Our case reports a fatal missile-type inadvertent sharp force trauma over the abdomen with intestinal perforation, a relatively uncommon scenario in occupational/workplace settings. The present case report describes the significance of the death scene visit and corroborating the medical findings with investigating agencies. This case further emphasizes on the need for adopting proper safety measures at the workplace.     

Classification of skin injuries inflicted by the teeth of the carnivorous animals

The current approaches to the classification of skin injuries inflicted by the teeth of the carnivores on the human body are discussed. The new morphological classification is proposed taking into consideration the current views of the mechanisms underlying the formation of tooth marks on the integumental tissues of the victims of attacks by carnivorous animals. Morphological characteristics of skin injuries are briefly described in the framework of the new classification.     

A comparative and comprehensive analysis of nonsexual assaults

The aim of this study was to make a comparative and comprehensive analysis of nonsexual assaults in 488 medico-legal cases presented to Forensic Medicine Outpatient Clinic of Celal Bayar University Hospital (Manisa, Turkey), between 2005 and 2009. There were blunt force injuries (BFI) in 262 cases (53.7%), sharp force injuries (SFI) in 163 cases (33.4%), and firearm-related wounds (FRW) in 63 cases (12.9%). The results showed significant differences in the monthly distribution of assaults, localization of injuries, and severity of injuries depending on the types of assaults. Most of the injuries were localized to the face, head, and neck in BFI and SFI and to the lower limbs in FRW. The results of this study will help researchers to investigate characteristics of victims, offenders, and injuries and types of assaults because of nonsexual violence.     

道路交通事故颅脑损伤的法医学鉴定

目的　研究道路交通事故中颅脑损伤的类型、特点、主要并发症及其受伤人员的伤残评定。方法　 862例道路交通事故颅脑损伤的案例资料 ,按伤者受伤的不同部位、有无并发症、并发症的类型及伤残程度进行统计分析。结果　复合性颅脑损伤 2 76例 ,脑挫伤 192例 ,颅骨骨折 79例 ,颅内出血 91例 ,头皮外伤 2 2 4例 ;主要并发症为脑积水 ( 19例 ,2 2 0 % )、癫痫 ( 16例 ,1 86% )、偏瘫 ( 14例 ,1 62 % )、植物人状态 ( 12例 ,1 3 9% )。结论　道路交通事故中颅脑损伤 ,以头部复合性损伤最多见 ,严重的脑挫伤为最常见的损伤类型 ,并发症的诊断应掌握诊断标准 ,并注意与相关疾病鉴别。     

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。