Forensic-medical assessment of diaphysis fractures in childhood

The authors established that special structure of bones in childhood have a significant influence on the fractures of long tubular bones. The formation of unusual fractures shows it. Under condition of low speed of bending in the area of fracture many microfissures are formed, which leads to structural failure of intraosseous microcirculation and osteocytes.     

Characteristics of the injuries to diaphyses of the long tubular bones in case of skew bending

The present experimental study was designed to elucidate specific morphological features emerging from the destruction of diaphyses of long tubular bones undergoing a combined strain/stress impact. It is concluded that the species-specific signs of the injuries to the long tubular bones can be used for the purpose of their differential diagnosis from other types of injuries.     

撕脱骨折与永存骨骺、籽骨、副骨的影像学鉴别

目的探讨撕脱性骨折与永存性骨骺、籽骨、副骨的影像学鉴别办法。方法回顾性分析了14个要求重新鉴定是否存在骨折的案例,观察撕脱性骨折的直接、间接征象,并结合其发生机制与永存性骨骺、籽骨及副骨的固有形态、特点等进行对照。结果所选案例中有2例永存性骨骺、3例籽骨、3例副骨均具有骨块边缘钝圆、骨皮质连续、局部软组织未见肿胀以及伤后该骨的连续摄片无明显变化等共同特征。结论正确掌握撕脱性骨折、生理性小骨骺、籽骨及解剖变异的副骨的特点,并综合运用影像学资料是鉴别撕脱性骨折的基本要素。     

Interpreting Injury Mechanisms of Blunt Force Trauma from Butterfly Fracture Formation

According to biomechanics of fracture production during blunt impact, tubular bones are subject to compressive (impact site) and tensile (opposite impact site) forces; this causes bones to break in tension before compression, producing Y-shaped fracture patterns with breakaway (butterfly) fragments. In current forensic models, the side of the bone exhibiting the breakaway fragment is designated the impact side, with initial breakage occurring opposite. Fracture production and patterning of blunt impacts to 255 sheep femora were analyzed. Contra the existing model, only 60% of complete butterfly fractures exhibited impact side breakaway fragments. Although fractures initiated on the tension, nonimpact side, butterfly fragments formed on either compression or tension sides. Using newly defined breakaway fragment shape criteria, impact side was estimated with 98% accuracy for both complete and partial butterfly fractures. Furthermore, the results suggest that the impact site is the located on one of the Y-fracture's arms, not the butterfly fragment's center, as previously modeled.     

Forensic medical expertise on burned bone remains

The series of 1138 cadaveric humerus and femurs of people of both sexes who died at the age of 17-91 years and 468 animal bones (cow, pig, sheep) was studied. Bones were burned (experimentally) at various temperature values and in different conditions. Investigations were carried out using osteometric, microscopic, microroentgenographic and mathematical methods. Species identification as well as sex and age determination using burned bone remains are possible regardless of the level of their burning. Regression equations to calculate victim's stature according to fragments of burned bones were received.     

Recognition of Skeletal Fractures in Infants: An Autopsy Technique

Abstract:  Complete recognition and documentation of injury pattern is crucial in the diagnosis of child abuse. Skeletal fractures regarded as highly specific to nonaccidental injury in infants include posterior rib, scapular, metaphyseal, and spinous process fractures. These injuries are often occult, especially when acute, to standard radiologic and autopsy procedures. The presented autopsy technique requires incising and reflecting skeletal muscles to expose the bones and costal osseous joints in situ , increasing the opportunity to recognize skeletal injury. Fractured or atypical appearing bones are removed and processed for complete evaluation. The bones are processed by macerating the soft tissue in a water soap bath at an elevated temperature. To aid in reconstruction of the decedent, long bones are replaced with wooden dowels and the chest cavity is packed with the organ bag. The technique is invasive and recommended for cases in which the pathologist has reasonable suspicion of acute or remote trauma.     

Stature estimation of 3-10-year-old children from long bone lengths

Estimation of stature in adult forensic cases with available long bones of the limbs is routine, but such estimation is less common in subadult cases. Long bones from subadult cases are often used to estimate age, but in some instances stature may be helpful or even critical for identification. Few published regression equations exist for consultation in such cases. Data from the longitudinal growth study conducted by the Child Research Council in Denver in the mid-1900s are utilized to produce dual-sex and single-sex regression equations for the six long bones of the limbs (humerus, radius, ulna, femur, tibia, and fibula) and for the combined femur+tibia length. All measurements are from radiographs and are of diaphyseal length. Examples show that similar results can be obtained using a two-step process of "ballpark" estimation from published tables of the Denver data, but these new regressions allow a one-step standard error estimate for the means. Regressions are further compared with those previously published by Finnish researchers, which are generally broadly comparable. More routine stature estimation in subadult cases is encouraged both as an aid to possible identification and as a test of the available regression equations.     

Multi-Rater Agreement Using the Adapted Fracture Healing Scale (AFHS) for the Assessment of Tubular Bones on Conventional Radiographs: Preliminary Study*

Better understanding of the timing of fracture healing may help in cases of interpersonal violence but also of personal identification. The intra- and inter-rater agreement for the adapted fracture healing scale (AFHS) assessing the post-traumatic time interval on radiographs were tested. This is a preliminary study, providing essential information on method reliability for upcoming studies using the AFHS. Five raters (two radiologists, a forensic pathologist, an orthopedist, and an anthropologist) were presented with a test in three parts consisting of 85 radiographs (from 30 adults) of fractures of tubular bones in different stages of healing purposefully selected from more than 1500 radiographs. The raters were firstly asked to assess 15 features describing fracture healing as present, absent, or not assessable. Thereafter, the raters were asked to choose from the AFHS a single-stage best representing the observed healing pattern. The intra- and inter-rater agreement were assessed using single-rating, absolute agreement, two-way mixed-effects intra-class correlation (ICC) coefficients. The intra-rater ICC of radiologist 1 ranged from 0.80 to 0.94. The radiologists’ inter-rater ICC ranged from 0.68 to 0.74, while it ranged from −0.01 to 0.90 for the other raters. The good to excellent ICC among the radiologists and forensic anthropologist provides good foundation for the use of the AFHS in forensic cases of trauma dating. The poor to good results for the other physicians indicate that using the AFHS requires training in skeletal anatomy and radiology.     

Estimation of stature in children from radiographically determined metacarpal length

Whether radiographically determined second metacarpal diaphyseal length could provide a reliable estimator of stature in children was investigated. The data consist of measurements of stature and 1597 left hand-wrist radiographs of children from 1 to 7 years of age from rural Guatemala. The errors in estimating stature in children from metacarpal length are comparable to those from equations estimating stature from long bones. It is concluded that second metacarpal length may be a reliable and practicable referent for the estimation of stature in children.     

The correlation between skull fractures and intracranial lesions due to traffic accidents

In this study, it was aimed to investigate the relationship between skull fractures and intracranial lesions following head injury. For this purpose, 500 cases, which were referred to the Third Committee of Council of Forensic Medicine in Istanbul due to traffic accidents by the courts of laws between 1998 and 2000, were examined retrospectively. They were categorized in 3 groups based on findings of their cranium x-rays and brain tomographies. 1- The cases who have fractures in skull bones with brain lesions 2- The cases who have fractures in skull bones with no brain lesions 3- The cases who have brain lesions with no skull fractures. They were examined in detail according to age, sex, localization of skull fractures and brain lesions, and if surgery was applied or not.Of the cases, 152 (30.4%) had only linear fractures, 69 (13.8%) had depressed fractures, 92 (18.4%) had linear fractures plus intracranial lesions, 49 (9.8%) had depressed fractures plus intracranial lesions and 138 (27.6%) had only intracranial lesions. The rate of intracranial lesion among the cases with the skull fracture was 38.9% (141/362), while the rate of skull fracture among the cases with the intracranial lesion was 50.3% (141/279) (P < 0.001). Male to female ratios were 2.4/1 for linear fractures, 5.2/1 for depressed fractures, and 3.5/1 for intracranial lesions. Linear fractures were more frequent among females whereas depressed fractures were often among males (chi2: 9.68, df: 4, p: 0.046). The mean age was 26.3. The rate of depressed fractures was higher the age groups of 0-30 years. (chi2: 16.28, df: 4, p: 0.003). Depressed fractures in the regions of frontal and parietal and, linear fracture in the regions of temporal and occipital were found at higher rates (P < 0.001).In conclusion, we reviewed skull fractures and/or intracranial lesions due to traffic accidents, and found depressed fractures to be more common among males whereas linear fractures to be more common among females and young males. In the male, the skull architecture is thicker and stronger than females and young males. We can state that presence of skull fractures lowers the incidence of intracranial lesions by lowering the intracranial pressure.     

122例鼻部骨折X线和CT诊断的法医学分析

目的　探讨CT在鼻部骨折诊断中的优点。方法　观察 12 2例鼻损伤伤者的鼻部CT和普通X线片 ,对鼻部诸骨骨折进行对比分析。结果　 12 2例鼻部骨折 (鼻骨骨折 3 2例 ,上颌骨额突骨折 3 3例 ,鼻中隔骨折 9例 ,多发性骨折 48例 )均经CT认定。其中 40例因X线片漏诊直接通过高分辨率鼻骨CT薄层扫描认定 ;82例通过鼻骨侧位X线片显示有鼻部骨折 ,因存在骨折类型认定不准确和 /或有漏诊鼻部其它部位骨折可能 ,通过鼻骨CT认定。结论　鼻骨侧位X线片易漏诊、误诊鼻部骨折 ;鼻骨CT能避免鼻部诸骨骨折的漏诊及误诊 ,且骨折认定准确。     

Forensic medical assessment of the skull bone fractures owing to blow impacts depending on anatomical characteristics and a nature of a trauma-causing objects

Fractures in bones of the skull base (BSB) are preconditioned by the contact zone of interaction between the two below surfaces, i.e. the trace-forming one (object) and the trace-receiving one (bone). On the basis of their independent research, the authors suggest a set of criteria for the expert evaluation of fractures in BSB for the purpose of specifying the properties of the trauma-causing object, which is made with due regard for the anatomic specific features of the trauma zone.     

Postnatal ontogenesis of the tibia. Implications for age and sex estimation

The growth of five variables of the tibia (diaphyseal length, diaphyseal length plus distal epiphysis, condylo-malleolar length, sagittal diameter of the proximal epiphysis, maximum breadth of the distal epiphysis) were analysed using polynomial regression in order to evaluate their significance and capacity for age and sex determination during and after growth. Data were collected from 181 (90♂ and 91♀) individuals ranging from birth to 25 years of age and belonging to three documented collections from Western Europe. Results indicate that all five variables exhibit linear behaviour during growth, which can be expressed by a first-degree polynomial function. Sexual significant differences were observed from age 15 onward in the two epiphysis measurements and condylo-malleolar length, suggesting that these three variables could be useful for sex determination in individuals older than 15 years. Strong correlation coefficients were identified between the five tibial variables and age. These results indicate that any of the studied tibial measurements is likely to serve as a useful source for estimating sub-adult age in both archaeological and forensic samples.     

Forensic-medical significance of the characteristics of gunshot perforating fractures of the skull bones

The study was made of gunshot perforating fractures of calvarial bones in cases of lethal perforating head wounds in long distance shots from a 9-mm Makarov gun. Morphological characteristics of inlet and outlet perforating fractures and bone fragments were found to differ. Gunshot fractures in calvarial bones inflicted by bullets from a 9-mm Makarov gun were studied in experiments with different kinetic energy. In low kinetic energy, bullets make oval holes on the outer table of the skull and round holes on the inner table with radial prominences on the walls of bullet channels, large bone fragments; in moderate kinetic energy--make round holes in the outer table and oval on the inner table with skew prominences on the walls of the outlet part of the channels, large and middle-sized flat bone fragments; in high kinetic energy injuries on both tables were round, prominences were cross, bone fragments were flat, small and middle-sized.     

Hyperostosis frontalis interna as an age-related phenomenon – Differences between males and females and possible use in identification

Hyperostosis frontalis interna (HFI) is a condition manifested by thickening of the inner surface of the frontal bone and it could be useful when dealing with the identification of human remains in various anthropological and forensic investigations. We compared the macroscopic appearance and morphologic (metric) features of the skulls in cases with and without HFI, in both sexes, and wanted to establish whether age determined occurrence of HFI. To achieve this aim, we performed prospective autopsy study, covering ten-year period (2007–2016). Study group consisted of southeast Europe Caucasian subjects, with determined age and sex. The severity of HFI was classified by two forensic pathologists independently, according to the four types (A–D) proposed by Hershkovitz et al. Thicknesses of the frontal and temporal bones, as well as the longitudinal and frontal diameters of the skulls were measured. The sample consisted of 35 males and 112 females with HFI, and 55 males and 202 females without HFI (404 individuals in total). Type B was the most common type of HFI among males (45%) and type C among females (41%). HFI type D was almost four times more common in females than in males (OR?=?3.73). Frontal and temporal bones were thicker in all subjects who have HFI. Thickness of the skull was not age-dependent, in the entire sample, or in subjects with HFI, or in the control group (in all the cases Spearman's Rho was <0.3). Age seemed to be a predicting factor for HFI occurrence only in females. Females younger than 55?years have similar risk for HFI occurrence as males. An unidentified skull with the general markers of old age and severe form HFI is most probably from a female decedent.     

The determination of the age of an individual by the morphological signs of the pubic symphysis

The series of 365 pelvic bones from the area of pubic joint (195 female and 170 male) were studied. The author developed regression equations to determine individual age on the basis of the results of age dynamics study in relation to 5 morphologic characteristics of pubic joint (joint surface, front and rear borders, upper and lower ends). This method makes it possible to determine individual age within the interval of 15-90 years of age (mean error 7.23 years, correlation factor 0.9261).     

Age estimation by measuring the racemization of aspartic acid from total amino acid content of several types of bone and rib cartilage: a preliminary account

Age estimation has been often performed based on the rate of aspartic acid racemization using bones. In this study, we investigated various kinds of bone and a cartilage for suitability to estimate age by racemization. Ten male cadavers aged 22 to 77 years at death were selected, and bone specimens and cartilage were taken from seven sites in each individual. The rate of racemization of aspartic acid among total amino acid contained in each specimen was analyzed by gas chromatography. The correlation coefficient between the rate of racemization and chronological age was relatively high in the sternum, skull, and femur. The rates of aspartic acid racemization were high in the costal cartilage, femur, and skull. In addition, we found that the rate of racemization was only slightly lower after the second irrigation than after the first irrigation in femur and skull bone specimens, but those of others were significantly lower. These findings showed that among the six different bones and rib cartilage, the skull and femur might be used most effectively for age estimation using total amino acid fraction.     

Spectrophotometric and tristimulus analysis of the colors of subcutaneous bleeding in living persons

Skeletal injuries are often strong indicators of child abuse and their detection is therefore crucial. The aim of this study was to compare the sensitivity of three diagnostic approaches, namely autopsy, traditional (conventional) radiology, and computed tomography on "battered" piglets, in order to verify the sensitivity of each method, with respect to the true number of bone fractures assessed once the piglet was skeletonised (osteological control). Four newborn cadaver piglets who had died from natural causes were severely beaten post-mortem in every district of the body. Traditional radiography, computed tomography (CT) and autopsy were performed. The piglet was then macerated until skeletonised and the number of all fractures present recorded (osteological control). On the cranium, traditional radiology revealed only 35% circa of actual fractures, autopsy detected only 31% (P<0.01 for both comparisons versus osteological control), whereas CT imaging detected all fractures actually present. For ribs, radiology detected only 47% of all fractures present, and autopsy 65% circa (P>0.05 for both comparisons versus osteological control), while CT scans detected 34% (P<0.01). In suspected cases of fatal child abuse, we suggest that the bones of specific districts be directly analysed either at autopsy or by collecting specific diagnostic sites, such as parts of the rib cage, and subjecting them to maceration. The removed areas could be replaced with artificial material for cosmetic purposes. The authors stress the importance of combined radiological, CT scan, autopsy and osteological survey in the detection of perimortem bone fractures.     

颅骨骨折断面细微结构的观察研究

作者利用扫描电子显微镜,对颅骨骨折断面上微细结构的形态学特征进行了观察与研究,发现在颅骨骨折断面上有微细的骨折裂线,向断面深部的骨质中延伸,其宽度为5至100um不等,主要分布在颅骨外板内,或外板与板障的交界处.分布于板障内的微细裂线可造成骨小梁横行、纵行和螺旋形骨折.骨折时,骨基质中的胶原纤维束可被分离或断裂,各胶原纤维层可分开.骨内血管可被骨折裂线横断或纵形撕裂,损伤的血管可被从哈佛氏管中拉出.生前骨折时,在微细裂线的深方可清楚见到纤维蛋白网和红细胞相互粘集,死后骨折则未见到此现象.本文还探讨了颅骨骨折发生的机理和推断生前骨折的可能性.