Radiographic comparison of a fractured clavicle exhibiting a pseudo-arthrosis

Bone remodeling is a natural process that is potentially problematic for radiographic comparisons because it can occur after antemortem (AM) imaging, thus interfering with the comparability of AM and postmortem (PM) radiographs from the same individual. While the effects of age-related remodeling have been studied, limited attention has been given to trauma-related remodeling with respect to radiographic comparisons. This report adds to the latter topic by presenting a case of AM clavicle fracture that developed into a pseudo-arthrosis over a 12-month period prior to the individual's death. Even though remodeling was discernable along the fracture margins, adjacent skeletal features on the PM radiograph remained unaltered and constituted compelling evidence for the identification. This case illustrates the potential of using both normal and pathological anatomy concurrently to maximize the surety of findings from radiographic comparisons.     

Sexual dimorphism of the scapula and the clavicle in a contemporary Greek population: applications in forensic identification

Sex estimation is the grounds for an accurate identification of unknown human skeletal elements. The need for reliable methods distinguishing males from females based upon various skeletal elements is evident in cases of commingled, eroded and/or missing remains. The aim of this work lays on establishing criteria for sex estimation from the scapula and the clavicle in modern Greeks. A total of 147 left scapulae and 147 clavicles (66 females and 81 males) were used in the study. Eight and six measurements were taken on the scapula and clavicle respectively and data were subjected to principal components analysis (PCA) and discriminant function analysis (DFA). Posterior probabilities for the classification of each individual are also calculated. Statistical analysis was carried out using the software PAST (Paleontological Statistics) and SPSS (Statistical Package for Social Sciences) 18. The results supported the existence of pronounced sexual dimorphism, which was mainly attributed to size differences among the two groups. Univariate and multivariate methods of statistical classification showed high accuracy for all scapular and most clavicular measurements, verifying their value as sex indicators in the under study population. We recommend the use of this method for sex assessment from the scapula and the clavicle in cases exhibiting over 95% probability of correct classification. This is regardless of the overall high degree of accuracy reported here, as the method of choice in forensic contexts should always be case-driven.     

Establishing personal identification based on specific patterns of missing,filled, and unrestored teeth

The primary goal of this research is to examine the overall utility of nonradiographic dental records for the establishment of individual identifications. It was found that even without radiographic lines of comparison, charts and notes that accurately detail a missing individual's antemortem dental condition can be essential for establishing an identification. Based on an analysis of two large datasets, individual dental patterns were determined to be generally unique, or at least very uncommon. Through this type of empirical comparison, it is possible to establish a strong, quantifiable association with a missing individual. The results of this research indicate that a definitive number of points of concordance do not need to be established in dental identification cases. Each case must be assessed individually. The critical factor is to remove subjective judgment calls from dental comparisons. This research has proposed a new method of empirical comparison that allows forensic odontologists to derive objective frequency information regarding the occurrence of specific dental patterns in the general population. The method is similar to that used for mtDNA casework, and a computer program (OdontoSearch) has been developed to make the technique accessible. It was found that even a small number of common dental characteristics may produce a very rare dental pattern, a point that may be counterintuitive to many forensic odontologists.     

Identification of unknown human remains by comparison of antemortem and postmortem radiographs

The identification of unknown human remains by comparison of ante mortem and post mortem radiographs has found wide acceptance in recent years. This report documents two recent cases in Hong Kong in which unequivocal positive identifications were achieved by comparison of radiographs. In both cases, comparison of radiographs was the only available means of establishment of personal identity. The first case involved the identification of a very badly burned body of a 22-year-old male by the matching of the ante mortem and post mortem radiographic images of the cranial base (in particular the sella turcica), hard palate, paranasal air sinuses, mastoid air cells, the lambdoid suture, and the upper molar teeth as revealed on comparable lateral skull films. The second was the identification of a deliberately mutilated torso of a 28-year-old female by comparison of the radiographic images of the lumbar spine, pelvis, and head of the femur as revealed on plain abdominal films taken before and after death. While evidence of injury or surgery did not figure in either of the identifications, the presence of a mild scoliosis and the absence of the twelfth ribs aided identification in the latter case. Emphasis is placed in this account on the value of radiographic comparison as a means of identification because it draws upon the matching of intricate and highly individual patterns of external and internal bony anatomy that are stable over long periods of time. In cases where ante mortem radiographs and photographs are available, establishment of personal identity by comparison of radiographs is deemed preferable to identification by photographic superimposition because radiographic comparison permits the matching of a potentially larger number of unique anatomical features and is less time consuming and technically exacting.     

Fingering a Murderer: A Successful Anthropological and Radiological Collaboration*

Abstract: We illustrate an interdisciplinary approach to identify a victim in a case with complex taphonomic and procedural issues. Burning, fragmentation, species commingling, and examination by multiple experts required anthropological preparation and analysis combined with radiographic adaptations to image and match trabecular patterns in unusually small, burned specimens. A missing person was last seen in the company of a reclusive female on a remote rural property. A warranted search found several burn sites containing human and animal bones. Fragment preparation, analysis, and development of a biological profile by anthropologists enabled examination by the odontologist, molecular biologist, and radiologist, and justified use of antemortem radiographs from one potential victim. Visual and radiological comparison resulted in a positive (later confirmed) identification of the victim by radiological matches of three carpal phalanges. Although some dimensional changes are expected with burning, morphological details were preserved, aided by selection of relatively intact, small bones for comparison.     

Implant Bone Integration Importance in Forensic Identification

Odontological identification consists of the comparison of antemortem dental information regarding a missing person with postmortem data from an unidentified corpse or human remains. Usually, the comparison concerns morphologic features that the operator chooses among all the visible characteristics because of inter‐individual uniqueness; for this reason, implants can be of enormous assistance. A case concerning the recovery of a burnt oral implant, connected to a bone fragment, among 2780 charred bone fragments, suspected to have belonged to a victim of homicide, is presented to demonstrate that dental implants and their site of bone integration represent a very precious element for personal forensic identification. Because of their morphological invariability in time and because of their morphologic uniqueness, they were used as evidence to associate unidentified human charred remains to a missing person where DNA analysis failed to do so. The case illustrates the fundamental contribution, not yet described in literature, given by the clinical aspects of tooth replacement with dental implants to a forensic discipline. Clinical practitioners should therefore be aware of the great importance of their work and of dental records in a forensic identification scenario.     

Identification of human skeletal remains by comparison of bony details of the cranium using computerized tomographic (CT) scans

A case is described where a cranium from an unknown individual is identified by comparison of antemortem and postmortem computerized tomographic (CT) images of the bony structure of the skull. While on at least one occasion CT scans of individual cranial landmarks have been used to identify unknown remains, this study is remarkable because positive identification of a deceased individual was accomplished by performing a CT scan on an unidentified cranium and comparing multiple landmarks and images with corresponding features in an antemortem CT scan of a missing man. Bony details of the frontal and sphenoid sinuses, ethmoid and mastoid air cells, sagittal cranial suture, and the torcula (the internal occipital protuberance) were exactly the same on both CT scans, confirming them as the same person.     

A Radiographic Study on the Utility of Cranial Vault Outlines for Positive Identifications

A standard method for positive identification is the use of antemortem and postmortem radiographic comparisons. The purpose of this research is to test the visual accuracy of antemortem and postmortem radiographic comparisons of cranial vault outlines and to evaluate their uniqueness using geometric morphometric methods. A sample of 106 individuals with varying levels of education and forensic case experience participated in a visual accuracy test. Of the 106 individuals, only 42% correctly assigned all of the radiographs, with accuracy rates ranging from 70 to 93% for each radiographic comparison. Vault shape was further examined using elliptic Fourier analysis, and paired t‐tests were computed on the first 10 principal components accounting for 100% of the variance, which found no significant differences. The visual accuracy test and elliptic Fourier analysis shows that vault outlines may not be unique enough for positive identifications when used as a sole indicator.     

Reconstruction of root morphology in skeletonized remains with postmortem dental loss.

A reversible technique is presented in which the root morphology of missing teeth in skeletonized human remains can be reconstructed for the purpose of radiographic comparison and postmortem identification. In this technique, which is based upon pilot studies with skeletonized mandibles of archival remains, the alveolar socket walls are sealed with a coat of cyanoacrylate cement and injected with a mixture of vinyl polysiloxane and barium sulfate. Radiographs are produced with the radiopaque mixture in place, which highlights the antemortem morphology of the roots. Subsequently, the impression material is removed, resulting in no gross alteration of the evidence. The radiographs made with this technique, as well as the impressions, can be stored for later use at a trial or pending the discovery of antemortem dental evidence.     

Craniofacial identification by comparison of antemortem and postmortem radiographs: two case reports dealing with burnt bodies

Two cases of positive identification of burnt bodies by radiographic comparison are reported. They emphasize that antemortem radiographs of the head are an important but sometimes overlooked source of information which can frequently provide useful objective data for comparison purposes. A positive identification can easily be achieved by medical examiners through visual comparison of the antemortem with the postmortem cranial and facial structures, even of bodies severely damaged by fire. In these bodies the radiographs of the skull can graphically depict structures which are often unique to the individual, such as the frontal sinus pattern and the morphology of dental restorations. However, the process of identification through radiographs is appropriate only in burnt bodies in which antemortem radiographs of the alleged deceased are available for comparison and unique craniofacial structures are still present on the body in a well-preserved state or at least not completely destroyed by fire, depending on the extent of the burn injury. Matching of corresponding features seems preferable to other methods of personal identification such as skull-photo superimposition, morphometric analysis, and/or other computer-aided methods since these techniques need trained personnel, as well as expensive equipment which is not invariably available in the medical examiner's office or department of anthropology.     

Resolution of small-scale commingling: a case report from the Vietnam War

A case is reported that involves the commingled skeletal remains of two individuals who died in a helicopter crash in 1969 during the Vietnam War. The incomplete portions of two bodies were initially recovered soon after the crash. These portions were identified by personnel at a U.S. Army Mortuary in Saigon and were returned to the next-of-kin. While searching for scrap metal in 2002, a Vietnamese citizen unexpectedly discovered human remains and personal effects interspersed with buried aircraft wreckage. The personal effects correlated with the individuals who died in the 1969 incident. These newly discovered remains and artifacts were subsequently received at the U.S. Army Central Identification Laboratory, Hawaii (CILHI) for analysis. As part of the CILHI analysis it was necessary to segregate the commingled remains into specific individuals for identification purposes. Details regarding various sorting techniques are described that provide a solid framework for systematically dealing with small-scale commingling. The sorting techniques used in the resolution of this case consist of visual pair-matching, articulation, process of elimination, osteometric comparison, and taphonomy. These techniques, when used in conjunction with each other, provided a solid basis for the individualization of most skeletal elements.     

Recognition by forensic facial approximation: case specific examples and empirical tests

The skeletal remains of one individual found near Adelaide in 1994, although not known at the time, were the first evidence of what was to be a serial killing reported to have resulted in the highest casualty list to date in Australia (12 victims). Since the usual methods of identification could not be used or were unsuccessful on these remains, facial approximations were produced and advertised over the 4-year period following their discovery, in an attempt to help to identify them. However, no identification was made. In 1999, the remains were reported to be identified by radiographic comparison. Approximately 3 months before this identification was made, another facial approximation was produced by the first author (CNS), but this face was never advertised in the media. Although rarely reported in the literature, this paper provides an example where facial approximation methods were not successful in a forensic scenario. The paper also reports on empirical tests of the facial approximation created by the first author to determine if this facial approximation might have been useful had it been advertised. The results provide further evidence that high resemblance of a facial approximation to the target individual does not indicate recognizability, as the facial approximation was poorly recognized even though it bore good resemblance to the target individual. The usefulness of facial approximation techniques is discussed within the context of this case and more broadly. Methods used to assess the accuracy of facial approximations are also discussed and further evaluated.     

Ellis Kerley's service to the military.

The purpose of this paper is to present the contributions Ellis Kerley has made to the United States Department of Defense in the area of forensic anthropology. His service began at the end of the Korean War in the identification laboratory established in Kokura, Japan, under the direction of T.D. Stewart. Ellis developed his research on the quantification of cortical bone microstructure as a means of age estimation while at the Armed Forces Institute of Pathology. In December 1985, Ellis was asked by the Army to form a commission to evaluate the Central Identification Laboratory, HI (CILHI). This lab is tasked with the mission of search and recovery and identification of American personnel killed or listed as missing from past military conflicts. Ellis's team reviewed the identification process and documentation, the qualifications of lab personnel, the adequacy of facilities and equipment, and some questionable cases. Their written report was supplemented with testimony in front of congressional committees. Ellis served as scientific director of CILHI from 1987 until 1991. In addition to overseeing the daily case work, he led several missions to Vietnam to examine human remains and served as spokesman for the lab. His input helped the lab gain needed scientific credibility. Despite the frustrations of trying to identify human remains within the Army's casualty and memorial affairs system, Ellis always maintained the utmost dignity, compassion, and respect for the victims and their families.     

Radiographic identification by mastoid sinus and arterial pattern

A skull and some incomplete postcranial remains were discovered in two searches over a two-month period near Santa Fe, New Mexico. The discoveries could be demonstrated to be from the same person, and the remains were shown to be consistent with a specific missing person on the basis of anthropological analysis. Further work led to a positive identification on multiple grounds, including agreement of the details of the mastoid sinus and endocranial arterial patterns observed radiographically. These features may be useful for establishing positive identification from skeletal remains when antemortem radiographic studies for comparison are limited to lateral cranial vault studies.     

Identification of a skeleton using DNA from teeth and a PAP smear.

Identification of unknown living or deceased persons using dental treatment records is an established forensic technique. However, some cases remain unidentified, especially when antemortem dental records are not available for comparison to postmortem dental records. Cytological smears have been previously reported to be potential sources of DNA reference samples which can be compared to DNA recovered from found human remains. The case described here involves an adult skeleton which exhibited extensive, complex dental restorative treatment. A putative identification of the found skeleton as a missing woman was established using circumstantial evidence found at the scene. However, it became important to establish a positive identification using reliable scientific methods. When it was discovered that antemortem dental records were not available because the treatment was completed in another country and the treating dentist could not be found, cytological smears stained with Papanicolaou (PAP) stain obtained from the putative decedent's medical records were used as a reference DNA sample. DNA was recovered from the teeth of the skeleton using cryogenic grinding. Comparison of the genotypes resulted in the conclusion that the DNA originated from the same source. The use of PAP smears in this way is seen as a valuable resource in cases where positive identification using traditional dental and medical records is not possible.     

A post-processing technique for cranial CT image identification

Objective: A major challenge in radiographic identification is the inconsistent orientation between clinical (ante-mortem, AM) and post-mortem (PM) radiographs. The objectivity and accuracy of radiological identification would be greatly enhanced by post-processing techniques that allow quantitative comparison of PM CT data in the same orientation as the AM CT data. Methods: We applied a post-processing technique to reposition a multislice computed tomography (MSCT) scan for spatial registration with a CT radiograph from the same patient. A second set of MSCT images from different individuals served as the non-matched control group. The consistency in radiographic positioning eliminated subjectivity in the comparison and identification process because the radiograph superposition provided objective evidence that confirmed the identification with fine detail. Results: A quantitative comparison with statistical validation was achieved by measuring a set of 14 landmarks from the images. Discrimination of identity based on logistic regression analysis of the earlier CT patient scans (the AM group) versus subsequent MSCT scans (the PM group) was objective and reliable. Conclusion: This quantitative comparison depends less on subjective judgment and the experience of the examiner, and so may meet legal standards.     

Enhancing accurate data collection in mass fatality kinship identifications: Lessons learned from Hurricane Katrina

A mass fatality DNA identification effort is a complex process in which direct matching and kinship analysis is used for identifying human remains. Kinship DNA identification is an important tool in the identification process in which victim's DNA profiles are compared to the profiles of “known” biologically related reference samples. Experience from the 9/11 World Trade Center DNA identification efforts showed that forms used to record biological relationships are important and that inaccurately documented information may hamper the kinship analysis and DNA identification process. In the identification efforts following Hurricane Katrina, a Family and/or Donor Reference Collection (FDRC) form was used as a means to document the reported relationship between the reference DNA donor and the purported missing individual. This FDRC form was developed based upon lessons learned from 9/11 and the Tsunami identification efforts. This paper analyses the effectiveness of the FDRC form used in the Hurricane Katrina kinship DNA identification efforts and proposes an improved sample collection form for kinship and other donor reference samples. The data presented can be used to enhance the accuracy of the data collection process through an improved sample collection form, streamlining the DNA kinship identification process and decreasing the burden on valuable resources.     

Nutrient canals of the alveolar process as an anatomic feature for dental identifications

Nutrient canals are anatomic structures of the alveolar bone through which neurovascular elements transit to supply teeth and supporting structures. A dental identification using a nutrient canal of the mandibular alveolar process as the most compelling anatomic feature for antemortem-postmortem radiographic comparison is described. Nutrient canals as a potential marker for clinical disease is also discussed.     

Video superimposition at the C.A. Pound Laboratory 1987 to 1992.

William R. Maples practiced many aspects of human identification using simple and relatively inexpensive video superimposition equipment. Identification of skulls by comparison to known photographs was a primary concern. Clear, smiling photographs revealing the spatial relationships of the teeth to one another led to uncomplicated positive identifications. However, without benefit of dentition, how accurate was an identification based on the alignment of soft tissues with the underlying skull? Most importantly, how often would a false positive result when anterior dentition were not available? A study conducted by this author and Dr. Maples used three human heads and 98 profile and full-face photographs. A 0.6% incidence of false match resulted when both views of the face were used. Lateral view and frontal view superimpositions were identified incorrectly in 9.6% and 8.5% of the sample respectively. As a result, multiple photographs from varying angles were requested for superimposition identity cases. Additional applications in laboratory case work were developed for the equipment. Light boxes under the television cameras allowed radiographic comparisons. Video taped comparisons of antemortem and postmortem radiographs were shown to medical examiners and families as proof of identification. Dr. Maples and this author were also involved in several cases in which photographs taken by a surveillance or ATM camera were compared to court ordered photographs of an alleged perpetrator. One case, which went to trial, led to the conviction of a habitual criminal under Florida statute. This individual had a condition known as Stahl's ear, a deformation of the cartilaginous structure. The ear was seen clearly in many of the ATM camera photographs and was aligned easily with the known photographic sample.