掌骨骨折致伤方式法医学鉴定附27例分析

目的探讨掌骨骨折的形成机制,为掌骨骨折致伤方式的法医学推断提供参考。方法通过对27例致伤方式明确的掌骨骨折案例进行回顾性分析．对不同部位、性质的掌骨骨折结合其致伤方式进行损伤机制分析,并分类统计。结果诸掌骨中以第5掌骨骨折最为常见。就部位而言,又以基底部骨折最为常见,多见于间接暴力传导作用所致;其次为掌骨颈骨折．往往为纵向暴力作用所致。常见于攻击伤、撞击伤;掌骨头骨折常见于握拳时暴力直接打击所致;掌骨体横行或粉碎性骨折为直接暴力作用所致．斜形或螺旋形骨折多为旋转暴力作用所致。结论根据掌骨骨折的部位、性质,通过分析其骨折的形成机制,可以推断其致伤方式,从而为司法鉴定提供有力证据。     

浮肩损伤的法医学鉴定15例分析

目的探讨浮肩损伤(floatingshoulderinjury,FSI)的法医学鉴定。方法回顾性分析1993年1月至2006年1月受理的FSI法医鉴定案件15例,其中肩胛颈骨折15例(首次X线漏诊7例),合并同侧锁骨干骨折13例,锁骨远端骨折2例。均于受伤后至少6个月进行法医学检查,全部进行X线拍片,必要时行CT三维重建及MRI检查,结合伤者的症状、体征及关节功能的检查情况,从肩关节活动范围、疼痛程度、局部肌力等几个方面综合评价其功能。结果参照Herscovici的疗效标准:良2例(13%)、可4例(27%)、差9例(60%)。依据GA35-92,GB18667-2002标准,评定为6级2例,7级9例,8级2例,9级1例,10级1例。结论FSI是一种高能量的特殊损伤,合并伤及多发伤发生率高,早期易被掩盖,导致漏诊、误诊、延误治疗。法医鉴定时应充分认识FSI的特殊性,全面客观分析,综合评价肩部功能,防止误鉴及漏鉴。     

Sudden Death by Spontaneous Epiglottic Hematoma Secondary to High Blood Levels of Warfarin

A 67‐year‐old man was found dead, at his home. On external examination, we found a voluminous purplish black ecchymosis of the anterior neck area. On internal examination, we found a voluminous epiglottis hematoma completely obstructing the upper airway. It was associated with other sites of intra‐abdominal hemorrhage. Toxicological studies revealed the presence of warfarin at a concentration of 8.4 mg/L in peripheral blood, which supposes an INR well above 4.5. To conclude, we supposed death was due to asphyxia secondary to a spontaneous epiglottic hematoma caused by a high blood concentration of warfarin. Hemorrhage in the epiglottis is very rare. To our knowledge, our patient is the only case of “sudden death” reported with spontaneous epiglottic hematoma due to high blood concentration of warfarin. In forensic practice, an anterior neck ecchymosis, without trauma, may suggest hemorrhage into soft airway tissues. Pathology findings make it possible to exclude exogenous trauma.     

Bilateral First Rib Anomalous Articulations with Pseudarthroses Mimicking Healing Fractures in an Infant with Abusive Head Injury

Bilateral symmetric bone nodules were observed in the anterolateral first ribs of an infant with shaking injuries at autopsy. The location prompted diagnostic considerations of healing fractures versus anomalous articulations with pseudarthroses. The forensic pathologist worked with forensic anthropologists and pediatric radiologists to evaluate autopsy findings and compare premortem and postmortem X‐rays. Gross examination of the bones by the pathologist and anthropologists confirmed bilateral, callus‐like bone nodules in first‐rib locations associated with pseudarthroses. Histologic examination of one of the bones further showed features most consistent with pseudarthrosis, not a healing fracture. Radiologists then compared multiple premortem and postmortem radiographs that showed no remodeling of the bone over a 2‐week interval between the time of injury and death, which would be unexpected for a healing fracture in an infant. This multidisciplinary approach resulted in the appropriate diagnosis of pseudarthroses due to anomalous articulations, an uncommon finding in forensic pathology.     

Blast Injury and the Human Skeleton: An Important Emerging Aspect of Conflict‐Related Trauma

Recent decades have seen an accelerating trend in warfare whereby a growing proportion of conflict‐related deaths have been caused by explosions. Analysis of blast injury features little in anthropological literature. We present a review of clinical literature that includes prevalence of injury to anatomical regions and potential indicators of blast injury which can be used by forensic anthropologists. This includes high prevalence of extremity (22.8–91.2%) and facial (19.6–40%) injury in combat contexts, lower limb fractures (19–74.3%) in suicide bombing, traumatic amputation (3–43%) and diffuse fracture patterns in terrorist bombings. Potential indicators of blast trauma include blowout fractures in sinus cavities from blast overpressure, transverse mandibular fractures, and visceral surface rib fractures. Ability to recognize blast trauma and distinguish it in the skeleton is of importance in investigations and judicial proceedings relating to war crimes, terrorism, and human rights violations and likely to become increasingly crucial to forensic anthropology knowledge.     

Petechial Hemorrhages and Ethanol in Deaths from Intoxication

Petechiae in conjunctivae and in the palpebrae/skin of the eyelids are of particular interest for the forensic pathologist, because of their association with pressure on the neck. They have been described in the eyelids of intoxicated persons both in case reports and in text books of forensic pathology. We studied 590 deaths caused by intoxication, and 75 had petechiae either in the conjunctivae, the eyelids, or in both locations. We examined the influence of drugs and ethanol on the location of the petechial hemorrhages in these deaths. Deaths with ethanol in blood and in urine/vitreous humor more often had petechiae in both locations than those without. This association was statistically significant, independent of body position and livor mortis. No association between the location of petechiae, medicinal drugs, or narcotics was found. These results suggest that ethanol may contribute to the development of petechial hemorrhages in deaths from intoxication.     

肋骨骨折影像学在法医鉴定中的应用及相关问题

肋骨骨折法医学的诊断主要依靠医学影像学检查结果,影像学的误诊或漏诊将直接影响鉴定意见的准确性,从而可能导致刑事或民事案件的审判错误。本文详尽地总结和分析了肋骨骨折各种影像学检查技术的优缺点、漏误诊原因、法医学鉴定现状及法医鉴定时需考虑的因素,以提高法医学鉴定的准确性。     

MSCT及图像后处理在鼻骨骨折法医鉴定中的应用

目的探讨多层螺旋CT(MSCT)及图像后处理在鼻骨骨折法医学鉴定中的应用价值。方法采用MSCT对134例被鉴定人进行薄层扫描并行多平面重建(MPR)和表面遮盖成像(SSD)。比较MSCT与常规X线诊断结果。结果线型骨折55(41.04%)例,粉碎型骨折46例(34.33%),凹陷型骨折27例(20.15%),未见骨折6例(4.48%)。X线平片及CR片漏、误诊48例(35.82%)。MSCT正确诊断133例(99.25%)。两者诊断结果存在显著差异(χ2=45.0816,P<0.001)。结论MSCT及后处理图像应作为鼻骨骨折法医鉴定的主要依据。     

Forensic Analysis of a Contact Lens in a Murder Case

Contact lenses have had rare relevance in trials and/or investigations. After 5 years of burial, orbital remnants were retrieved from an exhumed body and subsequently identified as a key piece of material evidence in a murder trial. The exhumed case materials were evaluated under laboratory conditions and were determined to be contact lens remnants. Contact lens fracture and burial simulation studies were performed to provide additional corroboration of the physical findings of the exhumed contact lens remnants. This material evidence was instrumental in providing factual proof refuting the defendant's testimony in the murder trial. A brief history of contact lens composition and use is provided for understanding the methods and observational results. This forensic case study represents the first published documentation of a contact lens from an exhumed body being used in a murder investigation and establishes an operational procedure for future forensic contact lens examinations.     

Structural analysis of human rib fracture and implications for forensic interpretation

Patterns of rib fractures are of significant clinical and forensic interest. Linking patterns of rib fracture with specific physical events provides a foundation for understanding the nature of traumatic events that are associated with rib fracture in forensic contexts. In this study, isolated human ribs (n = 8) were end-loaded to failure to investigate: (i) local deformations (bone strain) prior to and during structural failure, (ii) location of ultimate failure, and (iii) fracture mode. Structural properties of ribs were used to calculate theoretical stresses to determine whether such calculations could be used to predict site of fracture. Ribs fractured on the sternal side of midshaft in all experiments, but mode of failure varied with transverse, buckle, spiral, and "butterfly" fractures observed. Comparison of calculated stress with observed strain values suggest that experimental, rather than theoretical, approaches will be most productive in furthering understanding rib fracture in forensic contexts.     

Perimortem or Postmortem Bone Fractures? An Experimental Study of Fracture Patterns in Deer Femora*

The determination of perimortem trauma is important for forensic anthropologists. Characteristics of bone fractures such as sharp edges, presence of fracture lines, the shape of the broken ends, fracture surface morphology, fracture angle on the Z-axis, and butterfly fractures are said to differentiate perimortem from postmortem trauma. A Drop Weight Impact Test Machine was used to break 76 deer femora of various ages since death. The results of this study suggest that the characteristics listed above are unreliable at differentiating a perimortem fracture from a postmortem fracture in a forensic case. There are, however, statistically significant differences between fresh bones broken less than 4 days old and dry bones broken 44 days or 1 year old after death.     

Trichobezoar in Vagina: Assessment for Child Sexual Abuse and Diagnostic Result of Forensic Science

Vaginal discharge and bleeding in children require a through and thoughtful evaluation to diagnose the underlying problem including infections, sexual abuse, and vaginal foreign bodies. We report a 6‐year‐old girl presenting with bloody vaginal discharge, carefully evaluated for sexual abuse, and finally diagnosed as a vaginal foreign body after vaginoscopy. A rolling hair ball was extracted from the vagina and was diagnosed as trichobezoar pathologically without any endo–ecto‐mesodermal residual tissue. The hair ball was genetically detected and diagnosed to belong herself by containing no foreign structure. Child sexual abuse was ruled out by forensic interview at CAC and report of forensic science that reported genetic structure belonging to the child. Medicolegal assessment helped in final diagnosis to exclude child sexual abuse.     

Patterns of Trauma Induced by Motorboat and Ferry Propellers as Illustrated by Three Known Cases from Rhode Island*

Abstract: Understanding patterns of trauma is important to determining cause and manner of death. A thorough evaluation of taphonomy, trauma, and bone fracture mechanisms is necessary to reconstruct the circumstances of the death. This study examines the skeletal trauma caused by boat propeller strikes in terms of wound characteristics and location based on three cases from Rhode Island. These case studies review the traumatic characteristics caused by propeller injuries and highlight the anatomic regions most likely to sustain skeletal trauma. With this information, investigators may be able to identify propeller trauma even in severely decomposed remains. The discussion of boat propeller trauma also raises issues regarding how forensic anthropologists and forensic pathologists classify trauma (specifically blunt force vs. sharp) and highlights semantic issues arising in trauma classification. The study also discusses why these propeller cases should be classified as blunt trauma rather than sharp or chop/hack trauma. Ultimately, the authors urge consistency and communication between pathologist and forensic anthropologists performing trauma analyses.     

螺旋CT三维重建在肋骨骨折法医临床鉴定中的应用

目的探讨螺旋CT三维重建评价肋骨骨折在法医临床中应用价值。方法收集肋骨骨折35例,分别采用X线摄片、CT扫描及螺旋CT三维重建检查。结论35例检查都取得清晰的立体图像,且可以消除周围组织结构,单独观察肋骨骨折情况。结果:螺旋CT三维重建在肋骨骨折的诊断、法医临床学中有较高的价值。     

单纯性眶壁骨折法医学鉴定130例分析

目的 分析眶壁骨折的损伤特点,探讨眶壁骨折的法医学鉴定要点.方法 收集2010 2012年在某市公安局涉及单纯性眶壁骨折的130例案件进行回顾性分析,主要包括年龄、性别、致伤物、眶壁骨折的部位和形态、眶内及眶周的复合性损伤以及伤后6个月回访等. 结果 130例案例中,青壮年男性伤者比例较高,主要为拳头击打,单纯性眶内侧壁骨折的比例最高（81.5％）,眶内及眶周复合性损伤致眼睑挫伤（挫裂创）和筛窦（上颌窦）积血最为常见,6个月回访发现眶壁粉碎性骨折30例伤侧眼较健侧眼球略有凹陷. 结论 单纯性眶内侧壁骨折不宜评定轻伤,应待伤情稳定后再予以评定,全面详细的眼科检验是单纯性眶壁骨折鉴定的必要前提.     

眼眶骨折的影像学诊断及法医学评定

在眼眶骨折的法医学鉴定中常常出现漏诊和误诊。目前影像学技术在研究眼眶骨折的法医学特点和评价外伤的严重程度中有重要的意义。本文综述了眼眶骨折的分类、发病机制和影像学诊断的特点,对于眼眶骨折的法医学评价和鉴定有较好的帮助。     

Explosion Scene Forensic Image Interpretation

Image interpretation is an important aspect in the field of forensic science; however, it is seldom reported how to use these techniques in explosion scene forensic investigations. On 12 August 2015, a series of explosions killed 165 people and injured hundreds more at a container storage station at the Port of Tianjin. In this study, we applied image interpretation methods to determine the seat of the explosion by analyzing low‐quality video clips of the event. The interpretation fits well with recently published standard operating procedures, including the hypothesis, evaluation, inference, and confirmation. Image processing was adopted to enhance the images while the explosion scene was reconstructed with the same images. Some important features were extracted and utilized to distinguish whether the flashes were caused by reflection or a real blast. We reveal the real explosion location, which guides the overall investigation. The results indicate that image interpretation is a powerful tool for forensic investigators to analyze low‐quality images in complicated explosions or fire accidents.     

家庭暴力致骨折损伤机制分析1例(英文)

本文报道了一名37岁女性遭受丈夫殴打,造成下肢受伤。医院诊断为右髌骨和左胫骨骨折,伤者遂接受了切开复位内固定术。由于丈夫否认对其实施家庭暴力,声称其下肢骨折系交通事故坠落伤。警方遂委托对该女性的损伤进行法医学鉴定。经过审阅X线和CT检查资料,结果为伤者右侧髌骨骨折、左胫骨骨折,以及左眶内侧壁骨折。鉴定意见为髌骨的横向骨折系由肌肉的牵拉暴力引起,左胫骨损伤符合直接和间接外力所致,左眶内侧壁骨折在施暴期间形成的可能性较大。本文阐述了运用影像学技术对家庭暴力案件与交通事故损伤进行鉴别,强调了影像学技术在法医临床鉴定中的应用价值。     

An unusual blunt force trauma pattern and mechanism to the cranial vault: Investigation of an atypical infant homicide

This case report presents an unusual fracture pattern in the cranium of a four-month-old infant indicative of child abuse. Upon postmortem examination, the infant presented with numerous bilateral linear cranial fractures running perpendicular to the sagittal suture with depressed and curvilinear fractures apparent on the supra-auricular surfaces of the cranium. Histological evidence indicates multiple traumatic events to the cranium. In addition, the stair-step pattern of a parietal fracture may represent multiple contiguous fractures from repeated loading of the head at different times with variation of the focal points of compressive force. Additionally, the left humerus, left radius, and left ulna have healing metaphyseal fractures, and the left ulna also has an antemortem diaphyseal fracture which resulted in the distal metaphysis being rotated 45 degrees medially. Integration of autopsy, anthropological, and neuropathological reports for this case suggest multiple inflicted injury episodes with a repeated atypical mechanism(s) to the cranial vault of the infant. During investigative interviews, the caretaker admitted to squeezing the infant's head and neck on multiple occasions to quiet the child. This reported abusive mechanism is consistent with the pattern of symmetric cranial fractures and soft tissue injuries indicating asphyxiation. This case report provides forensic investigators with a potential trauma mechanism to explore in cases when a similar pattern of cranial trauma is observed and highlights the need for greater research on fracture propagation and fracture healing in the infant cranium.