The role of stretching in the process of fracture formation

The author analyses various kinds of bone deformations. The stretching development and its influence on fracture formation are described in the article. Morphological signs confirming presence of stretching as a destroy moment are represented.     

The forensic medical determination of the site of the external application of force by the bone microdamages

The article deals with new approach to determination of site of outer force application. Investigation of bone grind pieces from zones of supposed external action resulted in detection of microfissures whose maximal concentration corresponded to the point of force application. It was stated that these microfissures precede fracture formation and occur as a result of bone loading due to plastic deformation. That's why even in bones which experienced prethreshold loads microfissures are always detected and used as expert criteria for determination of site of outer force application. Zones of soft tissue lesions, signs of permanent (residual) bone deformity in fractures of adjacent bones serve as reference points for cutting bone fragments out and using them to prepare bone grind pieces.     

Case report: Forensic anthropological assessment in a suspected case of child abuse from South Africa

Not many case reports of suspected child abuse as assessed solely on skeletal remains are available. Forensic anthropologists have intimate knowledge of normal skeletal anatomy, bone trauma and processes of healing of bone and may therefore be of help in suspected cases of child abuse. Patterns of trauma in juvenile skeletal remains which are suggestive of abuse include fractures in different phases of healing, multiple fractures, typical fractures on ribs and long bones and severe, complicated cranial fractures. The aim of this paper is to report on the findings of the analysis of the skeletal remains of a 3.5 years old boy. Forensic pathological examination indicated that the boy had died from a massive cranial fracture, with multiple injuries present to the rest of the body. After the body had been buried for some time, it was exhumed and we were requested to look for signs of chronic, long-term abuse. Findings included a massive cranial fracture, another fracture in the roof of the orbit, two areas of non-specific subperiosteal bone growth and several untreated carious teeth. No clear healed fracture could be found, except for a possible healed cranial base fracture which stretched transversely across the petrosal bone. This area showed signs of recent bone activity. The court decided that this was not enough evidence of chronic abuse and found the accused guilty of murder but not of chronic child abuse. This case illustrates the difficulty to obtain clear signs of chronic injury on juvenile remains.     

Forensic medical expert evaluation of gunshot injuries of brain skull

Forensic medical experts are offered a set of morphological signs which help identify the gunshot origin of a skull injury, identify which of the injuries is the inlet and which is the outlet, specify the direction of the shot and succession of formation of injuries in cases with several shots. The author suggests evaluating a gunshot wound in the head with due consideration for the mechanisms of its formation. From a complex of signs of a gunshot injury to the brain skull he singles out the tissue defect with a conical channel and the edge of bone defect, additional injury to the external compact plate near the inlet, and type, number, and location of the radial and concentric cracks. Analysis of the morphology of the above listed signs of gunshot injuries to the skull notable extends the potentialities of forensic medical expert evaluation in cases with gunshot 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。     

PMCT在机械性窒息方面的研究进展

机械性窒息是公安法医日常检案中最常见的死因之一.如何快速准确的判断死者是否为机械性窒息死亡、以及作案手段是判断案件性质、指引案件侦破方向的重要因素.在法医鉴定过程中,诊断机械性窒息需要结合尸体体表征象、尸体内部征象、组织病理学检验等多方面综合判断.PMCT在骨折的检测、异物的检测和气体的检测方面具有极大的优势,在许多国...     

A schematic representation of the thoracic skeleton for the analysis of multiple fractures]

A scheme of the thoracic skeleton (a superior projection) is suggested for practical forensic medical evaluation. The scheme presents concentrically arranged costal arches connected to the image of the breast bone and the thoracic portion of the spine, with the ordinal numbers of the ribs, vertebrae, and anatomic lines. Special marks indicate rib fractures and other associated signs (repeated injuries, bleedings, whether the injury was inflicted in life or was postmortem, etc.). After the scheme is filled in, one may analyze a three-dimensional image of the injuries to determine the site and direction of an external exposure and its order.     

Osteological case study to narrow the timing of postmortem trauma to a skull

In the course of an exhumation performed 5.5 years after death, several bone fragments were uncovered during the excavation of the clay-rich soil. Amongst others, there was a large piece of the frontal neurocranium. In addition, a so-called coffin stain was discernible. The exhumed coffin was intact. The forensic autopsy revealed a complete corpse with distinct adipocere formation. Consultation with the cemetery administration allowed the conclusion that the additional bone fragments were from the first use of the grave approximately 100 years ago. The heavily soil-encrusted skull fragment bore clear signs of a half sharp force, that could immediately be classified as postmortem. The pattern of injury pointed to an excavator as the cause. However, the question arose whether the postmortem trauma occurred 5.5 years ago during the excavation of the grave or during the current exhumation. First the skull fragment was dried. However, it was then impossible to remove the clay-rich soil without damaging the bone. The fragment was therefore carefully washed and dried again. The cut and fracture areas then showed distinctly lighter surfaces than the rest of the bone, which pointed to the exhumation as the time of origin. For comparison, fresh injuries were inflicted with a hatchet. These distinctly showed even lighter surfaces, so that the time of origin could be assumed to have been during the excavation of the grave 5.5 years ago.     

Massive fat and necrotic bone marrow embolization in a previously undiagnosed patient with sickle cell disease

A case of sickle cell disease diagnosed postmortem is described. A 37-year-old black woman presented with anemia, respiratory distress, and abdominal and back pain. Death followed an intramuscular injection of iron, and anaphylaxis was clinically diagnosed. At autopsy, massive fat and necrotic bone marrow embolization of pulmonary and renal vessels was found. In the vertebral column, multifocal areas of ischemic necrosis were present, and proved to be the source of this embolization. Sickled red cells appeared in bone marrow sinusoids, and signs of disseminated intravascular coagulation were present.     

Virtual autopsy and forensic identification-practical application: a report of one case

The body of an unidentified elderly woman was found trapped in a floodgate. Prior to autopsy, full-body multislice computed tomography (MSCT) was performed for study of bone lesions and cause of death. Age was estimated by analysis of the sternal end of the fourth rib and of the pubic symphyseal medial articular surfaces. The results were then compared with the autopsy findings. MSCT was superior to autopsy in diagnosis of traumatic bone lesions and also revealed dental anomalies and signs of drowning. Age estimation gave a similar result for both methods. This case report illustrates the potential value of MSCT for medico-legal investigations of death: diagnosis of injuries, possibility of determining the cause of death, and anthropological study in order to estimate age or to visualize features likely to enable identification of a corpse.     

Criteria of personal identification by the hyoid bone

We studied 16 sizes of the hyoid bone (HB) from 158 corpses of known gender, Russians, who had died at the age over 15 years by the K. Miller et al program (1998) and 205 back projection electroroentgenograms of the neck of patients of the traumatological hospital in the town of Kirov. HB skeletization was made by the enzymatic drug enzyme. SPSS package and multidimentional statistics (regression and discriminant analyses) were used for data processing. It was established that HB is an informative object of forensic medical personal identification allowing determination of the body length and gender as well as anatomical, x-ray and osteometric individual features. Precision of human body length diagnosis by HB is 6.71-7.26 cm. Therefore, this method should be used in combination with the diagnosis by long tubular bones. Diagnosis of human gender by osteometric signs of HB based on one-dimentional discriminant analysis is feasible in 80-85%, based on canonical discriminant analysis--in 91.1% cases. The method of anatomic, osteometric and roentgenological assessment of HB individuality can be used in personal identification by intravital x-ray of cervical organs and in traumatic defects of HB. The methods may be applied in forensic medical practice in expert examination of body fragments or isolated bone fragments.     

The morphology of the gunshot entry wound

The main signs of inlet gunshot wound inflicted from non-close shot distance are the following: central defect of the tissue, presence of abrasion and rub zones along the margins. During experimental study high variability of these signs was stated and new morphologic characteristics of inlet gunshot wound were detected.     

Forensic anthropology: developments of a classical discipline in the new millennium

The present brief review is a survey of the role of forensic anthropology (FA) in the new millennium. After an introduction which deals with the expanding definition of the discipline and the issue of professionality and training, the author approaches the role and novel developments of the field, with particular reference to the past 5 years. Such developments are discussed in a sectorial manner, distinguishing the role of research in the areas of forensic anthropology which deal with human remains and those that deal with the living. As regards the "human remains" domain, advances and stalls still present in the fields of species and postmortem interval determination, sexing, aging and attribution of ancestry are stressed. The need for standards in facial reconstruction and positive identification by bone morphology are underlined, as well as the growing role of the anthropologist in detecting signs of trauma. Finally, the relatively new role of the forensic anthropologist in the domain of identification of the living is described, although this area is still underrepresented as regards research activity: these studies concern the strive to devise methods for identifying faces (e.g. in the case of crimes registered by videosurveillance systems), aging living individuals or juveniles represented in pedopornographic material.     

Macroscopic findings for the exclusion of a forensic relevant soil embedded resting period in skeletal remains--an approach based upon literature

A reliable determination of the post mortem interval (PMI) in human bones has neither been found by morphological nor by intensive analyses of other kinds. In most cases of legal medicine practice the question of PMI is restricted to a forensically relevant resting period. In a survey based upon literature, all osteological signs of decomposition, which have not been described for a soil embedded resting period of under 50 years, were collected. 21 research reports could be found, describing macroscopic findings on soil-embedded human bones with known PMI. All in all, 1295 individuals were examined in these investigations. A censorious review of the summarized results found in literature reveals that the following findings have never been seen in a PMI of 50 years or less. Outer appearance: macroscopically no adipocere, deep incisions of the outer compact layer, extensive defects of the bone surface, intense brownish-black lawn of microorganisms, fraying of the outer lamellar system, lifting of the cortical area, torsion of the tissue, attached brushit, bone manually breakable. On freshly sawn cross sections: lack of adipocere, brushit in the marrow area, reduced or lack of UV-fluorescence.     

Unusual circumstances in a fourfold complex suicide

Complex suicides are defined as suicides using more than one method, which may sometimes suggest homicide. We present the case of a 27-year-old man who killed himself by using four different methods. The man was known as a loner and sufferd from bipolar psychosis. An eyewitness saw him afire and falling out of a window on the 4th floor of a hotel. He was wearing a judo dress with the belt wound twice around his neck. He died in a hospital about two hours later. The autopsy showed signs of neck compression typical of (self)-strangulation, several stab and cut wounds in the thoracic and abdominal region from sharp force, extensive first- to third-degree burns caused by the effect of heat, contusions of internal organs, serial rib fractures and several bone fractures of the extremities as signs of blunt force. The CO-Hb value in the blood amounted to 7%; the other toxicological tests were negative. Death was found to be due to exsanguination from a deep stab wound in the abdomen and multiple trauma caused by the fall from a great height in the course of a suicide. Homicide could be excluded due to the circumstances of the case, which demonstrated again that both the medical findings and the investigation results of the police are indispensable for the differentiation between suicide and homicide.     

法医骨组织学研究

在实际检案中 ,当现场发现的骨骼残片体积较小时 ,用解剖学观察无法进行骨骼残片的法医鉴定 ,需使用骨组织学的方法进行骨骼残片的个体识别。目前 ,这是法医人类学中一门较活跃的领域 ,即法医骨组织学。法医骨组织学的内容主要包括两个方面 :(1)骨骼残片是否属于人类骨骼 ,或属于何种动物骨骼。这方面的研究包括人类骨骼的组织学特征研究及不同动物的组织学特征研究。 (2 )人类骨骼个体识别的组织学研究。这方面的研究主要包括 ,人类骨骼的组织学特征的年龄判断 ,例如股骨、胫骨、肱骨、锁骨等 ,以及使用骨组织学方法 ,进行人类骨骼的年龄评价的准确性研究。本文对上述内容进行了综述。     

Sudden Collapse due to Medullary and Cervical Cord Infarction—An Unusual Presentation of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is a common cancer worldwide with a great potential for metastatic spread. Hepatocellular carcinoma often arises in people with underlying viral hepatitides or liver cirrhosis and may present in various ways including abdominal pain, liver mass, and signs of hepatocellular decompensation. Many tumors may have metastasized to other organs such as the lungs, lymph nodes, bone, and adrenal glands at the time of diagnosis. However, it is uncommon for HCC to present purely due to its metastasis, such as spinal cord compression from vertebral metastasis. Here, an unusual presentation of a sudden cardiovascular collapse due to medullary and cervical cord infarction from compression of the cervical cord is presented. The importance of clinical investigations, the usefulness of postmortem computed tomography scans, and the examination of the cervical spine and cervical cord in people with no obvious cause of death after standard autopsy procedures are emphasized.     

Childhood panhypopituitarism presenting as child abuse: a case report and review of the literature

Childhood panhypopituitarism may be acquired or congenital. Children with panhypopituitarism can present clinically with diabetes, growth failure, decreased bone density, and morbid obesity. In the forensic setting without the proper history, it can be misdiagnosed as child abuse or neglect. We report a case of a 3-year-old black girl who was admitted to the emergency room with apnea and subsequently died. While at the emergency department, it was discovered that the child had a fractured left hip and was severely growth retarded for age. The coroner wanted to rule out child abuse and/or neglect and requested an autopsy based on the physical findings identified by hospital staff. Significant findings at autopsy included small for age (15th percentile for age), hypoplastic brain/pituitary gland/adrenal gland/thyroid gland, abnormally formed skull with an occipital protuberance, a fractured left hip with decreased bone density, and central adiposity. Subsequent to the autopsy, it was discovered that at 6 weeks of age the child suffered from group B streptococci meningitis that resulted in panhypopituitarism. The panhypopituitarism then resulted in seizure activity, diabetes insipidus, and growth retardation. The authors hope this case report and review of the literature will assist investigators, pathologists, and clinicians in making a distinction between neglect or inflicted injury of child abuse and panhypopituitarism that can present with similar signs and symptoms.     

Pericarotid bone splinter: a microscopic appearance in hanging

The investigation of the neck structures drawn from 145 cases of asphyxia involving pressure on the neck, for which microscopic examination was required at the Pathology Laboratory of the "Hotel Dieu" Hospital from Lyon, France, during January 1, 1999, to May 1, 2001, has pointed out in 3 cases, besides the classic signs already known, a particular lesion unmentioned yet in the literature, namely, a pericarotid bone splinter, placed in the proximity of the common carotid artery bifurcation. The bone splinters had dimensions between 0.25 and 0.7 mm and a certain antemortem character, surrounded by hemorrhagic areas and by fibrin. The 3 cases deal with adult males who had died through complete hanging, with the knot placed lateral, the hanging mark having the maximum depth in the laterocervical region, correspondent with our finding. Given the location of the bone splinter, we believe that this was produced by the tearing out from the transverse apophysis of the fourth cervical vertebra, as a consequence of the sudden traction during hanging. This sign appeared neither at other types of hanging nor at strangulation by hand or by ligature.     

The diagnosis of the mechanisms of bone tissue destruction from the surface of the break]

Data on bone tissue fractography are summarized and systematized. Possibilities of a microscopic fractography method in analysis of skeletal bone fractures in order to determine conditions of traumatic exposure were shown. Destruction of bone tissue is considered from the point of view of fragile and tough destruction using as a model solid body with crack at the top of which deformations of detachment, lateral and longitudinal shifts are acting. Morphologic features for different types of destruction were singled out. Use of these features may help to determine character and type of deformation at concrete areas of fracture during all destruction process.