Skull Fracture with Brain Expulsion in a One-Level Jumping-Fall

Abstract:  Here presented is the case of a one-level jumping-fall with extensive skull fractures and brain expulsion. The body was found on the basement floor at the foot of the stairs. At the autopsy, the skull was extensively fractured, with about half of the brain expulsed several feet away from the body. The cause of death was established as a craniocerebral trauma with brain expulsion. The circumstances and manner of death were still unclear at that time. A low fall seemed very unlikely considering the severity of the skull and brain damage. The police investigation clearly revealed that the man, in a paranoid psychotic state, attacked his wife with a knife and then was witnessed by his children to have hit his head several times with a hammer. Afterwards, they saw him running to the top of the basement stairs and jumping to the bottom of the stairs head first.     

Age‐Dependent Fracture Characteristics of Rigid and Compliant Surface Impacts on the Infant Skull—A Porcine Model*,†

Abstract: This study documents skull fracture characteristics on infant porcine specimens under known impact conditions with respect to age and interface. A single impact causing fracture was conducted on the skull of porcine specimens aged 2–28 days (n = 76). Paired rigid and compliant impacts at the same energy were conducted at each specimen age. Impact force, impact duration, and fracture length were recorded. Energy required to initiate skull fracture increased with specimen age. For a given energy, impact of the skull with a compliant interface caused more fracture damage than with a rigid interface for specimens aged under 17 days, but less damage for specimens aged 24–28 days. The documentation of energy required to cause fracture and resulting fracture propagation with respect to impact interface and age may be of critical importance in forensic investigations of infant skull trauma.     

Suicide by blasting caps: a case study of rare cranial trauma

Suicide is a deliberate act of ending one's life. Suicide by use of any explosive device, when not involved in a terrorist act, is quite rare in occurrence when compared with other methods routinely utilized. In this paper, we present to the medicolegal community a case of an adult male who committed suicide with blasting caps and the subsequent extensive damage to the cranial hard tissue. Although the cause and manner of death were relatively straightforward, consultation with forensic anthropologists was requested for an anthropological trauma assessment of the highly fragmented skull. After the skull was cleaned and reconstructed, the analysis revealed similarities between blasting cap trauma to the head and high velocity gunshot trauma to the head. Therefore, in a case where some evidence may have been removed or destroyed, forensic analysis involving trauma of this magnitude could result in a misinterpretation of the true mechanism responsible for the osseous damage. In this case, cooperation among the law enforcement agency, coroner's investigators, the forensic pathologist, and forensic anthropologists provided a comprehensive death case analysis.     

Vertebral artery laceration mimicking elder abuse

Elder abuse was first described almost 30 years ago. Today, approximately 1 in 25 elders is abused each year in the United States. A newly described form of domestic violence, the incidence of elder abuse will surely increase as the elderly population grows. Physical abuse/inflicted trauma is generally considered the most extreme form of elder mistreatment and includes blunt trauma, sexual assault, traumatic alopecia, and burns. Elder homicide is usually due to gunshot wounds, blunt trauma, stab wounds, or asphyxia. However, the difficult aspect of assessing the possible elder abuse homicide victim is delineating such inflicted trauma from accidental trauma. We report the case of a 94-year-old "demented" male, who reportedly fell out of his wheelchair. He was transported to a local emergency room, where he became unresponsive during examination. He experienced respiratory distress and was pronounced dead shortly thereafter. At autopsy, he had periorbital contusions and a midline abrasion between the eyes, with underlying supraorbital contusion. The skull, brain, and spinal cord were unremarkable for signs of trauma. The major traumatic finding was in the neck region. Neck dissection revealed hemorrhage extending from the base of the skull to the level of T-1 and anteriorly about the soft tissues, strap muscles, and vasculature. The strap muscles were individually examined and were free of hemorrhage. The carotid arteries and jugular veins were unremarkable. The larynx, hyoid, and thyroid were intact, with only surrounding hemorrhage. Further examination revealed a horizontal fracture of the C5 vertebral body and a medial laceration of the left vertebral artery at the C5 level; subarachnoid hemorrhage was absent. What initially appeared to be trauma to the neck, worrisome for strangulation or blunt force trauma, was a large retropharyngeal hematoma from the left vertebral artery laceration. Traumatic rupture of the vertebral artery usually occurs at the C1 and C2 levels, with resultant subarachnoid hemorrhage. This is an especially vulnerable location since it is where the artery turns and then enters the skull. Associated injuries include spinal cord transection or contusion, brachial plexus injury, pharyngoesophageal injury, and vertebral fractures. Retropharyngeal hemorrhage may result from deep neck infection, tumor, and trauma. Hemorrhage associated with trauma often involves flexion of the cervical spine, followed by hyperextension. The accumulation of blood slowly impinges on the pharynx/larynx and vasculature structures. The exact injuries and etiology of the hemorrhage must be determined to distinguish strangulation from blunt force trauma. The presentation of signs and symptoms can be helpful in assessing the decedent; however, in the practice of forensic pathology such a history is more often lacking.     

The forensic-medical expertise in craniofacial trauma

Archive materials of the recent 6 years, including 14720 death cases of victims, were analyzed for the purpose of detecting the general regularities of injuries within the craniofacial trauma (CFT). The diversity of CFT with injuries to skull bones and medullary substance was found not to interfere with establishing an actual type and mechanism of trauma provided all injuries are thoroughly and comprehensively examined. The trauma specificity must be evaluated with respect to a location and direction of traumatic force in order to define an actual impact that caused death. CFT is special variation of craniocerebral trauma, whose onset mechanism needs more research. The efficiency of forensic-medical examination of CFT cadavers directly depends on the coordination and logic of measure undertaken by expert as well as on his technical outfit and knowledge of such trauma. The diversity of variations of damage to anatomic head structures requires an interdisciplinary approach with the need to isolate a predominant chain that affects the course and outcome of trauma.     

Role of preoperative 3-dimensional computed tomography reconstruction in depressed skull fractures treated with craniectomy: a case report of forensic interest

Patients affected by cranial trauma with depressed skull fractures and increased intracranial pressure generally undergo neurosurgical intervention. Because craniotomy and craniectomy remove skull fragments and generate new fracture lines, they complicate forensic examination and sometimes prevent a clear identification of skull fracture etiology. A 3-dimensional reconstruction based on preoperative computed tomography (CT) scans, giving a picture of the injuries before surgical intervention, can help the forensic examiner in identifying skull fracture origin and the means of production.We report the case of a 41-year-old-man presenting at the emergency department with a depressed skull fracture at the vertex and bilateral subdural hemorrhage. The patient underwent 2 neurosurgical interventions (craniotomy and craniectomy) but died after 40 days of hospitalization in an intensive care unit. At autopsy, the absence of various bone fragments did not allow us to establish if the skull had been stricken by a blunt object or had hit the ground with high kinetic energy. To analyze bone injuries before craniectomy, a 3-dimensional CT reconstruction based on preoperative scans was performed. A comparative analysis between autoptic and radiological data allowed us to differentiate surgical from traumatic injuries. Moreover, based on the shape and size of the depressed skull fracture (measured from the CT reformations), we inferred that the man had been stricken by a cylindric blunt object with a diameter of about 3 cm.     

Capacity for physical action in traumatically-induced epidural hemorrhage

Authors report the case of a 55-year-old man with a nearly normal capacity to act for appr. 48 hours following epidural hematoma due to a blunt trauma of the head with skull fracture. The man was amnestic for the period of time since the trauma. According to the computertomographic findings, the cause for the mild clinical symptoms was a pre-existent atrophy of the brain.     

Fracture pattern interpretation in the skull: differentiating blunt force from ballistics trauma using concentric fractures

There have been several anthropological studies on trauma analysis in recent literature, but few studies have focused on the differences between the three mechanisms of trauma (sharp force trauma, blunt force trauma and ballistics trauma). The hypothesis of this study is that blunt force and ballistics fracture patterns in the skull can be differentiated using concentric fractures. Two-hundred and eleven injuries from skulls exhibiting concentric fractures were examined to determine if the mechanism of trauma could be determined by beveling direction. Fractures occurring in buttressed and non-buttressed regions were examined separately. Contingency tables and Pearson's Chi-Square were used to evaluate the relationship between the two variables (the mechanism of trauma and the direction of beveling), while Pearson's r correlation was used to determine the strength of the relationship. Contingency tables and Chi-square tests among the entire sample, the buttressed areas, and the non-buttressed areas led to the null hypothesis (no relationship) to be rejected. Pearson's r correlation indicated that the relationship between the variables studied is greater than chance allocation.     

Sharp-force trauma analysis and the forensic anthropologist: techniques advocated by William R. Maples, Ph.D.

Forensic anthropological tenets supported by William R. Maples, Ph.D. provide the bases for a case study from the C.A. Pound Human Identification Laboratory. Using a multidisciplinary team that included police investigators, pathologists, odontologists, entomologists, and anthropologists, a biological profile and trauma analysis was constructed. Our analysis determined that the decedent was a middle-aged Hispanic male, approximately 5'6"-5'7" in stature, who had died a minimum of three months before the discovery of his remains. Gross and microscopic analysis revealed 11 areas of sharp trauma to the skull and cervical vertebrae. To aid with analysis of the trauma, nonhuman trauma exemplars were created using a Tiger rear flail mower of the make known to have been used at the scene where the remains were recovered. This use of nonhuman trauma exemplars proved to be essential in the effort to exclude the rear flail mower as the possible trauma agent.     

Differential diagnosis of traumatic skull findings in infants: residues after vacuum extraction

If autopsy findings in an infant show traumatic changes on the skullcap, these are not always the result of a postnatal trauma due to child abuse, a fall or another accidental event. With regard to differential diagnosis a birth trauma should also be kept in mind, so that the history of the delivery is important. The spectrum of possible residues after vacuum extraction (circular fracture and/or elevation of the outer table of skull bones, subperiostal and intraossal haematoma, extradural and subdural haemorrhage) is demonstrated by means of three examples from the forensic autopsy material.     

Can Birth Trauma Be Confused for Abuse?

Abstract: An unexpected infant death is usually investigated with a complete autopsy. If evidence of prior trauma is found at autopsy in these cases, suspicion is raised for nonaccidental trauma. In a young infant, the residua of trauma received during birth has the potential to be incorrectly interpreted as nonaccidental trauma. We report a the findings of a 4 1/2‐month‐old‐infant that died unexpectedly with a healing linear skull fracture and a circular lesion over the calvarium found at autopsy. Though this lesion was concerning, the remainder of the autopsy and the histological findings did not support a diagnosis of recent trauma. Review of the literature describing birth injuries made the diagnosis of healing, residual birth trauma more convincing in this case.     

Histologic evidence of repetitive blunt force abdominal trauma in four pediatric fatalities

In cases of acute fatal child abuse, certain injuries, including cutaneous blunt force trauma, skull fractures, subdural hematomas, intra-abdominal hemorrhage, and retinal hemorrhages are common and well described in the pediatric and forensic literature. These gross findings at autopsy, when taken into consideration with scene investigation and interviews with caregivers, may indicate both a clear manner and cause of death. In such cases, the discovery of additional pathologic changes attributable to older abusive injuries helps support a conclusion of death due to inflicted trauma. We discuss four cases of fatal child abuse in which acute blunt force abdominal trauma was the cause of death. In each of these cases, careful examination with proper sectioning and microscopy of select abdominal tissues revealed that the acute tissue trauma was superimposed on a background of older, healing injury. This older trauma was characterized by classic histologic elements of tissue repair, including fibroblast proliferation, early scar formation, increased vascularity, and hemosiderin-laden macrophages. Iron and trichrome stains were used to confirm the presence of hemosiderin and fibrosis in all four cases, but the recognition of fibroblast proliferation and a reactive vascular pattern was best seen on routine hematoxylin and eosin stains. The gross and microscopic autopsy findings, along with available investigative information, established the diagnosis of chronic physical abuse.     

A Biomechanical Evaluation of Skull–Brain Surrogates to Blunt High‐Rate Impacts to Postmortem Human Subjects

The field of forensic injury biomechanics is an emerging field. Biomechanically validated tools may assist interdisciplinary teams of investigators in assessing mechanisms of blunt head trauma resulting in skull fractures. The objective of this study is to assess the biofidelity of spherical, frangible skull–brain (SB) surrogates. Blunt impacts were conducted at 20 m/s, using an instrumented 103 g rigid impactor, to the temporo‐parietal region of four defleshed cephalic postmortem human subjects (PMHS). Force–deformation response, fracture tolerance, and fracture patterns were recorded for comparison to spherical skull–brain surrogates. Three brain substitutes were assessed: 10% gelatin, lead shot with Styrofoam and water. Force–deformation response of the skull–brain surrogates was similar to defleshed PMHS up to the point of fracture; however, none of the surrogates fractured at tolerance levels comparable to the PMHS. Fracture patterns of the skull–brain surrogates were linear and radiating, while PMHS fractures were all depressed, comminuted.     

Healed Depressed Parasagittal Skull Fractures—A Feature of Archaic Australian Aboriginal Remains

The skeletal remains of eight Australian Aboriginals with healed depressed skull fractures were examined. Male:female ratio 5:3; age range 20‐60 yrs. Burial dates by ¹⁴C dating in three cases were 500 years BP (n = 2) and 1300 BP. There were 13 healed depressed skull fractures manifested by shallow indentations of cortical bone and thinning of diploe, with no significant disturbance of the inner skull tables. Nine (69%) were located within 35 mm of the sagittal suture/midline. These lesions represent another acquired feature that might be helpful in suggesting that a skull is from a tribal Aboriginal individual and may be particularly useful if the remains are represented by only fragments of calvarium. While obviously not a finding specific to this population, these healed injuries would be consistent with the possible results of certain types of conflict behavior reported in traditional Aboriginal groups that involved formalized inflicted blunt head trauma.     

Recovery of a mummified pregnant woman from a 55-gallon drum more than 30 years after her death

The body of a 28-year-old near-term pregnant woman was found in a 55-gallon steel drum in a crawl space under a house more than 30 years after her disappearance and death. At autopsy the body was remarkably well preserved and mummified, as was that of a male fetus. The decedent had 10 scalp lacerations and multiple comminuted depressed skull fractures and had died as a result of blunt force head trauma.     

Machinery‐Related Deaths: Relevance of Workplace Investigation and Antemortem Radiological Data in Reconstructing the Fatality

Abstract: Machinery‐related fatalities are one of the leading causes of traumatic occupational deaths. In our report, we present the case of a 40‐year‐old male who suffered a severe head trauma while working in a cut‐foam industry and died despite an early craniectomy. The radiological reconstruction of the skull based on preoperative computed tomography scans disclosed a large depressed conical fracture of the left parietal bone. The 3D‐reconstruction of the work area, combined with a fit‐matching analysis between the machinery and the depressed skull fracture allowed us to conclude that the head was crushed between the sliding bar of the cutting device and the metallic protuberance on the opposite side. The case underlines the importance of a detailed workplace investigation and of a thorough evaluation of all circumstantial, clinical, radiological, and autopsy data in the reconstruction of machinery‐related fatalities to identify any possible legal responsibilities of the worker and/or the employer.     

Skeletal evidence of the ethnic cleansing actions in the Free City of Danzig (1939-1942) based on the KL Stutthof victims analysis

In the early days of World War II, many of the prominent and influential people of Polish nationality from the Free City of Danzig were arrested by the Germans and sent to the nearby concentration camp KL Stutthof. Nearly a hundred of them died within the next seven months upon their arrival, and were buried in a clandestine mass grave in a nearby forest. However, the exact nature of their death is unknown, as it is unclear what the attitude of the aggressors was toward the victims. We do not know whether there was only one executioner or there were several assassins, nor if the killing methodology was consistent with the other state-regulated executions.The studied material represents the commingled remains of a minimum thirty-four people, possibly all male, aged from under eighteen to over sixty at the time of death. Perimortem traumatic lesions are shown mainly on the skull bones. We asked whether the perimortem trauma lesions visible on the victims’ skeletons could be informative on the cause and manner of their death.Our results show the prevalence of the perimortem trauma inflicted by a blunt object are on the parietal bones above the Hat Brim Line (HBL), which is commonly associated with a violent attack. The gunshot trauma was usually localized on the occipital bone or posterior parietal, which could indicate a shot to the back of the head, and this was commonly encountered during executions. No signs of defensive injuries can be explained either by restraining of the hands or by a surprise attack. The abundance and variability of the trauma type can be evident of multiple assailants. Moreover, the multiple impact points detected on several crania prove unnecessary overkill and brutality, which reflects the personal attitudes of the executioners towards the victims.     

Taphonomic changes to blunt force trauma: a preliminary study

This study examines the effects of taphonomic processes on blunt force trauma (BFT) through an experimental study involving pig heads. Of particular concern is the possibility that taphonomic changes can create pseudo-trauma and/or conceal evidence of actual trauma. BFT was inflicted on 10 pig skulls using a hammer. The skulls were subsequently exposed to the environment for 12 months. Seven taphonomic changes were evaluated: the freeze-thaw cycle; rodent gnawing; carnivore scavenging; presence/weight of soil; presence/weight of rain and snow; movement/displacement of bones; and discoloration due to sun bleaching and grass staining. Taphonomic effects varied between cancellous, compact, fresh, and degreased bone. Freezing and thawing, exposure to rain and snow, movement of the skulls, and soil erosion altered and, in some cases disguised, pre-existing trauma. Rodent and carnivore activity did not obliterate evidence of BFT. Recommendations for evaluating BFT on remains affected by taphonomic processes are presented. As each taphonomic process outlined by this study has the potential to disguise antemortem injury, the authors propose that one must carefully examine large, circular openings in the skull that may represent the remnant evidence of BFT.