Analysis of blunt trauma injuries: vertical deceleration versus horizontal deceleration injuries

There are several similarities found in blunt trauma injuries to humans sustained as a result of vertical deceleration (falling) and those sustained as a result of deceleration in a horizontal plane (automobile accidents). However, examination of the patterns of traumatic skeletal injuries can distinguish those injuries associated with falling from heights from those associated with automobile accidents. While there is considerable variation within each type of blunt trauma injury dependent on the angle at which one falls or is struck, there are several characteristic skeletal features associated with each type of trauma. In this study we review both the current literature and human skeletal remains from the University of New Mexico's Documented Collection known to have been subjected to blunt trauma. This collection is used to characterize and differentiate the pattern of skeletal injuries to various parts of the body for each type of trauma. These assessments are applied to investigate the traumatic skeletal lesions observed in a forensic case where the manner of death is unknown. Analyses suggest two possible scenarios that would explain the death of the individual investigated, with death most likely related to a vehicular-pedestrian accident.     

Cardiopulmonary resuscitation-related injuries and homicidal blunt abdominal trauma in children

Defendants accused of inflicting fatal abdominal injuries to children occasionally raise the defense that the injuries were caused by cardiopulmonary resuscitation (CPR). The purpose of this study is to answer the question: Does closed chest CPR result in fatal blunt abdominal injuries that can be mistaken for homicidal assault? To that end, a retrospective study was conducted of all homicidal blunt abdominal injuries in children 10 years and younger from the Dade, Broward, and Palm Beach Medical Examiner's Offices from 1981 through 1997. These were compared to cases of children who died of natural causes during the same time period in Broward County who had CPR (control group 1) and to children who died of nonvehicular accidental blunt abdominal trauma (control group 2). Children with life-threatening head injuries were excluded. Medical examiner records, autopsy reports, documenting photographs, and clinical records were reviewed. The data analyzed included subject demographics, whether CPR was performed and by whom, and autopsy findings. Thirty-three child homicides with fatal abdominal injuries were reviewed. Twenty-four (73%) of the homicides received CPR. There was no difference in the nature and severity of injuries between the 24 children who received CPR and the 9 who did not. Three hundred and twenty-four cases of pediatric natural deaths were reviewed, all of which had CPR. No traumatic abdominal injuries were found in any of the children who died of natural causes. Only four children who died of natural causes had evidence of extraabdominal trauma related to CPR. No cases of nonvehicular accidental blunt abdominal trauma were identified during the 17-year period, although there were nonvehicular accidental fatalities due to extraabdominal injuries. The likelihood of CPR-related primary abdominal trauma in child homicides is very low.     

The forensic medical characteristics of the injuries to the spleen in blunt trauma of the abdomen

Analysis of 220 sectional cases with blunt spleen trauma is given in this article. Trauma circumstances, morphologic features of spleen injuries depending on the kind of blunt trauma, mechanism of their formation were studied.     

Fatal blunt trauma of the larynx in a child

We report an autopsy case of an 11-year-old girl who suffered mechanical asphyxia from falling off the metal bars in the playground. This autopsy case is interesting because of the atypical trauma and lesions. To our knowledge there has been no similiar published case reports in the forensic literature. The young age of the victim, the setting and the pattern of the injuries are rare in a fall at playground by a child.     

Forensic-medical diagnosis of heart damage from blunt trauma

A total of 277 forensic expert medical conclusions on cases with closed heart injury are analyzed. The morphology and mechanisms of formation of heart injuries in various traumas are discussed.     

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.     

Peculiarities of combined blunt head injuries in children and adolescents

The objective of the present study was to evaluate the frequency and peculiar features of combined head injuries in children and adolescents who suffered the fatal blunt trauma. A total of 101 corpses and 188 archive records were available for the analysis. The control data group was comprised of 227 original observations of adult corpses. It was shown that head injuries prevail over injuries to other parts of the body in children with combined blunt traumas. The craniocerebral injuries are more frequent in children and adolescents than in adult subjects but their extent is smaller. Fractures of the facial bone skeleton in adults occur twice as frequently as in children. A peculiar feature of craniocerebral injuries in children and adolescents is incomplete splintered fractures and folded deformation of the bone plate. Subarachnoidal hemorrhage occurs equally frequently in children and adults with craniocerebral injuries. Other intracranial manifestations of the injury, such as ruptured brain tunics, epidural and subdural hemorrhage, cerebral contusion and ventricular hemorrhage in children occur less frequently than in adults.     

Identification of blunt objects according to the injuries caused by them

The article presents principles of forensic-medical identification of blunt objects by injuries inflicted with them. It is shown that each injury has its own complexes of identifying signs. It is necessary to consider mechanisms of action of blunt objects inflicting contact, noncontact and other injuries. Mathematical methods should be employed to estimate probability of identification of traumatic blunt object.     

Intimal tears of the right atrium of the heart due to blunt force injuries to the abdomen. Its mechanism and implications

We present six cases involving intimal tears of the right atrium of the heart. A proposed mechanism for this injury is discussed, along with implications of the lesion in fatally abused children and traumatized older patients who survive until hospitalization.     

Defining the quantity and sequence of impacts by craniogram in blunt object injuries

A possibility was studied to determine the quantity and sequence of traumatic impacts by using the craniogram; an error was calculated for measurements of injuries registered in craniograms with respect to their real sizes in the skull base bones.     

Morphology of acute lung injuries in mechanic trauma

The lungs from 60 subjects who had died of polytrauma were studied morphologically. The heads of the corpses were not injuried. The aim of the study was investigation of characteristics and time of development of structural changes associated with lung injury. Early structural changes in trauma were disorders of circulation including microcirculation, acute emphysema, distelectases and atelectases, injury of bronchial and bronchiolar mucosa. Pulmonary edema and systemic inflammatory reaction emerge in the first hours after trauma.