Skeletal Trauma Resulting From Fatal Low (≤3 m) Free Falls: An Analysis of Fracture Patterns and Morphologies

The skeletal trauma resulting from fatal low (≤3 m) free falls is poorly researched and understood by forensic practitioners. The aim of this study was to identify the types of skeletal trauma resulting from low falls through investigating fracture patterns and morphologies. Skeletal trauma was analyzed using full‐body postmortem computed tomography scans of 145 individuals who died from a low free fall. Trauma was then contextualized to the variables that influence how a person falls using multiple logistic regression. Results showed fracture patterning primarily involved the axial skeleton and that there were a number of patterns significantly associated with the height fallen, pre‐existing health conditions, and age. Analysis of fracture morphologies showed 108 possible fracture types, six of which were significantly associated with the height fallen. Understanding the skeletal trauma characteristic of low free falls will further inform anthropological interpretations of trauma in cases where a fall may be considered the possible mechanism.     

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.     

桃红四物汤加味联合PFNA内固定治疗老年股骨粗隆间骨折临床观察

目的 观察养血活血、健脾补肾中药内服配合股骨近端防旋髓内钉（proximal femoral nail antirotation,PFNA）内固定术治疗老年股骨粗隆间骨折的临床疗效。方法 将56例股骨粗隆间骨折行手术治疗的老年患者随机分为观察组和对照组,每组28例。观察组采用加味桃红四物汤内服联合PFNA内固定术治疗,对照组仅行PFNA内固定术。采用Harris评分评价髋关节功能,观察并比较两组患者术后肿胀消退时间、骨折愈合时间和总并发症发生率。结果 术后30、60 d,两组患者髋关节Harris评分逐渐升高,差异均有统计学意义（P＜0.05）,且观察组髋关节Harris评分显著高于对照组（P＜0.05）。观察组患者骨折愈合时间和患肢肿胀消退时间较对照组明显缩短(P<0.05),总并发症发生率显著降低（P<0.05）。结论 加味桃红四物汤内服配合PFNA内固定术可改善老年股骨粗隆间骨折患者髋关节功能,促进骨折愈合,减轻患肢肿胀,减少并发症发生率。     

闭合复位中空螺钉内固定结合中药内服治疗股骨颈骨折36例

目的 观察闭合复位中空螺钉内固定结合中药内服治疗股骨颈骨折的临床疗效。方法 将72例患者随机分为对照组、治疗组,每组各36例,两组均行中空加压螺钉内固定,治疗组依据辨证分期同时予中药内服,对照组常规预防处理。结果 治疗组总优良率显著优于对照组(94.44% vs 72.22%,P<0.05);两组术后1、3、6个月Harris评分比较,差异均有统计学意义(P<0.01)。结论 闭合复位中空螺钉内固定结合中药内服治疗股骨颈骨折临床疗效显著,值得临床推广应用。     

益肾蠲痛口服液治疗绝经后骨质疏松症临床观察

目的 观察益肾蠲痛口服液治疗肾阳虚型绝经后骨质疏松症（postmenopausal osteoporosis,PMOP）的临床疗效。方法 将120例肾阳虚型PMOP患者随机分为治疗组和对照组,每组60例。两组患者均口服钙尔奇,治疗组患者加服益肾蠲痛口服液,对照组患者加服骨康口服液,疗程均为12个月,随访24个月。治疗前后及随访时,分别采用视觉模拟评分法（visual analogue scale,VAS）评价腰背疼痛,采用双能X线检测骨密度（bone mineral density,BMD）;并观察两组中医证候疗效及脆性骨折发生情况。结果 治疗后,两组VAS评分均较治疗前显著降低（P<0.01）;腰椎、股骨颈、Ward三角BMD均较治疗前显著上升（P<0.01）;随访时,治疗组VAS下降值及腰椎（L2—4）、股骨颈、Ward三角BMD升高值均显著大于对照组（P<0.01）。两组中医证候疗效及脆性骨折复发率比较,差异均无统计学意义（P>0.05）。结论 益肾蠲痛口服液可减轻PMOP患者腰背疼痛,提高BMD,改善中医症状,防止脆性骨折复发,在减轻腰背疼痛和提高BMD方面较对照药具有明显优势。     

利用颅骨枪弹创骨折类型推断射击方向和顺序的实验

建立利用颅骨枪弹创骨折类型推断射击方向和顺序的方法。使用国产五四式7．62mm口径手枪及五六式7．62mm口径半自动步枪,以3m的距离2次射击16具尸体的头颞部及枕部,造成颅脑贯通创,制成颅骨枪弹射入、出口各32例,并根据定位标记进行观察。结果显示：颅骨枪弹创骨折形态可分为带有斜面的孔状骨折,锁孔状骨折,放射状骨折和环状隆起骨折4种类型,其出现多见于低速枪射击,并与射击方向和顺序有直接关系。根据颅骨枪弹创骨折类型可推断射击方向和顺序。     

一种高强度汽车车轮螺栓的异常断裂

目的研究典型断口形貌对失效分析工作的作用。方法利用金相分析、力学性能测试等方法对某交通事故中汽车车轮螺栓的异常断裂进行了检验分析。结果观察到了一种少见的高强度螺栓断口形貌,其上有聚集成群的球状碳化物,有的在疲劳裂纹的起始部位,有的在撕裂台阶的根部。结论螺栓成型时的塑性变形与热处理工艺匹配不合理可能是引起碳化物异常析出的原因,这些碳化物使螺栓的有效承载面积减小,从而引起了高应力疲劳断裂,并留下了低应力疲劳断裂的假象。     

Alcohol‐Induced Osteopenia Among In‐Custody and Homicide Deaths from the Harris County Institute of Forensic Sciences

Four cases of in‐custody or unlawful death are presented as examples of increased bone fragility with an associated increase in fracture rates due to ethanol‐induced osteopenia. In addition, one of the individuals suffered fractures several weeks premortem, allowing some healing to take place. Using radiographs and physical examination, the ribs from these individuals are compared with those retained from three individuals with no history of alcoholism to illustrate diagnostic characteristics that will be notable using standard autopsy and anthropological procedures. Trabecular bone mass is notably decreased in the alcoholic group leading to a greater chance of fracture occurring during conflict, including arrest and in‐custody situations. The average number of perimortem fractures among the alcoholic individuals is 15, while the control group is six. In the case of the individual with healing, the degree of bone repair on the ribs was less than is expected considering the interval between injury and death.     

Analysis of Bone Healing in a Postoperative Patient: Skeletal Evidence of Medical Neglect and Human Rights Violations

This study highlights complexities associated with postsurgical trauma interpretation of a 76‐year‐old female patient from a psychiatric institution in Mexico. The skeletal analysis identified complications from an unsuccessful surgical operation for an intertrochanteric fracture of the femur. An improperly placed surgical plate resulted in nonunion due to limited contact between fracture margins. However, it is unclear whether this resulted from surgical complications, ineffective postoperative care, or from the decedent's limited ability to follow postoperative care instructions. Additionally, failure of the plate resulted in degenerative changes to the acetabulum. These complications, associated with degenerative changes to upper limb joints, suggest significant mobility issues. The pattern of antemortem trauma and contextual information support a conclusion of postoperative medical neglect, a documented problem in psychiatric institutions in Latin America. This study provides insight into the relevance of detailed trauma assessment of skeletal remains in cases where neglect and human rights violations are suspected.     

骨生丸治疗股骨颈骨折后早期股骨头坏死的实验研究

目的：探讨中药制剂骨生丸治疗股骨颈骨折后早期股骨头坏死的作用机制。方法：按照Kenzora方法，复制大白兔凤骨颈骨折后早期股骨头坏死动物模型，灌药4周后断头取血，取出股容、血沉、还原粘度、聚集指数及纤维蛋白等血液流变性指标。结果：骨生丸能够有效地降低空骨陷窝率，改善血液流变性状态。结论：骨生丸通过逆转股骨颈骨折后早期股骨头坏死的股骨头缺血状态，促进股骨头坏死修复而起治疗作用。