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.     

246例高坠案件中坠落高度与损伤分析

目的对高坠案件进行统计分析,为相关鉴定研究提供参考。方法收集上海市浦东地区最近十年来记录有坠落距离的246例高坠案件,对人体损伤的特点进行比较分析。结果自杀高坠的高度显著高于意外高坠的高度(25.70m:13.98m);所有高坠中,头部损伤概率较高(75.2%),颈部损伤概率较低(6.5%);意外高坠的头部损伤概率高于自杀组(89.4%:75.2%)。结论意外高坠的死者比自杀高坠的死者更缺乏四肢对于头部的保护;过低的颈部损伤发现率提示国内法医工作者应该更加重视在高坠案件中的对于颈部损伤的检查。     

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。     

Early Signs of Fracture Repair in the Human Rib Cage: Implications for Forensic Casework

The decomposed body of a woman discovered beneath a collapsed structure was examined at the C.A. Pound Human Identification Laboratory. Despite a mix of rib fractures with and without indications of healing, it is most likely that all fractures occurred as a result of a single, compressive event. Signs of intramembranous, and possibly direct, fracture healing at the incomplete fractures without signs of endochondral ossification at the complete fractures suggest the individual died very shortly—but not immediately—after injury. Given the case circumstances, the findings inform immediate cause of death. This case study highlights that differential healing as a result of a single event is possible. Further, it illustrates the importance of careful examination of micro‐discontinuities/cracks that can occur in association with major fractures. Fracture healing and dating data are discussed, as is the possible need for critical evaluation of the antemortem/perimortem boundary.     

手法复位小夹板固定配合接骨续筋汤治疗老年骨质疏松性Colles骨折临床观察

目的 观察手法复位小夹板固定配合接骨续筋汤治疗老年骨质疏松性Colles骨折的临床疗效。方法 将68例老年骨质疏松性Colles骨折患者随机分为治疗组和对照组,每组34例。两组患者均接受手法复位小夹板固定治疗,并给予常规治疗,治疗组在此基础上内服接骨续筋汤治疗。观察并记录两组患者治疗前,治疗1、2周后视觉模拟评分（visual analogue scale,VAS）,患侧肿胀情况,治疗4、8周后骨折愈合X线评分,并记录骨折愈合时间;骨折愈合后采用Garland-Werley评分对腕关节的活动功能进行评价;治疗90 d后,对两组患者的临床疗效进行评价。结果 治疗1、2周后,两组VAS评分及患侧肿胀度均较治疗前明显降低（P<0.05）,且治疗组VAS评分和患侧肿胀度均明显低于对照组（P＜0.05）。治疗8周后,两组骨折愈合X线评分均较治疗4周后显著上升（P＜0.05）,且治疗组骨折愈合X线评分明显高于对照组（P＜0.05）。与对照组比较,治疗组骨折愈合时间显著缩短（P＜0.05）,Garland-Werley评分显著降低（P＜0.05）。治疗90 d后,两组临床疗效的差异有统计学意义（P＜0.05）,治疗组临床疗效优于对照组。结论 在手法复位小夹板固定基础上服用接骨续筋汤可提高老年骨质疏松性Colles骨折的疗效,能有效缓解患者骨折后疼痛、肿胀程度,缩短骨折愈合时间,改善腕关节活动功能。