Postmortem injury quantification for the fatally injured cyclists in the Osijek-Baranja county over a 21-year period.

OBJECTIVE: The objective of this study was to quantify injuries in fatal cyclists' traffic crashes by performing injury analysis and determine injury trends as well as main epidemiological data of the cyclists' fatalities. METHODS: The study was organized as a cross-sectional retrospective study, which included 125 cyclists' fatalities autopsied at the Clinical Department of Pathology and Forensic Medicine, Clinical Hospital Center Osijek from 1998 to 2018. We applied The Abbreviated Injury Scale (AIS©) classification for all fatally injured cyclists in traffic crashes and determined the severity of injuries by body region from the description of injuries reported in the autopsy report. RESULTS: The majority of victims in our study (80%) were male and older than 45 (80.8%). A significant majority of cyclists (78.4%) were not wearing a helmet at the time of the fatal crash. For the rest of the cyclists (21.6%) we were not able to establish if they were wearing a helmet at the time of the crash based on the traffic police reports. Most of those who died on the spot or during transport had severe injuries to three or more ISS body regions (26/46 = 54%) and the majority of deceased cyclist had severe injuries to the head and brain, regardless of the time of death. Older cyclists died on the spot with lower injury severity scores (ISS). CONCLUSIONS: Measures against dangerous cycling behavior such as driving under the influence of alcohol and driving without the helmet could lead to reduction of fatal, and probably, non-fatal bicycle crashes. We believe that policy change regarding mandatory helmet usage is of upmost importance. Injury analysis can provide us with valuable information regarding where the focus of treatment should be among severely injured cyclists as well as where the prevention should be targeted. Further injury analysis studies are needed, with studies including both fatal and non-fatal crashes. The Abbreviated Injury Scale represents a valuable system for describing (coding) and quantifying the severity of injuries during autopsies.

Fatal motorcycle crashes in wide urban area of Zagreb, Croatia-A 10-year review.

Objective: The objective of our study was to determine the prevalence of alcohol and drug intoxication among fatally injured motorcyclists in a wide urban area of Zagreb, Croatia. Methods: We conducted a single-center observational retrospective study over a 10-year period (2007-2016) in 3 counties covering an area including 1.2 million residents. We reviewed the records on fatally injured motorcyclists, collecting information relating to sex, age, cause of death, time of death in relation to the time of the crash, and the circumstances of the crash (time of day, day of the week, season). Blood alcohol concentration (BAC) and toxicology analysis results were collected and analyzed. Results: We identified 163 deaths (95.7% males, 4.3% females). Overall, 64.2% of the victims were 20 to 39 years old. The majority (50.9%) of those fatally injured were responsible for causing the traffic crash; the rest were determined not to be responsible or the responsibility could not be determined. The most frequent causes of death were multiple injuries (55.8%) and isolated head trauma (23.3%). The rider's BAC was above the legal limit for driving (>0.50 g/kg) in 53.8% of cases, with a mean BAC of 1.91 g/kg. There was no difference in riding a motorcycle with a BAC above the legal limit between groups defined as younger (≤39 years of age) and older (≥40 years of age). The number of people with an illegal BAC was significantly higher during weekends than during the work week. The BAC of riders who were responsible for the crash was significantly higher than that of those who were not responsible or whose responsibility could not be determined. Use of illegal drugs or nontherapeutic use of legal drugs was not common and was detected in 10.4% of fatally injured riders. Conclusions: Alcohol intoxication has a major role in motorcycle crash-related mortality. A significant difference in BAC between fatally injured riders responsible for the accident and those who were not responsible implies that measures directed toward prevention of drinking and driving behavior could lower the number of fatal motorcycle crashes. Weekend measures, especially during spring and summer, could have particularly significant effects.

Acetabular osteometric standards for sex estimation in contemporary Croatian population.

AIM: To determine the sexual dimorphism of acetabular measurements in contemporary Croatian population and to provide a discriminant function equation for sex estimation. METHODS: The sample consisted of 200 adult pelvic bones (100 male and 100 female) from positively identified victims of Croatian War of Independence. In total, 96 left (48 male and 48 female) and 104 right (52 male and 52 female) acetabula were measured. One author measured two acetabular parameters using a sliding caliper: acetabular diameter (AD) and transverse acetabular diameter (TAD). Another author re-measured the acetabula of 40 randomly selected individuals to determine the inter-observer error. RESULTS: Both measured variables showed significant sexual dimorphism. Men had significantly higher values for AD and TAD than women. Receiver operating characteristic curve analysis showed that the cut-off point for prediction of male sex when using acetabular diameter was higher than 54 mm. For transverse acetabular diameter it was higher than 52 mm. The discriminant function was generated by using both acetabular variables, with 88% of accuracy in sex estimation. Inter-observer error was not significant. CONCLUSION: The acetabular measurements can be used for sex estimation in contemporary Croatian population with high accuracy.

Shot through the heart-firepower and potential lethality of air weapons.

Although certain air weapons attain muzzle velocities comparable to some firearms, their successful use for committing suicide is rarely seen. Herein, we report a case of a young female died shortly after urgent admission to the hospital with penetrating gunshot wound to the chest. The autopsy revealed perforation of the pericardium and two perforative defects to the right heart ventricle. Injury was inflicted by a 0.177 caliber pellet, fired from an air rifle found near her body. Investigation ruled the death as suicide. The used air rifle fired the pellet with the energy density of 1.9 J/mm(2) , substantially above the threshold for inflicting injury. The pellet penetrated through two layers of cotton fabric and several layers of tissue to inflict fatal injury to the heart. In addition, we provide an insight into the wounding potential of air weapons, which illustrates the need for greater caution in handling those devices.

Sex determination by discriminant function analysis of the tibia for contemporary Croats.

Previous studies have demonstrated that populations differ from each other in size and proportion, and that these differences can affect metric assessment of sex. This paper establishes standards for determining sex from fragmentary and complete tibiae in the modern Croatian population. Measurements were taken on 180 tibiae (109 male and 71 female) from positively identified victims of the 1991-1995 War in Croatia. Six standard dimensions: length of the tibia (CML), maximum epiphyseal breadth of the proximal tibia (MPEB), maximum epiphyseal breadth of the distal tibia (MDEB), maximum diameter of the tibia at the nutrient foramen (MDNF), transverse diameter of the tibia at the nutrient foramen (TDNF), and circumference of the tibia at the nutrient foramen (CNF), were taken and subjected to different discriminant function analyses. The highest level of accuracy (91.1%) in the analyzed data set was achieved employing the variables: maximum epiphyseal breadth of the proximal tibia, maximum epiphyseal breadth of the distal tibia, maximum diameter of the tibia at the nutrient foramen, transverse diameter of the tibia at the nutrient foramen, and circumference of the tibia at the nutrient foramen. The second highest level of accuracy (90.6%) was achieved using a combination of only three variables: maximum epiphyseal breadth of the proximal tibia, maximum diameter of the tibia at the nutrient foramen, and circumference of the tibia at the nutrient foramen. The lowest accuracy (84.4%) was obtained when only one variable (maximum diameter of the tibia at the nutrient foramen) was employed. The results of this study show that the modern Croatian tibia is a good skeletal component for determining sex. Standardized coefficients of the discriminant functions generated in this study support the results of previous studies that found that breadth dimensions provide better separation of the sexes than length.

Positive identification by a skull with multiple epigenetic traits and abnormal structure of the neurocranium, viscerocranium, and the skeleton.

Wormian bones are small ossicles appearing within the cranial sutures in more than 40% of skulls, most commonly at the lambdoid suture and pterion. During the skeletal analysis of an unidentified male war victim, we observed multiple wormian bones and a patent metopic suture. Additionally, the right elbow was deformed, probably as a consequence of an old trauma. The skull was analyzed by cranial measurements and computerized tomography, revealing the presence of cranial deformities including hyperbrachicrania, localized reduction in hemispheral widths, increased cranial capacity, and sclerosis of the viscerocranium. Besides unique anatomical features and their anthropological value, such skeletal abnormalities also have a forensic value as the evidence to support the final identification of the victim.

Iatrogenic tracheal laceration causing asphyxia.

Endotracheal intubation is a simple, rapid, and safe technique that is being used as a standard procedure for airway management. However, airway injury during endotracheal intubation could be a significant source of morbidity or even mortality for patients and a source of liability for physicians as well. We report an unusual case of fatal tracheal occlusion by intraluminal blood clot complicating endotracheal intubation. The patient, a 62-year-old woman, with renovascular hypertension and incipient renal failure was scheduled for renal autotransplantation. The surgery was uneventful but the postoperative course was complicated with a lethal airway obstruction. At autopsy a linear longitudinal tracheal laceration was identified with an intraluminal blood clot obstructing the tracheal lumen. Tracheal laceration as a cause of death is a rare and potentially fatal complication of endotracheal intubation with intratracheal bleeding, clot formation, tracheal occlusion, and subsequent asphyxia.

Chronic unreduced anterior shoulder dislocation: application of anatomy to forensic identification.

The uniqueness of anatomic structures and their variations provide the basis for forensic identification. During the identification process of 1991-1995 Croatian war victims, forensic pathologists and forensic anthropologists were faced with the problem of incomplete skeletal remains and insufficient premortem medical data. Here we present a case of anterior shoulder dislocation, which was a key confirmation in the identification of a war victim. In our case, anterior shoulder dislocation was not medically treated for 15 years, and the changes in the glenoid cavity and coracoid process indicated morphologic adaptation of anatomic structures to the new mechanical and physiological demands.

Contribution of forensic anthropology to identification process in Croatia: examples of victims recovered in wells.

AIM: To describe the contribution of forensic anthropology to the recovery, analysis, and identification of victims from the 1991-1995 war in Croatia recovered in wells. METHODS: From 1996 to the present, human remains of a total of 61 individuals have been recovered from 13 wells. Six wells contained the remains of a single individual, one well contained the remains of 2 individuals, and 6 wells contained the remains 3 or more individuals. The majority of wells, containing 90.2% (55/61) of recovered individuals, were located within a 4 km radius of the Croatian-Serbian border. RESULTS: Forensic anthropologists re-individualized 26/61 (42.6%) individuals out of skeletonized and commingled remains, provided basic biological data on sex, age-at-death, and stature in all identifications (n=37), as well as established positive identification by recognizing unique skeletal features (antemortem fractures and skeletal evidence of antemortem surgical interventions) in 3/37 (8.1%) cases. Trauma analyses carried out by forensic anthropologists contributed to the determination of the cause of death in 38/61 (62.3%) individuals and to the probable cause of death in an additional 18/61 (29.5%) individuals. The most frequent (27/38, 71.0%) type of trauma causing death in individuals recovered from wells was a single gunshot wound. CONCLUSION: Forensic anthropologists, collaborating closely with forensic pathologists, forensic odontologists, forensic radiologists, criminologists, and molecular biologists contributed significantly to trauma analysis and identification of war victims recovered from wells.

Prediction of stature based on radiographic measurements of cadaver long bones: a study of the Croatian population.

We tested a new approach to the stature prediction that could be used in the identification process of human skeletal remains of unknown identity. The stature of 19 female and 21 male adult cadavers was measured within 24 h after death and considered to be equal to the living stature. The antero-posterior radiographs of all limbs were taken, and the maximum length of the six long bones was measured from radiographs. There was a significant difference in the stature and maximum length of long bones between female and male cadavers (p<0.001 for all). The correlation between the stature and long bone length was the best for the humerus in females (r=0.792) and the tibia in males (r=0.891). Regression equations specific to the Croatian population were computed separately for each long bone in males and females and proven to be reliable in predicting the living stature of the individual.

Identification and analysis of human remains recovered from wells from the 1991 War in Croatia.

From 1996 to the present, the remains of 61 individuals killed during the 1991 War in Croatia were recovered from both dried out and functioning wells. Positive identification was established in 60.7% or 37/61 cases. Remains recovered from the same geographical region but from non-well settings were identified in 77.4% or 1256/1623 cases. The purpose of this paper is to report on the taphonomic, demographic and trauma characteristics of remains recovered from wells and identify factors responsible for the discrepancy in the identification ratios. The age and sex distributions in the well and non-well series were similar, as were the frequencies of recovered personal documents, jewelry and other artifacts. The taphonomic features of the remains were, however, significantly different. Preservation of remains was considerably better in non-well settings (1400/1623 or 86.3% compared to 40/61 or 65.5% in wells). Congruently, commingling of remains was more frequent in wells (26/61 or 42.6% compared to 77/1623 or 4.7% in non-well settings). In bodies recovered from non-well settings the preservation, state and commingling of the remains were strongly correlated with positive identification. None of these features were correlated with the identification of bodies from wells. Instead, identification of remains from wells was significantly affected by the presence or absence of water in the well. As both series have similar frequencies, and identical rankings of identification factors, the reason for the discrepancy in the identification ratios lies in the fact that by themselves, these factors were rarely sufficient for positive identification. In both series the majority of identifications (51.4% in the well, and 58.1% in the non-well series) were established through a combination of biological and non-biological features. The significantly lower identification ratio in the well series resulted from the difficult recovery conditions in wells with significant amounts of water, and the negative effect that water had on the preservation of clothing, personal artifacts and some dental features. Significant differences were also noted in the types and locations of perimortem traumas. There is a significantly higher frequency of entrance gunshot wounds to the back of the head, suggestive of execution style murders, in the well series.

[Human or animal skeletal remains?]. / Ljudski ili zivotinjski kostani ostatci?

The aim of the article is to provide physicians with guidelines for differentiating human from animal skeletal remains. Morphologic features which clearly distinguish human and nonhuman bones are presented, together with an overview of the methods available for further analysis of bone material. Process of bone identification is exemplified through the case of skeletal remains recovered in Lika district in Croatia. Instructions for the physicians faced with bone material are given in order to better understand their possibilities and limitations when interpreting such findings.

Discriminant function sexing of fragmentary and complete femora: standards for contemporary Croatia.

Determining sex is one of the first and most important steps in identifying decomposed corpses or skeletal remains. Previous studies have demonstrated that populations differ from each other in size and proportion and that these differences can affect metric assessment of sex. This paper establishes standards for determining sex from fragmentary and complete femurs in a modern Croatian population. The sample is composed of 195 femora (104 male and 91 female) from positively identified victims of the 1991 War in Croatia. Six discriminant functions were generated. one using seven variables, three using two variables, and two employing one variable. Results show that complete femora can be sexed with 94.4% accuracy. The same overall accuracy, with slight differences in male/female accuracy, was achieved using a combination of two variables defining the epiphyses, and with the variable maximum diameter of the femoral head.