Microscopic characteristics of peri- and postmortem fracture surfaces.

This study investigated if microscopic surface features captured with a scanning electron microscope (SEM) effectively discriminate fracture timing. We hypothesized that microscopic fracture characteristics, including delamination, osteon pullout, and microcracks, may vary as bone elasticity decreases, elucidating perimortem and postmortem events more reliably than macroscopic analyses. Thirty-seven unembalmed, defleshed human femoral shafts from males (n=18) and females (n=2) aged 33-81 years were fractured at experimentally simulated postmortem intervals (PMIs) ranging from 1 to 60 warm weather days (250-40,600 ADH). A gravity convection oven was used to approximate tissue decomposition at 37 C and 27 C, and the resulting heat-time unit (accumulated degree hours, or ADH) was used to examine fractures in elastic/wet versus brittle/dry bone. The bones were fractured with a drop test frame using a three-point bending setup, sensors were used to calculate fracture energy, and high-speed photography documented fracture events. The following data were collected to relate fracture appearance to the biomechanical properties of bone: PMI (postmortem interval) length in ADH, temperature, humidity, collagen percentage, water loss, bone mineral density, cortical bone thickness, fracture energy, age, sex, cause of death, and microscopic fracture feature scores. SEM micrographs were collected from the primary tension zones of each fracture surface, and three microscopic fracture characteristics were scored from a region of interest in the center of the tension zone: percentage of delaminated osteons, percent osteon pullout, and number of microcracks. Multiple linear regression showed that microscopic fracture surface features are strong predictors of ADH (adjusted R-squared=0.67 for the 0 - 40,000 ADH samples; adjusted R-squared=0.92 for the 0-16,000 ADH samples). Osteon pullout is the single best predictor of ADH. Additionally, water loss is the primary driver of bone elasticity changes in low ADH samples, while collagen fibers appear to remain intact until later in the postmortem interval (approximately 40,000 ADH in this study). The results of this study indicate microscopic fracture surface analysis detects the biomechanical effects of decreased elasticity more reliably and with greater sensitivity than macroscopic analysis.

Utilizing augmented reality for reconstruction of fractured, fragmented and damaged craniofacial remains in forensic anthropology.

Forensic anthropologists are often confronted with human remains that have been damaged due to trauma, fire, or postmortem taphonomic alteration, frequently resulting in the fracture and fragmentation of skeletal elements. The augmented reality (AR) technology introduced in this paper builds on familiar 3D visualization methods and utilizes them to make three dimensional holographic meshes of skeletal fragments that can be manipulated, tagged, and examined by the user. Here, CT scans, neural radiance fields (NeRF) artificial intelligence software, and Unreal Engine production software are utilized to construct a three-dimensional holographic image that can be manipulated with HoloLens™ technology to analyze the fracture margin and reconstruct craniofacial elements without causing damage to fragile remains via excessive handling. This allows forensic anthropologists a means of assessing aspects of the biological profile and traumatic injuries without risking further damage to the skeleton. It can also be utilized by students and professional anthropologists to practice refitting before reconstructing craniofacial fragments if refitting is necessary. Additionally, the holographic images can be used to explain complicated concepts in a courtroom without the emotional response related to using bony elements as courtroom exhibits.

Stereomicroscopic analysis of cut marks inflicted by a knife with blade damage.

Skeletal cut mark analysis provides relevant information on the general class characteristics of suspect knife. However, there is a lack of research on the influence of blade damage on cut mark analysis. This study aimed to thoroughly investigate the effects of damaged knife blades on cut marks' morphological and morphometrical characteristics. Fifteen undamaged, non-serrated knives were used to cut human ribs to make control cut marks. The knife blades were then damaged by a series of cuts on the bones. A comparison was made between the control cuts and 3 groups of cut marks inflicted by blades that had been damaged to different degrees. The results showed that the damaged blades created wider cut marks than undamaged one. Kerf morphology was likely to imitate the cuts made by the serrated blades such as an elliptical shape, a V-shaped cross-section and the presence of coarse striations. Wear-related features can affect cut mark analysis as the marks left behind by blades damaged to different degrees showed dissimilar dimensions and morphologies. The findings of this study can be applied to a forensic investigation when cut marks were caused by a knife with a damaged blade.

Interpreting perimortem blast trauma from skeletal remains: Complications and considerations.

Blast trauma results from highly variable events that can lead to similar effects in the skeleton. Clinical literature, which largely focuses on soft tissue, provides limited efficacy for interpreting fully skeletonized cases. Interpretation of skeletal blast trauma is hampered by the low number of fully skeletonized case studies and experimental replication studies, which mainly use nonhuman proxies. The purpose of this study is to discuss fracture patterns on two individuals from WWII as a means to better understand and identify fracture patterns associated with blast trauma. Existing clinical and anthropological criteria are reviewed and applied to two World War II cases, both presumed to exhibit blast trauma based on historical contexts. These case studies exhibit combinations of complicated and extensive signs of blunt-force and projectile trauma, reflecting the diversity of skeletal trauma resulting from blast-related events. This analysis emphasizes the arguably impossible task of establishing a diagnosis based on the available literature and lack of prior knowledge about specific losses. Ultimately, analysts must consider the totality of skeletal trauma, combining biomechanical theory and relevant clinical and anthropological literature to arrive at useful yet defensible assessments of trauma. However, refined criteria and additional studies are needed to assess complicated trauma from blast-related events in anthropological contexts.

Caring for the injured: Exploring the immediate and long-term consequences of injury in medieval Cambridge, England.

OBJECTIVE: To combine paleopathological and biomechanical analysis to reconstruct the impact that a severe skeletal injury had on an individual's ability to function and participate in medieval society. MATERIALS: Three medieval individuals from Cambridge, England with ante-mortem fractures to the lower limb were analyzed. METHODS: Plain X-rays were used to determine the degree of malunion, rotation and overlap of each fracture. Cortical bone architecture of the injured individuals and 28 uninjured controls were analyzed using micro-computed tomography (µCT). Clinical and functional consequences were examined using the Bioarcheology of Care framework. RESULTS: The mechanism of injury, the secondary complications, and the extent of the care received was reconstructed for each individual. Bilateral asymmetry in the cortical bone architecture revealed the long-term alterations to each individual's gait. CONCLUSION: Each of these individuals survived a severe injury resulting in chronic physical impairment, though not all would have been considered 'disabled'. SIGNIFICANCE: This research contributes to the discussion about medieval care provision and social constructions of disability by illustrating how an interdisciplinary approach provides insight into the experiences of those with physical impairments. The integration of µCT imaging within the Bioarcheology of Care model is a novel approach with great potential for application across the field. LIMITATIONS: Biomechanical analysis was restricted to cortical geometry. SUGGESTIONS FOR FUTURE RESEARCH: Further study of bilateral asymmetry in trabecular architecture could complement our understanding of altered loading modalities in past societies.

Identification of a decedent in a 103-year-old homicide case using forensic anthropology and genetic genealogy.

Anthropologists are often the custodians of long-term unidentified human remains though their positions as curators of university or museum skeletal collections. Various factors decrease the solvability of these legacy cases including the passage of time, the loss of provenience for specific cases, and lack of documentation or case records. While anthropologists can contribute important information toward identification, it is often necessary to explore novel and cross-disciplinary strategies to resolve difficult cold cases. In long cold cases, the postmortem interval, in particular, may be difficult to estimate leading to further challenges in achieving identification. Modern advances in radiocarbon bomb pulse dating, isotope analysis, and actualistic studies have contributed to positive identification of unidentified human remains in some legacy cases, but may not be available to all forensic practitioners and law enforcement from resource-poor agencies. Pooling resources, as well as collaborating with professionals outside of forensic anthropology, is a useful strategy to pursue when anthropological methods are exhausted.The case study presented here demonstrates a collaborative approach between forensic anthropologists, forensic genetic genealogists, and law enforcement in a century-old homicide. The dismembered and mummified parts of a male body were recovered in a remote cave in 1979 and again in 1991. Despite forensic anthropologists creating and updating the biological profile over the decades from recovery to present, no identification was made until the application of forensic genetic genealogy (FGG) to the case in 2019. New interpretations of bone microstructure and trauma analysis are presented for the case, alongside the historical documentation and "proof of life" evidence used by the genealogy team. A review of the FGG methods underscores the challenges in this case (e.g. significant endogamy, multiple aliases used by the victim) and the steps taken toward resolution. Ultimately, a combined anthropology and genealogy approach resulted in a confirmed identity for a man who was murdered in 1916.Key pointsForensic scientists should leverage a collaborative, interdisciplinary approach toward human identification.When combined with forensic anthropology methods, forensic genetic genealogy is a valuable tool linking biological and cultural-historical aspects of identity.Forensic anthropologists should review challenging cases in their labs as new methods are introduced and new resources become available.

Exploring the use of machine learning for the assessment of skeletal fracture morphology and differentiation between impact mechanisms: A pilot study.

Analyzing and interpreting traumatic injuries is a fundamental aspect of routine forensic case work. As the human skeleton can be impacted through a combination of loading mechanisms and varying impact energies, the analysis and interpretation of skeletal trauma can be complex. Therefore, it is imperative that the reliability of techniques used for analysis are well-established. There is growing interest in machine learning (ML) in medicine (especially radiology) regarding the use of image classification (a subset of ML) to categorize and predict classes of medical images. Therefore, the feasibility of using image classification for skeletal trauma analysis should be explored for its benefits to forensic pathology and anthropology. The method explored in this paper examined the potential for machine learning, using three dimensional (3D) convolutional neural networks (CNNs), to assess whether morphological features of skeletal trauma to the femur can be used to differentiate between impact mechanisms within a forensic population. The objective of this study was to assess if morphological differences in femoral fractures seen in post-mortem-computed tomographic images (PMCT) could be categorized according to mechanism, specifically horizontal impacts resulting from pedestrian motor vehicle impacts (PMVIs) and vertical impact s resulting from high impact falls. Final model results indicated an accuracy between 69.95%-72.86% and 63.08%-66.24% validation. Although these results mean the method could not be practically used in its current form, as a proof of concept, there is potential for it to be developed as a tool to assist in classifying complex fracture states.

Diagnostic accuracies of CTs, X-rays and Lodox to detect blunt force trauma in adults, using a pig model.

The accurate radiological detection of skeletal trauma is crucial for the investigation of blunt force trauma (BFT) cases. The sensitivities of CTs, X-rays and Lodox in identifying BFT fractures and minimum number of impacts in pigs, used as proxies for adult humans, were assessed. Ten human sized pig carcasses were struck with a mallet and scanned, after which the number of fractures and minimum number of impacts detected radiologically were recorded. Pig carcasses were then macerated, and the defleshed, skeletonized remains were considered the gold standard as far as number and location of fractures were concerned. CTs were most sensitive in identifying fractures and impacts in all body regions, with overall sensitivities of 55.4% and 71.5% respectively, while X-rays and Lodox had sensitivities of 25.8% and 29.3% for fractures, and 43.5% and 41.1% for impacts, respectively. All modalities were highly specific for identifying fractures (CT: 99.1%; X-ray: 98.9%; Lodox: 99.4%). CTs should be used to analyze blunt force trauma when a radiological assessment is required, but an examination of the defleshed bones remains the gold standard for the deceased whenever feasible. X-rays and Lodox have limited diagnostic value in these cases and relying on them to detect fractures may compromise the accurate forensic investigation of blunt trauma victims. However, the use of Lodox for initial screening of major trauma is still of value. Sensitivities are generally higher for detecting fractures in pigs compared to piglets, indicating that increased diagnostic value is achieved when imaging pigs compared to piglets.

Knife cut marks inflicted by different blade types and the changes induced by heat: a dimensional and morphological study.

Detailed information on skeletal trauma analysis of burned bone is important to ascertain the manner and cause of death in forensic casework. This research used three different knife types, one with a non-serrated blade, one a fine-serrated blade, and one a coarse-serrated blade, to inflict trauma to manually macerated Sus scrofa ribs (n = 240), and these ribs were later exposed to heat. Qualitative and quantitative analyses were conducted using macroscopic and microscopic techniques to assess specific characteristics of the cut marks. Differences in cut mark dimension and morphology of the ribs were investigated. After heat exposure, the cut marks on the rib samples remained recognisable and did not alter considerably. A level of dimensional and morphological preservation was reliant on the cutting action and the features of the knife blade as well as surrounding bone injury. The cut marks inflicted by the non-serrated blade remained recognisable despite exposure to the burning process. However, the cut marks inflicted by the coarse-serrated blade were likely to change significantly when exposed to heat. This study leads to two important results: (1) identification of pre-existing cut marks prior to heat exposure is possible in reconstructed burned bone fragments, and (2) cut marks from different types of knife blades showed dissimilar responses to heat. The outcomes obtained in this study stressed the need to adopt great care with the effects of heat on skeletal trauma analysis.

Providing a Forensic Expert Opinion on the "Degree of Force": Evidentiary Considerations.

Forensic pathologists and anthropologists are often asked in court for an opinion about the degree of force required to cause a specific injury. This paper examines and discusses the concept of 'degree of force' and why it is considered a pertinent issue in legal proceedings. This discussion identifies the implicit assumptions that often underpin questions about the 'degree of force'. The current knowledge base for opinions on the degree of force is then provided by means of a literature review. A critical appraisal of this literature shows that much of the results from experimental research is of limited value in routine casework. An alternative approach to addressing the issue is provided through a discussion of the application of Bayes' theorem, also called the likelihood ratio framework. It is argued that the use of this framework makes it possible for an expert to provide relevant and specific evidence, whilst maintaining the boundaries of their field of expertise.

Artificial intelligence in musculoskeletal conditions.

Artificial intelligence (AI) is an iterative process by which information is captured, transformed into knowledge and processed to produce adaptive changes in the environment. AI is a broad concept, involving virtual (computing) and physical (robotics) elements. In this narrative literature review, we focus on the aspects of AI that present major opportunities for developing health care. Within a few years, AI will be part of our daily clinical practice. Although significant advances are being made, the application of AI in musculoskeletal medicine is still in its early stages compared with its implementation in other areas of medicine. AI is increasingly being employed in fields such as musculoskeletal radiology, skeletal trauma, orthopedic surgery, physical and rehabilitation medicine and sports medicine, as well as for "big data" and AI in gastrointestinal (GI) endoscopy related injuries. Among the limitations of IA are that it analyzes information based on the data it is supplied, which must therefore be well-labeled and that some algorithms such as DL uses more time, data, and computational power than other techniques. Moreover, AI currently does not solve the problem of causality that exists in medicine with observational data; information that physicians interpret within a broad clinical context. AI should therefore be integrated in a prudent and reasonable manner into the workflows of health professionals.

Analyzing the outcomes of skeletal trauma within a forensic population: Potential issues and implications in inferential modeling of blunt force trauma.

Analyzing complex skeletal trauma can present a challenge for forensic practitioners to reliably determine the causes and circumstances of traumatic injury. The forensic value of skeletal fracture pattern analysis can be diminished due to obscuration and similarity between injuries associated with various impact mechanisms (e.g., vertical vs horizontal blunt force) and can provide issues when questions arise surrounding circumstances of traumatic injuries. Using the Python coding language, code was written that segments traumatized regions of interest from post-mortem computed tomography (PMCT) scans, allowing the user to calculate percentage of fragmentation in the context of extreme trauma events. Using cases of known trauma which resulted in fragmentation of the femur, the objective was to assess if there were statistical differences in the fragmentation resulting from horizontal pedestrian motor vehicle impacts (PMVIs; n = 44) compared to vertical high impact falls (>3 m; n = 41). Results indicated that percentage differences between the PMVI group and high impact falls group were statistically significant. Although it was possible to develop a standardized method that records fragmentation, and results were significant in distinguishing between the two groups, the outcomes of the data follow an exponential distribution which has implications for how skeletal trauma is modeled.

An evaluation of the differences in paediatric skeletal trauma between fatal simple short falls and physical abuse blunt impact loads: An international multicentre pilot study.

In cases where a deceased child exhibits trauma as a result of a physical abuse blunt impact load, a parent/caregiver may provide a simple short fall (SSF) as the justification for that trauma. The skeletal fractures remain difficult to differentiate between a SSF and physical abuse however, as both are the result of a blunt impact load, and are therefore biomechanically alike, and the rare nature of these fatalities means only anecdotal research has been available to validate such claims. The aim of this pilot study was to investigate if there may be differences in the skeletal fracture patterns and types resulting from SSFs compared with those resulting from physical abuse blunt impacts. Paediatric (<10 years) cases of fatal SSFs (≤1.5 m) and physical abuse were collected from the Victorian Institute of Forensic Medicine (Australia), Institut Médico-Légal de Paris (France), University of Pretoria (South Africa) and Great Ormond Street Hospital (England). For each case the intrinsic and extrinsic variables were recorded from medico-legal reports and skeletal trauma was documented using post-mortem computed tomography scans and/or skeletal surveys. Three SSFs and 18 physical abuse cases were identified. Of the SSF cases, two exhibited fractures; both of which were simple linear neurocranial fractures. Comparatively, 12 of the physical abuse cases exhibited fractures and these were distributed across the skeleton; 58% located only in the skull, 17% only in the post-cranial and 25% located in both. Skull fracture types were single linear, multiple linear and comminuted. This pilot study suggests, anecdotally, there may be differences in the fracture patterns and types between blunt impact loads resulting from a SSF and physical abuse. This data will form the foundation of the Registry of Paediatric Fatal Fractures (RPFF) which, with further multicentre contributions, would allow this finding to be validated.

A multidisciplinary investigation of chronic animal abuse: Collaboration between veterinary forensics and forensic anthropology.

An unknown juvenile female mixed breed dog was found non-ambulatory on a dead-end street in an urban setting adjacent to a public park. During initial veterinary examination, she was assessed to have untreatable injuries and was humanely euthanized. The forensic veterinarian requested consultation from a forensic anthropologist to assist with documenting antemortem skeletal trauma. Analyses of skeletal tissues indicated numerous injuries in various stages of healing diagnostic of non-accidental injuries. Veterinary forensic cases may benefit from collaborative analysis of bony remains by forensic anthropologists.

A comparison of computed tomography, X-ray and Lodox® scans in assessing pediatric skull fractures using piglets.

Skull fractures are common in children both due to abuse and accidental incidences. The accurate detection of these fractures may therefore be critical. The aim of this study was to investigate the reliability of CT, X-ray, and Lodox® scans, the latter which has not previously been evaluated and is commonly employed in South Africa, in detecting the number, location and type of pediatric skull fractures. Blunt force trauma was inflicted with a mallet on ten piglet skulls, which were CT, X-ray, and Lodox® scanned and then macerated. The number, location, and type of skull fractures visible using each imaging modality, and on the cleaned skulls, were recorded. Sensitivities and specificities of each method were calculated. For fracture number and location, CTs had a sensitivity of 47.3%, X-rays 22.4% and Lodox® 23.3%. For fracture type, sensitivities were 46.1%, 16.6%, and 17.8% for CT, X-ray, and Lodox® , respectively. Specificities were high (92.5%-100%) which reduces the risk of incorrectly diagnosing fractures. However, low sensitivities increase the risk of failing to identify fractures and possible victims of abuse. Osteological analysis should preferably be the method of choice when evaluating pediatric skull trauma, and CTs should be used when osteological analysis is not feasible. If CT scanners are not available, X-rays and Lodox® may have to be used. In these cases, additional radiographic views of the skull are imperative and may increase the sensitivity of these methods, although they are not recommended to detect exact pediatric skull fracture number, location, and type.

Blast and Aircraft Crash Trauma: A Selection of WWII Cases from the Defense POW/MIA Accounting Agency Laboratory*, †.

This study examines patterns of skeletal trauma in propeller-driven aircraft crashes and blast-related ground loss incidents from WWII. Specifically, descriptions and criteria used to characterize aircraft deceleration- versus blast-related skeletal injuries are examined from 35 recently identified forensic anthropology cases to determine possible diagnostic traits and characterize skeletal trauma associated with these events. Among these cases, blast trauma is more localized within the skeleton and is associated with one or few primary directions of force. It is recommended that analysts differentiate between secondary and nonspecific blast trauma categories. Conversely, aircraft crash deceleration trauma is more widespread throughout the skeleton, with torsional fractures and injuries occurring from multiple or indeterminate directions. These traits reflect factors such as more complex loading environments than is seen in blast events. Two case studies are presented in detail to further illustrate differences in aircraft crash and blast-related incidents. Both studies emphasize consideration of the body as a whole unit to facilitate interpretations. While the cases presented herein result from historic war-related casualties that characterize the Defense POW/MIA Accounting Agency's (DPAA) casework, these skeletal cases provide guidelines more appropriate than clinically derived criteria developed through assessments of soft tissue injuries. These guidelines can be used by anthropologists and pathologists working with skeletal remain from mass disasters and other complex contexts, as well as provide avenues for future research.

Examination of Hacking and Blunt Force Skeletal Trauma.

Hacking trauma is prevalent in forensic cases involving genocide and dismemberment, but research into the identification of this type of trauma is lacking. The present study examines characteristics of hacking and blunt force skeletal trauma in order to determine if there is a point at which blunt force trauma becomes distinguishable from hacking trauma. Ten implements with a range of blade angles (i.e., the striking surface of the implement) were used in conjunction with a controlled-force hacking device to impact 100 limb bones of white-tailed deer (Odocoileus virginianus). Observations of the trauma included the occurrence and degree of fragmentation, the entrance widths of the impacts, and composite scores of six hacking characteristics, especially the distinctive V-shaped kerf. ANOVA tests and regression analyses were used to assess the relationships between these characteristics and the blade angles. A significant relationship (p-value = 0.011) was found between the composite hacking scores and the blade angles, indicating that blunt force and hacking trauma can be distinguished. The entrance widths of the impacts exhibited a significant relationship with the blade angles (p-value = 0.037). There was also a significant relationship between the visibility of a V-shaped kerf in the bones (p-value = 0.003), with visibility decreasing around the 60° blade angle. These data should assist in establishing guidelines to differentiate hacking and blunt force skeletal trauma in cases where the implement is on a spectrum between sharp and blunt.

Skeletal trauma reporting; perceptions and experiences of radiographer practitioners exposed to the reporting role.

INTRODUCTION: Increased demand for diagnostic imaging and professional body directives have resulted in radiographer reporting which requires postgraduate education due to the associated high degree of autonomy and complex decision making. Little research has focused on the transition from practitioner to the skeletal trauma reporting role. METHODS: Two-phase, qualitative research using Interpretative Phenomenological Analysis (IPA) explored perceptions and experiences. Phase 2, one-one, semi-structured interviews (n = 6) were recorded, transcribed verbatim and reviewed using the IPA six stage thematic analysis, generating three super-ordinate themes. Researcher reflexivity, ethics and quality assessment were considered. RESULTS: This paper reflects the IPA generated from Super-ordinate Theme 2; Exposure to the reporting role. Participant reflections indicated positive opinion with agreement that combining the reporting role with the diagnostic radiographer role enhanced practice and increased job satisfaction. Potential for stress associated with increased responsibility and accountability was described but there was recognition that skeletal trauma reporting was what they had chosen and been educated to do. CONCLUSION: The interpretative approach and IPA for Super-ordinate Theme 2, fills a gap in existing knowledge, providing a unique and valuable insight into perceptions and experiences of practitioners as they became exposed to the skeletal reporting role. IMPLICATIONS FOR PRACTICE: Participants were on their journey to advanced practice with plans to further develop their role. Excellent clinical practice had been demonstrated as well as facilitating learning with others. If there is expectation to achieve all domains associated with advanced practitioner status then time, commitment and support is essential from employers and management.

A Comparison of Skeletal Injuries Arising from Moped and Motorcycle Collisions.

Motorcycle and moped injuries remain a significant cause of motor-vehicle related morbidity and mortality. There is a paucity of literature describing the skeletal injuries of moped riders and how these compare to those of motorcyclists, however. This study seeks to examine the skeletal injuries sustained in such incidents and determine if there are significant differences. Hospitalized riders injured on powered two-wheeled vehicles (PTW) between 2004 and 2007 were entered into a registry along with their presentation and clinical course. This registry was sorted by PTW type. Riders with injuries of the appendicular skeleton, bony pelvis, and spine were extracted. Injuries were categorized by bone location. Demographic data, helmet use, head injury, facial fracture, Injury Severity Score (ISS), and mortality were extracted. Overall, 406/578 motorcyclists, 197/357 moped riders, and 62/92 dirt-bike riders sustained fractures of the appendicular skeleton, pelvis and/or spine. Motorcyclists had a significantly higher ISS upon presentation and had increased first-hospital day mortality in addition to more skeletal injuries, more fractures of the upper extremity, and more fractures of the spine, pelvis, and foot. Moped riders had a significantly lower rate of helmet use and higher rate of head injuries and facial fractures. In summary, while both moped and motorcycle riders share a risk for injuries of the lower extremity, their overall pattern of injury differs. Motorcyclists appear to be at increased risk for more severe injuries and injuries of the upper extremity, spine, and pelvis, while moped riders are at increased risk for significant head and facial injury.

Histologic and radiological analysis on bone fractures: Estimation of posttraumatic survival time in skeletal trauma.

In antemortem fractures, the estimation of the amount of time that has lapsed between the traumatic event and eventual death (the socalled 'posttraumatic survival time' or PTST) can have substantial implications in legal proceedings. It might for instance help to corroborate witness testimonies, to reconstruct the chain of events leading to eventual death or to establish a sequence when multiple traumata in a single individual are encountered. However, PTST estimation of bone trauma is impeded by a myriad of theoretical and practical issues, and is therefore almost invariably considered challenging. A few years ago, a method that combines radiological and histological analysis of fractures to estimate the minimum amount of lapsed PTST in skeletonized remains was proposed. This study aims to test its accuracy on a set of five rib fractures and four skull lesions fractures with known and varying amounts of posttraumatic survival time. In addition, it explores the differences between the assessment on ribs and skull bones and it expands on the proposed method by including computed tomography (CT) scanning. Using conventional radiology and histology, the minimum amount of PTST was accurately estimated in 8 out of 9 of the cases (89%). The one discrepancy between the estimated and known PTST was minimal, being just one day. The precision of the method diminishes as healing advances. It was noted that skull lesions showed less advanced and less well-developed healing features than the lapsed PTST would suggest. Of the three used modalities, conventional radiology proved to be the least accurate. CT scanning proved to be a valuable, sometimes even superior alternative to conventional radiology. Histology was superior to both conventional radiology and CT scanning. The results of our study illustrate the potential of the combined application of radiology and histology to estimate the PSTS in skeletonized human fractures.