On the evidential value of a Messerer fracture sustained in a car-pedestrian traffic accident.

A pedestrian was killed in a road traffic accident by collision with a car coming from the right. The victim's right femur was observed to have sustained a wedge-shaped fracture with biconcave side edges (so-called Messerer fracture), with the apex of the wedge pointing in the direction opposite to the direction of travel of the car. The absence of skin or soft tissue injuries in the area of the fracture means that it is reasonable to assume that this 'reverse wedge fracture' is an indirect fracture. The mechanism by which characteristic wedge-shaped fractures are produced through compression along the longitudinal axis of the bone has long been known. When reconstructing the direction of travel of a car involved in a collision with a pedestrian, forensic pathologists should therefore be cautious of assessing Messerer fractures in isolation.

On manual laterality (handedness) in humans and its forensic significance - a literature review.

Manual laterality (handedness) in humans has some significance for forensic practice where it is primarily employed in the form of handedness preference, based on a simplified three-stage classification (right-handed, left-handed and ambidextrous). In cases of homicide or suicide, the pattern of injuries, particularly cutting or stab injuries and gunshot wounds, may provide clues as to the perpetrator's handedness. In injuries inflicted by another person, the pattern of findings can in isolated cases allow to draw conclusions as to the handedness of the perpetrator. In self-inflicted injuries and suicide, the dominant hand is usually used either alone or as the lead hand. If it is found that fatal injuries were inflicted by the non-dominant hand, this gives rise to doubt that the manner of death is suicide. Evidence of handedness is of little value in distinguishing between suicide and homicide. Due to new developments in dentistry, imaging procedures and especially genetics, the utility of handedness in the identification of unknown persons or cadavers has significantly diminished. In living subjects, useful evidence of handedness can be obtained by observing the performance of specific gestures or activities. The subject should be asked to perform tasks involving one and two hands in a specific sequence. Standardised measurements of the morphology of the shoulders and upper extremities are able to make a statistical distinction between right and left. Since the accuracy of this process is, however, only,around 75 %, morphological determination of handedness should not be used in living subjects, but should be restricted to the identification of unknown cadavers or other post-mortem examinations.

[Forensic age estimation in juveniles and young adults: Reducing the range of scatter in age diagnosis by combining different methods]. / Forensische Altersschätzung bei Jugendlichen und jungen Erwachsenen: Streubreitenreduktion der Altersdiagnose durch Kombination der Methoden.

The dramatic rise in the number of refugees entering Germany means that age estimation for juveniles and young adults whose age is unclear but relevant to legal and official procedures has become more important than ever. Until now, whether and to what extent the combination of methods recommended by the Study Group on Forensic Age Diagnostics has resulted in a reduction of the range of scatter of the summarized age diagnosis has been unclear. Hand skeletal age, third molar mineralization stage and ossification stage of the medial clavicular epiphyses were determined for 307 individuals aged between 10 and 29 at time of death on whom autopsies were performed at the Institutes of Legal Medicine in Berlin, Frankfurt am Main and Hamburg between 2001 and 2011. To measure the range of scatter, linear regression analysis was used to calculate the standard error of estimate for each of the above methods individually and in combination. It was found that combining the above methods led to a reduction in the range of scatter. Due to various limitations of the study, the statistical parameters determined cannot, however, be used for age estimation practice.

[A literature review on the Messerer's fracture]. / Über den Messerer-Bruch--eine Literaturstudie.

The characteristic wedge-shaped fracture was first described by Messerer (1880) and Bruns (1884) after performing experiments on long bones. Not much later, Messerer (1885) formulated the forensic significance of the direct bending fracture for the detection of the location and direction of blunt impact trauma. He developed the basic biomechanical theory of the origin of this fracture type, which is therefore called Messerer's fracture in the German-speaking world. In the following decades, the findings concerning the origin, specificity and forensic usability of Messerer's fractures were confirmed and supplemented by experiments and case studies. For forensic examinations, it is important to bear in mind that there are exceptions to the rule according to which the level of the wedge-shaped fracture corresponds exactly to the point of impact. The possibility of "false" or "reversed" wedges must also be considered. Already in the 19th century, authors had pointed out the mechanism of indirect formation of wedge-shaped bone fragments. That is why a forensic examination always has to consider the investigation results and medical findings in their entirety. Autopsy of traffic victims is of paramount importance. It must include a thorough examination of clothing, skin, soft tissues and skeletal system using special preparation techniques. The examination of bone injuries in living victims also requires special expertise. If properly applied, valuable results can be obtained by the forensic expert from the wedge-shaped fracture. Until recently, Messerer's fracture was a typical injury sustained by pedestrians hit by vehicles with protruding frontal elements. In modern car production, not only the dimensions of cars have been changed, but the front-end structures have also been modified, e. g. by integrated bumpers. These constructional changes are likely to reduce the frequency of narrow points of impact in collisions. However, further research on the frequency and significance of Messerer's fractures in road traffic accident victims is required.

[Walcher's hat brim line rule--a literature review]. / Über die Walcher'sche Hutkrempenregel--eine Literaturstudie.

The first description in the forensic medical literature of a demarcation line for the localization of head injuries resulting from falling to the ground appears in Kratter (1919). Regarding a similar line, Walcher (1931) later introduced the relation to the hat brim (Hutkrempe), which gave the rule its name: the hat brim line rule (Hutkrempenregel). Thenceforth it was supposed to be called Kratter's and Walcher's hat brim line rule (Kratter-Walcher'sche Hutkrempenregel). Over the following decades, not only its content but also the area of application and the definition of the hat brim line rule were repeatedly, and in part significantly, altered. This could be one of the reasons for the confusing diversity of academic opinions about the rule's applicability. Generally, the hat brim line rule should be retained in its original sense: Fall-related injuries do not lie above the hat brim line if the fall occurred from a standing position to the ground, without intermediary blows to the head. If applied in this way, the rule can be a helpful point of orientation for experts. The demarcation line in the original anatomical definition according to Kratter (1919) should also be used henceforth: the line which connects "the frontal eminence, the parietal eminence and the tip of the occipital plate" and lies "somewhat.above the usual saw-line of the calvarium". This line corresponds roughly to the hat brim line as it is understood by hat makers. The hat brim line rule should not be applied with regard to small children, as they show a different falling behaviour due to their disproportionately large and heavy heads. The rule is also in no way applicable to the assessment of injuries from blows, falls from a height (including from stairs) or traffic accidents. There is an urgent need for research as to the applicability of the hat brim line rule in relation to falling backwards, particularly in cases of high alcohol consumption.

Genetic Kinship Investigation from Blood Groups to DNA Markers.

The forensic application of hereditary characteristics became possible after the discovery of human blood groups by Karl Landsteiner in 1901. The foundation for their use in kinship investigation was laid by Emil von Dungern and Ludwig Hirschfeld in 1910 by clarification of the inheritance of the ABO groups. Up to the middle of the 20th century further red cell membrane systems were discovered. From the 1920s Fritz Schiff and Georg Strassmann fought for the introduction of blood groups into forensic kinship investigation. A new era of hemogenetics was opened from 1955 as genetic polymorphisms were described in serum proteins. Starting in 1958 there followed the complex HLA system of white blood cells, which from 1963 was joined by polymophisms in erythrocyte enzymes. Therefore, from the 1980s, it was possible to clarify the majority of kinship cases with a combination of conventional markers. From 1990 to 2000 the conventional markers were gradually replaced by the more effective DNA markers. Simultaneously typing shifted from the phenotype level to the genotype level. The genomic structure of conventional genetic markers could also now be explained. As a reflection of scientific progress the legal situation also changed, particularly in the form of the official guidelines for kinship investigation.

[Puppe's rule--a literature review]. / Uber die Puppe'sche Regel--eine Literaturstudie.

As early as 1903, it was pointed out by Puppe that it is possible to determine the sequence of injuries in skull fractures caused by blows to the head: the second fracture ends at the point where a break in cohesion is already present. This finding was confirmed by tests carried out by other forensic pathologists. It soon became clear that the rule also applies to gunshot fractures. In the case of gunshot injuries, it is even possible to make more detailed statements. However, the applicability of Puppe's rule is limited by incomplete ossification or ossification disorders. The priority rule is also found in English-language literature, but without the name of the author who first described it.

[Simon's bleedings as a vital sign of hanging--a literature review]. / Uber die Simon'schen Blutungen als vitales Zeichen des Erhängens--eine Literaturstudie.

The intervertebral haemorrhages described by Simon in 1968 as a vital sign of hanging have been verified and endorsed by other authors. They occur in 40-50 % of hanging cases, most frequently in the lumbar spine, in younger age groups, and in cases of free suspension. The haemorrhages are not unique to hanging, but may occur in particular as a result of other traumatic elongation or overextension of the spinal column (e. g. in the course of traffic accidents). In cases of decomposition of the body, "false positive" findings are relatively common. As external findings scarcely provide any reliable vital signs of hanging, there is still a high demand for autopsies. In addition to Simon's bleedings, internal findings which are diagnostically conclusive also include microscopic examinations of the lungs and the neck musculature. More recent findings such as haemorrhages in the back and auxiliary respiratory muscles as well as the intestinal wall, if confirmed, could supplement Simon's bleedings. Frei's fibre sample and evidence of histamine in the ligature mark should not be neglected. Finally, it must be emphasized that the forensic assessment of hanging cases should always be based on a criminological and forensic evaluation of all the circumstances of the offence as well as on post-mortem findings.

[The Berlin morgue of 1886--the 125-year-old morgue of Berlin-Mitte]. / Die Berliner Morgue von 1886--125 Jahre Leichenschauhaus in Berlin-mitte.

On 1 March 1886, a new morgue built along the lines of the Paris morgue, was opened in Berlin, Germany. Experts from many European countries were interested in the new building with its modern design and equipment. As the morgue, the Institute of Legal Medicine of the Berlin University accommodated in the same building also acquired international reputation. However, neither the scientific nor the economic achievements of this long-standing institution could prevent the closure of this historic site in Berlin-Mitte after almost 125 years.

[Tardieu's spots and asphyxia--a literature study]. / Uber die Tardieu'schen Flecke--eine Literaturstudie.

Subpleural, epicardial and pericranial ecchymoses have been described in cases of suffocation since the 18th century. In the 19th century, great diagnostic importance was attributed to ecchymoses. Tardieu was the most determined defender of the specificity of ecchymoses for suffocations. He thought that he could diagnose violent suffocation by means of ecchymoses and claimed that he was able to differentiate violent suffocation from other unnatural causes of death (hanging, choking, strangulation, and drowning). Other physicians, among them numerous German medical examiners, proved Tardieu's opinions wrong by means of observations and animal studies. The most dedicated disputant against Tardieu's false doctrines was Liman. According to today's knowledge of pathophysiology, the haemorrhages concerned cannot have a specificity for suffocation or even a specific form of suffocation. Therefore, the confusing term of "suffocation haemorrages" should be avoided.

[Medicolegal identification of victims in mass disasters using the example of aircraft accidents]. / Rechtsmedizinische Identifizierungsaufgaben bei Katastrophen am Beispiel von Flugunfällen.

In mass disasters, the main task of the medicolegal expert is to support the victims' identification. As such events are rare, the knowledge obtained during previous operations should be evaluated and published to improve the quality and effectiveness of the identification work in future disasters. This report describes the experience gained at the Institute of Forensic Medicine of the Humboldt University in Berlin during the identification of the victims of three aircraft accidents (1972, 1986, 1989). The advantages and disadvantages of the identification methods used are discussed. Medicolegal experts should make themselves familiar with available experiences to be adequately prepared for the responsible task of identifying the victims in an emergency.

[Werkgartner's muzzle imprint mark--a literature study]. / Uber die Werkgartner'sche Stanzmarke--eine Literaturstudie.

Since Werkgartner described and correctly interpreted the muzzle imprint mark around the gunshot entrance wound in 1922, this finding has been generally accepted as a sign of a contact shot. In further studies, it could finally be clarified that the muzzle imprint mark is caused by the expansive power of the powder gases with pressure on and abrasion of the skin at the muzzle (weapon imprint). Its shape depends on the firearm, the ammunition and the anatomical conditions, but does not require a bullet. Examinations under a magnifying glass microscope and histological investigations can complete the macroscopic findings. Occasionally, the muzzle imprint mark requires a certain "drying period" in order to become clearly visible. In rare cases, muzzle imprint marks also form on textiles perforated by the projectile. Characteristically shaped muzzled imprint marks can provide clues to the type of the firearm and its position at the time of discharge.

[Medico-legal autopsies in Berlin from 1999 to 2003]. / Rechtsmedizinische Obduktionen in Berlin von 1999 bis 2003.

This paper presents statistical data on medico-legal autopsies at the three Berlin institutes from 1999 to 2003. With an autopsy frequency of 6.5% in 1999, Berlin was ranking at the top in Germany. The relatively high autopsy rate--compared to other German institutes--led to a higher share of women, a higher mean age of the examined bodies and a higher percentage of cases of natural death. In accordance with studies from other major cities, there were more cases with an unknown cause of death and a higher number of drug victims than in rural areas. The negative consequences of a far too low autopsy rate in Germany regarding legal certainty, the quality of medical care and the validity of the statistics of causes of death are discussed in connection with possible measures to increase the frequency of autopsies.

[The University Institute of Legal Medicine in Berlin 1833-2008].

The university institute of legal medicine of the Charité in Berlin was founded on February 11th, 1833 as a "Praktische Unterrichtsanstalt für die Staatsarzneikunde (Practice-oriented School of Public Health and Medicine)" at the Friedrich-Wilhelms-Universität (founded in 1810). In 1886 the oldest faculty in Germany obtained its own building in Berlin-Mitte. Starting with Wilhelm Wagner, Johann Ludwig Casper, Fritz Strassmann, Otto Prokop and their successors established the Berlin School of Legal Medicine, which has been playing an important role for the subject's progress in the German-speaking area until today. Since the visit of Kuniyoshi Katayama to Berlin in 1884 there have been productive relationships with Japanese forensic pathologists to this day. Regardless of the accepted scientific achievements the institute fell victim to the Berlin policy of austerity after 2003 leading to staff reduction and the closure of the historical location. Due to the new appointment to the chair in 2007 and the planned junction of the subject in Berlin-Moabit there is now the chance for a new impetus of forensic medicine in the German capital.

Forensic Age Estimation.

BACKGROUND: Forensic age estimation is requested by courts and other government authorities so that immigrants whose real age is unknown should not suffer unfair disadvantages because of their supposed age, and so that all legal procedures to which an individual's age is relevant can be properly followed. 157 age estimations were requested in Berlin in 2014, more than twice as many as in 2004. METHODS: This review is based on pertinent articles retrieved by a selective search in the PubMed and MEDPILOT databases, supplemented by relevant recommendations and by the findings of the authors' own research. RESULTS: The essential components of age estimation are the history, physical examination, X-rays of the hands, panorama films of the jaws, and, if indicated, a thin-slice CT of the medial clavicular epiphyses, provided that there is a legal basis for X-ray examinations without a medical indication. Multiple methods are always used in combination, for optimal accuracy. Depending on the legal issues at hand, the examiner may be asked to estimate the individual's minimum age and/or his or her most probable age. The minimum-age concept can be used in determinations whether an individual has reached the age of legal majority. It is designed to ensure that practically all persons classified as adults have, in fact, attained legal majority, even though some other persons will be incorrectly classified as minors. CONCLUSION: Forensic age estimation lets courts and other government authorities determine the official age of persons whose actual age is unknown-in most cases, unaccompanied refugees who may be minors. The goal is to carry out age-dependent legal procedures appropriately in accordance with the rule of law. The minimum-age concept is designed to prevent the erroneous classification of minors as legal adults.

Statistical analysis and verification of forensic age estimation of living persons in the Institute of Legal Medicine of the Berlin University Hospital Charité.

In recent years, the increase in international migration movements has led to a greater demand for forensic age estimation of foreigners without valid identification documents in numerous countries. The growing importance of forensic age determination is underlined by a rapid rise in the number of expert reports by the Institute of Legal Medicine of the Berlin University Hospital Charité. A total of 247 expert opinions on estimated age were given between 1992 and 31 December 2000. Subject to formal court ruling, age is estimated based on the physical inspection, in combination with an X-ray of the left hand and the clavicles as well as dental assessment. However, the statistical proof of the range of scatter for the summarized age diagnosis still remains to be clarified in the context of this assessment procedure. The age estimations made by the Institute of Legal Medicine of the Berlin University Hospital Charité were statistically analyzed with respect to the validity of the different methods. For verification of the age diagnoses, the age estimates were compared with the court records and the age determined in the course of legal proceedings. In 45 cases, the age diagnoses could be verified. In all cases where the age could be verified beyond doubt, deviations from the actual age did not exceed +/-12 months. From this, it can be concluded that the combined application of the above-mentioned methods allows forensic age estimations with a sufficiently high degree of reliability.

Studies on the chronology of third molar mineralization in a Japanese population.

In Germany, a sharp increase in forensic age estimations of living individuals has been observed in recent years. With regard to the relevant age group, radiologic assessment of the mineralization stage of the third molars is of particular importance. Still, the influence of ethnicity on the pace of mineralization has been insufficiently analyzed. A total of 1615 orthopantomograms of 929 female and 686 male Japanese subjects aged between 12 and 30 years was examined. The mineralization stages of third molars were evaluated on the basis of Demirjian's stages modified in accordance with Mincer's model. For the individual mineralization stages, the study presents the means and standard deviations for the genders separately. No statistically significant differences in the chronology of third molar mineralization between maxilla and mandible and between sides were observed. A comparison between genders largely did not render significant differences either. Apart from forensic age determination in living subjects, the presented reference data can also be used for age estimations of unidentified corpses and skeletons.

Comparative study on the chronology of third molar mineralization in a Japanese and a German population.

In Germany, a sharp increase in forensic age estimations of living persons has been observed in recent years. German law defines four legally relevant age limits: 14, 16, 18 and 21 years. In these age groups, radiographic assessment of the mineralization status of third molars is of particular importance. So far, the influence of ethnicity on the mineralization rate has been insufficiently analyzed. A total of 3031 orthopantomograms of 1597 Japanese and 1434 Germans aged between 12 and 26 years were examined. The mineralization status of third molars was evaluated on the basis of the classification proposed by Demirjian. For the individual mineralization stages, the study presents the mean values and standard deviations (SD) separately for both populations and sexes. The majority of probands from both the Japanese and the German population achieved the C stage and the late G and H stages of third molar development at similar ages. Significant differences between Japanese and Germans were observed, however, with regard to the D, E and F stages defined by Demirjian. Japanese men and women achieved the D, E and F stages approximately 2-3 years later than German men and women. In addition to forensic age determination in living persons, the presented reference data can also be used for age estimations of unidentified deceased persons and skeletons.

[Decapitation due to early post-mortem canine gnawing]. / Dekapitation durch frühpostmortalen Hundefrass.

A 53-year-old male was found dead in his home. The deceased's head, almost totally skeletonized, was lying at a distance of about 150 cm from the thorax inlet. The other occupant of the flat was a mongrel sheepdog. The autopsy conducted for the inquest established extensive damage to soft tissue in the head, neck and chest. The second to sixth cervical vertebrae were missing. The seventh cervical vertebra and the right first rib displayed bone lesions. The tissue injuries were attributed in the diagnosis to post-mortem canine gnawing. Cause of death was given as intermittent haemorrhaging of the gastro-intestinal tract from oesophageal varices in a status of hepatic cirrhosis. There was no indication that death had been caused by another party. About two days were estimated to have elapsed since death. Attention is drawn to this doubtless rare instance of total decapitation of the deceased with displacement of the head caused by a dog during the early post-mortem period.

[Radiologically determined DMF index variations for forensic age estimation of young adults]. / Radiologisch bestimmte Varianten des DMF-Index zur forensischen Altersschätzung bei jungen Erwachsenen.

The eruption and mineralization of third molars are the main criteria for dental age estimation of living people involved in criminal proceedings. Since the development of third molars is usually completed by the age of 19 or 20 years, this feature cannot be used to ascertain whether a person has attained the forensically relevant age of 21 years. This study examined whether the DMFT index or the third molar DFT index could supply reliable information enabling conclusions to be drawn about whether a person has reached the age of 21. To this end, 650 conventional orthopantomograms of German subjects aged 18 to 30 years were evaluated. The DMF index variations considered were found to be unsuitable for determining whether a person is over 21 because they displayed a weak correlation with age and considerable individual scatter. A high indicative value can only be attributed to a third molar DFT index of 4, although this is rarely observed in the relevant age group. An X-ray examination of the medial clavicular epiphyseal cartilage is, therefore, strongly recommended when assessing whether a person has attained 21 years of age.