Tree failure - A natural phenomenon with forensic implications.

Tree failure, or summer branch drop, refers to situations where large branches or whole trees may unexpectedly drop on unsuspecting victims. On occasion, this involves vehicles impacted by falling overhanging trees or branches. To study this phenomenon further review of the Forensic Science SA, Adelaide, Australia, database and an internet news search were undertaken over a 20 year period from March 2004 to February 2024 for all cases where unexpected accidental deaths in South Australia had been caused by falling branches or trees. There were six cases (age range 12-63 years; average 39 years; M:F 1:2). Three deaths occurred when branches dropped onto vehicles being driven along roads, 2 occurred when entire trees dropped onto the victims (one in windy weather) and 1 was due to a branch drop. Three tree species were identified as a grey box gum tree (Eucalyptus microcarpa), a lemon-scented gum tree (Corymbia citriodora) and a Cottonwood tree (Populus deltoides). The remainder were variants of eucalyptus (gum) trees. Deaths due to tree failures are uncommon and may involve a variety of different tree species with these events not necessarily occurring during high winds or storms. The major findings at autopsy are blunt force injuries.

Death Following a Skiing Incident: Severe Exsanguination Due to Rupture of the Left Renal Artery.

With the growing popularity of winter sports, it is necessary to pay more attention to the types of traumatic injuries that a person can sustain in various incidents related to their practice. We present a case in which an adult man died as a result of a collision with a tree while skiing. Although the deaths are associated with different types and severity of craniocerebral injuries in the majority of the cases, here we are dealing with an abdominal injury with rupture of the stomach, pancreas, and left renal artery. The exact localization of the resulting traumatic injuries and the mechanism of their occurrence were examined. Both macroscopic autopsy findings (gross pathology) and histologically proven ones are presented and described. Presenting this case, we want to raise awareness of the different types of injuries received while skiing, as well as to emphasize the possibility of death in the absence of visible external injuries over the victim's body.

Fracture variation in survivable versus fatal blunt force trauma associated with intimate partner violence.

Intimate partner violence (IPV) is a global human rights issue that affects approximately 25% of women and 10% of men and is the leading cause of homicides of women worldwide. Multiple interventional studies have been conducted to screen for IPV; however, fractures associated with intimate partner homicide (IPH) have not been studied from a forensic anthropological perspective. Therefore, this study uses computed tomography scans of IPH victims (n=33) obtained from the New Mexico Office of the Medical Investigator to 1) classify and quantify perimortem craniofacial blunt force fractures, and 2) compare the IPH-related fractures to those associated with non-lethal IPV using previously published studies. The results indicate that IPH cases presented similarly to non-lethal IPV cases in that they were concentrated on the middle and lower face, but fractures were more frequent in the upper face and cranial vault in IPH cases. While IPH cases showed more fractures, they were not necessarily associated with extensive fracturing, as 75.8% of IPH victims had five or fewer fractures-the most common being comminuted and linear fractures, comprising 93.8% of IPH-related fractures. As IPV is significantly underreported, understanding the nuances of fracture patterns associated with IPH can help to aid holistic forensic investigations.

Osteonal Damage Patterns from Ballistic and Blunt Force Trauma in Human Long Bones.

Forensic anthropologists play a key role in skeletal trauma analysis and commonly use macroscopic features to distinguish between trauma types. However, this approach can be challenging, particularly in cases of highly comminuted or incompletely recovered fractures. Histological analysis of microscopic fracture characteristics in fractured bones may thus help provide additional information on trauma type and bone fracture biomechanics in general. This study analysed the extent of microcrack damage to osteons in long bones with blunt force trauma (BFT) and gunshot trauma (GST), from both traumatic death cases and post-mortem experimental fractures. We identified four types of osteonal damage (OD). In traumatic death cases, OD affecting the inside of the osteon and compromising the Haversian canal (type 1) was found to be indicative of BFT. Moreover, OD affecting the cement line (type 3) and interstitial lamellae (type 4) was more common in the GST samples. OD affecting the inside of the osteon without compromising the Haversian canal (type 2) was not found to be indicative of either trauma type. In cases of experimental fractures, our study revealed that post-mortem fractures in dry bone samples featured the highest amount of OD, particularly of type 4. This study also found that the experimentally produced GST featured similar OD patterns to GST death cases. These findings support our hypothesis that there are distinct osteonal damage patterns in human long bones with BFT and GST, which are of relevant value for trauma analysis in forensic anthropology.

Laparoscopic Repair of Blunt Traumatic Diaphragmatic Hernia.

Traumatic diaphragmatic hernias (TDHs) can occur after both blunt and penetrating injury. Laparotomy and thoracotomy are commonly done for the management of TDHs. Minimally invasive surgery, especially laparoscopic surgery, is being accepted as an effective and safe alternative to open surgical repair even in trauma cases. Laparoscopy also allows for the detection and management of clinically occult TDHs, thereby preventing the complications of missed or delayed diagnosis. Our case highlights the importance of timely intervention with a minimally invasive approach. A 39-year-old male presented to the emergency room after a road traffic accident. Computed tomography scan confirmed left-sided diaphragmatic rupture with gastric herniation. Laparoscopic repair of the hernia was done. He had an uneventful post-operative period. At the one-year follow-up, he was asymptomatic and was doing well. TDHs have a variable clinical presentation and radiological findings are not always diagnostic. Such cases can progress to potentially life-threatening complications such as strangulation and perforation of the herniated viscera. Timely diagnosis and management are therefore essential. A minimally invasive approach such as laparoscopy should be used for the management of TDHs in the acute setting where the patient is stable, and resources are available. In this case, once the gastric contents were aspirated via a nasogastric tube in the middle of the night, the immediate need for surgery was converted to an urgent nature, and the patient underwent surgery the next morning in a more controlled setting. In addition, timely intervention can prevent future complications that may occur if the condition is left untreated during the initial admission.

Traumatic hemorrhage of the thyroid as a work-related injury: a case report and review of the literature.

Traumatic hemorrhage of the thyroid gland resulting from blunt injury to the neck is a very rare event. Particular neck positions can expose the thyroid to trauma, especially in motor vehicle collisions, falls, direct blows, or sport activities. Preexisting conditions such as goiters, adenomas, and cysts can increase the risk of bleeding, reducing the force required to rupture the gland and make the thyroid more prone to injury. The authors report the case of a 53-year-old man who was involved in a fire while working on maintenance of a liquid petroleum gas (LPG)-powered car. He subsequently presented to the emergency department with painful swelling of his right anterior neck with a palpable mass. CT scan showed a right thyroid hemorrhagic cyst. The worker reported that he had jumped into the car trunk to extinguish the fire and covered the gas tank nozzle with his own body to prevent dispersal of the accelerant. In this case, the medico-legal evaluation was useful to delineate between natural and traumatic causes of the injury. Medico-legal assessment is key in understanding the dynamics involved in work-related events to identify any legal responsibilities of the worker or the employer.

Combination of Lactate and Base Deficit Levels at Admission to Predict Mortality in Blunt Trauma Patients.

INTRODUCTION: Elevated lactate levels are associated with increased mortality in both trauma and non-trauma patients. The relation between base deficit (BD) and mortality is less clear. Traumatologists debate the utility of elevated lactate (EL) versus BD in predicting mortality. We hypothesized that EL (2mmol/L to 5mmol/L) and BD (≤-2mmol/L) in combination could predict mortality in blunt trauma patients.  Methods: This is a retrospective analysis of the trauma registry from 2012 to 2021 at a level 1 trauma center. Blunt trauma patients with admission lactate and BD values were included in the analysis. Exclusion criteria were age <18, penetrating trauma, unknown mortality, and unknown lactate or BD. Logistics regression of the total 5153 charts showed 93% of the patients presented with lactate levels <5mmol/L, therefore patients with lactate >5mmol/L were excluded as outliers. The primary outcome was mortality. RESULTS: A total of 4794 patients (151 non-survivors) were included in the analysis. Non-survivors had higher rates of EL + BD (35.8% vs. 14.4%, p <0.001). When comparing survivors and non-survivors, EL + BD (OR 5.69), age >65 (5.17), injury severity score (ISS) >25 (8.87), Glasgow coma scale <8 (8.51), systolic blood pressure (SBP) <90 (4.2), and ICU admission (2.61) were significant predictors of mortality. Other than GCS <8 and ISS >25, EL + BD had the highest odds of predicting mortality. CONCLUSION: Elevated lactate + BD on admission in combination represents a 5.6-fold increase in mortality in blunt trauma patients and can be used to predict a patient's outcome on admission. This combination variable provides an additional early data point to identify patients at elevated risk of mortality at the moment of admission.

Discrimination between falls and blows from the localization and the number of fractures on computed tomography scans of the skull and the trunk.

The distinction between falls and blows is a common and difficult task in forensic sciences. One of the most often used criteria to address this issue is the hat brim line (HBL) rule, which states that fall-related injuries do not lie above the HBL. Some studies, however, have found that the use of HBL rule is not so relevant. This study assesses the aetiologies, the number of fractures, and their location on the skull and the trunk in a sample of 400 individuals aged 20-49 years, which were CT scanned after traumas. This may facilitate the interpretation of such injuries in skeletonized or heavily decomposed bodies in which soft tissues are no longer available. Our aim is to improve the distinction rate between falls and blows by combining several criteria and assessing their predictability. Skeletal lesions were analysed using retrospective CT scans. Cases selected comprise 235 falls and 165 blows. We registered the presence and the number of fractures in 14 skeletal anatomical regions related to the two different aetiologies. We showed that the HBL rule should be used with caution, but there is nevertheless a possibility of discussing the aetiology of blunt fractures. Possibly, parameters like the anatomical location and the number of fractures by region can be used to distinguish falls and blows.

Numerical and clinical analysis of an eyeball injuries under direct impact.

OBJECTIVES: The objective of this study was to develop a numerical model of the eyeball and orbit to simulate a blunt injury to the eyeball leading to its rupture, as well as to conduct a comparative analysis of the results obtained using the finite element method against the clinical material concerning patients who had suffered an eyeball rupture due to a blunt force trauma. MATERIAL AND METHODS: Using available sclera biometric and strength data, a numerical model of the eyeball, the orbital contents, and the bony walls were developed from the ground up. Then, 8 different blunt force injury scenarios were simulated. The results of numerical analyses made it possible to identify possible locations and configurations of scleral rupture. The obtained results were compared against the clinical picture of patients hospitalized at the Department of Ophtalmology, Medical University of Gdansk in 2010-2016 due to isolated blunt force trauma to the eyeball. RESULTS: It has been demonstrated that the extent of damage observed on the numerical model that indicated a possible location of eyeball rupture did not differ from the clinically observed configurations of the scleral injuries. It has been found that the direction of the impact applied determines the location of eyeball rupture. Most often the rupture occurs at the point opposite to the clock-hour/positions of the impact application. The eyeball rupture occurs in the first 7-8 ms after the contact with the striking rigid object. It has been established that the injuries most often affected the upper sectors of the eyeball. Men are definitely more likely to sustain such injuries. Eyeball ruptures lead to significant impairment of visual acuity. CONCLUSIONS: This study may contribute to a better understanding of injury mechanisms and better treatment planning. It may also contribute to the development of eyeball protection methods for employees exposed to ocular injuries. Int J Occup Med Environ Health. 2023;36(2):263-73.

Traumatic Lateral Abdominal Wall Hernia: A Rare Manifestation of Blunt Trauma.

Traumatic abdominal wall hernia (TAWH) following blunt injury is a rare clinical entity, induced by traumatic disruption of the abdominal wall's muscle and fascia, alongside abdominal organ herniation. A thorough clinical examination and a high level of suspicion are necessary for the diagnosis. We present the case of a 45-year-old individual who presented to the surgical outpatient clinic with a left lateral bulge in his belly caused by a mountaineering accident. After obtaining a thorough history of the mechanism of injury and clinical assessment, abdominal ultrasonography and computed tomography (CT) scan revealed a significant traumatic left lateral abdominal wall hernia. The patient subsequently underwent an open surgical mesh repair, followed by anatomical and functional restoration of the muscular deficit over the mesh, with an uneventful postoperative course. TAWH constitutes a diagnostic challenge, and in many cases remains untreated for long periods of time. Considering that TAWH occurs in less than 1% of all blunt abdominal trauma, many surgeons are unaware of this rare manifestation. Here we suggest that elective surgery with an open, tension-free polypropylene mesh repair appears to be an appropriate therapeutic option.

Abdominal Wall Evisceration Coupled With Iliac Vascular Injury After Blunt Trauma.

Abdominal evisceration after blunt trauma is uncommon and rarely survivable when coupled with a concomitant iliac vascular injury. Blunt abdominal injury is rarely a cause of abdominal evisceration but may, on occasion, present in patients affected by a unique or high-energy traumatic injury. In these instances, major vascular injury is exceedingly rare but is associated with a high mortality rate. Damage to important vessels that may present more subtly, such as iliac arterial injury, can still be lethal and are important to evaluate in the trauma workup for blunt evisceration. We report the case of a 20-year-old woman who survived an abdominal wall and vascular injury in a motor vehicle accident. Management of this unusual association is discussed.

A meta-analytic review of the frequency and patterning of laryngohyoid and cervical fractures in cases of suicide by hanging.

The frequency and distribution of fractures are commonly utilized to assist in interpreting the manner of death. In cases of alleged suicide by hanging, however, the evidence base for the frequency and patterning of laryngohyoid and cervical vertebrae fractures resulting from such blunt force traumatic events is limited and so fractures cannot be reliably used to assist in interpreting the manner. Using meta-analytic techniques, this study aimed to estimate frequency and distribution of fractures in the context of relevant intrinsic and extrinsic variables. A systematic review of the literature identified 20 studies with relevant data (8523 cases of suicide by hanging). Meta-analyses identified the frequency and distribution of fractures present and how fracture frequency was affected by the subgroups of age, sex, completeness of suspension, ligature knot position and study design. Results indicated that fracture frequency was variable, there was no unique patterning, and high levels of heterogeneity were present in all variable sub-groups. Age was the only subgroup to show differences. Findings suggest that neck fracture frequency is inconsistent and cannot be predicted by the chosen variables. Subsequently, neck fractures in isolation should not be given weight in medico-legal interpretations of a hanging death as suicidal.

Osteonal Microcracking Pattern: A Potential Vitality Marker in Human Bone Trauma.

In forensic anthropology, the differential diagnosis between peri- and postmortem bone fractures is mainly based on macroscopic criteria. In contrast, studies focusing on bone histology are very scarce. In a recent publication, we showed that (perimortem) fractures in fresh human bones exhibit a different osteonal microcracking pattern than (postmortem) damage in dry bones. In the current work, we explored whether this osteonal microcracking pattern is distinctive of the vitality of (perimortem) fresh bone fractures. To this end, we compared the number, length and structural distribution of microcracks in vital humeral fractures from forensic autopsy cases with experimentally reproduced, three point-bending fractures in fresh and dry human humeri. Half of the fresh experimental bones were fractured whilst applying axial compression, i.e., attempting to simulate intra vitam conditions more accurately. The results showed a similar osteonal microcracking pattern between vital fractures and experimental fractures of fresh humeri subjected to axial compression. Interestingly, this pattern was significantly different from the one observed in the experimental fractures of fresh humeri without axial compression and dry humeri. This supports our hypothesis that the osteonal microcracking pattern can potentially be used as a marker for vital perimortem trauma, providing a histomorphometric tool for fracture timing.

Review of patterns in homicides by sharp force: one institution's experience.

This paper presents a retrospective review of patterns found in cases of homicides by sharp force over a 13-year period at the Department of Forensic Pathology of the Ostrava University Hospital, Czech Republic. The review summarizes all frequently discussed aspects of such cases including the number and localization of injuries, the presence of defensive wounds, the type of the offending weapon, the cause of death, the place of death, victims' and perpetrators' profiles, their relationship, or toxicological findings. Furthermore, special attention was paid to the evaluation of any accompanying blunt force trauma that may be indicative of an escalation of the assault. The set of data was statistically analyzed. Even though most of the results of this review are consistent with available published studies, noteworthy differences have emerged in some aspects such as the sex and age of the victims, the relationship between the number of injuries suffered and the victims' sex, or the severity of alcohol intoxication in victims.

Blows or Falls? Distinction by Random Forest Classification.

In this study, we propose a classification method between falls and blows using random forests. In total, 400 anonymized patients presenting with fractures from falls or blows aged between 20 and 49 years old were used. There were 549 types of fractures for 57 bones and 12 anatomical regions observed. We first tested various models according to the sensibility of random forest parameters and their effects on model accuracies. The best model was based on the binary coding of 12 anatomical regions or 28 bones with or without baseline (age and sex). Our method achieved the highest accuracy rate of 83% in the distinction between falls and blows. Our findings pave the way for applications to help forensic experts and archaeologists.

Average thickness of the bones of the human neurocranium: development of reference measurements to assist with blunt force trauma interpretations.

The accurate interpretation of a blunt force head injury relies on an understanding of the case circumstances (extrinsic variables) and anatomical details of the individual (intrinsic variables). Whilst it is often possible to account for many of these variables, the intrinsic variable of neurocranial thickness is difficult to account for as data for what constitutes 'normal' thickness is limited. The aim of this study was to investigate the effects of age, sex and ancestry on neurocranial thickness, and develop reference ranges for average neurocranial thickness in the context of those biological variables. Thickness (mm) was measured at 20 points across the frontal, left and right parietals, left and right temporals and occipital bones. Measurements were taken from post-mortem computed tomography scans of 604 individuals. Inferential statistics assessed how age, sex and ancestry affected thickness and descriptive statistics established thickness means. Mean thickness ranged from 2.11 mm (temporal squama) to 19.19 mm (petrous portion). Significant differences were noted in thickness of the frontal and temporal bones when age was considered, all bones when sex was considered and the, right parietal, left and right temporal and occipital bones when ancestry was considered. Furthermore, significant interactions in thickness were seen between age and sex in the frontal bone, ancestry and age in the temporal bone, ancestry and sex in the temporal bone, and age, sex and ancestry in the occipital bone. Given the assorted influence of the biological variables, reference measurement ranges for average thickness incorporated these variables. Such reference measurements allow forensic practitioners to identify when a neurocranial bone is of normal, or abnormal, thickness.

Correlation of soft tissue and skeletal injuries in cases of violent death: A retrospective study of autopsy cases for forensic anthropology.

In forensic pathology, deaths due to mechanical injuries (blunt, sharp, and gunshot) require an autopsy in order to determine the cause and manner of death through a detailed examination of viscera, soft tissues, and the skeletal system. Sometimes, such as in cases of severe putrefaction, only the skeleton is observable. In such cases, the absence of bony defects does not mean that a trauma-related death should not be considered: yet, how often will a lethal mechanical death produce a defect in the skeletal system? The present study involved a retrospective review of autopsy reports to investigate the frequencies of soft tissue and related skeletal injuries in cases of violent deaths. A total of 200 autopsy reports for cases of four mechanisms of injury including sharp force trauma (n = 50), gunshot (n = 50), blunt force trauma (n = 50), and mechanical asphyxia (n = 50) were examined. Manner of death, localization of bone fractures, and correspondence between external injuries and bone fractures were reported. Frequencies of bone fractures and degree of correspondence with soft tissue injuries for each trauma group were evaluated. The result showed that lethal blunt trauma always caused bone fractures; 94.0% of violent deaths by gunshot involved bones; 48.0% of sharp force soft tissue injuries involved the bone tissue; and hyoid bone fractures were observed in 20.0% of cases of mechanical asphyxia.

An overview of suicides related to motor vehicles.

Although vehicles may be used in a wide variety of suicides, this has not been a focus in the forensic literature. Thus, an analysis of coronial autopsy reports at Forensic Science SA, Adelaide, South Australia over a 16-year period from January 2005 to December 2020 was undertaken to provide an overview of cases in which it was considered that a vehicle had been integral to the successful completion of a suicide. De-identified details were collected from all cases in which a vehicle had facilitated or been used as a method of suicide. A number of different types of vehicle-related suicide methods were identified, including cases where vehicles had been used as secure places for suicide or where the vehicle had been used to cause significant blunt force trauma or to enter a lethal environment such as water. Specific examples were taken from the following categories: (1) inhalation of gas, (2) drug toxicity, (3) hanging or ligature strangulation, (4) self-immolation, (5) drowning, (6) vehicle collision, (7) driving off a cliff, (8) jumping or lying in front of a vehicle and (9) the use of more than one method (i.e. complex). This report is not intended to provide an epidemiological analysis of car-related suicides. Instead, the details of selected cases have been used to illustrate the spectrum of methods that may be used in vehicle-assisted suicides.

Fatal non-accidental pediatric cranial fracture risk and three-layered cranial architecture development.

This study examines the influence of three-layered cranial architecture development upon blunt force trauma (BFT) cranial outcomes associated with pediatric non-accidental injury (NAI). Macroscopic and microscopic metric and morphological comparisons of subadult crania ranging from perinatal to 17 years of age chronicle the ontogenetic development and spatial and temporal variability in the emergence of a mature cranial architecture. Cranial vault thickness increases with subadult age, accelerating in the first 2 years of life due to rapid brain growth during this period. Three-layer differentiation of the cranial tables and diploë initiates by 3-6 months but is not consistently observed until 18 months to 2 years; diploë formation is not well developed until after age 4 and does not manifest a mature appearance until after age 8. These results allow topographic documentation of cortical and diploic development and temporal and spatial variability across the growing cranium. The lateral cranial vault is identified as expressing delayed development and reduced expression of the three-layer architecture, a pattern that continues into adulthood. Comparison of fracture locations from known BFT pediatric cases with identified cranial fracture high-risk impact regions shows a concordance and suggests the presence of a higher fracture risk associated with non-accidental BFT in the lateral vault region in subadults below the age of 2. The absence or lesser development of a three-layered architecture in subadults leaves their cranial bones, particularly in the lateral vault, thin and vulnerable to the effects of BFT.

Microcracking pattern in fractured bones: new approach for distinguishing between peri- and postmortem fractures.

Timing bone fractures is one of the main tasks of a forensic anthropologist, but still an uncertain diagnostic. In the literature, there are many macroscopic methods to distinguish perimortem from postmortem fractures, based on the distinct structural and mechanical properties of fresh and dry bones. However, this differentiation is still challenging, in particular when the bones are fragmented or still exhibit fresh properties. Although histologic analysis is often used as a complementary diagnostic tool in forensic pathology, its application in the evaluation of bone fractures is uncommon. The aim of this study was to investigate whether fractures of fresh bones reveal a distinct microcracking pattern compared to fractures of dry bones, in order to optimise the fracture timing. To this purpose, we histologically analysed perimortem and postmortem fractures in human humeri. The fresh bones were retrieved from traumatic autopsy cases, and the dry bones from donors which were experimentally fractured. Our results showed that the highest density and length of microcracks (MCKs) were found in the interstitial area of dry fractured bones, which may be considered a marker of postmortem damage. In fresh fractured bones, we generally observed a lower density of MCKs, but a higher proportion of osteonal MCKs, which may be considered a marker of perimortem trauma. In summary, the results of our exploratory study suggest that changes in intrinsic bone factors (mineral/organic components) result in a different microcracking pattern that can be used in fracture timing.