Compressive rib fracture: peri-mortem and post-mortem trauma patterns in a pig model

Forensic applications of micro-computed tomography: a systematic review

Purpose

The aim of this systematic review was to provide a comprehensive overview of micro-CT current applications in forensic pathology, anthropology, odontology, and neonatology.

Methods

A bibliographic research on the electronic databases Pubmed and Scopus was conducted in the time frame 01/01/2001–31/12/2021 without any language restrictions and applying the following free-text search strategy: “(micro-computed tomography OR micro-CT) AND (forensic OR legal)”. The following inclusion criteria were used: (A) English language; (B) Application of micro-CT to biological and/or non-biological materials to address at least one forensic issue (e.g., age estimation, identification of post-mortem interval). The papers selected by three independent investigators have been then classified according to the investigated materials.

Results

The bibliographic search provided 651 records, duplicates excluded. After screening for title and/or abstracts, according to criteria A and B, 157 full-text papers were evaluated for eligibility. Ninety-three papers, mostly (64) published between 2017 and 2021, were included; considering that two papers investigated several materials, an overall amount of 99 classifiable items was counted when referring to the materials investigated. It emerged that bones and cartilages (54.55%), followed by teeth (13.13%), were the most frequently analyzed materials. Moreover, micro-CT allowed the collection of structural, qualitative and/or quantitative information also for soft tissues, fetuses, insects, and foreign materials.

Conclusion

Forensic applications of micro-CT progressively increased in the last 5 years with very promising results. According to this evidence, we might expect in the near future a shift of its use from research purposes to clinical forensic cases.

Chest wall mechanics during mechanical chest compression and its relationship to CPR-related injuries and survival

Aim

To determine compression force variation (CFV) during mechanical cardiopulmonary resuscitation (CPR) and its relationship with CPR-related injuries and survival.

Methods

Adult non-traumatic OHCA patients who had been treated with mechanical CPR were evaluated for CPR-related injuries using chest X-rays, thoracic computed tomography or autopsy. The CFV exerted by the LUCAS 2 device was calculated as the difference between the maximum and the minimum force values and was categorised into three different groups (high positive CFV ≥ 95 newton (N), high negative CFV ≤ -95 N, and low variation for intermediate CFV). The CFV was correlated with the CPR injuries findings and survival data.

Results

Fifty-two patients were included. The median (IQR) age was 57 (49-66) years, and 13 (25%) cases survived until hospital admission. High positive CFV was found in 21 (40.4%) patients, high negative CFV in 9 (17.3%) and a low CFV in 22 (42.3%). The median (IQR) number of rib fractures was higher in the high positive and negative CFV groups compared with the low CFV group [7(1-9) and 9 (4-11) vs 0 (0-6) (p = 0.021)]. More bilateral fracture cases were found in the high positive and negative CFV groups [16 (76.2%) and 6 (66.7%) vs 6 (27.3%) (p = 0.004)]. In the younger half of the sample more patients survived until hospital admission in the low CFV group compared with the high CFV groups [5 (41.7%) vs 1 (7.1%) (p = 0.037)].

Conclusions

High CFV was associated with ribcage injuries. In the younger patients low CFV was associated with survival until hospital admission.

Traumatic Impact Assessment of CPR Load on a Human Ribcage

Chest compression is a parameter of injury criteria assessment for human beings. Additionally, it is used to find the external compression response as a result of vehicle crashes, falls, or sporting impacts. This behavioral feature is described by many deterministic models related to specific experimental tests, hindering distinct scenarios. The present study evaluates the energy absorbed as a function of rib compression. The proposed model was obtained from three different computed tomography (CT) studies. The anthropometric values are interpolated to obtain a parametric curve for a human rib’s average size. The computed results are compared against an STL-DICOM^® file used to obtain a virtual reconstruction of one rib. A numerical model of the behavior of the thorax displacement expressed injury in the human rib model’s stiffness. The proposed model is used to determine the correlation of the input payload versus the numerical stiffness value. The outcome is confirmed by numerical analyses applied to a virtual human rib reconstruction.

Biological kinship in 750 year old human remains from Central Argentina with signs of interpersonal violence

Human skeletal remains of an adult male (20-24 years old) and a juvenile (4-8 years old), dated to 750 ± 85 ¹⁴C years BP, were found on the southern margin of Mar Chiquita Lagoon (Córdoba, Argentina). Both individuals show signs of being victims of interpersonal violence, with arrowheads associated with the remains and perimortem lesions on the juvenile, as well as an unusual form of burial, with the juvenile partially overlapped with the adult. The aim of this work is to study a possible kin relationship between these two individuals through ancient DNA analysis. Biological kinship was evaluated by autosomal and Y-chromosome STR (short tandem repeat) typing, PCR-APLP for SNP determination and hypervariable region I sequencing of the mitochondrial DNA. Genetic analyses indicated that these individuals shared the same Y-chromosomal haplotype but different mitochondrial lineages. The likelihood ratio based on autosomal loci indicates that the genetic profiles of the human remains would be more likely to be that indicating a father-son bond. The paleogenetic approach combined with forensic genetic methods applied to this study allowed us to confirm a hypothesis that originated in bioarchaeological evidence. This study constitutes a unique case in Argentina of kinship determination based on DNA profiles of human remains in an archaeological context of interpersonal violence. It is important to highlight the contribution made by these studies to address topics usually hidden in bioarchaeological studies, such as community organization, cultural customs and mortuary practices.

Stabbing angle alters peak force and work during sharp force trauma of porcine ribs

Forensic anthropologists have traditionally relied on a qualitative scale (mild, moderate, severe) for describing the forces required to generate a bony injury; however, recently efforts have focused on providing more quantitative data. The current study considers the effects of blade angle on the peak force, average force, and work measured during an instrumented sharp force impact. Sixty-two porcine side ribs were stabbed with the long axis of the blade perpendicular to the convex surface and the blade edge in one of three orientations (0°, 45°, 90°). Peak force was highest when the cutting edge was perpendicular to the long axis of the rib (90°) and lowest when it was aligned (0°). Conversely, work was highest when the blade was at an oblique angle (45°) to the rib. These results confirm that the orientation of a sharp force event must be considered when estimating the mechanical loading required to generate an injury.

Aerosol production during autopsies: The risk of sawing in bone

When sawing during autopsies on human remains, fine dust is produced, which consists of particles of sizes that may fall within the human respirable range, and can act as vectors for pathogens. The goal of this study was to explore the potential effects of saw blade frequency and saw blade contact load on the number and size of airborne bone particles produced. The methodology involved the use of an oscillating saw with variable saw blade frequencies and different saw blade contact loads on dry human femora. Released airborne particles were counted per diameter by a particle counter inside a closed and controlled environment. Results corroborated with the hypotheses: higher frequencies or lower contact loads resulted in higher numbers of aerosol particles produced. However, it was found that even in the best-case scenario tested on dry bone, the number of aerosol particles produced was still high enough to provide a potential health risk to the forensic practitioners. Protective breathing gear such as respirators and biosafety protocols are recommended to be put into practice to protect forensic practitioners from acquiring pathologies, or from other biological hazards when performing autopsies.

Perimortem fracture pattern in ribs by blunt force trauma

Literature on timing of rib trauma is scarce but remains challenging during forensic cases. This study analysed the macroscopic fracture patterns of perimortem rib fractures and compared them to experimentally reproduced rib fractures on fresh and dry ribs. Six distinctive macroscopic traits were found in ribs that might provide information about the timing of trauma, fracture mechanism and/or trauma circumstances. These traits are peels, folds, differential fracture edges, incomplete fractures, plastic deformation and longitudinal lines. Peels, folds and plastic deformation might provide information about trauma timing. Folds and different fracture edges might provide information about the fracture mechanism. Statistical analyses showed that longitudinal lines, folds and incomplete fractures might provide information about the trauma circumstances and that age might have an influence on the occurrence of complete fractures, longitudinal lines and peels (p ≤ 0.05). The new insights presented in this study might be valuable for forensic anthropologists in rib trauma analysis.

A Morphological and Morphometric Study of Bite Marks Caused by Mice (Mus Musculus) on Different Baits for Forensic Purposes

In animal bites, the dental attributes can be fundamental in identifying the marks made by various species on different matrices. Although rodent bite marks have been studied in the context of postmortem interference, little research has used different baits to analyze these marks linking not only specific behavior patterns but also the possibility of structural damage. Twenty mice (Mus musculus) were exposed to different baits to study their bite marks in a controlled model. The known pattern of parallel and multiple grooves has been seen in all baits, but polyvinyl chloride and fiber-optic cable were significantly different between each other and the other baits. Some baits showed patterns of anchorage of the upper incisors and space between the lower incisors when gnawing. This technical note represents a novel model of analysis where veterinarians and/or dentists may be asked to give an opinion on alleged animal bite marks.

A novel ex vivo model of compressive immature rib fractures at pathophysiological rates of loading

INTRODUCTION

Compressive rib fractures are considered to be indicative of non-accidental injury (NAI) in infants, which is a significant and growing issue worldwide. The diagnosis of NAI is often disputed in a legal setting, and as a consequence there is a need to model such injuries ex vivo in order to characterise the forces required to produce non-accidental rib fractures. However, current models are limited by type of sample, loading method and rate of loading. Here, we aimed to: i) develop a loading system for inducing compressive fractures in whole immature ribs that is more representative of the physiological conditions and mechanism of injury employed in NAI and ii) assess the influence of loading rate and rib geometry on the mechanical performance of the tissue.

METHODS

Porcine ribs (5-6 weeks of age) from 12 animals (n=8 ribs/animal) were subjected to axial compressive load directed through the anterior-posterior rib axis at loading rates of 1, 30, 60 or 90 mm/s. Key mechanical parameters (including peak load, load and percentage deformation to failure and effective stiffness) were quantified from the load-displacement curves. Measurements of the rib length, thickness at midpoint, distance between anterior and posterior extremities, rib curvature and fracture location were determined from radiographs.

RESULTS

This loading method typically produced incomplete fractures around the midpoint of the ribs, with 87% failing in this manner; higher loads and less deformation were required for ribs to completely fracture through both cortices. Loading rate, within the range of 1-90 mm/s, did not significantly affect any key mechanical parameters of the ribs. Load-displacement curves displaying characteristic and quantifiable features were produced for 90% of the ribs tested, and multiple regression analyses indicate that, in addition to the geometrical variables, there are other factors such as the micro- and nano-structure that influence the measured mechanical data.

CONCLUSIONS

A reproducible method of inducing fractures in a consistent location in immature porcine ribs has been successfully developed. Fracture appearance may be indicative of the amount of load and deformation that produced the fracture, which is an important finding for NAI, where knowledge of the aetiology of fractures is vital. Characteristic rib behaviour independent of loading rate and, to an extent, rib geometry has been demonstrated, allowing further investigation into how the complex micro- and nano-structure of immature ribs influences the mechanical performance under compressive load. This research will ultimately enable improved characterisation of the loading pattern involved in non-accidental rib fractures.

New pitfalls of high-density postmortem computed tomography

An 80-year-old female was transferred to the hospital due to a traffic accident. Multiple cranial bone fractures with intracranial hemorrhage and intracranial air were detected. Despite treatment, the patient died after 6h. Twenty-one hours after the patient died, her whole body was scanned by postmortem CT, and a region of high density was detected within the left putamen. The autopsy revealed a cerebral contusion and multiple skull base fractures. Moreover, superabsorbent polymers (SAPs) were found within the left lateral ventricle and adjacent to the putamen, which appeared as a high-density lesion on postmortem CT at the left putamen, where the SAPs were compacted. Both ante- and postmortem conditions should be considered to prevent misdiagnoses based only on postmortem CT.

The Value of the Pediatric Skeletal Examination in the Autopsy of Children

The pediatric skeletal examination (PSE) is an autopsy technique recommended for pediatric cases suspicious for nonaccidental injury. The technique requires the reflection of the musculature and periosteum of the ribs, clavicles, long bones, and scapulae, and inspection of the bone surfaces and chondro-osseous interfaces. The technique is time consuming, labor intensive and possibly disfiguring. Therefore, the value of the technique must be measured against the cost.

The present study was designed to evaluate the impact of the PSE on the sensitivity of the autopsy. A non-randomized retrospective review of 94 autopsy reports was done. The cause and manner of death for each case was classified as blunt force trauma and homicide. Half of the sample received a PSE during the autopsy and half did not.

The number of rib and long bone fractures noted in the reports was significantly greater in the group that received the PSE. The number of cranial, scapular and clavicular fractures was not significantly different between the two groups. The PSE does not increase the visibility of the neurocranium; therefore, a difference in the number of cranial fractures was not expected. Scapular and clavicular fractures were rare in the study population. The insignificant difference between the two groups may be a reflection of the rarity of the fracture as opposed to the sensitivity of the PSE. The results of the study indicate that the PSE increases the sensitivity of the pediatric autopsy with respect to long bone and rib fractures.