Discussing the possibilities and limitations of the analysis of antemortem fractures through a forensic case report

Abstract

Differential diagnosis of antemortem injuries and pathologies is a relevant part of the anthropological analysis of the human skeleton. A proper recognition of specific pathological conditions and healed traumatic events in cases of unidentified remains facilitates the presumption of identity and corroborates the identification of the deceased. We report a case of unidentified skeletal remains that exhibited interesting antemortem injuries and medical interventions used to presume the identity of the deceased. The skeleton showed an extensive injury to the femur treated by intramedullary fixation with a healed irregular defect (hole) in its distal portion. The interpretation of the injury and defect with their possible causes has been presented during the reconstruction of the biological profile of the remains. These included a potential gunshot wound (GSW) and/or an infection of the injured site. The successful identification of the remains allowed to confirm the assumptions made relying on a nearly complete medical documentation of the deceased. The documentation revealed other important information that were not detected during the macroscopic analysis of the remains, like the fact that the femur suffered two extensive fractures in the same location in different periods, both treated in the same manner. Through this case report the differential diagnosis of a healed GSW as well as the different possibilities and means that a forensic anthropologist has to identify and interpret different antemortem traumatic events in the same bone will be reviewed and presented. In addition, although the identification in this case has been achieved through primary identifiers (the comparative dental analysis), the possible value of the presented secondary identifiers in the ultimate identification of remains will be discussed.