Antemortem Fractures Research Articles

Autopsy-Based Comparative Study of Gross and Histopathological Findings at Bone Fracture Surfaces Before and After Death.

Fractures of bones are commonly encountered in traumatic injuries, and distinguishing between antemortem (AM) and postmortem (PM) bone fractures is crucial for estimating the time since injury and has important medicolegal implications. Correct differentiation enables understanding the dynamics of the injury and, in some cases, the cause of death. The present study aims to evaluate the gross morphological and histopathological characteristics of bony fracture surfaces to determine whether they occurred before or after an individual's death.Fifty-seven sets of bone samples, including both antemortem and artificially created postmortem fractures, were collected from cadavers during medicolegal autopsies, meeting the inclusion criteria. Gross morphological and histopathological features were examined after staining the bony fracture edges with hematoxylin and eosin stain. The study revealed distinct morphological characteristics at fracture surfaces for both antemortem and artificially created postmortem fractures. In addition, signs of vital reaction were observed exclusively in antemortem fracture cases.In conclusion, the findings emphasize the importance of meticulous morphological and histopathological examination of bony fracture surfaces to differentiate between antemortem fractures and artificially created postmortem artifacts. This differentiation holds significant value in forensic investigations and medicolegal cases.

Bioarchaeological investigation of WWI burials at Nowa Osuchowa, Poland

ABSTRACT During construction works in eastern Poland, the remains of 25 individuals were discovered. The site near Nowa Osuchowa was excavated in 2016 and after osteological and taphonomical analyses the remains were reburied. The remains were identified as members of the Prussian Army fighting in WWI. Radiographic imaging was employed to aide differential diagnosis of pathologies. Skeletal evidence of antemortem fractures, dislocation and infection was found. Several individuals showed evidence of perimortem fractures and high-velocity projectile trauma. Taphonomic analyses indicate that some of the individuals were buried at the location very soon after death, while others were likely already in more advanced stages of decomposition at the time of burial at the site.

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

ObjectiveTo 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. MaterialsThree medieval individuals from Cambridge, England with ante-mortem fractures to the lower limb were analyzed. MethodsPlain 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. ResultsThe 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. ConclusionEach of these individuals survived a severe injury resulting in chronic physical impairment, though not all would have been considered ‘disabled’. SignificanceThis 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. LimitationsBiomechanical analysis was restricted to cortical geometry. Suggestions for future researchFurther study of bilateral asymmetry in trabecular architecture could complement our understanding of altered loading modalities in past societies.

Trauma patterns and injury prevalence in early medieval Säben‐Sabiona, Italy

AbstractIn the Early Middle Ages (fifth to 11th centuries AD), central Europe was marked by geo‐political instabilities and important socio‐cultural changes that led to the admixture of different cultures named barbari by the Romans, whose demographic impact is still not fully understood. These events also involved the populations settled in modern day South Tyrol, a region in the north‐eastern Italian Alps. In this context, the early medieval site of Säben‐Sabiona (Eisack‐Isarco valley, Province of Bozen‐Bolzano) had a relevant political role, and particularly due to its geographical location and religious importance, it was a prestigious burial site for individuals of different cultural and social backgrounds. This study aims to gain novel insights into the possible effects of these instabilities on daily life and general health of the people buried in Säben‐Sabiona, based on a thorough analysis of accident and violence‐related trauma. A total number of 226 individuals underwent a detailed osteological analysis to establish the number of individuals affected by trauma and to reconstruct the distribution, timing and type of injury. Trauma was assessed through macroscopic and metric analyses. Both crude, injuries per individual, and true prevalence rates, trauma per bone, were calculated. Signs of trauma were found on 37/226 individuals, whereby males exhibited more trauma than females and subadults. Most injuries were identified as antemortem fractures on the appendicular skeleton or perimortem sharp force trauma that was predominantly found on the skull. Most individuals featured less than five trauma; however, seven individuals account for more than half of the observed lesions. The trauma investigation suggests that most of the injured experienced skeletal injuries associated with labour‐related accidents and only a few, all of which were males, displayed signs of contemplated violence. Hence, it appears that the lives of the studied individuals were largely non‐violent, yet, sporadic situations of hostility and interpersonal conflict were also common.

East of Rome: Exploring potential impacts of Roman imperialism on Northeastern Mediterranean populations through a bioarchaeological perspective

The sociopolitical and biocultural impacts of Roman imperialism on eastern provincial and peripheral populations have been underexamined in archaeological and bioarchaeological research. While many western territories experienced arguably dramatic changes to local infrastructure and culture, eastern provinces were incorporated into the Empire with some modifications to, but general continuation of, political and societal organization. However, provincial governance varied across the Northeastern Mediterranean, with populations falling under senatorial or imperial jurisdiction. Drawing from published bioarchaeological data from 19 archaeological sites in Crete, Cyprus, Greece, and Turkey, this exploratory study examines skeletal and dento-alveolar proxies of stress, diet, and disease in light of a community’s political (senatorial or imperial province) and geographical (coastal or inland) positioning to evaluate impacts of Roman imperial rule. True (TPR) and crude (CPR) prevalence rates from childhood (linear enamel defects) and adult (antemortem fractures) stress markers, dietary proxies (carious lesions, calculus, and tooth loss), and specific (periodontal disease) and non-specific (periosteal new bone) bone lesions were compared within political (senatorial/imperial) and geographical (inland/coastal) groups. Results from Mann-Whitney U tests showed no significant differences in conditions between senatorial and imperial sites. Higher frequencies of pathological conditions were observed in inland than coastal communities but significant, or approaching significant, differences were only found in calculus distributions. These preliminary results suggest that communities in senatorial and imperial provinces did not experience prescriptive levels of stress based on governance. Rather, the heterogeneity in stress, diet, and disease proxies demonstrates how communities in the Northeastern Mediterranean were impacted differentially by Roman imperialism.

Differentiation of Antemortem and Postmortem Appendicular Fractures Using Magnetic Resonance Imaging Signal Intensity Changes in Bone and Soft Tissues.

Intraosseous T1-weighted (T1W) and short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) signal intensity changes-so-called bone marrow edema-may be able to differentiate antemortem and postmortem fractures in human forensic imaging. The primary objective of this study was to investigate this hypothesis using an animal model. Three juvenile Landrace pigs were anesthetized and underwent MRI of both tibiae and both radii using a 1.5 T magnet. T1W, T2-weighted (T2W), STIR, and T2* sequences were included. Antemortem fractures were induced in both tibiae and postmortem fractures in both radii, and MRI was repeated. Two board-certified radiologists blinded to fracture group jointly evaluated the images for intraosseous and soft tissue signal intensity changes. Sensitivity (Se) and specificity (Sp) in identifying antemortem fractures were calculated based on intraosseous, soft tissue, and combined intraosseous and soft tissue signal intensity changes. Intraosseous and soft tissue signal intensity changes, when present, were hyperintense in all sequences. Intraosseous hyperintensity in T1W and T2W sequences yielded Sp of 100% for antemortem fractures. Regardless of sequence, soft tissue hyperintensity was comparatively more sensitive than intraosseous hyperintensity. Sensitivity for each sequence could be maximized by assessment of soft tissue and intraosseous hyperintense signals together; for the T1W sequence, such assessment optimized diagnostic utility yielding a Se of 100% and Sp of 83%. In summary, MRI-particularly the T1W sequence-can differentiate antemortem and postmortem fractures and may be a useful adjunct to the forensic analyses of fractures.

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.

Estimation of stature by the US Army Central Identification Unit, Kokura, Japan, 1951–1955

ABSTRACTFrom 1951–1955, the skeletal remains of United Nations casualties in the Korean War were processed for identification at the US Army Central Identification Unit (CIU) in Kokura, Japan. Anthropologists examined the remains to provide estimates of race, age, stature, and ante-mortem fractures or other individuating features. Initially, procedures followed those used in the earlier analysis of Second World War casualties, in which stature was estimated from long bone lengths using tables derived from work by Rollet and Krogman. However, in 1952, Trotter and Gleser published a study of stature estimation based on the skeletal remains of 1200 US Second World War casualties, and the next year the CIU shifted to using these formulae. After the conclusion of CIU operations, Trotter and Gleser analysed skeletal measurements from 5517 US Korean War casualties and published a new set of regression equations, which continue to be used by many anthropologists. Analysis of osteometric data for historically identified US Korean War casualties has illuminated the calculation and use of stature estimates at the CIU and the nature of the data available to Trotter and Gleser. In particular, it has revealed a shift in measurement techniques that accompanied the shift in regression formulae.

Frequency and intensity of pulmonary bone marrow and fat embolism due to manual or automated chest compressions during cardiopulmonary resuscitation.

Iatrogenic consequences of cardiopulmonary resuscitation (CPR) include sternal or rib fractures, pulmonary bone marrow embolisms (BME) and fat embolisms (FE). This report aimed to analyze the frequency and intensity of pulmonary BME and FE in fatal cases receiving final CPR efforts with the use of automated chest compression devices (ACCD) or manual chest compressions (mCC). The study cohort (all cardiac causes of death, no ante-mortem fractures) consisted of 15 cases for each group 'ACCD', 'mCC' and 'no CPR'. Lung tissue samples were retrieved and stained with hematoxylin eosin (n = 4 each) and Sudan III (n = 2 each). Evaluation was conducted microscopically for any existence of BME or FE, the frequency of BME-positive vessels, vessel size for BME and the graduation according to Falzi for FE. The data were compared statistically using non-parametric analyses. All groups were matched except for CPR duration (ACCD > mCC) but this time interval was linked to the existence of pulmonary BME (p = 0.031). Both entities occur in less than 25% of all cases following unsuccessful CPR. BME was only detectable in CPR cases, but was similar between ACCD and mCC cases for BME frequency (p = 0.666), BME intensity (p = 0.857) and the size of BME-affected pulmonary vessels (p = 0.075). If any, only mild pulmonary FE (grade I) was diagnosed without differences in the CPR method (p = 0.624). There was a significant correlation between existence of BME and FE (p = 0.043). Given the frequency, intensity and size of pulmonary BME and FE following CPR, these conditions may unlikely be considered as causative for death in case of initial survival but can be found in lower frequencies in autopsy histology.

Tooth fractures in the Krapina Neandertals

Dental fractures can be produced during life or post-mortem. Ante-mortem chipping may be indicative of different uses of the dentition in masticatory and non-masticatory activities related to variable diets and behaviors. The Krapina collection (Croatia, 130,000 years BP), thanks to the large number of teeth (293 teeth and tooth fragments) within it, offers an excellent sample to investigate dental fractures systematically. Recorded were the distribution, position and severity of the ante-mortem fractures according to standardized methods. High frequencies of teeth with chipping in both Krapina adults and subadults suggest that the permanent and deciduous dentition were heavily subjected to mechanical stress. This is particularly evident when the frequencies of chipping are compared with those in modern humans (Upper Paleolithic and historic samples) that we analysed using the same methods. The distribution of chipping in the Krapina sample (anterior teeth are more affected) and its position (labial) suggest a systematic use of the anterior teeth for non-masticatory tasks.

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

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.

An accident at work? Traumatic lesions in the skeleton of a 4th millennium BCE “wagon driver” from Sharakhalsun, Russia

The study of ante-mortem trauma is a popular and important aspect of palaeopathological analysis. The majority of publications focus on a particular assemblage, skeletal element or type of fracture, with case studies of single individuals with multiple/unusual traumata being much rarer in the literature. This paper presents the case of an adult male from the Bronze Age site of Sharakhalsun, Russia, buried, uniquely, in a sitting position on a fully assembled wagon, who displayed evidence for multiple healed ante-mortem fractures of the cranium, axial and appendicular skeleton. The mechanisms and likely etiologies of the fractures are presented, with reference to modern and 19th century clinical literature, and possible interpretations suggested: that the individual was involved in a severe accident involving a wagon or draft animals, or both, a number of years before his death. The suggestion is also made that the unique burial position of the individual was a form of commemoration by the community of the survival and recovery of the individual from such a serious incident.

A Neolithic case of fibrous dysplasia from Çatalhöyük (Turkey)

The vast majority of primary burials at Neolithic Çatalhöyük (Central Anatolia, Turkey, 7100–6000cal BC) are recovered from beneath house floors, with burials in external spaces extremely rare. Excavations at Çatalhöyük in 1998 brought to light a young adult male buried in a midden (a burial location observed so far for only 4 out of 440 individuals), showing a suite of pathological features affecting the entire skeleton. The observed pathological changes include perimortem and antemortem fractures, proliferative and resorptive areas, thinning of the bone cortex, and localized areas of disorganized spongy bone invaded by fibrous tissue. We propose a differential diagnosis by considering a set of conditions: Paget’s disease, osteomyelitis, hyperparathyrhoidism, Ollier’s disease, fibrosarcoma, and fibrous dysplasia. The severity and distribution of the observed skeletal changes are consistent with a diagnosis of polyostotic fibrous dysplasia, a possibly debilitating and disfiguring condition. This, together with an unusual depositional context, may suggest a socially-mediated reaction to this individual’s infirmity.

Identification of the Unknown: a Case Report

Background : Identification is the determination of the individuality of a person based on certain physical characteristics. It is the process of exact fixation of personality. In partial or incomplete identification, certain facts are determined, such as; race, age, sex, stature and etc., while other characteristics are not known. Case Report: Unknown skeleton came to the department of forensic medicine, Institute of Medical Sciences, Banaras Hindu University, and Varanasi in 2015 for the purpose of identification and to determine the cause of death. It was estimated to be a male of age 25-35 years with a depressed comminuted fracture along with two other antemortem fractures in the skull. So, based upon the type of skull fracture found, the most likely cause of death was opined to be coma as a result of head injury. Time since death was estimated to around 3-4 weeks based on the ambient temperature being 40±5oC, entomology and semi-skeletonised condition of the body. Conclusion: The case has been reported in view of the fact that an unknown body with a little history came to us mainly for the purpose of identification had eventually turned out to be a case of possible homicide. Hence, a thorough examination of each and every case is recommended.

Fractures as identifiers

Identification of the deceased is an important feature of any death investigation. Generally, the main types of identification confirma-tion that are acceptable to the Courts are visual, dental, DNA and fingerprints. On occasion, these traditional identifiers are not available due to the condition of the body or lack of ante-mortem records, and other forms of acceptable identification must be sought. To be acceptable as a form of positive identification the feature in question must be unambiguous and there must be several points of concurrence between the deceased and ante-mortem records. The aim of this study is to investigate the usefulness of ante-mortem fractures as identifiers when the traditional methods are not available. An overview of a number of cases admitted to the Western Australian State Mortuary, where the identification process is problematic, will be presented. The number of ante-mortem fractures present in a random sample of deceased and their uniqueness will be examined. A case study involving a combined pathology and anthropology examination will be used to illustrate the usefulness and acceptability, at the Coronial level, of ante-mortem fractures as identifiers.

Assessing Post‐traumatic Time Interval in Human Dry Bone

AbstractThe post‐traumatic status of antemortem fractures in human dry bone remains is currently defined as being either ‘healing’ or ‘healed’. However, detailed ‘dating’ of the related post‐traumatic time interval would be desirable, since it would aid in assessing individual medical status and care at the time of death. Within forensic pathology practice, fresh tissue healing phases are routinely used as an intrinsic parameter for the length of the post‐traumatic time interval. Unfortunately, the direct application of such a method is hampered when applied to dry bone skeletal material.This study explores the possibility of applying a fracture dating system, drawn forth from the traditional forensic pathology method, on dry bone remains. More specifically, the aim is to establish the extent to which various histomorphological features indicative of specific time intervals of healing are consistently detectable. Human dry bones with fractures and amputations in various phases of healing were studied.Results show that the complementary use of radiological and histological investigation techniques improves the differentiation between various healing phases and thus allow for a more detailed dating of lesions. For future use, healing features that have proven to be consistently detectable and their related post traumatic time intervals are listed. The system aids in demarcating a considerably more ‘narrow’ post‐traumatic time interval than usual. Copyright © 2012 John Wiley & Sons, Ltd.

Child Abuse Fatalities: Pattern of Injury

Child Abuse & Neglect| September 01 2009 Child Abuse Fatalities: Pattern of Injury AAP Grand Rounds (2009) 22 (3): 31. https://doi.org/10.1542/gr.22-3-31 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Child Abuse Fatalities: Pattern of Injury. AAP Grand Rounds September 2009; 22 (3): 31. https://doi.org/10.1542/gr.22-3-31 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: child abuse, fractures, skeletal injury, homicide, fractures in children Source: Ross A, Abel S, Radisch D. Pattern of injury in child fatalities resulting from child abuse. Forensic Science International. 2009;188(1–3):99–102; doi:10.1016/j.forsciint.2009.03.021 To assess the rate and pattern of antemortem fractures in children dying from child maltreatment, researchers from North and South Carolina reviewed case files from child homicide fatalities occurring between 2000 and 2005 in North Carolina and Charleston County, South Carolina. The investigators reviewed reports to identify children with fractures and to categorize these fractures as antemortem or perimortem. Data from 162 child homicide fatalities were reviewed. Filmy percent of all homicide deaths were in infants younger than 9 months and 68% were males. The most common body region injured was craniofacial (47%). Antemortem fractures were identified in 24% of cases and perimortem fractures were identified in 38%. There was a statistical association between finding antemortem and perimortem fractures in the same... You do not currently have access to this content.

Pattern of injury in child fatalities resulting from child abuse

According to the US Department of Health and Human Services, in 2005, an estimated 1460 children died of maltreatment. The purpose of this study is to further examine the pattern of bony injuries in child maltreatment fatalities, with an emphasis on the prevalence of antemortem fractures and the presence of associated perimortem fractures. The sample was 162 male and female children. The majority of the data were collected from the case files of the NC Child Fatality Prevention Team at the Office of the Chief Medical Examiner in Chapel Hill, North Carolina ( n = 152) spanning from 2000 to 2005. An additional 10 cases from 2001 to 2006 were included from the Charleston County Coroner's Office, Charleston, SC. Six age categories were used in this study: 0–3 months, 4–6 months, 7–9 months, 10–16 months, 17 months to 2 years, and 2–6 years. Lesions were documented and categorized into four general body loci: craniofacial, thoraco/abdominal, appendicular, and multiple. The peak age categories of death were 0–3 months (25%) and 2–6 years (19%), with 50% of deaths occurring in infants 9 months old or younger. The body locus most frequently affected was craniofacial.

Study on the microstructures of skull fracture

The authors observed the edges of skull fractures under the scanning electron microscope. Many microfractures can be found along the main fracture lines. The width of the microfractures varies from 5 to 100 μm. They may be located either in the external compact bone or between the outer compact bone and diplöe, or in the diplöe. Those within the diplöe form transverse, longitudinal or spiral fractures of bony trabeculae. Collagenous fibre bunches in the bony matrix may be divided or broken and the different layers of collagenous fibre may be separated. The blood vessels inside the skull may be crosscut or longitudinally torn by the fracture lines. Sometimes the torn blood vessels may be drawn out of the Haversian canals. In antemortem fractures, the fibrin networks and red blood cells can be easily found in the depths of those cracks. The possible mechanism of formation of the microfractures and the possibility of differentiation between ante- and post-mortem fractures are discussed.

Trauma among early Californians

The incidence and distribution of trauma is examined in a large number of individuals from many burial sites in California. The material represents part of an on-going curational effort at the Lowie Museum of Anthropology. Trauma is confined to fractures, dislocations, and projectile wounds for the purposes of this study. Only antemortem fractures are considered.