Difference between revisions of "Forensic pathology"

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Forensic pathology (view source)

Revision as of 02:13, 29 March 2012

819 bytes added ,  02:13, 29 March 2012
→‎Bone fractures: +basal skull fracture
(→‎Bone fractures: +basal skull fracture)
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=Bone fractures=
=Bone fractures=
*[[AKA]] ''fractures''.
*[[AKA]] ''fractures''.
===Artefactual===
==Artefactual==
*"Undertaker's fracture" - cervical fracture due to rough handling.<ref>URL: [http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html]. Accessed on: 29 September 2010.</ref>
*"Undertaker's fracture" - cervical fracture due to rough handling.<ref>URL: [http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html http://www.the-crankshaft.info/2010/07/postmortem-changes_29.html]. Accessed on: 29 September 2010.</ref>
*Basal skull fracture due to opening of skull.<ref>MSP. 29 September 2010.</ref>
*Basal skull fracture due to opening of skull.<ref>MSP. 29 September 2010.</ref>
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**Mechanism to explain trauma not present in history; a fall/tripping not sufficient.
**Mechanism to explain trauma not present in history; a fall/tripping not sufficient.


===Child abuse-related===
==Healing of fractures==
*Paravertebral (bony) nodules = classic location for rib fractures in child abuse.
*Metaphyseal fractures  - "classical metaphyseal lesions".<ref name=pmid8615271>{{Cite journal  | last1 = Kleinman | first1 = PK. | last2 = Marks | first2 = SC. | title = A regional approach to classic metaphyseal lesions in abused infants: the distal tibia. | journal = AJR Am J Roentgenol | volume = 166 | issue = 5 | pages = 1207-12 | month = May | year = 1996 | doi =  | PMID = 8615271 }}</ref>
 
===Healing===
Simplified classification:
Simplified classification:
*Primary callus (cartilaginous) - early.
*Primary callus (cartilaginous) - early.
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*Radiology is not good at dating fratures,<ref name=pmid15788611>{{Cite journal  | last1 = Prosser | first1 = I. | last2 = Maguire | first2 = S. | last3 = Harrison | first3 = SK. | last4 = Mann | first4 = M. | last5 = Sibert | first5 = JR. | last6 = Kemp | first6 = AM. | title = How old is this fracture? Radiologic dating of fractures in children: a systematic review. | journal = AJR Am J Roentgenol | volume = 184 | issue = 4 | pages = 1282-6 | month = Apr | year = 2005 | doi =  | PMID = 15788611 | url=http://www.ajronline.org/cgi/content/full/184/4/1282 }}
*Radiology is not good at dating fratures,<ref name=pmid15788611>{{Cite journal  | last1 = Prosser | first1 = I. | last2 = Maguire | first2 = S. | last3 = Harrison | first3 = SK. | last4 = Mann | first4 = M. | last5 = Sibert | first5 = JR. | last6 = Kemp | first6 = AM. | title = How old is this fracture? Radiologic dating of fractures in children: a systematic review. | journal = AJR Am J Roentgenol | volume = 184 | issue = 4 | pages = 1282-6 | month = Apr | year = 2005 | doi =  | PMID = 15788611 | url=http://www.ajronline.org/cgi/content/full/184/4/1282 }}
</ref> but good at finding 'em.
</ref> but good at finding 'em.
==Pattern and cause==
===Child abuse-related===
*Paravertebral (bony) nodules = classic location for rib fractures in child abuse.
*Metaphyseal fractures  - "classical metaphyseal lesions".<ref name=pmid8615271>{{Cite journal  | last1 = Kleinman | first1 = PK. | last2 = Marks | first2 = SC. | title = A regional approach to classic metaphyseal lesions in abused infants: the distal tibia. | journal = AJR Am J Roentgenol | volume = 166 | issue = 5 | pages = 1207-12 | month = May | year = 1996 | doi =  | PMID = 8615271 }}</ref>


===Motor vehicle versus pedestrian===
===Motor vehicle versus pedestrian===
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</ref> the wedge points in the direction of the (impact) force.
</ref> the wedge points in the direction of the (impact) force.


==Location==
===Orbital floor fractures===
===Orbital floor fractures===
*[[AKA]] ''blow-out fractures''.<ref name=pmid17333039>{{Cite journal  | last1 = Punke | first1 = C. | last2 = Fritsche | first2 = A. | last3 = Martin | first3 = H. | last4 = Schmitz | first4 = KP. | last5 = Pau | first5 = HW. | last6 = Kramp | first6 = B. | title = [Investigation of the mechanisms involved in isolated orbital floor fracture. Simulation using a finite element model of the human skull]. | journal = HNO | volume = 55 | issue = 12 | pages = 938-44 | month = Dec | year = 2007 | doi = 10.1007/s00106-007-1545-5 | PMID = 17333039 }}</ref>
*[[AKA]] ''blow-out fractures''.<ref name=pmid17333039>{{Cite journal  | last1 = Punke | first1 = C. | last2 = Fritsche | first2 = A. | last3 = Martin | first3 = H. | last4 = Schmitz | first4 = KP. | last5 = Pau | first5 = HW. | last6 = Kramp | first6 = B. | title = [Investigation of the mechanisms involved in isolated orbital floor fracture. Simulation using a finite element model of the human skull]. | journal = HNO | volume = 55 | issue = 12 | pages = 938-44 | month = Dec | year = 2007 | doi = 10.1007/s00106-007-1545-5 | PMID = 17333039 }}</ref>
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*Classically due to fights, followed by traffic accidents.<ref name=pmid20165966>{{Cite journal  | last1 = Gosau | first1 = M. | last2 = Schöneich | first2 = M. | last3 = Draenert | first3 = FG. | last4 = Ettl | first4 = T. | last5 = Driemel | first5 = O. | last6 = Reichert | first6 = TE. | title = Retrospective analysis of orbital floor fractures--complications, outcome, and review of literature. | journal = Clin Oral Investig | volume = 15 | issue = 3 | pages = 305-13 | month = Jun | year = 2011 | doi = 10.1007/s00784-010-0385-y | PMID = 20165966 }}</ref>
*Classically due to fights, followed by traffic accidents.<ref name=pmid20165966>{{Cite journal  | last1 = Gosau | first1 = M. | last2 = Schöneich | first2 = M. | last3 = Draenert | first3 = FG. | last4 = Ettl | first4 = T. | last5 = Driemel | first5 = O. | last6 = Reichert | first6 = TE. | title = Retrospective analysis of orbital floor fractures--complications, outcome, and review of literature. | journal = Clin Oral Investig | volume = 15 | issue = 3 | pages = 305-13 | month = Jun | year = 2011 | doi = 10.1007/s00784-010-0385-y | PMID = 20165966 }}</ref>
*Thought to result from loading on the orbital rim directly or the orbit - both are transmitted to the orbital floor.<ref name=pmid17333039/>
*Thought to result from loading on the orbital rim directly or the orbit - both are transmitted to the orbital floor.<ref name=pmid17333039/>
===Basal skull fracture==
====General====
Etiology:
*Blunt force trauma - high energy & velocity.
**Seen in ''motor vehicle collisions'', ''descent from height''.
Clinical/external findings:
*Raccoon eyes.
*Battle sign.
*Cerebrospinal fluid rhinorrhea.
*Hemorrhage from nose and ears.
*Hemotympanum.
Note:
*There is a dictum that states ''bilateral petrous bone fractures are due to impact to the side of the head'' - it isn't true.<ref name=pmid7391790>{{Cite journal  | last1 = Harvey | first1 = FH. | last2 = Jones | first2 = AM. | title = Typical basal skull fracture of both petrous bones: an unreliable indicator of head impact site. | journal = J Forensic Sci | volume = 25 | issue = 2 | pages = 280-6 | month = Apr | year = 1980 | doi =  | PMID = 7391790 }}</ref>


=Autopsy=
=Autopsy=
Michael
48,830

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