relatively wide area causing discontinuities and fracture lines - implements such as a club or areas like the ground (or during car accidents, airplane crashes etc.) - assessing the specific characteristics of causative instruments is very difficult because of the variety involved
Characteristics of Instruments
- bludgeons (baseball bats, wood, crowbars, other metal objects, rocks) - any hard surface (ground, parts of automobiles, bulkheads)
Size - length and width - hard to estimate based on an objective scale (inches) but can be deemed with long or short - similarly, width is usually only defined as wide or narrow - an injury to the skull where the area of impact is clear, but an imprint is not visible indicates a focused force - by contrast, diffused forces would cause trauma that would not exhibit a distinct area of impact - things like the ground have neither width nor length - the determination between bludgeon v. collision can be complicated - falling onto rocks - a hammer may mimic a wound from a fall - it is important that FAs be familiar with how the remains were recovered - narrow instruments require less strength to be wielded and can deliver more force more easily
Shape - two cross-sectional shapes are recognized: round and angular - round common in tools, bats, clubs, bottles, crowbars etc. - angular common with lumber, metal, etc. - more likely to leave imprint of shape - distinct, incisive edges with fewer fracture lines - only under special circumstances can an angled instrument be identified because of the variance in striking possibilities - patterned injuries: specifically identify the causative instrument; clearly visible on affected tissue - things like a belt buckle or a unique tool - only the cranial vault exhibits these wounds with bone
Weight - can usually only be measured as heavy or light - light injuries cause smaller injuries with fewer fracture lines - heavy objects swung with determination can cause catastrophic injuries to bone - often the concept of weight does not apply (car crashes, large falls
Types of Fractures
- divided by incomplete and complete fractures - incomplete fractures - 1. bow fracture or plastic deformation: caused by compression along the long axis of the bone - common in kids forearms - cause bone to bend at unnatural degree - appear microscopically as mini fractures running obliquely across long axis - 2. bone bruise or occult intraosseous fracture - visible in radiographs or MRIs - microfractures to trabecular bone due to compression - 3. torus or buckling fracture: result of compressive forces that cause outward buckling of the cortex around the circumference of bone - seen at junction of metaphyses and epiphyses - 4. Greenstick fracture: incomplete, transverse fracture to long bones - diaphyses are meant at an abnormal angle - 5. Toddlers fracture: oblique or spiral fracture where ends do not separate - seen in lower limbs of infants and toddlers - 6. vertical fracture: due to compressive forces which split bone along long axis - 7. depressed fracture: segments of bone that point inwardly to the bones center - seen most often in skull due to compression - complete fractures - 1. transverse fracture: crosses diaphyses at right angles to the long axis - long bones - due to bending and possibly shearing - 2. oblique fracture: passes through shaft at angle approximating 45 - bending and compression - 3. spiral fracture - excessive torsion - produces an oblique-like break - 4. comminuted fracture: break producing more than 2 pieces - butterfly: wedge of bone separates from the other two pieces on the side where the fracturing forces impacts the bone 12 - legs of pedestrians struck by automobiles - same forces that cause oblique fractures - segmental fracture: three segments: medial and lateral piece, separated by a section between their two ends - two separate forces applied or when bone contacts large surface - 5. epiphyseal fracture: occurs to ends of long limb bones - separate epiphyses from metaphyses - divide these structures in 2+ pieces - seen mainly in subadults (they are fused in adults)
Effects of Blunt Instruments
- skull reacts differently than other bones - thick bones respond differently than thin ones
Skull - several phases - inbending at site of impact w/ concomitant outbending surrounding the impact site (Fig. 13.1) - fracture lines can form from outbending site - if fracture lines do not dissipate force enough, wedge-shaped pieces of bone begin forming - if force penetrates vault, concentric fractures occur around area of impact as wedge shaped pieces are forced inward - internally beveled (opposite of projectile) - angles away from point of impact - these hoop fractures partially or completely encircle point of impact - bone fails more rapidly under tension - fracture lines start on inner surface and progress outward (13.2a) - in more brittle bone, a plug is pushed out (13.2b) - in other cases when trabecular bone is brittle, diploe crushes under force, causing a depressed fracture - if inner part is more brittle than outer, it will divide in a number of segments (13.2d) - fractures to the face are guided by three paired areas - alveolar ridge, malar eminences, nasofrontal processes of the maxillae - when force is applied to face it results in LeFort fractures - 1. LeFort 1: separation of the alveolar part of the maxilla from the rest of the face in the area between the alveolar ridges and the nasofrontal processes - blow to lower face from front to side - 2. LeFort 2: involves separation of the mid-face from the rest of the cranium - fractures occur b/w buttresses formed by the malar eminence and the nasofrontal processes - anterior blow mid face - 3. LeFort 3: entire face is separated from the braincase - centrally focused blow to the upper part of this structure - area b/w malar eminence buttress, frontal buttress, and the anterior temporal buttress - many times, fractures do not fall into one of these specific categories - blunt forces to cranial vault: four areas of buttressing - midfrontal, midoccipital, posterior temporal, and anterior temporal - speed of force is important - slow force results in a complete fracture on one side and a hinge on the other - fast forces result in complete fractures - ring fracture: skull is forced down or pulled away from the vertebral column - direction can be determined by the bevel - bends inwardly: pushed together - bends outwardly: pulling apart - proceeds from the occipital anteriorly - if severe enough, will completely encircle foramen magnum, ending at the sella turcica (osseous structure where the occipital meets the sphenoid) - mandible can be fractured - zygomatic area (as a result of an off center blow) can fracture along sutures and the arch can also fracture at the blow, and anteriorly and posteriorly
Long Bones - usually compression and bending forces (complete simple fractures without fracture lines) - complete fractures more common (except with green stick) - comminuted fractures can result if blunt force delivers significant energy
Other Bones - adult ribs generally break toward anterior end - variety of fractures - vertebrae can manifest similar fractures at any of the transverse or spinous processes - pelvis: breakage of pubis and the iliac crest - blunt trauma to scapula result in separation of the glenoid as well as coronoid and corocoid processes
Wound Analysis
Description of Wound(s) - placement within skeleton - help with MOD - homicide results in wounds to head to parry fractures - accident or suicide can result in a variety of injuries - name the bone affected, location, and fractures (include side)
Estimation of Size - large variety of objects makes this hard (or sometimes easy)
Estimation of Shape - again, much variety - cross sectional outline: shape across long axis - axial configuration: bludgeons can be angled
Estimation of Direction - kind of obvious
Estimation of Energy - can be determined only broadly - low speed generally leads to infraction - high speed results in complete fracture - same with light v. heavy - bone thickness also translates to difficulty in fracturing - broader fields of contact may not result in complete fractures
Estimation of Number - some forces may not cause fracture - may not be able to detect repeated blows to the same location - points are located using fracture lines - knapping or flaking along edges along the edges may indicate multiple blows
Estimation of Sequence - fracture lines traced to see which end naturally and which end at another fracture
Miscellaneous Estimations - in auto accidents, bumper height and stance of the victim can be measured - attacks to left may indicate a right handed person
Blunt Force Trauma - blunt force trauma occurs when a force impacts bone over a relatively wide area - causative factors can be anything used as a bludgeon (e.g. baseball bat), or contact of moving body with fixed hard surfaces (ground, edge of table, dashboard, etc.)
Wound Analysis - the goal of wound analysis is to provide law enforcement officials with as much information as possible about the causative weapon and assailant by providing - description of the wound, estimation of size, shape, direction, energy, number, sequence
Size - the size of an object causing blunt trauma refers to its length and width - because the long axis of an instrument is rarely imprinted completely on the bone, estimations of length must be in general terms such as long or short - similarly, the width of the instrument must be described in terms of narrow or wide - because of the availability of only comparative measurements, blunt force trauma is almost always described as focused or diffused - focused trauma is indicated by an area of visible impact - diffused trauma has no definitive area of impact - not all objects causing blunt trauma have defined length and width. Impact on the ground or collision with a windshield are such examples. In these cases, the trauma is defined as diffused. - however, determining bludgeoning versus collision is complicated. Falling on an uneven surface could mimic a focused impact, while being bludgeoned with a flat object could mimic a wound from a fall. - width of the instrument is, to an extent, inversely proportional to its ability to fracture the skull. For example, a 3 wide object needs only 2/3 the amount of force of a 20 wide object to fracture a human frontal - this information can provide clues as to the strength of the assailant
Shape - shape can be described by two aspects, its cross-sectional outline and its longitudinal configuration - there are two main cross-sectional shapes: - round and angular - round outlines are common in bludgeoning tools such as bats, glass bottles, clubs, etc. - round outlines leave a relatively focused area of impact, fracture lines, and seldom leave dimensional imprints - angular outlines are common in bludgeons such as 2x4s, crowbars, and pieces of metal - angular outlines are likely to leave a distinctly focused area of impact, few fracture lines, and often leave an imprint of their shape with almost incisive edges - longitudinal configuration can be of either a straight long axis or a curved, angled, or bent axis - bludgeons with a straight axis leave a straight area of impact, while those with a curved axis are difficult to recognize because of the infinite number of degrees of striking - patterned injuries are a rare type of injury that directly identifies the causative weapon, such as the imprint of a belt buckle
Effects of Blunt Instruments - blunt force affects different types of bones differently. Thin bones react differently than thick bones, cranial bones react differently than long bones, etc. - wounding effects are divided into three main areas: - skull, long bones, other bones (particularly elements of the axial skeleton)
Skull - when a blunt force of sufficient magnitude is applied to the skull, fracturing occurs in several phases - first there is an inbending at the impact site, accompanied by outbending around the impact site - incompressible fluid between brain and skull - pressure increases - bone weaker in tension than in compression - crack under area of impact forms first (stretching) - cracks form in the periphery (from pressure) - if there is sufficient force, fracture lines form on the outbent surface and move inward toward the impact site, forming radiating fracture lines - if the force continues, the fracture lines continue outward and form wedge shaped pieces of bone (largely triangular in nature) - finally, if the force penetrates the cranial vault, concentric fracture lines occur around the area of impact - fracturing from blunt force trauma to the cranial vault is guided by four buttresses: - midfrontal, midoccipital, posterior temporal, anterior temporal - the effect of blunt force to the face is also determiend by three paired areas of buttressing: - alveolar ridge, malar eminences, nasofrontal processes of the maxillae - these areas guide the dissipation of blunt force, resulting in LeFort fractures - LeFort 1: separation of the alveolar part of the maxilla from the rest of the face (blow impacting lower face from either side) - LeFort 2: separation of the midface from the rest of the cranium (blow to mid-face) - LeFort 3: separation of the entire face from the braincase (centrally focused blow to upper-face (centrally focused blow to upper face - a ring fracture is a special type of fracture that occurs at the base of the skull caused by the skull being wither forced down on pulled away from the vertebral column - the direction of the force is determined by the bevel of the fracture. Inward beveling indicates that the skull and vertebral column were driven toward each other. Outward beveling indicates that the two were pulled apart
Long Bones - blunt force trauma to long bones inflict two types of fractures - complete fractures: characterized by compression and bending forces that create simple fractures - comminuted fractures: seen when the force is delivered with sufficient energy to shatter the cortex of the bone into many fragments
Estimation of number - estimation of the number of blows becomes complicated due to many factors - some forces may not have impacted with enough energy to cause a fracture - forces applied to areas that lack osteological material do not leave prints on the bone - multiple blows to the same area may hide previous fractures - similar to wound analysis of projectile trauma, assessment of fracture lines is necessary to obtain a minimum number of blows - multiple blows can be recognized by the presence of flaking. This feature only indicates that multiple blows have occurred. There is no present method of determining the actual count
Estimation of sequence - sequence of blows is once again determined by fracture lines. Similar to analysis of projectile wounds, fracture lines are traced from the impact sites to determine which end naturally and which end at another fracture line
CASE STUDY 17: The Case of Mr. Miracle Purpose: - to reinforce some of the principles involved in analysis of blunt force (and other) trauma - to reinforce distinctions between antemortem and perimortem trauma, and to show how both of these types of trauma can be germane to a case - to explore the types of inferences that can be made when multiple types of perimortem trauma are evident in a single skeleton - decomposing body encased in hardened soil (the adobe body) delivered to FAs by investigators of the NMS OMI. FAs not informed of details of case - removal of adobe jacket reveals advanced state of decomposition. Bones macerated for further analysis. - craniofacial and pelvic features indicated male sex; dental wear, vertebral degenerative changes (osteophytes), and pubic symphyseal age estimators suggest 40-45 at death - facial skeleton and cranial vault exhibited both European and Asian features, consistent with an Hispanic individual. Stature estimated at 55.5-58.5 - abundant evidence of healed trauma - both nasal bones extensively fractured and healed; nose deviated to left - left zygomatic arch fractured and healed (old, well- healed callus evident) - 13 of 24 ribs broken at one time or another. Based on degree of healing, represented at least two episodes (right before left) - right elbow only ca. 15 motion (vs. 160 normally) due to untreated trauma - also abundant evidence of perimortem trauma - blunt force trauma - three fresh bone, unhealed fractures to the left zygomatic (overlaying healed fracture) - hinge fracture to right clavicle (tension fracture on superior surface, bone held together by inferior cortical bone), consistent with force applied from below - transverse processes of three thoracic vertebrae exhibited unhealed fracture, suggesting three separate blows (blunt force) to middle back - right 5th rib fractured ventrally, either by blow to chest or blow to back with prone victim - overall blunt trauma pattern suggests victim rolling on ground while being kicked and perhaps stomped on by attacker - skeleton also exhibited evidence of GSW: - proximal 11 cm of right humerus shattered. Restoration revealed a round entry wound 10 mm in diameter - beveling of entry wound (no butterfly pattern) and comminution of exit area consistent with GSW - skeleton also exhibited evidence of sharp force trauma: - penetrating knife wound evident in manubrium (likely reached pericardial cavity) - knife wound to right 4th rib midshaft - body of left scapula exhibited incised hole: wedging of bone indicates blade came from front (likely intersecting heart) - knife wound evident on shaft or right humerus - knife imprints on body of 7th cervical vertebra (knife coming from front) and 2 thoracic vertebrae - knife wound to superior portion of left pubic bone - knife blade estimated ! 4 - FAs conclude that around the time of death, victim was: - hit in the left side of head, shot in right arm, kicked in chest, kicked or hit multiple times on back, stabbed ! 8 times - FAs conclude that suicide, accident, natural death unlikely MODs: suggest homicide - multiple types of insults suggests multiple attackers (attackers seldom stop to change weapons) - given inferred knife pathways, COD thought to be exsanguination from heart wound - man confessed to NM state authorities to having been involved in a homicide three years earlier - a small group of vigilantes had killed Mr. Mark Miracle, a nefarious character with a history of violent behavior - Miracle was Hispanic, 42 years old at death, 55 tall - vigilante group had lured Miracle to a remote grave site in desert of NM (excavated grave awaited victim) - once on site, group sets upon Miracle, beating him, shooting him, and dropping him into a hole - however, Miracle was reluctant to comply, and rose out of the grave - whereupon his attackers renewed their assault of kicks, blows and stabs, eventually quieting Miracle down enough to get him to return to the hole for burial
Take Home Messages - despite knowing the ID of the victim and the details of the case, law enforcement (correctly) did not bias the analysis of the FAs - multiple types of perimortem trauma is generally an indication of multiple attackers - had authorities not known the ID of the victim, the plethora of antemortem traumas would have provided useful information for making an ID