Forensic significance of X-ray data in the definition prescription of diaphyseal fractures: a case from expert practice

Abstract

BACKGROUND: Determining the prescription of fractures is important when conducting a forensic medical examination of victims, accused persons, etc. This allows the expert to immediately determine the causal relationship of the skeletal injury found in the sub-expert with the events described in the decision on the forensic medical examination, especially in cases when the conducted examination according to medical documents may be concealed or distorted of the incidental circumstances; thus the investigating authorities need to decide on the case and establish the truth. Often, medical documents, especially in cases of a single request for medical help, do not contain enough information about the clinical picture of the fracture, with limited or missing descriptions of the local status. In such cases, one of the most important sources of information for the expert is radiography data (radiographs in electronic form or on X-ray film and computed tomograms), which the study allows the expert to conclude the mechanism of injury and the prescription of fractures. The study of literary sources on this topic did not reveal the exact criteria for determining the prescription of fractures based on the study of the X-ray examination results in the forensic aspect.

CASE PRESENTATION: The description of a case from practice was provided. In our practice, a case with fractures that did not correspond to the events of the described incident in the resolution as found by the sub-expert, and these fractures were not regarded by the surgeon as “old” and unrelated to the specified circumstances of the case. The presented radiograph examination allowed the forensic medical expert to determine the time frame of the detected fractures and establish the absence of a causal relationship of this injury with the events specified in the resolution.

CONCLUSION: The analysis of this expert case allows us to conclude the importance of examining the radiography data by the forensic medical expert to determine the description of fractures.

SIGNIFICANCE FOR FORENSIC MEDICINE: The presented case from the practice demonstrates the need for a critical approach of the forensic expert, both to the presented medical data and the information contained in the materials of the preliminary examination or criminal case, as well as the importance of an independent study of the X-ray examination results of the subject.

Keywords

prescription of fractures / diaphyseal fractures / forensic radiology / harm to health

References

[1] Chunikhina NA, Shestopalov KK, Plaksin VO. A comprehensive assessment of the prescription of fractures with local damage to the diaphyseal sections of long tubular bones using the X-ray diagnostic method. Problems of Expertise in Medicine. 2001;1(4):3–6. (In Russ).

[2] Чулихина Н.А., Шестопалов К.К., Плаксин В.О. Комплексная оценка давности переломов при локальном повреждении диафизарных отделов длинных трубчатых костей с использованием рентгенологического метода диагностики // Проблемы экспертизы в медицине. 2001. Т. 1, № 4. С. 3–6.

[3] Badyaeva EE. Possible errors in determining the prescription of a blunt neck injury. In: Selected issues of forensic medical examination: Proceedings of the conference, December 04, 2018. Issue 18. Khabarovsk; 2019. Р. 49–50. (In Russ).

[4] Бадяева Е.Е. Возможные ошибки при определении давности тупой травмы шеи // Избранные вопросы судебно-медицинской экспертизы: сборник трудов конференции, 04 декабря 2018 г. Вып. 18. Хабаровск, 2019. С. 49–50.

[5] Klevno VA, Kireeva EA, Bogomolova IN. Forensic medical determination of the prescription of rib fractures. Forensic Medical Examination. 2008;51(1):44–47. (In Russ).

[6] Клевно В.А., Киреева Е.А., Богомолова И.Н. Судебно-медицинское определение давности переломов ребер // Судебно-медицинская экспертиза. 2008. Т. 51, № 1. С. 44–47.

[7] Yakovenko LL, Yakovenko OO, Gonchar DG. Forensic medical expert assessment of damage to the maxillofacial region. Forensic Medical Examination. 2016;59(2):10–13. (In Russ). doi: 10.17116/sudmed201659210-13

[8] Яковенко Л.Л., Яковенко О.О., Гончар Д.Г. Судебно-медицинская экспертная оценка повреждений челюстно-лицевой области // Судебно-медицинская экспертиза. 2016. Т. 59, № 2. С. 10–13. doi: 10.17116/sudmed201659210-13

[9] Shiryaeva YuN, Zhurikhina SI, Makarov IYu. Features of periosteal damage from the action of mechanical damaging factors. Selected issues of forensic medical examination: Proceedings of the conference, December 04, 2018. Issue 18. Khabarovsk; 2019. Р. 210–213. (In Russ).

[10] Ширяева Ю.Н., Журихина С.И., Макаров И.Ю. Особенности повреждения надкостницы от действия механических повреждающих факторов // Избранные вопросы судебно-медицинской экспертизы: сборник трудов конференции, 04 декабря 2018 г. Вып. 18. Хабаровск, 2019. С. 210–213.

[11] Matveev RP, Bragina SV. Radiology in traumatology and orthopedics. Selected sections: textbook. Arkhangelsk: Publishing House of the Northern State Medical University; 2018. 151 p. (In Russ).

[12] Матвеев Р.П., Брагина С.В. Рентгенология в травматологии и ортопедии. Избранные разделы: учебное пособие. Архангельск: Изд-во Северного государственного медицинского университета, 2018. 151 с.

[13] Lindenbraten LD, Korolyuk IP. Radiation diagnostics. Textbook. 3rd ed. Moscow: Binom; 2013. 496 p. (In Russ).

[14] Линденбратен Л.Д., Королюк И.П. Лучевая диагностика. Учебник. 3-е изд. Москва: Бином, 2013. 496 с.

[15] Reinberg SA. X-ray diagnostics of diseases of bones and joints. 4th revised and updated. Moscow: Medicine; 1964. (In Russ).

[16] Рейнберг С.А. Рентгенодиагностика заболеваний костей и суставов. В 2 т. 4-е изд., испр. и доп. Москва: Медицина, 1964.

[17] Burgener FA, Kormano M, Pudas T. Radiation diagnostics of diseases of bones and joints: atlas. Transl. from the English by V.V. Pozharsky, ed. by S.K. Ternovoy, A.I. Shechter. Moscow: GEOTAR-Media; 2011. 539 p. (In Russ).

[18] Бургенер Ф.А., Кормано М., Пудас Т. Лучевая диагностика заболеваний костей и суставов: атлас / пер. с англ. В.В. Пожарского; под ред. С.К. Тернового, А.И. Шехтера. Москва: ГЭОТАР-Медиа, 2011. 539 с.

[19] Semizorov AN. Radiography in the diagnosis and treatment of bone fractures: a manual for doctors. Moscow: Vidar-M; 2007. 176 p (In Russ).

[20] Семизоров А.Н. Рентгенография в диагностике и лечении переломов костей: пособие для врачей. Москва: Видар-М, 2007. 176 с.

[21] Stepanov RV. Complex radiation diagnostics in the assessment of the reparative process in the treatment of patients with closed diaphyseal fractures of the lower leg bones [dissertation abstract]. Moscow; 2011. 21 p. (In Russ).

[22] Степанов Р.В. Комплексная лучевая диагностика в оценке репаративного процесса при лечении больных с закрытыми диафизарными переломами костей голени: Автореф. дис. … канд. мед. наук. Москва, 2011. 21 с.

[23] Omelianenko NP, Karpov IN. Regularities of cell-matrix interactions in the process of formation of distraction bone regenerates. Bulletin of Experimental Biology and Medicine. 2017;163(4):514–519. (In Russ).

[24] Омельяненко Н.П., Карпов И.Н. Закономерности клеточно-матриксных взаимодействий в процессе формирования дистракционных костных регенератов // Бюллетень экспериментальной биологии и медицины. 2017. Т. 163, № 4. С. 514–519.

[25] Omelianenko NP, Slutsky LI. Connective tissue. Ed. by S.P. Mironov. Moscow: Izvestia; 2009. 380 p. (In Russ).

[26] Омельяненко Н.П., Слуцкий Л.И. Соединительная ткань / под ред. С.П. Миронова. Москва: Известия, 2009. 380 с.

[27] Verhoff MA, Ramsthaler F, Kreutz K, Schiewy-Bochat KH. Forensische anthropologie und osteologie. Übersicht und definitionen. Dtsch Arztebl. 2006;103:A782–A788. (In Deutsch).

[28] Verhoff M.A., Ramsthaler F., Kreutz K., Schiewy-Bochat K.H. Forensische anthropologie und osteologie. Übersicht und definitionen // Dtsch Arztebl. 2006. Vol. 103. Р. A782–A788.

[29] Keil I. Frakturen bei kleinkindern in den ersten 2 lebensjahren: häufigkeiten, lokalisationen, ursachen und die bedeutung der kindesmisshandlung. Lübeck; 2009. 133 р. (In Deutsch).

[30] Keil I. Frakturen bei kleinkindern in den ersten 2 lebensjahren: häufigkeiten, lokalisationen, ursachen und die bedeutung der kindesmisshandlung. Lübeck, 2009. 133 р.

[31] Claes L. Dynamisierung der osteosynthese. Zeitpunkt und Methoden. Zeitschrift: Der Unfallchirurg Ausgabe. 2018;(1). (In Deutsch).

[32] Claes L. Dynamisierung der osteosynthese. Zeitpunkt und Methoden // Zeitschrift: Der Unfallchirurg Ausgabe. 2018. N 1.

[33] Muhm M, Winkler H. Fixateurexterne und knochenbruchheilung. OP-Journal. 2008;24:52–57. (In Deutsch).

[34] Muhm M., Winkler H. Fixateurexterne und knochenbruchheilung // OP-Journal. 2008. Vol. 24. Р. 52–57.

RIGHTS & PERMISSIONS

Li Y.B., Vishniakova M.V., Klevno V.A.