Tatjana Atanasijevic

Frequency and severity of injuries in correlation with the height of fall

The main aim of this study was to examine the correlation between the height of fall and the frequency, extensiveness, and type of injuries of certain body regions and organs. The specific objective was to determine characteristic injuries of the analyzed body regions in relation to the certain height of fall. The study included 660 cases of fatal falls from height (469 males and 191 females). Results support the hypothesis that the frequency and extent of the injured body regions and organs are related to the fall height. Head injuries are characteristic of the falls from heights up to 7 m and beyond 30 m. Brain injuries in high falls from heights beyond 30 m show an absence of contre coup contusions and macroscopically evident intracranial bleeding. The extensiveness of chest injuries is significantly statistically associated with fall height. In cases of high falls, the frequency of abdominal injuries is not significantly statistically related to the height of fall. Liver injuries are the most common abdominal injury and the critical height of fall at which the liver injury occurs is 15 m. Injuries of liver and spleen are concomitant in high falls from heights beyond 24 m, irrespective of the manner of impact. The height of fall over 15 m appears to be a reasonable boundary height beyond which the injuries of two or three body regions are generally associated.

Analysis of neck injuries in hanging

Retrospective study of suicidal hangings was made on 175 cases (133 male victims, 42 female victims) for a 5-year period. The mean age was 47.33 ± 17.51 years. The sample was divided in 4 groups according to the position of the ligature knot (anterior, right, left, and posterior hanging). The authors analyzed all visible injuries of soft tissues and bones and cartilage of the neck, and in 150 cases (85.7%), we established that there was at least one injury of these structures (hematoma or fracture for example). The most frequent injury was to sternocleidomastoid muscles. Fracture of throat skeleton was detected in 119 cases (68%). The proportion of fractures increases with age of the deceased. There was no clear correlation between frequency of neck injuries and type of hanging.

Mechanisms of aortic blunt rupture in fatally injured front-seat passengers in frontal car collisions: an autopsy study

We tried to explain the mechanisms of the aortic blunt ruptures in fatally injured drivers and front passengers, unrestrained by seatbelts, by analyzing the frequencies of both aortic ruptures and concomitant injuries to 12 organs and body regions. The sample consisted of 393 subjects: 251 drivers and 142 front passengers (325 male and 68 female passengers, the mean age 41.0 ± 15.5). The total number of the complete blunt aortic ruptures in the sample was 116 (80 in the drivers and 36 in the front passengers). The weakest part of the aorta seems to be the isthmus (47 isthmus ruptures in the drivers and 27 in the front passengers). The statistically significant concomitant injured organs and body regions with the aortic ruptures were the liver, the sternum, and the diaphragm in the car drivers and the head and the neck in the front passengers. According to these results, the mechanisms of thoracic aorta rupture are different for fatally injured drivers and front passengers. For car drivers, they are associated and simultaneous with both thoracic and abdominal compression due to deceleration of the body at the moment when the drivers body slides forward and flexes across and against the steering wheel. For the front passengers, the mechanism is the caudorostral hyperextension of the thoracic aorta at the moment when the body is stopped by a dashboard, but the head continues forward with great velocity: the carotid vessels pull the aortic arch forward at the same time as the intercostal arteries fix the thoracic part of the aorta and pull it downwards.

Could lactates in vitreous humour be used to estimate the time since death

Vitreous humour (VH) is a useful medium for postmortem analysis. During the supravital period, anaerobic glycolysis that occurs results in the increased lactate concentration (L) in cytosol. We analysed the concentration of lactic acid in 567 samples of VH from 63 autopsy cases by a repetitive withdrawal of VH from the same corpse, while the outside temperature remained constant. The samples were taken from the same eye in intervals of three hours for the period of 24 hours. The subjects were divided into two groups: group 1 included individuals who died during winter and were kept for analysis at 4°C, while group 2 consisted of those who died during spring and autumn (continental climate) and were stored at 20°C. Only the cases of a sudden traumatic death of previously healthy individuals were included in the study. Statistically significant correlation of L against postmortem interval (PMI) was observed in the group 1 experiment (r = 0.675; P < 0.01), but the effect of hypothermia made the estimation of PMI practically impossible. A much stronger correlation of L against PMI was observed in group 2 (r = 0.866, P < 0.01); a functional relationship between PMI and L were demonstrated using the formula PMI = 1.696 × L − 10.562, which enabled more accurate prediction of the PMI.

Hyoid-laryngeal fractures in hanging: where was the knot in the noose?

The aims of this study were to determine the frequency of hyoid-laryngeal fractures in hanging in relation to the position of the ligature knot, to reconstruct the location of the ligature knot in cases of hanging when the furrow is not detectable on the skin, and to identify the possible mechanism of neck structure injuries. We report a retrospective autopsy study which included 557 cases of suicidal hanging: 413 men and 144 women, with an average age of 52.4 ± 17.8 years. In 57.3% of them, hyoid-laryngeal fractures were found (average age was 54.3 ± 16.5 years): 15.1% had only hyoid bone fracture, 26% had only thyroid cartilage fracture and 16.2% had both types of injury at the same time. Hyoid-laryngeal fractures were found more often in persons aged over 30 years. Hyoid bone fracture was a weak predictor of ligature knot position in our sample. Fracture frequencies of the thyroid cartilage show a statistically significant difference in relation to the ligature knot position among persons older than 30 years, which indicated the ipsilateral and posterior position of the knot. Absence or presence of any form of hyoid-laryngeal fracture indicated that knot position was anterior or posterior, respectively. The derived data would be useful for cases where the ligature has been removed from the body of the deceased shortly after hanging, where the noose is unavailable, and in cases where the ligature mark has faded such as with soft ligatures removed promptly or in decomposed bodies.

Amount of postmortem bleeding: an experimental autopsy study.

An experimental autopsy study was performed on 64 cases (55 male, 9 female; average age 51.5 ± 16.2 years) of sudden natural (38 cases) and asphyxic deaths (26 cases). The study objective was the amount of postmortem bleeding from postmortem cutting of the thoracic aorta, related to the time since death. The amount of postmortem bleeding ranged from 100 to 1300 cm3, 440.6 ± 268.1 cm3 on average. The time since death up to the autopsy time ranged from 4 to 72 hours, 19.4 ± 12.9 in average. A statistically significant correlation between the amount of postmortem bleeding and postmortem time interval was stated: Pearson correlation test value r = −0.461 (P = 0.000): the shorter the time interval, the larger the amount of bleeding. The formula of linear regression was estimated according to this correlation: amount of postmortem bleeding (cm3) = −9.571 × time since death (h) + 626.659. This proves that the amount of postmortem bleeding (eg, from aortic blunt rupture) could be about 620 cm3.

Estimation of the postmortem interval by analyzing potassium in the vitreous humor: could repetitive sampling enhance accuracy?

AbstractThe relationship between the postmortem interval and the potassium concentration in the vitreous humor has been described by different authors. A limitation of most previous studies might be that all of the vitreous humor has been extracted in 1 sample from different subjects and that the sample was therefore inhomogeneous. In 32 traumatic deaths with known postmortem intervals, small quantities of vitreous humor have been sampled repetitively in 3-hour interval. The bodies were stored at 20°C. The average concentrations of potassium in relation to the postmortem interval were 6.11 to 14.46 mmol/L. An equation that allows accurate prediction of the postmortem interval was established: postmortem interval (h) = 2.749 × [K+] − 11.978.

Pontomedullary Lacerations in Falls from a Height—A Retrospective Autopsy Study

Abstract:  Brainstem pontomedullary laceration (PML) in falls from a height appears as isolated cases and usually in feet‐first impacts with a ring fracture. The aim of this study was to determine the frequency of PML in falls from a height, as well as the frequency of concomitant head and neck injuries. Out of 261 cases, PML was present in 40. An impact to the chin, as well as a feet‐ or buttocks‐first impact, most often led to PML owing to transmission of the impact force. Also, a lateral, frontal, or posterior head impact, with subsequent hinge fracture, as well as the frontoposterior hyperextension of the head associated with an upper spine fracture, could be possible mechanisms of PML in falls from a height. The jawbone and other facial bones act as shock absorbers, and their fracture diminishes energy transfer toward the skull and protects the brain and brainstem from injury.

The Role of Vitreous Magnesium Quantification in Estimating the Postmortem Interval

The use of magnesium as a parameter to estimate the time of death is controversial. In 32 traumatic deaths with known postmortem intervals (PMIs), small quantities of vitreous humor (VH) were sampled repetitively every 3 h until 24 h postmortem. The bodies were kept at the constant ambient temperature of 20°C (68°F). The concentrations of magnesium were in the range of 0.47–1.15 mM. A statistically significant correlation of the concentration of magnesium with the PMI was observed (r = 0.453, p < 0.01), but with small predictive value—coefficient of variation for regression was 45.5%; the average of the paired differences between the estimated and actual PMIs was 5.24 + 3.19 h. Although useful results might be expected due to the large transmembrane gradient for magnesium, the results of this study strongly disprove the usefulness of measuring magnesium in VH to estimate the time of death.

Anatomical aspects of the gastrocnemius muscles: A study in 47 fresh cadavers

BACKGROUND This study offers objective dimensions of the gastrocnemius muscle and analyzes correlations between dimensional variables, with a view to providing guidance on the proportions of a healthy gastrocnemius muscle for both genders. METHODS This anatomical study was conducted at the Institute of Forensic Medicine Faculty of Medicine University of Belgrade, Serbia, from May until November 2014. We included 47 fresh cadavers (up to 12-h postmortem interval) both male and female. The inclusion criteria were absence of any trauma or degenerative findings in lower limbs, normally weighed, and age between 18 and 60 years. The exclusion criteria were significant difference in dimensions between legs and overweighed cadavers. RESULTS After statistical analysis of gathered data, we were able to define the exact shape and average measures of the medial and lateral head of gastrocnemius muscle in male and female. Factors affecting muscle dimensions are also defined in this study. CONCLUSION The method of dissection that we applied could be recommended for exploration of different anatomical structures of calf region. The reported dimensions and correlations are useful guide in planning cosmetic and reconstructive procedures with high accuracy.