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Blunt Trauma

- when a force impacts bone over a


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