Forensic Science International 228 (2013) e67e70

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Forensic Science International

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Case report

Car-to-pedestrian accident with a unique decollement injury

Valter Stemberga a, Anja Petaros a,*, Anita Barisic b, Miran Coklo a, Ivan Sosa a, Alan Bosnar a
a
b

Department of Forensic Medicine and Criminalistics, Rijeka University School of Medicine, Brace Bracnhetta 20, 51 000 Rijeka, Croatia
Rijeka University, School of Medicine, Brace Bracnhetta 20, 51 000 Rijeka, Croatia

A R T I C L E I N F O

A B S T R A C T

Article history:
Received 22 May 2012
Received in revised form 23 September 2012
Accepted 4 February 2013
Available online 1 March 2013

The authors present a unique case of decollement injury found on an 85-year-old victim that was runover by a tank truck. While external examination evidenced multiple severe injuries, autopsy conrmed
the preliminary ndings and revealed also the presence of an extensive decollement that spread from the
left hemithorax to a wound on the left ankle, through which parts of the small intestines and pertaining
mesentery protruded.
The article offers an interpretation of the injuries sustained by the victim, focusing on the most
probable decollement mechanism. The forensic pathologist in this case could rely also on the valuable
help of surveillance cameras of a nearby bank ofce that helped to better understand the events that
brought to the fatal injuries. The authors concluded that the expulsion of the jejunum was produced by a
combination of two movements: a forward passage that created the decollement and detachment of the
jejunum and a backward movement that completed the expulsion of the jejunum through the open
fracture of the ankle.
This case report evidences the importance of the forensic pathologist and a correct and detailed
investigation of injuries in reconstructing an accident, as well that of surveillance cameras as
investigation tool in forensic cases.
2013 Elsevier Ireland Ltd. All rights reserved.

Keywords:
Decollement
Car accident
Surveillance cameras
Legal medicine

1. Introduction
One of the main responsibilities of the forensic pathologist,
besides determining the cause of death, is to document injuries and
to deduce how the injuries occurred [1]. The interpretation of carto-pedestrian accidents is a habitual and challenging task for a
forensic pathologist. Although certain patterns of injuries in
pedestrians can clearly elucidate the circumstances of a trafc
accident, determine the direction of hit and injury mechanism,
there is still lack of satisfactory methods for reconstructing the
accident or determining clearly the sequence of the sustained
injuries [2].
Decollement is believed to be a very good indicator of run-over
accidents [3]. It is most often produced by a tangential force
applied on a body part by a turning wheel that rolls across it. The
skin is then torn-off from the underlying muscular fascia, resulting
in a pocket formation lled with blood and fat tissue [4].
However, decollement can be produced also by an oblique or
tangential force applied on a person in an erect position [3], or
perpendicular force during free fall impact [5]. Therefore, the

* Corresponding author. Tel.: +385 98 260 339.

E-mail addresses: anja.petaros@yahoo.com, anja.petaros@medri.uniri.hr
(A. Petaros).
0379-0738/$ see front matter 2013 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.forsciint.2013.02.007

interpretation of decollement must be carefully given, as it has

been demonstrated that the mechanism of the injury is more
complex than was believed before [5]. Yet, decollement in forensic
practice has been shown useful in reconstructing lethal accidents
pertaining to motor vehicle and suicide victims [3,6].
The authors present a unique case of decollement that resulted
from a run-over accident. Along with the description of the
decollement, this case report offers an explanation of the possible
mechanism of injury that arose both from the autopsy ndings and
the analysis of the video material from the local surveillance
cameras and scene photos of the accident.
2. Case report
An 85-year-old man was fatally injured after being run over by a
tank truck while walking on the roadway. The accident happened
when the road tanker just started moving slowly at the moment
the trafc light turned green. The victim was found lying face
down, beneath the rst pair of trailer sections wheels (the cabin
section of the road tanker had two axles and two pairs of wheels,
while the trailer section had three pairs of doubled wheels placed
on three axles), in a nearly longitudinal position with the head
oriented toward the cabin.
Not one of the people present at the accident spot provided a
reliable eyewitness account. The forensic pathologist was not

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called upon to inspect the accident scene, so any interpretation and

reconstruction of the injury mechanisms depended on the careful
autopsy examination. This was later supplemented by accident
scene photographs and videotapes of a nearby surveillance camera
that helped to conrm the pathologists ndings and reconstruct
better the mechanism of the sustained injuries.

apparent during the process of skin preparation in the left leg and
abdomen. The decollement along the medial and anterior aspect of
the left leg communicated with the abdominal cavity and
continued to the pocket formation of the left thoracic region.
Through the extensive subcutaneous hemorrhagic tunnel the
jejunum with related mesentery reached and protruded on the left
ankle (Fig. 1).

2.1. Autopsy ndings

2.2. Surveillance camera ndings
The external examination evidenced multiple severe injuries,
especially to the head that was extensively deformed, showing
comminuted fractures with many bone fragments missing and a
nearly empty cranial cavity. A wide-ranging laceration was present
in the fronto-temporal region. There was an excoriation on the left
side of the face. The back showed diagonal patterned abrasions
corresponding to tire tread marks. Two more soft-tissue injuries
were present on the left lower extremity a laceration behind the
knee and an open wound resulting from the fracture of the ankle.
Besides the skull, there were fractures observed in the left
scapula, both right and left 1st to 12th ribs, sternum, thoracic
vertebrae (Th6 and Th7), left ilium and sacroiliac joint, both knees,
and left foot.
Internal examination showed severe injuries with the displacement of internal organs and ruptures of the heart, both lungs,
thoracic aorta, liver, spleen, intestines and diaphragm, as well as
contusion and displacement of the kidneys.
The most interesting autopsy nding was the presence of an
extensive decollement that spread from the left hemithorax to the
left ankle wound, through which parts of the small intestines and
pertaining mesentery protruded (Fig. 1).
During external examination the skin detachment was observed only in the left thoracic region, while its range became

The forensic pathologist in this case could rely also on the

valuable help of surveillance cameras of a nearby bank ofce. There
were two cameras: one static outdoor camera and one rotating
outdoor camera. Unfortunately, the angle covered by the static
camera has not allowed the visualization of the complete scene of
accident and neither of the complete truck, but only its bottom
(Fig. 2). On the other hand, it was enough to gain information on
the sequence of events and on the number of wheels that ran over
the victim.
The rotating camera was recording a series of different angles
during a minute interval that meant that it was unable to record the
exact moment of the accident, as it was lming a different fraction of
the bank surrounding area (Fig. 2). However, the mobile camera
recorded the moments that followed the accident, evidencing the
position of the victims body in relation to the truck immediately
after being run over, and after the police intervention.
Additional limitation to the analysis of the video material was
the poor resolution of the video data.
The static camera evidenced that the victim fell under a heavy
tanker after a lateral contact with the vehicle. After the fall, he was
run over by two pairs of wheels (the second pair of cabins wheels
and the rst pair of trailers wheels) (Fig. 3).

Fig. 1. Wound on left ankle, through which ileum protrudes (left) and extensive decollement visible after skin preparation (right).

Fig. 2. Angles covered by the two cameras: static camera (left) and mobile camera (right). In both, the tanker truck position is visible (on the static camera it can be observed
just the bottom of the truck).

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Fig. 3. Screenshots of the videotape showing the victim (arrow) run over by two wheels (circled): the second cabins and the rst trailers wheel.

Fig. 4. Screenshot of the rotating camera showing the position of the body upon arrival of police (left) and after the truck has made a reverse movement to liberate the corpse
(right).

When the driver realized what happened he stopped the

vehicle, in the instance when the rst pair of trailers wheels was
located above the victims thorax. In order to liberate the corpse,
after the police intervention, the driver made a reverse movement.
The backward movement was detected when comparing the
rotating cameras records before and after the arrival of police
(Fig. 4).
3. Discussion
In a number of motor-vehicle fatalities, the forensic pathologist
is asked to provide an objective interpretation of the injuries
sustained by the victim and to deduce what mechanisms caused
the injuries relying exclusively on the results of an autopsy [7].
Such situations are very often in hit-and-run cases or in
circumstances where there is little evidence on the accident (lack
of or unreliable witness statements, lack of scene ndings).
However, in most cases the autopsy nding alone is not enough to
reconstruct properly the accident dynamics. We presented a runover case with a unique pattern of injury, in which it was possible
to compare and verify the pathologists preliminary report, which
was based exclusively on a careful investigation of the sustained
injuries, with the images of a local surveillance camera that
objectively recorded the dynamics of the event.
The injuries found on the corpse suggested that the person was
run-over by a vehicle that passed across the left side of the body
(from the left feet to the head). Tire tread marks visible on the
victims back indicated that the victim was in prone position when
the truck ran over him. Given that the majority of injures were
localized on the left side of the body, the bilateral facture of the

knees suggested that the person fell on his knees when hit, so he
was most likely walking in the same direction of the fuel tanker.
This was later conrmed by the videotape of the surveillance
camera. There was no internal or external evidence that could
suggest the direction of the hit, but the camera showed that the
victims fell under the wheels when walking side by side with the
fuel tank (most probably his umbrella get stuck in the posterior
part of the cabin while the truck started moving, pulling the victim
under the wheels).
The autopsy revealed an extensive comminuted fracture of the
skull that was produced by the passage of the large vehicle over it
as shown in the video records. The extensiveness of fractures and
internal injuries (dislocation, laceration and rupture of internal
organs) was in line with other run-over cases and impact with
large vehicles [8]. Although the thoracic region was extensively
deformed and fractured, there was a concentration of fractures in
the middle thoracic region (sternum, 6th, 7th thoracic vertebrae,
scapula) indicating a longer period of compression. It has been
demonstrated that the extent of chest compression and related
injuries is dependent on the loading time, so a longer concentration
of a loading over a localized area results in greater compression of
the chest and more extensive fractures [9], like in our case. The
injuries of the victim thus suggested that the vehicle most
probably slowed down or stopped when running over the thorax.
This nding has been conrmed by the video records that showed
the truck stopping over the victims trunk. However, the autopsy
could not conrm multiple passes over the body: tire imprints,
present on the victims back, corresponded to at least one run-over
but could not exclude multiple passes [8]. In addition, since
extensive internal injuries and fracturing can occur also with a

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V. Stemberga et al. / Forensic Science International 228 (2013) e67e70

single pass [8], the extent of fragmentation and organ dislocation

present in our case could not be useful to conrm multiple passes.
So in this instance the videotape helped again to complete the
ndings of the autopsy, as two passes and a reverse movement
over the body have been recorded by the static camera.
The most interesting nding of the autopsy was the unique
decollement injury present along the anterior and medial aspect of
the left leg, left abdomen and left thorax, through which a part of
the jejunum reached the left ankle. As this type of injury has not yet
been described in literature, the forensic pathologist tried to
reconstruct the possible mechanisms of the decollement relying on
the injuries and evidences present on the victims body. The
decollement, together with the patterned band of abrasions (tire
tread marks), evidenced the run-over mechanism. Although
decollement can be observed also as an initial collision injury
when the victim is still in an erect position [3] (e.g. lateral hit), the
extensiveness and the medial (internal) location of the decollement in our case, went in favor of the run over mechanism of
injury. The decollement was produced by a force parallel to the
surface produced by the tire that pulled across the extremity and
the trunk of the victim. The same tangential force caused the
shearing of the mesentery that is commonly pulled off by a severe
traction force exerted on the membrane [1]. These, along with
transaction of the jejunum that occurred 25 cm distally to the
Treitz ligament, allowed the small intestine to be easily displaced.
The mobility of the loops of the small intestine facilitates its
dislocation during blunt force trauma accidents [1] that only
occasionally produce the rupture of abdominal viscera. During
run over accidents thoracoabdominal crushing injuries most often
result in dislocation of the bowl segments into the thorax with
rupture or laceration of the diaphragm [8,10]. In our case, the
dislocation occurred in the left hemithorax, but the jejunum and
its mesentery were displaced also through the ruptured abdominal wall that acted as locus minoris resistantiae into the
decollement of the leg, through which it reached the left ankle.
So, the decollement injury and the hemorrhagic tunnel had to be
formed prior to intestinal displacement. In addition, a strong and
long lasting force was necessary to enable the protracted passage
of the jejunum from the abdomen to the left ankle. The force
exerted by a single pass could bring to the formation of the
decollement (tangential force), as well the displacement of the
abdominal viscera due to the fact that the wheel while moving
forward, produces also a backward force. In case that there was a
longer spinning over a persons corpse, the movement and forces
exerted by a spinning tire could push the detached intestines in
the preformed tunnel. However, the camera did not evidence any
spinning movement so the forensic pathologist concluded that
there was small probability that a single pass could push the
jejunal convolutes till the wound of the ankle. A more probable
scenario, conrmed also by video records, was that the expulsion
of the jejunum was produced by a combination of movement: the
forward passage created the decollement and the detachment of
the jejunum, and probably pushed a part of the jejunum in the
preformed tunnel as well in the thoracic region, while the
backward movement completed the expulsion of the jejunum
through the open ankle fracture.
In conclusion, the autopsy ndings helped to elucidate a
number of queries regarding the accident: the position of the
person in relation to the vehicle, the fact that the person was runover by a large, slow moving vehicle, the fact that the vehicle most
probably stopped or exerted for a longer time a force over the
middle thorax of the victim. The autopsy nding could not help to
establish if the person was hit by the anterior or the lateral side of
the vehicle, neither with certainty the number of passages over the
body. These queries have been solved with the analysis of the video
material. However, although the video material conrmed and

elucidated the majority of the pathologists ndings, the real

mechanics of the decollement remains uncertain, although the
authors tend to the idea that the reverse movement was essential
for the nal ejection of the jejunum convolutions through the left
ankle that could not happen just by the passage of two slowmoving wheels with no spinning movement over the body.
4. Conclusion
This case report evidences the importance of the forensic
pathologist and a correct and detailed investigation of injuries in
reconstructing an accident, as well that of surveillance cameras as
investigation tool in forensic cases [11]. Forensic pathologists often
have to recreate the dynamics of an accident based only on the
autopsy ndings and their interpretation, relying on the theoretical knowledge and practical experience of the specialist. In this
case the forensic pathologist was able to test his conclusion against
the actual records of the event captured by the surveillance
cameras. In the authors opinion, surveillance cameras should start
to be used, whenever possible, as an auxiliary tool by forensic
pathologists, because they can objectively conrm some suppositions and theories made by the pathologist that cannot be
denitely proven by autopsy examination. After an objective
verication, these can consequently be accepted as valid and
applied in the interpretation and reconstruction of similar
accidents.
The study has also shown how surveillance cameras added
information to the interpretation of the decollement, but have not
succeeded to completely solve its origin. Thus, the authors
highlight once again the complexity of the mechanism of
decollement, emphasized also by previous studies [5]. More case
studies on decollement injuries, their origin, characteristics and
mechanics must be reported. Furthermore, there is a need to
conduct experimental studies on the biomechanics of decollement,
as well as further research on the biomechanics of abdominal
injuries taking in account the inuence of the spine, the nonhomogenous characteristics of the abdomen and also different
impact and compression sides [12].
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