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

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

Article history: The authors present a unique case of decollement injury found on an 85-year-old victim that was run-over by a tank truck.
Received 22 May 2012 While external examination evidenced multiple severe injuries, autopsy confirmed the preliminary findings and revealed also
Received in revised form 23 September 2012 the presence of an extensive decollement that spread from the left hemithorax to a wound on the left ankle, through which
Accepted 4 February 2013
parts of the small intestines and pertaining mesentery protruded.
Available online 1 March 2013

The article offers an interpretation of the injuries sustained by the victim, focusing on the most probable decollement
Keywords:
mechanism. The forensic pathologist in this case could rely also on the valuable help of surveillance cameras of a nearby bank
Decollement
office that helped to better understand the events that brought to the fatal injuries. The authors concluded that the expulsion of
Car accident
Surveillance cameras the jejunum was produced by a combination of two movements: a forward passage that created the decollement and
Legal medicine 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.

1. Introduction interpretation of decollement must be carefully given, as it has been

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 car-to-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
traffic 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].
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 findings and the analysis of the video material from the local
surveillance cameras and scene photos of the accident.

Decollement is believed to be a very good indicator of run-over accidents 2. Case report

[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 filled 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).
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 traffic light turned green.
The victim was found lying face down, beneath the first 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
0379-0738/$ see front matter 2013 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.forsciint.2013.02.007
e68 V. Stemberga et al. / Forensic Science International 228 (2013) e67e70
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 confirm the
pathologists findings and reconstruct better the mechanism of the sustained
injuries.
2.1. Autopsy findings
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 displace-ment 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 finding 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 ob-served only in
the left thoracic region, while its range became
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).
2.2. Surveillance camera findings
The forensic pathologist in this case could rely also on the valuable help
of surveillance cameras of a nearby bank office. 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 filming 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 first 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).
 V. Stemberga et al. / Forensic Science International 228 (2013) e67e70
Fig. 3. Screenshots of the videotape showing the victim (arrow) run over by two wheels (circled): the second cabins and the first 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 first 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 findings). However, in most cases
the autopsy finding alone is not enough to reconstruct properly the accident
dynamics. We presented a run-over 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
e69
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
confirmed 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 finding has been
confirmed by the video records that showed the truck stopping over the
victims trunk. However, the autopsy could not confirm 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
e70 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 confirm multiple passes.
So in this instance the videotape
helped again to complete the
findings of the autopsy, as two
passes and a reverse movement
over the body have been recorded
by the static camera.
The most interesting finding 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 decolle-
ment 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 abdomi-nal
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,
confirmed 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
findings 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 run-over 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 finding
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 confirmed and
elucidated the majority of the
pathologists findings, the real
mechanics of the decollement
remains uncertain, although the
authors tend to the idea that the
reverse movement was essential for
the final ejection of the jejunum
convolutions through the left ankle
that could not happen just by the
passage of two slow-moving 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
findings and their interpretation,
relying on the theoreti-cal
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
confirm some supposi-tions and
theories made by the pathologist
that cannot be definitely proven by
autopsy examination. After an
objective verification, 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 influence of the spine,
the non-homogenous characteristics
of the abdomen and also different
impact and compression sides [12].
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2013 Elsevier