ANTHROPOLOGY/Skeletal Analysis 261
Skeletal Analysis
N J Sauer and W L Lackey,
Department of Anthropology, Michigan State
University, East Lausing, MI, USA
Copyright # 2000 Academic Press
doi:10.1006/rwfs.2000.0609
Introduction
Because they are so durable, bones and teeth are often
pivotal to the solution of human remains cases. The
skin, flesh, organs and body fluids (the domain of
forensic pathologists) that provide such a wealth of
data for identification and the interpretation of events
that surround death, normally disappear after a few
months or weeks. But the skeleton may endure, often
intact, for centuries. Of course, in events like fires,
remains may become skeletonized within minutes.
What can be learned from a skeleton? How can
skeletal remains contribute to forensic science?
Forensic anthropologists are specialists in human
skeletal biology who apply their skills to medicolegal
cases. Typically, forensic anthropologists have ob-
tained an advanced degree (Masters or PhD) in phy-
sical anthropology with a specialization in skeletal
biology and training in the legal applications of their
skills. In North America most forensic anthropolo-
gists are members of the Physical Anthropology Sec-
tion of the American Academy of Forensic Sciences.
About 50 North American forensic anthropologists
have been certified by (and are Diplomates of) the
America Board of Forensic Anthropology. Board
Certification requires a PhD in Physical Anthropol-
ogy (human osteology specialization), a minimum of
3 years of practical experience, and the successful
completion of written and practical exams.
Currently, most forensic anthropologists are
employed by universities, however, some work for
local, state or federal government agencies. The Uni-
ted States Central Identification Laboratory in
Hawaii (CILHI), for example, has a staff that includes
more than 20 full-time forensic anthropologists. The
CILHI anthropologists help carry out the mission of
identifying the remains of Americans found on for-
eign soil. A few forensic anthropologists assist the
United Nations and the organization, Physicians for
Human Rights, with the identification of suspected
victims of political activity in places like Latin Amer-
ica, the former Yugoslavia and Central Africa.
Investigators who bring remains to forensic anthro-
pologists usually want one or several of the following
questions answered: Are these remains human? Are
they recent enough in origin to be of medicolegal
interest? Who do the remains represent? Is there
evidence for cause or manner of death? This article
illustrates the most important kinds of information
that can be gained from studying the skeleton and
illustrate how such information can contribute to
forensic science.
Identification
Are the remains human?
Forensic anthropologists are experts in the morphol-
ogy (form) of the human skeleton. Many suspected
human cases are decided in the few minutes that it
takes the anthropologist to recognize that a single
bone or bone fragment does not come from a human
skeleton. The ability to quickly and confidently make
such a judgment results from years of intensive study
of the form and function of human bone. Most
forensic anthropologists have studied human gross
anatomy, usually in a medical school, and all have
spent years poring over minute details of the skeleton.
The anthropologist may not always be able to identify
the species from a fragment of bone, but in most cases,
he or she can determine rather quickly if it is human.
Because of their skeletal structure, some species are
more difficult than others to distinguish from human
remains. In North America, for example, bear bones
can be particularly vexing (Fig. 1). For people without
specialized training or experience it can be very
difficult to distinguish between the bones of many
mammals and even birds and those that are human.
On occasion, bone fragments are so small that
species identification by gross morphology is not
possible. In some of these cases, a microscope may
be helpful. Because of the way in which the mineral
component of bone (mainly calcium and phosphate) is
deposited and later remodeled, the microscopic struc-
ture or (histomorphology) of bone is unique. And,
since the bone of different species is deposited in
different patterns it is usually possible to identify
human bone fragments from microscopic sections.
Figure 2 is a comparison of a cross-section of human
Figure 1 (A) Bear foot (B) human foot. The human foot is a right
foot; the bear foot is a left foot. Both are viewed from above.
262 ANTHROPOLOGY/Skeletal Analysis
A of the conditions of discovery is essential. Forensic
B
Figure 2 Microscopic sections of (A) cow and (B) human
cortical bone. The arrows indicate Haversian systems in the
human bone.
bone and one from a cow. Note that the human bone
displays a number of circular structures, known as
Haversian systems, distributed among a backdrop of
parallel layers. Haversian systems result from the
remodeling of parallel layers that are generally con-
centric to the cross-section of bone. The rectangular
(plexiform) pattern displayed by the cow section is
generally characteristic of herbivores. There are a few
species where confusion with humans may arise, large
dogs or wolves, for example, but to an experienced
bone histomorphologist, human bone is unique.
Are the remains recent?
Estimating the time since death is one of the most
difficult tasks of the forensic anthropologist. When a
fresh human body is deposited in the environment, a
series of regular and relatively rapid changes begin to
occur. If the remains are discovered within a few
months, it is often possible to estimate the post-
mortem interval to within a few weeks. In such
cases input from a forensic entomologist, who may
analyze insects associated with the corpse, may be
very helpful. After the soft tissue has decomposed and
only the skeleton remains, however, the decomposi-
tional process slows down. The bones lose their
moisture content and the fatty marrow begins to
leach out of the medulary cavity (hollow space inside
the bone). The bones become lighter, lose the smell of
fat and decomposing organic matter and usually begin
to take up stain from the surroundings or soil. After a
few years it may be very difficult to distinguish
between bone that is generally too old to be of forensic
interest (50 years or more) and the remains of a more
recently deceased individual that might be identified.
The context of the remains may provide key infor-
mation for the determination of time since death.
Evidence of past burial practices, including ancient
artifacts, like stone or early metal tools, may signal a
particular cultural horizon and therefore indicate
time of death. Even coffin handles or coffin nails
may help date remains. Because the direct association
between such associated items and human remains
must be firmly established, a thorough understanding
anthropologists often work closely with archaeolo-
gists, or may have experience in archaeological tech-
niques themselves. Archaeological methods of
recovery have proved invaluable for the collection
of decomposed human remains and for understanding
their context.
Who is it?
If it can be established that the remains are human
and are recent enough in origin to be of medicolegal
interest, then identification is likely to be attempted.
Identification normally begins with the construction
of a biological profile, the primary elements of which
are: age, sex, race and height. In some cases evidence
for medical history (such as a healed bone fracture),
may provide clues to identity. With a biological
profile, authorities are able to begin scanning their
missing person reports and hopefully provide one or a
few candidates for positive identification. If such a
profile does not yield a positive identification, a facial
approximation (from the skull) may be carried out.
Estimation of age Estimating age at death can be
extremely difficult, especially as people mature.
Although it may be possible to estimate the age of a
child or infant to within a few months, the age ranges
for adults may be 20 years or more. Because different
methods are used to estimate the age of infants and
children, young adults and older adults, the methods
for each are discussed separately.
Infants and children (fetal to about 15 years) The
best methods for estimating fetal age and that of
young children involve dental development. Decid-
uous (baby) teeth begin to calcify early in the fetal
period and continue developing until the third year, at
which time the development of the permanent denti-
tion is well underway. By comparing to established
norms, the stage of formation of each available tooth
and the eruption of teeth to the chewing surface,
biological age can be estimated to within several
months or a couple of years (Fig. 3). Because dental
enamel is the hardest substance in the human body
and, therefore, most likely to be preserved, dental
development is particularly useful for forensic cases.
Less accurate than dental development, but also
important for estimating skeletal age is bone growth
 ANTHROPOLOGY/Skeletal Analysis 263

Figure 3 The sequence of formation and eruption of teeth among American Indians (Adapted from Ubelaker 1989, p.64).
264 ANTHROPOLOGY/Skeletal Analysis
and development. In cases involving fetal remains and
those of young children, it is often possible to esti-
mate age by comparing the length of long bones (like
the femur or tibia) to published charts. Because rates
of growth vary in different groups, it is important to
use data collected from a population that is most
representative of the remains in question.
Finally, the appearance and union of growth
centers can be useful tools for subadult age estima-
tion. Most bones do not grow as single units, but as
primary and secondary centers of growth or ossifica-
tion. The primary center is the first to develop, the
shaft of the femur, for example, at around the eighth-
week of fetal life, and the secondary centers at either
end (epiphyses) appear much later in fetal develop-
ment or after birth. Bones with multiple centers of
ossification cease to grow when the primary and
secondary centers of ossification fuse together.
Because the various epiphyses of different bones
appear and fuse at different times, the study of
growth centers is a valuable tool for estimating the
age of children and young adults. Most useful for
estimating the age of older children and young adults
are the femur, the shoulder, the clavicle and portions
of the hip bone.
Young adults (15 to about 35 years) Epiphyseal
union continues to be an important age indicator in
young adults. The last epiphysis to completely fuse is
the medial end of the clavicle, usually at between 25
and 30 years of age.
Beginning in the later teenage years, a number of
systematic changes have been recognized to occur on
several joint surfaces. Probably the best known is the
metamorphosis of the pubic symphysis (the joint
between the two pubic bones of the pelvis). Initially
the surface of the joint is characterized by a series of
deep horizontal furrows and the joint flares ante-
riorly. During the twenties the furrows fill in and
the build-up of bone causes the opposing bone sur-
faces to flatten. Usually during the thirties, a recog-
nizable rim forms around the margin of the joint. The
transformation of the pubic joint surfaces begins at
about 18±20 years of age and continues throughout
life (Fig. 4). Age can be estimated by comparing the
pubic joint surface to available descriptions, illus-
trations and casts. For a variety of reasons, including
the involvement of the pubic joint in childbirth, pubic
symphysis aging is most reliable in males and, for both
sexes, the reliability of pubic symphysis declines
dramatically after about 35 years of age.
Regular changes have also been recognized for the
sternal (chest) end of ribs. In the 1980s, Susan Loth
and Yasar IÇsËcan began to collect and analyze the
sternal ends of fourth ribs from a large sample of
individuals of known age and sex. They described for
males and females, how the sternal extremity of the
rib changes from a flat, billowed surface to first a `V'
shaped then a `U' shaped pit. As the pit deepens, its
surface becomes pitted and the margins become
increasingly irregular. As is the case for the pubic
symphysis, photographs accompany the description
of the changes in the sternal extremity of the fourth
rib. Also, like the pubic symphysis, the rib ends
become increasingly unreliable after the third or
fourth decade. An advantage of both these methods
is that they involve bones that are close to the surface
and can easily be removed during autopsy.
Older adults (over 35 years of age) Beginning during
the fifth or sixth decades of life, a number of `degen-
erative' changes may be identifiable on the skeleton.
Joint surfaces often begin to show progressive
changes associated with arthritis. Tiny spicules of
bone may appear on the margins of the vertebral
bodies (osteophytosis) (Fig. 5) and some lipping may
appear around the edges of moveable joints like the
knee and elbow or hands and feet. The pubic sym-
physis and rib ends also show signs of advancing age.
As individuals mature, the dentition and support-
ing bone also display characteristic changes. The
chewing surfaces of teeth slowly wear, the effects of
dental disease accumulate, and the bone of the max-
illa and mandible tends to resorb. Older people are
also more likely to be missing certain teeth.
Aging by histomorphology It was mentioned above
that the microscopic structure of bone is useful for
distinguishing between human and nonhuman bone.
Because of changes in microstructure that occur dur-
ing an individual's life (for example, Haversian sys-
tem accumulate), it is also possible to estimate the age
at death of an individual by studying sections of bone
under a microscope.
Determining sex Because most sexual dimorphism
(differences in shape between males and females)
develop during puberty, most forensic anthropolo-
gists agree that the determination of sex from the
skeleton is only practical for late teenagers or adults.
Generally, male skeletons are larger and more robust
than female skeletons. By studying features of the
skull and especially the hip bones, experienced osteol-
ogists should be able to identify sex with a better than
95% degree of accuracy.
Innominates (hip bones) Three features on the
pubic region of the innominates are particularly use-
ful indicators of sex; the ventral arc, the subpubic
concavity and the shape of the ischiopubic ramus
 ANTHROPOLOGY/Skeletal Analysis 265

Figure 4 Suchey±Brooks pubic symphyseal phases (I±VI). V, ventral side. Redrawn from Burch and Suchey, 1986
266 ANTHROPOLOGY/Skeletal Analysis
Figure 5 Two lumbar vertebrae of a 60-year-old male. Arrows
indicate osteophytosis.
(Fig. 6). The ventral arc is a curved ridge of bone on
the anterior surface of the pubic bone just lateral to
the pubic joint. It is a common feature in females and
almost never seen in males. Viewed from the front,
the medial edge of the bone that extends laterally and
Figure 6 Female (A) and male (B) pubic bones. VA, ventral arc;
SPC, subpubic concavity; SPA, subpubic angle.
inferiorly from the joint between the pubic bones is
often concave in females and straight or convex in
males. And finally, the medial (inner) edge of the bone
connecting the pubic bone and the ischium is nor-
mally wide and flat in males and a narrow ridge in
females. If a pubic region displays a ventral arc,
subpubic concavity and narrow ischiopubic ramus,
the specimen is very likely to be female. Another sign
that a hip bone is from a female is a wide subpubic
angle (Fig. 6).
The skull Sexually dimorphic features of the skull
include the brow ridges, the mastoid processes, and
the external occipital protuberance, all of which are
usually more pronounced or larger in males (Fig. 7).
The chin portion of the mandible tends to be squarer
in males and more rounded (or `V' shaped) in females.
Ancestry and race The estimation of one's ancestry
is complicated by the fact that most anthropologists
agree that dividing the World's human populations
into three or four broad races is unscientific and not
warranted on biological grounds alone. Nonetheless,
the popular notion that there are three or four races of
humankind permeates much of our thinking and is
the framework usually used by the law enforcement
community to identify missing persons and suspects.
Therefore, it is usually useful to include in a biological
profile, a prediction about the racial identity of a set
of unidentified human remains. This is usually
accomplished by identifying the broad geographic
region of one's ancestry and translating that into
terms that are used in the community. In the US,
remains that suggest European ancestry are likely to
be labeled `White'.
To estimate ancestry, investigators usually evaluate
features of the skull like the shape of the eye orbits, the
nasal opening, and the zygomatic or cheek bones.
Some anthropologists find the root of the nasal
Figure 7 Male cranium. BR, brow ridge; MP, mastoid process;
EOP, external occipital protuberance.

bones in the area between the eye sockets particularly
useful. Skull shape may also be evaluated by taking a
series of measurements. A computer program may
then be used to evaluate ancestry by comparing cra-
nial dimensions of an unidentified specimen to those
from a large sample of crania of known ancestry.
Stature Anthropologists usually use one of two
methods to estimate living height from the skeleton:
the anatomical method or limb bone proportionality.
The anatomical method involves measuring all of the
skeletal elements that contribute to height and then
adding a constant. To use the method, the investiga-
tor measures the distance from the top of the skull to
the foramen magnum, where the skull joins the
uppermost vertebra; the height of all of the cervical,
thoracic and lumbar vertebral bodies; the femurs; the
tibiae; and the talus and calcaneus of the foot. A
constant of 10±12 cm is then added to account for
soft tissue and other distances that are not taken into
account by the measurements.
The limb bone proportionality method relies on
well-studied relationships between the length of limb
bones and living height. The formulas used most often
today are equations that were originally developed in
the 1950s on documented anatomical collections and
victims of World War II and the Korean War. Because
of the variation in long bone-to-height ratios among
the world's populations, different formulas are pro-
vided for different groups. Probably because of ease of
use and the fact that the skeleton need not be so
complete, forensic anthropologists rely more heavily
on the limb bone proportionality method for estimat-
ing living stature from the skeleton.
Secondary features (SES, medical history, markers of
habitual activity) In addition to the four customary
categories of most biological profiles (age, sex, ances-
try/race and height) forensic anthropologists may also
contribute information about socioeconomic status,
medical history and evidence for habitual activity.
Although such generalizations must be approached
with caution, it is sometimes possible to estimate that
a person is from a lower or higher socioeconomic
level because of the location of the remains and
associated items like clothing or jewelry. Evidence
for certain dental procedures or lack thereof may also
indicate access to particular types of treatment. A
skeleton that presents advanced untreated dental
caries (cavities) or evidence for particularly severe
and chronic gum disease may signal that a person is
from a low socioeconomic status.
Certain aspects of medical history may also be use-
ful for identification. For example, the presence of an
artificial limb or joint may help match an unidentified
ANTHROPOLOGY/Skeletal Analysis 267
skeleton with a missing person. In one recent case in
our lab, an unidentified skeleton was diagnosed with a
rare metabolic disease, acromegaly, which dramati-
cally affects the growth of bone. If a missing person
were described as suffering from acromegaly, then the
recognition of the disease on the skeleton might have
been very useful for identification.
Throughout an individual's life, the bones of the
skeleton continue to remodel and reshape themselves
according to stresses that are placed upon them. This
is known as Wolff's law. By studying the robustness
of selected bones and the nature of certain muscle
attachments it is sometimes possible to draw con-
clusions about a person's activities during life. A
person who spent most of their life as a stone
mason, lugging around cement blocks, is likely to
have a very different looking skeleton than a typical
anthropology professor.
Facial approximation A useful addition to the bio-
logical profile (age, sex, height, ancestry, etc.) is often
a facial approximation. Traditionally, facial approx-
imations entail placing tissue depth markers at a
number of specified points on and around the facial
skeleton, then connecting these markers with clay.
Nose, lips and ears are formed using certain skull and
tooth dimensions as guidelines. Prosthetic eyes are
carefully positioned in the eye sockets before the
surrounding eyelids are shaped. The final product
(Fig. 8) is an image that can be distributed to regional
law enforcement agencies and displayed on television
and in the newspapers. It is hoped that someone will
recognize the face and contact the authorities.
Figure 8 Facial approximation from the skull of a female
believed to have been 30±50 years of age at the time of death.
268 ANTHROPOLOGY/Skeletal Analysis

In recent years, facial approximations are increas- life. This process, known as skull±photo superimposi-
ingly being carried out with the aid of computers. An tion, may, under certain circumstances, also yield a
image of the skull is displayed on the screen and the positive identification. Skull±photo superimposition,
soft tissues are added as appropriate for the biological is performed more often in parts of the world, e.g.
profile. Some experts prefer to sketch soft tissue China and Japan, where antemortem X-rays are less
features over an image of a skull, then scan images common.
of both the skull and drawing onto a computer screen
for final adjustment. Computer assisted approxima-
tions are not only quicker to carry out than clay Manner and Cause of Death
reconstruction, they are also easier to modify after In addition to identifying human remains, forensic
the process is complete. There are no reliable studies anthropologists are often called upon to help inter-
that compare the accuracy or effectiveness of the pret evidence for manner or cause of death.
various methods of facial approximation. Marks on the bones themselves can provide very
important clues about how a death occurred. Bullets
penetrating the skull, for example, typically create a
Positive identification Once a biological profile and
characteristic defect (Fig. 10). From such damage, an
possibly a facial approximation have been generated
expert may be able to make judgments about the
for a set of remains, they can be compared to lists and
maximum caliber of a gun and the angle and velocity
descriptions of missing persons. If there is a match in
of a projectile. Similarly, details of weapons may be
the general features, then an attempt is normally
indicated by blunt force damage (like that from a
made at positive identification. Most commonly,
hammer) or various knife strikes. It has shown that it
positive identifications are made by comparing X-
may even be possible to identify a specific knife using
rays (usually dental) taken during a missing person's
electron microscope images of skeletal damage.
life with X-rays taken from the same area of the
With all evidence of skeletal trauma, it is impera-
unidentified skeleton. If, in the judgment of an expert
tive to recognize and distinguish among antemortem
with training and experience in the interpretation of
(before death), perimortem (around the time of
X-rays, there is a match in a sufficient number of
death) and postmortem (after death) trauma. A
features, then the remains may be considered posi-
skull fracture may indeed reflect a blow to the head
tively identified. Figure 9 is a comparison of the
that caused death. But before such a conclusion is
frontal sinuses of a missing male, and of a skeleton
that was discovered in a nearby wooded locale. X-
rays of parts of the skeleton other than the skull, such
as limb joints and the vertebral column, are also
useful for positive identification.
Sometimes, when there are no appropriate ante-
mortem (before death) X-rays available for a missing
person, it may be necessary to compare the shape of
the skull and its features to a photograph taken during

Figure 9 Comparison of postmortem (A) and antemortem (B) Figure 10 Bullet damage to the rear of a skull. The opening in
images of the frontal sinus of a male skull (arrows). the inside is much larger and reflects a cone-shaped defect.

drawn, it must be established that the damage is not
evidence of an old injury, from which the victim
survived, or that the damage occurred to the skull
as it lay on the forest floor long after death. The
hallmark of antemortem injuries, evidence for healing
near the margins of the fractured bone, may appear as
soon as two or three weeks after an injury (Fig. 11).
Because dried bone has different fracture charac-
teristics than bone from living organisms, it is some-
times possible to distinguish between perimortem
and postmortem damage by studying details of
skeletal lesions. Differential staining may also indi-
cate postmortem damage. When bone lies in a soil
environment for a period of years, the exposed sur-
faces typically become stained from ground water.
When a fracture occurs at or near the time of dis-
covery, a new unstained surface may be created that
contrasts distinctly with the stained bone.
The context in which remains have been recovered
can also provide important clues about how a person
dies. The techniques of forensic archaeology may
demonstrate that the orientation of a body (for exam-
ple, with the hands bound behind the back) or the
position of a potential murder weapon are clues that a
homicide took place and that death was unlikely to
have been accidental.
The Forensic Anthropology Laboratory
Although all forensic anthropologists are capable
of generating a biological profile from a person's
skeletal remains and assisting with positive iden-
tification, some have specialized in specific areas
like trauma analysis, facial approximation or micro-
Figure 11 The right side of a fractured human jaw. Notice the
evidence for healing (arrows).
ANTHROPOLOGY/Skeletal Analysis 269
scopy. Similarly, forensic anthropology laboratories
are variously equipped to provide different kinds of
services. Presumably a forensic anthropology lab
would minimally include adequate work surfaces for
the examination of a set of skeletonized human re-
mains, appropriate water sources and disposal facil-
ities, a comparative skeletal collection and a full range
of calipers. An ideally suited forensic anthropology
lab might also include facilities for handling remains
in all stages of decomposition; instrumentation for
thin section preparation and microscopic analysis,
including electron microscopy; image superimposi-
tion equipment; and instrumentation for DNA analy-
sis. Although such labs and combinations of expertise
are rare, cooperation among forensic anthropologists
and other scientists usually allows for sufficiently
complete anthropological evaluations of cases invol-
ving decomposed remains.
See also: Accident Investigation: Motor Vehicle; Rail;
Determination of Cause: Overview. Anthropology: Ar-
chaeology; Morphological Age Estimation; Sex Determi-
nation; Determination of Racial Affinity; Excavation and
Retrieval of Forensic Remains; Bone Pathology and Ante-
mortem Trauma in Forensic Cases; Skeletal Trauma; Ani-
mal Effects on Human Remains; Assessment of
Occupational Stress; Stature Estimation from the Skele-
ton. Causes of Death: Overview; Scene of Death; Post-
mortem Changes; Sudden Natural Death; Blunt Injury;
Sharp Injury; Traffic Deaths; Systemic Response to
Trauma. Crime-scene Investigation and Examination:
Recording. Deoxyribonucleic Acid: Significance. Ento-
mology. Identification/Individualization: Overview and
Meaning of ID. Odontology. Pathology: Overview. Acci-
dent Investigation: Airbag Related Injuries and Deaths;
Driver Versus Passenger in Motor Vehicle Collisions.
Further Reading
Bass WM (1987) Human Osteology: A Laboratory and
Field Manual, 3rd edn. Columbia: Missouri Archae-
ological Society.
Burch M, and Suchey J (1986) Age determination of the
male OS pubis. Physical Anthropology 69:427±435.
Galloway A, Birkby WH, Kahana T and Fulginiti L (1990)
Physical anthropology and the law: legal responsibilities
of forensic anthropologists. Yearbook of Physical
Anthropology 33:39±57.
Haglund WD and Sorg MH (1997) Forensic Taphonomy:
The Postmortem Fate of Human Remains. Boca Raton:
CRC Press.
Hunter JR and Roberts C (1996) Studies in Crime: An
Introduction to Forensic Archaeology. London: Batsford.
Houck MM (1998) Skeletal trauma and the individualiza-
tion of knife marks in bones. In: Reichs K (ed.) Forensic
Osteology: Advances in the Identification of Human
Remains, 2nd edn. Springfield: Charles C.
270 ANTHROPOLOGY/Skeletal Trauma
IÇsËcan MY and Kennedy KAR (1989) Reconstruction of
Life from the Skeleton. New York: Alan R. Liss.
Rathbun TA and Buikstra JE (eds) (1984) Human Identi-
fication. Springfield: Charles C. Thomas.
Reichs KJ (1998) Forensic Osteology: Advanced in the
Identification of Human Remains, 2nd edn. Springfield:
Charles C. Thomas.
Stewart TD (1979) Essentials of Forensic Anthropology:
Especially as Developed in the United States. Spring-
field: Charles C. Thomas.
Ubelaker DH (1989) Human Skeletal Remains: Excava-
tion, Analysis and Interpretation, 2nd edn. Washington,
DC: Taraxacum.
Skeletal Trauma
M Y IÇsËcan, Adli Tip Enstitusu, Istanbul Univesitesi,
Istanbul, Turkey
G Quatrehomme, Faculte de MeÂdecine de Nice,
Laboratoire de MeÂdecine LeÂgale, Nice, France
Copyright # 2000 Academic Press
doi:10.1006/rwfs.2000.0760
Introduction
One of the purposes of the medicolegal system is to
protect the innocent and prosecute the guilty. Evi-
dence is needed to try the accused. An analysis of
trauma that may have caused death to the victim is an
important step in this direction. It may also give
information about antemortem injuries such as
those resulting from accidents, child abuse, torture
or other human rights violation. The term trauma
may be defined in a number of ways. However, it is
the response of the body against any sudden external
insult. It may alter an individual's life from normal to
a functional and esthetic abnormality and may lead to
death or irreversible injury to the victim. Determina-
tion of the cause of trauma is a difficult task and
therefore may be very complex to explain. The pro-
blem may be worse if the remains are skeletonized or
in a state of advanced decomposition.
Anthropological literature classifies trauma by its
origin into dental trauma, fractures, dislocation,
scalping, surgery, perimortem cuts and breaks, and
weapon wounds. Some of these categories are pri-
marily antemortem in origin (e.g. dental trauma,
fractures, dislocations) and may not be responsible
for acute death. Some (e.g. surgery) are handled in
hospitals. Of the remaining, perimortem cuts and
breaks and weapon wounds are of immediate concern
for forensic scientists, particularly if the victim died
because of them. Once the trauma is classified as such
it must be assessed in terms of its relation to death. So,
a trauma can be considered antemortem, perimortem
or postmortem. Trauma-like appearance of the ske-
leton may also be caused by other agents such as
animal or other environment events.
No matter what the origin of trauma it must be
assessed with suspicion within the perspective of legal
sciences. The ultimate aim of such an assessment is to
determine not only the cause of the damage but also
the manner of death. The purpose of this article is to
discuss the causes of trauma that are observable from
the skeleton and their implication in forensic sciences.
Cause and Manner of Death
In the case of a crime involving injury or death, the
cause must be established. If the victim dies from it,
the manner must be decided. Terms cause and man-
ner have specific meanings in forensic medicine. The
cause may be defined as an injury or disease which
may lead to death. Gunshot wound to the head is a
cause that will often kill the victim.
Manner is the classificatory system of death and
can be one of four main and classical assessments:
natural, accidental, suicide and homicide. The deci-
sion as to which one of these is to be considered as the
manner is made by the authorized individual, e.g.
medical examiner or coroner. The coroner (or med-
ical examiner) in turn needs the advice and eviden-
tiary support from the pathologist, anthropologist,
criminalist and others, who are involved in the inves-
tigation, and have expertise of the crime and scene
where the deceased is found, and have expertise to
explain what may have killed the victim. Using the
gunshot wound as the cause of death as an example,
the manner can be one of several. The victim may
have killed himself/herself with a single shot into the
mouth and thus it may be considered suicide. The
person may have been shot from the back of the head
several times by an assailant. This suggests homicide.
The gun may have been accidentally fired while
cleaning. Natural deaths may occur for a number of
reasons including malfunctioning of vital organs such
as heart attack and other acute diseases, or terminal
death resulting from chronic diseases.
In order to make decisions about the manner, a
number of issues must be resolved. There are two
kinds of remains that may shed light into the cause of
death. The first, includes those that have an obvious