RADIOLOGY OF THE ORBITAL WALL FRACTURES AND ITS ROLE

IN THE FORENSIC MEDICAL EXAMINATION OF LIVING PERSONS

 

Medvedeva N.А.^1,2, Serova N.S.¹, Pavlova O.Yu.¹, Gridasova I.S.¹

 

1 - I.M. Sechenov First Moscow State Medical University (Sechenov University). Russia, Moscow.

2 - State budgetary healthcare institution of the city of Moscow «Bureau of Forensic Medicine of the Department of Health of the City of Moscow». Russia, Moscow.

P

urpose. To determine the possibilities of radiological diagnostics in detailing the connection of fracture lines of the orbital walls to the skull cap and base during the forensic medical examination of living persons. To demonstrate the dependence of determining the severity of harm to health on a detailed radiological interpretation of fractures of the orbital walls with indication of anatomical landmarks of the facial skeleton in victims with traumatic brain injury and involvement of the ethmoidal, sphenoid and frontal bones.

Materials and methods. The study included case materials, medical histories, data from radiology methods of 68 victims (n=68, 100%) who underwent a forensic medical examination procedure for bone-traumatic changes of the orbital walls involving the ethmoidal, sphenoid and frontal bones at the Bureau of Forensic Medicine of the Department of Health of the City of Moscow. The average age of the group (n=68, 100%) was 35.5 years. There were of 7 boys (n=7; 10.3%), 2 girls (n=2; 2.9%), 19 women (n=28; %), 40 men (n=40; 59%). As part of the commission examination a radiologist was involved who had to answer the question of a forensic medical expert about the presence of fracture lines of the orbital walls and their connection to the skull cap and/or base of the skull, during the analysis of the MSCT in the framework of a forensic medical examination. All the examinees underwent computed tomography and radiography of the skull bones in order to clarify the distribution of fracture lines to the skull cap and base of the skull.

Results. According to the primary documentation, in 65 people (n=65; 95.6%), it was not possible to reliably come to a conclusion about the degree of harm to health, since the primary conclusion of the radiologist lacked anatomical detail of the course of the fracture line along the facial skeleton and/or along the skull cap and base. Using an algorithm of the radiological interpretation with separation to the facial skeleton and the skull base/cap when the fractures of the orbits involved ethmoidal, sphenoid and frontal bones, it was possible to differentiate severe and moderate harm to health in 97% of cases during forensic medical examination of living persons.

Discussion. In the legal and judicial practice of the Russian Federation, serious harm to health implies criminal liability and a criminal record. In our work, we have demonstrated how anatomical detailing of the course of fractures of the frontal, wedge-shaped and latticed bones with a list of the surfaces, walls and structures involved can affect the subsequent life and health of those involved, and at the moment the great responsibility lies precisely on the shoulders of radiologists. When conducting a forensic medical examination of living persons, in order to determine the severity of bodily injuries, it is necessary to rely not only on medical criteria for determining the severity of harm, but also on the relevant branches of medicine, primarily on normal and topographic anatomy.

Conclusion. The results of our work demonstrated the capabilities of MSCT in detailing the course of the fracture line of the orbital walls in the area of anatomical surfaces of ethmoidal, sphenoid and frontal bones. It is  necessary to  use an  algorithm  of radiological  interpretation with a de-

 

tailed display in the protocol all the anatomical structures of the ethmoidal, sphenoid and frontal bones in order to ifferentiate isolated fractures of the facial skeleton and their spread to the skull cap and/or base, since the qualification of the degree of harm to health directly depends on the involvement of the skull cap and/or base considering fractures of the orbital walls.

 

Keywords: fractures of the orbital walls, forensic medical examination, skull bones, traumatic brain injury, fractures of the skull cap and/or base, traumatic brain injury, forensic medical examination of living persons.

 

Corresponding author: Medvedeva N.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Medvedeva N.А., Serova N.S., Pavlova O.Yu., Gridasova I.S. Radiology of the orbital wall fractures and its role in the forensic medical examination of living persons. REJR 2024; 14(2):6-18. DOI: 10.21569/2222-7415-2024-14-2-6-18.

Received:        05.06.24                 Accepted:       19.06.24