DIAGNOSTICS OF CONTACT (DIRECT) AND STRUCTURAL FRACTURES OF THE SKULL BASED ON CT DATA FOR FORENSIC EXAMINATION OF LIVING PERSONS

 

Medvedeva N.А.^1,2, Serova N.S¹

 

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

2 - Bureau of Forensic Medicine of the Department of Health of the City of Moscow. Russia, Moscow.

T

o determine the capabilities of CT and 3D-CT in forensic medical examination of living persons to detail the point of force application in local linear skull vault fractures and differentiate them from remote fractures.

Materials and methods. The study includes 43 cases of linear skull vault fractures in living patients after traumatic brain injury (traffic accidents, falls, criminal, industrial, and domestic injuries). Diagnostic methods used were: multispiral CT (MSCT), 3D reconstruction, analysis of soft tissue and brain damage, and differential diagnosis. Upon admission, CT was performed to identify acute injuries and hematomas. Repeated data analysis was performed electronically with the creation of 3D images.

Results. In 43 cases (100%) a linear skull vault fracture was detected and in 31 cases (72%) remote structural fractures extending to the cranial base were identified. On CT and 3D reconstructions, the points of force application were determined in 95% of cases. In 2 cases (4.6%), due to the complex fracture shape, it was not possible to detail the point of force application. Three-dimensional reconstruction allowed for detailed examination of changes both outside and inside the skull which is important for forensic medical examination. Direct fractures were characterized by clear localization at the point of impact, minimal bone fragment displacements and local epidural hematomas. Indirect fractures, or structural fractures, were localized in remote areas and had radial or ring-shaped forms, multiple fracture lines and often accompanied by subarachnoid hemorrhages.

Discussion. Traumatic brain injury (TBI) is a common pathology in forensic medical practice. Skull fractures can be direct, occurring at the point of force application and indirect, occurring due to the propagation of the shock wave. Diagnosis of TBI includes determining the mechanism of injury, which is important for forensic medical examination. Computed tomography (CT) is a key method for accurate localization and differentiation of fractures, especially in living patients. The distinction between direct and indirect fractures helps reconstruct events and assess the degree of harm to health.

Conclusion. Differentiation between direct and indirect fractures requires a comprehensive approach, including analysis of radiological signs, injury mechanism and clinical data. Modern CT methods significantly increase diagnostic accuracy and help experts form well-founded conclusions in forensic examination of living persons. CT and 3D-CT are highly informative for diagnosing linear fractures and determining the point of force application. Differentiation between local and remote fractures is possible considering soft tissue changes, which has high practical significance for reconstructing the circumstances of the injury.

 

Keywords: forensic medical examination, local and remote skull bone fractures, craniocerebral trauma, 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. Diagnostics of contact (direct) and structural fractures of the skull based on CT data for forensic examination of living persons. REJR 2025; 15(1):21-28. DOI: 10.21569/2222-7415-2025-15-1-21-28.

Received:        25.11.24 Accepted:       23.01.25