A UNIFIED PROTOCOL FOR THE INTERPRETATION OF CT DATA FOR THE FORENSIC

ASSESSMENT OF THE SEVERITY OF INJURY TO HEALTH IN ETHMOIDAL BONE FRACTURES

 

Medvedeva N.А., Serova N.S.

 

Sechenov University. Moscow, Russia.

Purpose. To evaluate the impact of a unified protocol for interpreting CT data detailing the course of the fracture line for various anatomical elements of the ethmoidal bone on the objectivity of expert conclusions in determining the severity of injury to health.

Materials and methods. A forensic medical examination of the injury severity was conducted based on the materials of 73 cases (100%) with fractures of the ethmoidal bone. The average age was 39.5 years, 34 women (46.5%) and 40 men (53.5%). As part of the examination, a radiologist was involved to assess the extent of involvement of anatomical elements of the ethmoidal bone in the fracture area. A unified data interpretation protocol was used to analyze the CT data. CT was performed in the hospital after the admission of the patients by the ambulance team.

Results. CT was performed on all 73 victims with a fractured ethmoidal bone. Primary X-ray reports did not allow assessing the harm to health in 70 people (96%) due to the lack of anatomical detailing. After the CT scan was reviewed according to the unified protocol: in 56 (76.7%) cases an isolated fracture of the orbital plates was detected, in 10 (13.7%) cases – fracture of the cells of the ethmoidal labyrinth with concomitant injuries, in 66 (90.4%) – fracture did not affect the arch and base of the skull, excluding serious harm.  In 7 (9.6%) cases – fracture spread to the base of the skull, which was classified as serious injury.

Discussion. Damage to the lamina cribrosa of the ethmoidal bone is considered as a fracture of the base of the skull and qualifies as serious harm to health. However, fractures of other parts of the ethmoidal bone, such as the orbital plates, the cells of the latticed labyrinth and the perpendicular plate should not qualify as serious harm. Thus, it is necessary to use interdisciplinary knowledge of anatomy and radiological data. The results of our work demonstrate the capabilities of CT in detailing the course of the fracture line along the anatomical elements of the ethmoidal bone. These elements can be classified into two groups: the base of the skull in the area of the anterior cranial fossa and the facial skull.

Conclusion. The use of a unified protocol for interpreting CT data with a detailed mapping of the anatomical structures of the ethmoidal bone makes it possible to differentiate isolated fractures of the facial skeleton and their spread to the skull base. The qualification of the degree of harm to health directly depends on the involvement of the arch and/or base of the skull in fractures of the ethmoidal bone.

 

Keywords: fractures of the ethmoidal bone, forensic medical examination, skull bones, traumatic brain injury, fractures of the arch and base of the skull, 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. A unified protocol for the interpretation of CT data for the forensic assessment of the severity of injury to health in ethmoidal bone fractures. REJR 2025; 15(2):21-28. DOI: 10.21569/2222-7415-2025-15-2-21-28.

Received:        13.02.25 Accepted:       26.03.25