Steven A. Symes

Steven A. Symes is primarily known for his scholarly work on skeletal trauma analysis and for his applied casework and frequent courtroom appearances providing forensic anthropology testimony. However, many may not know that throughout his career Steve has also been a proponent of photography and microscopy. This biography serves to introduce some and enlighten others as to how Steve ended up in forensic anthropology, highlighting aspects of Steve as a mentor, colleague, and friend. This manuscript is based on a chat between the authors, with some details filled in via supporting documents and colleagues.

Analysis of causes and risk factors of lethality of ingured persons with abdominal trauma

The study was carried out on the basis of the polytrauma department of the KNP “Municipal Clinical Emergency and Critical Care Hospital named after O. I. Meshchaninov” of Kharkiv City Council. O. I. Meshchaninov” of the Kharkiv City Council. The initial data, results of treatment of 240 victims and their dependence on peculiarities of trauma and peculiarities of victims with abdominal trauma were analysed. Patients with concomitant abdominal trauma predominated in the structure of the injured — 178 (74,2 %), including concomitant injuries of one anatomofunctional area (AFA) in 80 (33,3 %), two AFA– in 67 (27,9 %), and three AFA– in 31 (12,9 %) patients. Isolated abdominal trauma was diagnosed — in 62 (25.9 %) patients. In addition to abdominal injuries, the majority of patients had injuries of other localisations: thoracic trauma — in 129 (53.8 %) patients, skeletal trauma was found — in 96 (40 %) patients, craniocerebral trauma — in 84 (35 %) patients. During in-hospital treatment, 34 (14.2 %) victims died. In the acute period of trauma (1–7 days) 12 (35 %) victims died, including 5 cases within the first day. Lethality was found to increase with the number of injured ASOs, from 4.8 % for isolated abdominal trauma to 41.9 % for additional trauma, thoracic and skeletal trauma (χ2 = 27, 791, p < 0.001), and an increase in injury severity from 7.7 % to 6.7 % for mild to moderately severe trauma to 58.8 % for extremely severe trauma (χ2 = 34.342, p < 0.001) as well as the severity of individual injuries. An increase in lethality was also found with increasing age of the victims and in the presence of increased weight and obesity.

Epidemiology of skeletal trauma and skull fractures in children younger than 1 year in Shenzhen: a retrospective study of 664 patients

Background Unintentional injury is one of the top three causes of death for infants. However, the epidemiological studies of skeletal trauma and skull fractures in infants younger than 1 year were poorly understood in China. Therefore, our study aimed to examine accidental and emergency attendance in infants under 1 year. It also tried to determine the prevalence and severity of accident types in infants. Methods A retrospective analysis was performed on the demographic characteristics of infants younger than 1 year with skeletal trauma and skull fractures who visited the Shenzhen Children’s Hospital from January 1, 2016 to December 31, 2019. Age, gender, fracture site and type, mechanism of injury, length of visit, length of hospital stay, hospitalization cost, and treatment methods were analyzed. Results A total number of 675 fractures in 664 infants were included, the median age was 187days (IQR,90-273days), including 394 males and 270 females. The top three fracture sites were the skull (430 sites, 63.70 %), long bones of the limbs (168 sites, 24.89 %), and clavicle (53 sites, 7.85 %). The top three causes of injury were locomotion injuries (256 cases, 38.55 %), falls or trips from low height (from beds, tables, chairs, etc.) (130 cases, 19.58 %), and birth injuries (97 cases, 14.61 %). The greatest amount of fractures occurred in children 1–28 days of life (d) reached a top of 101 cases, followed by 331–365 days, accounting for 15.21 and 10.24 %, respectively. The number of fractures reached a trough of 29 cases in the 29-60d group (4.37 %). And increased again to 65 cases in the 151-180d group (9.79 %). The proportion remained relatively constant at 9 % in the 181-210d group (9.19 %) and 211-240d group (9.64 %). The interval between injury and visiting our hospital was ≤ 72 h in 554 cases. Conclusions Special attention should be given to the demographic characteristics of fractures in infants under 1 year of age, and appropriate outreach should be implemented. For example, health education should be provided to aid in the prevention especially for frequently occurring locomotion injuries, and prompt access to specialist medical care should be recommended for skull fractures, which are prone to delayed treatment. In addition, multidisciplinary collaboration should be implemented in trauma care, while also promoting the establishment of trauma centers in specialist children’s hospitals with a stronger capacity to treat pediatric trauma, and a regional system for pediatric trauma treatment.

Forensic Fractography of Bone

Fractography involves the study of fractures and cracks in a material in order to understand the cause of failure. Even as a complex, highly hierarchical composite, bone is a material that obeys physical laws, including cracking behavior. The fields of fractography and fracture mechanics, therefore, have much to offer in our understanding of bone’s response to loading and force. Here we discuss how fractography can be used in the assessment of fractures originating from impacts including those from projectiles. Fractures and fracture patterns frequently associated with impact trauma—including radial fractures, circumferential fractures, and beveling—are described and used interpretively in forensic analyses; however, the mechanisms for their production and arrangement are often underutilized in fully understanding the trauma event. These mechanisms are reviewed here from a fractography perspective. Furthermore, a review is presented of new data indicating that beveling in bone associated with impacts, especially with projectiles, is produced by cone cracking, a process that is also well documented in other brittle materials. This information can be used to enhance understanding of impact trauma in general, as well as in the context of specific forensic cases. Moreover, describing and interpreting skeletal trauma within the context of fracture mechanics and fractography has the advantage of aligning the nomenclature used in forensic anthropology with that used in other scientific fields, particularly those involved in the study of material failure. To facilitate this alignment, we provide discussion and definitions for various fractography-related terms.

186 Acute Kidney Injury in Skeletal Trauma Admissions to Intensive Care: An Under-Estimated Complication

Introduction Acute kidney injury (AKI) is associated with prolonged admission and 3.5 times increased mortality for trauma patients requiring intensive care (ICU) treatment. Blunt trauma confers greater risk of AKI than penetrating trauma, potentially related to long bone fracture. The relationship between skeletal trauma and AKI in ICU has not previously been investigated. Method Retrospective data was analysed from 202 consecutive adult patients admitted to ICU with skeletal trauma from 01/06/2018 to 01/06/2019. AKI was defined by creatinine rise &gt;1.5 times baseline. Results AKI was found in 70/202 (34.65%) patients aged 16-99 years, 138 males and 64 females. Mean limb Abbreviated Injury Scale (AIS) was significantly higher in AKI (AIS= 2.57 (SD 0.53) versus non-AKI AIS=2.38 (SD 0.61), p = 0.027). Other body regions and total Injury Severity Score (ISS) were non-significant. AKI was associated with a significantly worse Glasgow Outcome Score (AKI 3.28 (SD 1.52) versus 4.02 (SD 1.08) p &lt; 0.001), increased intensive care stay (AKI 7.03 (SD 8.30) days versus non-AKI 3.8 (SD 4.1) days p &lt; 0.001) and increased 30-day mortality (AKI 18/70 (25.71%) versus non-AKI 10/132 (7.58%) p &lt; 0.001) Conclusions Skeletal trauma patients have a high incidence of AKI, which was significantly correlated with severity of skeletal limb trauma but not overall ISS.