Forensic Expertise Based on Findings through Postmortem Mammography Imaging

In forensic cases where standard macroscopic examination and conventional radiological analysis are inconclusive, mammography can be a useful technique. This applies especially when bodies are found in an advanced state of decomposition, with the dissolution of the soft tissues, and with fragile skeletal structures. This study proposes the use of soft X-rays (i.e., mammography) in particular cases for forensic evaluation, with specific regard to the cause of death, age estimation, and body identification. Here we report three cases in which mammography was particularly useful to obtain fundamental medico-legal information. The first case involved a body that had reached the mummification stage, the second a woman who died from asphyxiation by strangulation, and the last a charred femur found in a field. Mammography uses low-energy X-rays. This technique provides increased image quality through better contrast and higher definition. In the first case, it highlighted a complete fracture of the thyroid cartilage; in the second, it revealed a complete fracture of the horn of the hyoid bone; in the last, it showed rarefaction of the reticular substance of the charred bone. As shown in this study, in selected cases, mammography is a useful tool for post-mortem imaging.

The Biomechanical Role of the Fibula in Lower Limbs: A Fracture Mechanics Analysis

BackgroundFibular grafting is widely used in the treatment of various bone nonunions and defects because of its good therapeutic effects. Furthermore, partial fibular resection has been used as a treatment for fibular tumors, injuries, and other conditions. The fibula plays important roles in the biomechanics of the lower limbs. Some experts have used cadaver specimens to study these aspects. In this study, the biomechanical effects of the fibula in lower limbs were researched through mechanics analysis.MethodsWe randomly collected knee joint computed tomography (CT) scans from eight adults, including three left knees and five right knees. The DICOM formatted CT scan images were imported into Mimics software. The tibia and fibula were extracted with the CT-bone function in Mimics software, and 3D models of the tibia and fibula were obtained. Each model was imported into 3-MATIC and LS-DYNA software to smooth the surface, perform meshing, define material properties, and set the failure parameters, interface properties, vertical loads and boundary conditions. The tibial fractures in both models were calculated to evaluate the biomechanical role of the fibula in the lower leg.ResultsThe validity of the model was verified, and the fibular load condition was similar to those previously reported. In the model with fibular support, the fracture load of the tibia was 78.27±3.36 KN, the initial fracture time was 0.69±0.01 s, and the complete fracture time was 0.75±0.01 s. The fibula carried approximately 7% of the load on the lower leg. In the fibular defect model, the fracture load of the tibia was 72.71±3.25 KN, the initial fracture time was 0.54±0.02 s, and the complete fracture time was 0.62±0.01 s.ConclusionsThe fibula play an essential biomechanical role in lower limb load-bearing and therefore is worthy of clinical attention. We believe that LS-DYNA can be used as an effective tool for the study of fracture mechanics.

Biomechanical Role of Fibula in Lower Limbs: a Fracture Mechanics Analysis

Background Fibular grafting is widely used in the treatment of various bone nonunion and bone defect because of its good therapeutic effect. Besides, partial fibular resection has also been used as a treatment for fibular tumors, injuries, etc. However, fibula plays an important role in the biomechanics of the lower limbs. Some experts have used cadaver specimens to study these aspect. In this study, the biomechanical effects of fibula in lower limbs were researched based on mechanics analysis.Methods The CT image data of a middle-aged male normal knee joint were selected. The tibia and fibula were extracted by CT-bone function in Mimics software, and the 3D model of tibia and fibula was obtained. The model was imported into 3-matic and LS-DYNA software to smooth the surface, mesh, define material properties, set failure parameters and interface properties, and set vertical loads and boundary conditions. The tibial fractures in both models were calculated to evaluate the biomechanical role of the fibula in the lower leg.Results The validity of the model was verified, and the fibula load condition was similar to the previous references. In the model with fibula support, the fracture load of the tibia was 78.5KN, the initial fracture time was 0.67164S, and the complete fracture time was 0.73225S. The fibula distributes about 7% of the load on the lower leg. In the fibula defect model, the fracture load of tibia was 73.5KN, the initial fracture time was 0.54034S, and the complete fracture time was 0.61105S.Conclusions Fibula plays an irreplaceable biomechanical role in the process of lower limb load-bearing, which is worthy of clinical attention. Meanwhile, LS-DYNA can be used as an effective tool for bone fracture and numerical analysis.

Spontaneous healing response of oblique root fracture: case report with 4-year follow-up

Root fractures can involve the dentin, cementum, and pulp and commonly can occur as oblique fractures with varying orientations. The aim of this study was to demonstrate the maintenance of pulp health in a tooth with a fractured root without any endodontic treatment and to discuss the advantage of cone-bean computed tomography (CBCT) compared with traditional radiographs in the diagnosis of oblique root fractures. Intra-oral radiography of tooth 11 revealed a horizontal root fracture at the level of the apical third, while the sagittal CBCT slice reveals a complete fracture line running obliquely from the apical third on the buccal aspect through the cervical third on the palatal aspect. Four years follow-up, the tooth has kept its pulp vitality, no tooth discoloration or discrepancy in arch position, without endodontic treatment. This result illustrates spontaneous healing of root fracture including preservation of pulp health. In addition, it confirms the importance of exams in 3 dimensions to correctly locate the fracture and assist in the treatment decision.

Clinical Features and Outcomes of Bilateral Atypical Femoral Fractures

Bilateral atypical femoral fractures (AFFs) are relatively rare. In this report, we retrospectively researched clinical features and outcomes of bilateral AFFs treated at our institution. We previously treated 4 patients (8 limbs) with intramedullary nailing for complete AFFs (6 limbs) and incomplete AFFs (2 limbs). The mean age at the first operation was 53.3 years, and all patients were female. Of the 4 patients, two had breast cancer, and another two had systemic lupus erythematosus. Three of them received bisphosphonates, and 2 received denosumab, proton pump inhibitor, or glucocorticoid therapy. Only 2 of 6 cases of incomplete AFFs had prodromal pain before progressing to complete fracture. The mean interval from the first surgery to contralateral fracture or prophylactic surgery was 16 months. Radiographically, complete bone union was achieved in 6 limbs. However, a small gap at the lateral cortex of fracture site remained in 2 limbs. Finally, all of the patients were pain-free and able to walk without a cane. It is absolutely necessary to confirm contralateral femoral conditions; however, prediction of progression to complete fracture based solely on prodromal pain was difficult. Therefore, we should advise patients about the danger of progression to complete AFFs even if they are asymptomatic, and a prophylactic surgery should be performed after obtaining informed consent.

Socioeconomic Measures Influence on Therapy Selection in Closed Complete Fracture Evaluated by Social Economy Status from June 2018 – 2019 at Raden Mattaher Hospital, Jambi

Objectives: Fractures are loss of continuity of bone structure, not only cracks or separation of the cortex, fractures often result in complete damage and separate bone fragments. Fractures themselves have many different types in clinical terms, a fracture is divided into 2, complete fracture and incomplete fracture, where the treatment process and management are different. In the case of closed complete fracture, cultural and economic are still the main reason for patients to refuse medical treatment. Because of that matter, people are still reluctant to go to the hospital and prefer alternative therapy. The purpose of this study was to determine the relationship between therapy selection of closed complete fracture based on the condition of the socio-economic status of the patient in Raden Mattaher Hospital Jambi. Methods: The study was conducted retrospectively from medical record data of patients who experienced closed complete fracture from June 2018 to June 2019. The sampling method is using a Non-Probability sampling with a purposive sampling technique, and later the data was processed descriptively which included the patient’s socioeconomic status. Results: From the results of the research conducted from June 2018 - June 2019 in Raden Mattaher General Hospital Jambi, 125 patients were found with cases of closed complete fracture. From 125 cases of close complete fracture, as many as 91 patients (72.8%) are men with productive age who came from various fields of work. The location that is often affected is femur bone as many as 37 patients (29.6%). From 125 patients with closed complete fracture, we found that 48 patients (38.4%) prefer alternative therapy and 26 of them (54,17%) are from the Class III treatment room, 13 patients (27.08%) are from the Class II treatment room, and class I treatment room as many as 9 patients (18.75%). This shows the lower the treatment class, the higher the patient chooses alternative therapy. Conclusion: Socio-economic status is still related to the therapy selection.

Reimplantation of a Large Extruded Segment of Tibia in an Open Fracture in a Pediatric Patient

A 6-year-old boy presented with a Gustilo type IIIB open fracture on his left leg with a segment of bone loss in his tibia. The boy's attendants brought two bone fragments recovered from the scene of the accident. The extruded bones were a segment with a length of 5.5 cm and a cortical bone with a length of 4 cm. The extruded fragments were reimplanted after scrubbing with 10% povidone–iodine for 20 minutes, soaking in 2% chlorhexidine solution for 20 minutes, and rinsing with normal saline. Four months after the injury, the extruded fragments were incorporated in the callus of the fracture site and complete fracture union in appropriate alignment was achieved.