Morphology of direct and indirect rib fractures
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ORIGINAL ARTICLE
Morphology of direct and indirect rib fractures Steffen Kissling 1 & Roland Hausmann 1 Received: 1 May 2020 / Accepted: 10 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Rib fractures are a common finding in legal medicine and information on the impact mechanism is relevant for trauma reconstruction. This study focuses on morphological characteristics of rib fractures resulting from direct or indirect force. Fresh human ribs (n = 312) were divided into two groups and broken through local force (direct) and bending (indirect) in anterolateral areas. The ribs were macerated, visually investigated and the results statistically analysed. The indirect fractures showed a significant larger lateral offset of the internal and external fracture ends while the fracture ends of the direct fractures were more often straight, in line. Also, the morphology of the inner and outer fracture edges was significantly related to fracture type. Direct fractures mostly had rough and jagged inner edges (tension side) and straight, smooth outer edges (compression side), whereas indirect fractures more often showed the characteristics vice versa. The results were more convincing in combination and in ribs from persons aged ≤ 75 years at death. In summary, the direct and indirect rib fractures showed significantly different characteristics regarding orientation and offset of the fracture lines and roughness of the inner and outer fracture edges, which can be helpful to distinguish the traumatizing impact mechanisms in forensic autopsy routine. Keywords Rib fractures . Ribs . Autopsy . Morphology . Biomechanics
Introduction Rib fractures are a common finding in medico-legal fields. Besides clinical examinations and radiological findings in living people, rib fractures can frequently be seen in autopsy cases after thoracic trauma. The incidence in polytrauma cases is described with 50% [1]. The mechanisms for the incurrence of rib fractures are primarily direct impact or compression of the thorax [2–4]. Rib fractures can occur peri- or postmortem during cardiopulmonary resuscitation [5, 6] or as a result of pathological conditions, such as osteoporosis, tuberculosis or proliferative diseases. There are several studies focusing on different aspects regarding the interpretation of rib fractures. Klevno published profound cognitions on the occurrence, autopsy technique and interpretations of rib fractures [7–9] while other work groups focussed on fracture location and types [10, 11] or indications for vital trauma [12].
For trauma reconstruction, the forensic pathologist has to determine whether the fractured rib resulted from a direct impact or compression of the thorax, maybe as a perimortem artefact [13]. Lesions of surrounding structures, such as clothing or soft tissue, are helpful, and other forensic scientists, like crime scene technicians, can provide useful information. The objective of this study is the distinction between direct and indirect fractures by analysing morphological
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