LABANOF (Laboratorio di Antropologia e Odontologia Forense), Sezione di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, University of Milan, Via Mangiagalli n.37, 20133, Milan, Italy.
LABANOF (Laboratorio di Antropologia e Odontologia Forense), Sezione di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, University of Milan, Via Mangiagalli n.37, 20133, Milan, Italy.
Forensic Sci Int. 2019 Sep;302:109856. doi: 10.1016/j.forsciint.2019.06.014. Epub 2019 Jun 19.
The assessment and interpretation of the timing of skeletal trauma can be of extreme difficulty in post-mortem specimens, especially because of post-mortem processes and taphonomic events. The chronological diagnosis of bone trauma, consisting usually in the gross distinction between antemortem, perimortem and post-mortem, is based almost uniquely on macroscopic and morphologic parameters in the anthropological field. However, both the interference of taphonomy and the scarce persistence of specific features indicating vitality (meaning etymologically "produced in life") and/or some very early bone healing reactions, make it extremely difficult. In this perspective, it is important not only to distinguish between peri and post-mortem lesions, but also to interpret perimortem lesions with respect to vitality and time elapsed since the trauma which may change the course of the investigations. And techniques of forensic pathology applied to forensic anthropology can come in extremely handy. If any traces of vital blood extravasation, haemorrhage, hematoma, inflammation, and biomarkers of early healing reaction are found in the bone tissue of a skeletal lesion (regardless the state of preservation of the body), then can they be used as a diagnostic tool or marker of vitality for that lesion? In these terms, vital reactions like bleeding or any early sign of bone healing can be the only evidence for demonstrating that a traumatic event was prior the death. Nevertheless, very little information, or research for that matter, is available in literature concerning persistence and detectability of vitality markers during the bone decomposition process. A fundamental point for properly determining the vitality of a fracture and estimating the post-traumatic time interval in skeletal lesions is the physio-pathological picture of the very initial healing process. This article attempts to provide a review of the physiopathological current knowledge available and applicable to osteology.
骨骼创伤的时间评估和解读在尸检标本中可能极具难度，尤其是因为死后过程和埋藏学事件的影响。骨创伤的时间诊断通常包括在大体上区分生前、濒死和死后，主要基于人类学领域的宏观和形态学参数。然而，埋藏学的干扰以及几乎没有指示生命力（从词源上讲是“生命中产生的”）和/或一些非常早期的骨愈合反应的特定特征的持续存在，使得这变得极其困难。从这个角度来看，不仅要区分生前和死后的损伤，还要根据创伤后剩余的生命力和时间来解释濒死期的损伤，这可能会改变调查的进程。应用于法医人类学的法医病理学技术在这方面非常有用。如果在骨骼损伤的骨组织中发现任何生命血液外渗、出血、血肿、炎症和早期愈合反应的生物标志物的痕迹（无论身体的保存状态如何），那么它们可以用作该损伤的生命力的诊断工具或标志物吗？在这些情况下，像出血或任何早期骨愈合迹象这样的生命反应可以作为证明创伤事件发生在死亡之前的唯一证据。然而，关于生命力标志物在骨骼分解过程中的持续存在和可检测性，文献中几乎没有提供相关信息或研究。正确确定骨折的生命力并估计骨骼损伤中的创伤后时间间隔的一个基本点是非常初始的愈合过程的生理病理图像。本文试图提供对可应用于骨科学的当前生理病理学知识的综述。
