Legal Medicine and Toxicology Unit, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy; Laboratorio di Antropologia e Odontologia Forense (LABANOF), Sezione di Medicina Legale, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, P.le Scuro, 10-37134, Verona, Italy.
Laboratorio di Antropologia e Odontologia Forense (LABANOF), Sezione di Medicina Legale, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Centre for Forensic Anthropology, School of Social Sciences, The University of Western Australia, Australia.
Forensic Sci Int. 2021 Dec;329:111058. doi: 10.1016/j.forsciint.2021.111058. Epub 2021 Oct 17.
Accurate dating of bone fractures can be crucial in the context of forensic trauma analysis since it may provide essential information for the corroboration or contradiction of statements by victims or suspects in cases of domestic abuse or torture. The different stages of bone healing have been well described in the existing literature, and some previous studies attempted to define related timelines particularly in the paediatric population. However, the bone healing process can be very variable and despite the importance of the topic in the forensic field, so far little is known about the radiological appearance of bone fractures at different healing stages, and how this correlates with time, especially in an adult population. The aim of this retrospective observational study was to describe the temporal aspect of pre-defined healing stages as they appear on radiographs of tubular bone fractures in adults, and explore the effect of potential cofounding variables. A dynamic nomogram was developed as a user-friendly tool to be eventually applied in clinical or medico-legal settings. This study showed that the posttraumatic time interval (PTTI) increased progressively with the pre-defined healing stages. However, confounding factors, such as patients' age, sex, and location of the fracture need to be accounted for in the final estimation model. Further studies are needed to explore more potentially confounding variables to refine the presented outcomes. Better knowledge of the effect of different confounding variables in the dating of fracture healing will contribute to greater accuracy of PTTI estimation of bone fractures in adults.
准确鉴定骨折的发生时间在法医创伤分析中至关重要，因为它可能为受害者或嫌疑人在虐待或酷刑案件中的陈述提供重要信息，以证实或反驳这些陈述。现有文献中已经很好地描述了骨愈合的不同阶段，一些先前的研究试图在小儿人群中定义相关的时间线。然而，骨愈合过程可能非常多变，尽管在法医领域这个话题非常重要，但目前对于不同愈合阶段的骨折的放射学表现以及与时间的相关性知之甚少，尤其是在成年人群中。本回顾性观察研究旨在描述管状骨骨折在成人 X 光片上的预定义愈合阶段的时间方面，并探讨潜在混杂变量的影响。开发了一个动态列线图作为一个用户友好的工具，最终将应用于临床或法医环境中。本研究表明，创伤后时间间隔（PTTI）随着预定义的愈合阶段逐渐增加。然而，在最终的估计模型中需要考虑患者的年龄、性别和骨折部位等混杂因素。需要进一步研究以探索更多潜在的混杂变量，以完善所呈现的结果。更好地了解不同混杂变量对骨折愈合时间鉴定的影响将有助于提高成人骨折 PTTI 估计的准确性。
