Forensic Pathology of Trauma

Forensic Pathology of Trauma

F O R E N S I C

S C I E N C E ^{A N D} M E D I C I N E

Steven B. Karch, MD , S

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by Michael J. Shkrum and David A. Ramsay, 2007

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F ^ORENSIC P ^ATHOLOGY

OF T ^RAUMA

Common Problems for the Pathologist

By

Michael J. Shkrum, ^MD

Department of Pathology London Health Sciences Centre and The University of Western Ontario London, Ontario

Canada

and

David A. Ramsay, ^{MB C h B}

Departments of Pathology and Clinical Neurological Sciences London Health Sciences Centre

and The University of Western Ontario London, Ontario

Canada

© 2007 Humana Press Inc.

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Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 eISBN: 1-59745-138-X

13-digit ISBN: 978-1-58829-458-6

Library of Congress Cataloging-in-Publication Data Shkrum, Michael J.

Forensic pathology of trauma : common problems for the pathologist / by Michael J. Shkrum and David A. Ramsay.

p. ; cm. -- (Forensic science and medicine) Includes bibliographical references and index.

ISBN 1-58829-458-7 (alk. paper)

1. Forensic pathology. 2. Wounds and injuries. I. Ramsay, David A. II. Title. III. Series.

[DNLM: 1. Wounds and Injuries--pathology. 2. Autopsy--methods.

3. Forensic Pathology. W 843 S558f 2007]

RA1053.4.S55 2007 614'.1--dc22

2006000940

v

Dedication

To my parents, who showed me the way, and to Susan, Stephanie, and Paul, who kept me on the path.

M. J. Shkrum

To my parents and other teachers, and to Calum and Mhairi.

D. A. Ramsay

vii

Preface

The practice of forensic pathology includes the collection and analysis of evidence in relation to a corpse in order to establish the cause of death. Knowledge of the cause of death contributes to the determination of the manner of death by medical examiners and coroners, who are occasionally assisted by law enforcement officers. In the process of establishing the cause and manner of death, representatives of various investigative bodies have several responsibilities, including explaining the death to family members, attempting to reduce the risk of similar deaths in the future, and, if applicable, apprehending the individuals who are responsible for the death.

The most well-known and popular role of a forensic pathologist is in the investi- gation of cases of suspicious death; however, most medicolegal autopsies involve unexpected deaths that are above suspicion, many of which are caused by trauma (trauma being defined as any physical force or agent that causes bodily harm). The purpose of Forensic Pathology of Trauma: Common Problems for the Pathologist is to provide practical advice and information about the conduct of the forensic autopsy in cases of trauma, and to offer guidance about the analysis of the autopsy findings in these cases. Forensic Pathology of Trauma: Common Problems for the Pathologist will help pathologists—particularly those more accustomed to “hospital”

autopsies—avoid common mistakes in medicolegal cases by ensuring that they attend to the fundamental purposes of the forensic autopsy that, in addition to demonstrating the cause of death, addresses such issues as: “(1) the identity of the dead person; (2) the time of death; (3) the circumstances in which the fatal injury was sustained; (4) the type of weapon or agent that was responsible for the injury; (5) factors that may have predisposed the victim to injury, or modified the effects of injury...”(1).

Our approach is to describe common medicolegal “syndromes” or trauma pat- terns, which are exemplified by the chapter titles, and to provide comprehensive cov- erage of both the common and uncommon causes of these patterns. Although the book does not cover the autopsy investigation of suspicious death in detail, sufficient infor- mation is provided to ensure that a pathologist is aware of the pitfalls in such cases, and that these cases are dealt with appropriately when they do occur.

Forensic Pathology of Trauma: Common Problems for the Pathologist is prima- rily intended for the use of pathologists who perform forensic autopsies as part of a general autopsy service, as opposed to those employed in dedicated forensic autopsy centers; however, we believe the contents will also be of service to anyone who wants to understand the strengths and, more importantly, the limitations of the forensic autopsy.

Michael J. Shkrum,

David A. Ramsay,

Reference

1. Moritz AR. Classical mistakes in forensic pathology. Am J Clin Pathol 26:1382–1397, 1956.

viii Preface

ix

Acknowledgments

We thank the following for their contributions to this undertaking: Lisa Noseworthy and Paula Miller (Department of Pathology, London Health Sciences Centre [LHSC]) for their secretarial assistance; Kris Milne (Department of Pathology, The University of Western Ontario [UWO]) for the preparation of the figures; Kim Walsh, former graduate student in the Department of Pathology, UWO, for assistance in the manuscript preparation; library technicians at the LHSC Library—Linda Crosby and Wendy Tippin—for dealing with our numerous requests for references; Dr. Barry McLellan, the Chief Coroner for Ontario, and Drs. David Legge and Thomas Wilson, Regional Coroners for the Northwestern and Southwestern Ontario regions, respec- tively, for their support; the coroners and various police agencies in Ontario for their diligent death investigations; Drs. David King and Chitra Rao (Regional Forensic Pathol- ogy Unit, Hamilton, Ontario, Canada), and Dr. Michael Pollanen (Provincial Forensic Pathology Unit, Toronto, Ontario, Canada) for their contribution of figures; Dr. Bertha Garcia, the Chief of the Department of Pathology at LHSC for her help and encour- agement. We especially thank the pathologists and staff with whom we have worked with over the years in London and southern Ontario for their patience and dedication to the medicolegal autopsy service.—MJS and DAR

* * *

I would like to thank the late Dr. Marvin Smout and the late Dr. Douglas Mills, former Chiefs of Pathology in London, Ontario, Canada, for fostering my interest in Forensic Pathology, and Drs. Page Hudson and John Butts, former and current Chief Medical Examiners of North Carolina, respectively, for their mentoring roles. My colleagues at the Multi-disciplinary Accident Research Team (Faculty of Engineering Science, UWO)—Kevin McClafferty, Paul Tiessen, Dr. Robert Green, and Dr. Edwin Nowak—have helped me understand issues related to motor vehicle trauma. Dr. Alan German, Chief, Collision Investigation and Research, Road Safety, and Motor Vehicle Regulation Directorate, has kindly allowed the use of Transport Canada information.

—MJS

* * *

My colleague, Dr. L. C. Ang, has been a constant and friendly supporter of my

involvement in forensic neuropathology, and, with the assistance of Dr. J. Keith, he

has provided many thoughtful and helpful comments on the neurological sections in

this book. My secretary, Lynn James, has been an invaluable, cheerful, and highly

organized assistant for more than a decade and a half. I also wish to acknowledge the

influences of Professor J. Z. Young and Dr. M. R. Matthews, who taught me to in-

quire, think, and persist; of Professor D. I. Graham, who unwittingly swayed me into

a career in neuropathology; and of Dr. I. D. Melville, whose humanity inspires me

still.—DAR

xi

Table of Contents

Dedication ... v

Preface ... vii

Acknowledgments ... ix

Companion CD ... xiii

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1 The “Complete Autopsy”: The Management of Risk ... 1

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2 Postmortem Changes: The “Great Pretenders” ... 23

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3 Asphyxia ... 65

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4 Thermal Injury ... 181

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5 Bodies Recovered From Water ... 243

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6 Penetrating Trauma: Close-Range Firearm Wounds ... 295

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7 Penetrating Trauma: Sharp Force Injuries ... 357

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8 Blunt Trauma: With Reference to Planes, Trains, and Automobiles ... 405

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9 Craniocerebral Trauma and Vertebrospinal Trauma ... 519

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10 Sudden Neurological Death... 607

Index ... 623

Companion CD

All figures appear in both color and black and white on the companion CD.

xiii