Forensic assessment of blunt thoracic trauma - correlations between pattern of injuries and trauma dynamics

The forensic pathologist often has to assess - solely based on the traumatic injuries - the mechanism and circumstances of trauma. We have reviewed 747 cases with blunt thoracic trauma, focusing on the aspect, presence and particularities of traumatic injuries noted, in relation to the circumstances of their occurrence. The parameters analyzed included the number and localization of rib fractures, the presence of first and second rib fractures, and the presence of pulmonary contusions and cardio-vascular injuries. We have ascertained a correlation between the parameters listed above and the circumstances of injury (assault, motor vehicle accident and fall from height). The presence of more than 3 consecutive rib fractures, double or multiple fractures of the same rib, first and second rib fractures, pulmonary contusions and cardiac or great vessels injury were indicators to exclude an assault. The association of aortic injuries with cardiac contusion or rupture was indicator for the possibility of motor vehicle accident (driver/occupant). Pulmonary artery injuries were found to be indicative for falls from height. From a purely statistical point of view the traumatic pattern can be used for deducting the circumstances of injury, but a global assessment of injuries and corroboration with evidence from the scene and any anamnesis data available is advised in particular cases.