Perimortem versus postmortem fractures: the usefulness of morphological observation using scanning electron microscope in forensic pathology

BACKGROUND: One of the most important evaluations in the forensic assessment of a trauma is the timing of the injuries in respect of the time of death, that is particularly difficult for bone fractures. The purpose of this study is the identification of morphologic markers of vitality that can be useful in the distinction between perimortem and postmortem fractures.METHODS: The ultrastructural morphology of the fracture edges was studied, using scanning electron microscope, on 20 fragments of fractures collected from the skull of individuals died from head traumas. Each sample was compared to postmortem fractures.RESULTS: The vital fractures, compared to postmortem ones, showed: pull-out of collagen fibers, as well as "bridges" formed by fibers; fibrin nets, in which erythrocytes and platelets are embedded; torn and ripped small vessels. All these differences were statistically significant.CONCLUSIONS: The results suggest that the distinction between perimortem and postmortem fractures is not unrealistic, and the scanning electron microscope can be a valuable tool in this task.