Scene–autopsy integration in fatal tractor-related compression: two cases with unequal evidentiary completeness

Fatal tractor incidents involve blunt polytrauma or traumatic asphyxia; these mechanisms are well described, but the consequences of incomplete scene documentation are less often demonstrated. We compare two medicolegal deaths from southern Italy. In Case 1, a 31-year-old worker was found near a tractor on a rural road without a judicial scene examination. Autopsy showed atlanto-occipital dislocation, left atrial laceration, extensive thoracic fractures and T6–T9 spinal injury. These findings established fatal high-energy compression but did not permit definitive reconstruction of the vehicle dynamics or roll-over protective structure status. In Case 2, a 63-year-old operator was documented beneath a laterally overturned tractor by scene inspection and drone imaging. The body–vehicle relationship, ecchymotic mask, pulmonary congestion and oedema, and C1–C2 dislocation supported traumatic asphyxia from sustained crushing. Severe chronic coronary disease showed no acute thrombosis or morphologically demonstrable infarction and was considered contributory; transient arrhythmia could not be excluded morphologically. The cases show that autopsy can establish injury mechanism and cause of death, whereas scene–autopsy integration is required for dynamic reconstruction and assessment of safety-device compliance. A structured protocol should include scene documentation, body–vehicle correlation, posterior cervical dissection, cardiac examination, toxicology and explicit reporting of residual uncertainty.