A n t h r o p o l o g y ; P a t h o l o g y / B i o l o g y

Cranial vault fractures are of medicolegal interest as they have long-term impacts to someone's health and may contribute to an individual's death. The ability to distinguish antemortem from perimortem fractures and to assess the age of the injury is increasingly dependent on histology. Despite the increasing role of histology in assessing the microanatomy of osseous fractures, there are no methods currently available which account for the nuances and difficulties in creating high-quality histologic slides of cranial vault fractures that allow visualization of cellular features associated with healing bone. The authors present a modified method specific to slide development of human cranial vault fractures derived from the trial-and-error process of creating 730 such slides over a 3-year period which are suitable for the evaluation of the tissues, cells, and nuclei involved in fracture healing. This method adapts and troubleshoots typical histological procedures including sample excision, fixation, decalcification, dehydrating, clearing, embedding, microtomy, and staining, and introduces new procedures including preprocessing photography and cassette placement.By implementing these modifications, the number of poor-quality slides that required a new section to be sent to the histology laboratory was greatly reduced. Proactively implementing this new method into cranial fracture histologic slide development significantly reduces the number of slide rejections due to common issues like folding, chatter, or insufficient staining, saving both time and financial resources for forensic practitioners, researchers, and histotechnologists.

This report describes the differential diagnosis of osseous growths in the first metatarsals of an adult male previously unreported in the literature. Examination of the remains via macroscopic analysis and conventional radiography identified unusual bilateral growths arising from the lateral aspects of the first metatarsals with growth directed towards the tarsometatarsal joint. Two exostoses in the ribs were also observed. Using the available evidence, hereditary multiple osteochondromas (HMO) was determined the likely causative disorder for the pedal growths based on the presence of cartilage caps on the ends of the growths, a lack of articular morphology, and the presence of a rib exostosis consistent with HMO. The potential bilateral expression of HMO in the first metatarsals in this case challenges the dominating diagnostic criteria that HMO growths are directed away from the growth plate and only occur in the metaphysis, expanding the spectrum of HMO’s manifestation in the human skeleton. Medical records for the decedent provided no indication of a disorder associated with the development of osteochondromas, nor any indication that medical treatment was undertaken to manage the growths.

No abstract

This case report presents an unusual fracture pattern in the cranium of a four‐month‐old infant indicative of child abuse. Upon postmortem examination, the infant presented with numerous bilateral linear cranial fractures running perpendicular to the sagittal suture with depressed and curvilinear fractures apparent on the supra‐auricular surfaces of the cranium. Histological evidence indicates multiple traumatic events to the cranium. In addition, the stair‐step pattern of a parietal fracture may represent multiple contiguous fractures from repeated loading of the head at different times with variation of the focal points of compressive force. Additionally, the left humerus, left radius, and left ulna have healing metaphyseal fractures, and the left ulna also has an antemortem diaphyseal fracture which resulted in the distal metaphysis being rotated 45 degrees medially. Integration of autopsy, anthropological, and neuropathological reports for this case suggest multiple inflicted injury episodes with a repeated atypical mechanism(s) to the cranial vault of the infant. During investigative interviews, the caretaker admitted to squeezing the infant's head and neck on multiple occasions to quiet the child. This reported abusive mechanism is consistent with the pattern of symmetric cranial fractures and soft tissue injuries indicating asphyxiation. This case report provides forensic investigators with a potential trauma mechanism to explore in cases when a similar pattern of cranial trauma is observed and highlights the need for greater research on fracture propagation and fracture healing in the infant cranium.