Forensic Pathology of Trauma - Common Problems for the Pathologist (Forensic Science and Medicine)

662 Pages·2006·15.86 MB·English

by  Michael J. Shkrum

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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, SERIES EDITOR
HERBAL PRODUCTS: TOXICOLOGY AND CLINICAL PHARMACOLOGY, SECOND EDITION,
edited by Richard L. Kingston and Timothy S. Tracy, 2007
CRIMINAL POISONING: INVESTIGATIONAL GUIDE FOR LAW ENFORCEMENT, TOXICOLOGISTS,
FORENSIC SCIENTISTS, AND ATTORNEYS, SECOND EDITION, by John H. Trestrail, III, 2007
FORENSIC PATHOLOGY OF TRAUMA: COMMON PROBLEMS FOR THE PATHOLOGIST,
by Michael J. Shkrum and David A. Ramsay, 2007
MARIJUANA AND THE CANNABINOIDS, edited by Mahmoud A. ElSohly, 2006
SUDDEN DEATHS IN CUSTODY, edited by Darrell L. Ross and Theodore C. Chan, 2006
THE FORENSIC LABORATORY HANDBOOK: PROCEDURES AND PRACTICE, edited by
Ashraf Mozayani and Carla Noziglia, 2006
DRUGS OF ABUSE: BODY FLUID TESTING, edited by Raphael C. Wong and Harley Y. Tse, 2005
A PHYSICIAN’S GUIDE TO CLINICAL FORENSIC MEDICINE: SECOND EDITION, edited by
Margaret M. Stark, 2005
FORENSIC MEDICINE OF THE LOWER EXTREMITY: HUMAN IDENTIFICATION AND TRAUMA
ANALYSIS OF THE THIGH, LEG, AND FOOT, by Jeremy Rich, Dorothy E. Dean,
and Robert H. Powers, 2005
FORENSIC AND CLINICAL APPLICATIONS OF SOLID PHASE EXTRACTION, by Michael J.Telepchak,
Thomas F. August, and Glynn Chaney, 2004
HANDBOOK OF DRUG INTERACTIONS: A CLINICAL AND FORENSIC GUIDE, edited by
Ashraf Mozayani and Lionel P. Raymon, 2004
DIETARY SUPPLEMENTS: TOXICOLOGY AND CLINICAL PHARMACOLOGY, edited by
Melanie Johns Cupp and Timothy S. Tracy, 2003
BUPRENOPHINE THERAPY OF OPIATE ADDICTION, edited by Pascal Kintz and Pierre Marquet,
2002
BENZODIAZEPINES AND GHB: DETECTION AND PHARMACOLOGY, edited by
Salvatore J. Salamone, 2002
ON-SITE DRUG TESTING, edited by Amanda J. Jenkins and Bruce A. Goldberger, 2001
BRAIN IMAGING IN SUBSTANCE ABUSE: RESEARCH, CLINICAL, AND FORENSIC APPLICATIONS,
edited by Marc J. Kaufman, 2001
TOXICOLOGY AND CLINICAL PHARMACOLOGY OF HERBAL PRODUCTS, edited by
MelanieJohns Cupp, 2000
CRIMINAL POISONING: INVESTIGATIONAL GUIDE FOR LAW ENFORCEMENT, TOXICOLOGISTS,
FORENSIC SCIENTISTS, AND ATTORNEYS, by John H. Trestrail, III, 2000
F P
ORENSIC ATHOLOGY
T
OF 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 ChB
Departments of Pathology and Clinical Neurological Sciences
London Health Sciences Centre
and The University of Western Ontario
London, Ontario
Canada
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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
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
v

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, MD
David A. Ramsay, MB ChB
vii
viii Preface
Reference
1. Moritz AR. Classical mistakes in forensic pathology. Am J Clin Pathol 26:1382–1397, 1956.
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
ix