Internal Examination 61 Skeletal and Cartilaginous Injuries

Bone and cartilaginous injuries are seen in homicides and suicides (6,106). Costal and sternal injuries were seen less frequently in homicides involving children (23). Chest wall injuries are more likely when multiple skin wounds are evident ( 106). The anatomic site of bone/cartilaginous wounds usually corresponds to the site of injuries responsible for death (106). In one study, laryngeal cartilage trauma occurred in cases of homicide and suicide,

Fig. 30. Recent self-inflicted wrist incisions. Suicidal shotgun wound of chest.
Fig. 31. Healed wrist incisions. Found dead in bathtub (pronounced wrinkling of hand resulting from water immersion). Diphenhydramine overdose.
Fig. 32. Schizophrenic. Self-inflicted head wounds from insertion of fork. Eye gouged and vertex of cranium penetrated causing subdural hemorrhage. The latter act bent the fork.

but injuries of the ribs, vertebrae, and skull were limited to homicides (see Subheading 6.2. and refs. 23 and 106). Injured ribs and sternal bone penetration/transection are possible in suicides (Fig. 19). Sternal transection has been described in severely mentally ill individuals (6). Rib and sternal wounds may have associated intercostal or internal mammary artery injuries (see Chapter 8, Subheading 6.1. and refs. 38, 73, and 107).

Tool classification is possible in the assessment of knife wounds involving rib cartilage (108). The consequent striations may have only general class characteristics, but small imperfections in the knife can produce individual marking patterns (108,109). These striations can be matched with the cutting edge of the knife using specialized techniques (109). Bone and cartilage from the injury site can excised and retained in formalin fixative (109).

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