Patterns of Torture and Terrorism

Physical beating is a widespread form of torture (56). Palmatoria is a form of localized torture virtually unique to the small West African country Guinea-Bissau. Palmatoria involve repetitive blows by a slender rod to the shin, where the tibia lies closest beneath the skin. Ordinary radiographs (of somewhat limited quality) have shown a periosteal reaction, presumably as a result of subperiosteal hemorrhage and hematoma. Somewhat peculiar endosteal and medullary changes have also been seen (Fig. 71). Recent case reports in the United States and France (57,58) have shown that this specific injury can produce a hidden endosteal fracture that is likely to be undetected on plain films but becomes obvious on a CT scan (Figs. 72, 73). It seems possible (perhaps likely) that some of the cases that took place in Guinea-Bissau would show similar findings when more sophisticated imaging modalities were used.

Falaca is a form of torture characterized by beating the foot, primarily the sole of the foot (56). This is a widespread form of torture in the Middle East, especially in Turkey and Iraq, as well as in Asia and in some Spanish-speaking areas (where it is called bastinado). Substantial injuries can be produced by this form of torture, including edema, hematoma, fractures, and injuries to ligaments, tendons, fascia, and aponeuroses. The clinical findings are usually diagnostic if they are made immediately after such torture. Radiography can confirm or exclude fractures and allows the investigator to estimate the extent of soft tissue injury and the time interval since torture. Early nuclear medicine studies show a massive increased uptake in the affected areas. Later radiographic studies demonstrate bone and soft tissue injury and evidence of subsequent healing (Figs. 74-76).

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Fig. 22. Focal deposits of compact bone in a knee. Diagnostic of osteopoikilosis.

5.3.1. Knee Capping

The punitive destruction of a major joint by gunshot wound was originally thought to be the signature injury of certain criminal elements in the United States. More recently, it has been seen as an act of terrorism in other parts of the world, especially

Fig. 23. Neurogenic destruction in the ankle and hindfoot of a 7-yr-old female with congenital insensitivity to pain. Reprinted from Brogdon BG, Vogel H, McDowell JD, eds. A radiologic atlas of abuse, torture, terrorism, and inflicted trauma (2003) with permission from CRC Press.

Northern Ireland (59). The punishment is not limited to the knee; other major joints have also been targeted (Figs. 77-80).

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