A comparative study of cranial, blunt trauma fractures as seen at medicolegal autopsy and by Computed Tomography

The autopsy fracture diagnosis was compared to the diagnosis of two CT readings (reconstructed with Multiplanar and Maximum Intensity Projection reconstructions) by registering the fractures on schematic drawings. The extent of the fractures was quantified by merging 3-dimensional datasets from both the autopsy as input by 3D digitizer tracing and CT scan.The results showed a good diagnostic agreement regarding fractures localised in the posterior fossa, while the fracture diagnosis in the medial and anterior fossa was difficult at the first CT scan reading. The fracture diagnosis improved during the second CT scan reading. Thus using two different CT reconstructions improved diagnosis in the medial fossa and at the impact points in the cranial vault. However, fracture diagnosis in the anterior and medial fossa and of hairline fractures in general still remained difficult.The study showed that the forensically important fracture systems to a large extent were diagnosed on CT images using Multiplanar and Maximum Intensity Projection reconstructions. Difficulties remained in the minute diagnosis of hairline fractures. These inconsistencies need to be resolved in order to use CT scan data of victims for individual head modelling and trauma analysis.Computed tomography (CT) scanning of bodies prior to medico legal autopsy has become a powerful tool in several forensic institutes throughout the world [1-3]. Indeed, there may be a number of advantages to performing a CT scan before a medico legal autopsy. In forensic pathology as well as in clinical settings the investigation of head trauma is based on a combined analysis of the present external lesions, cranial fractures and intracranial lesions. The scans of the head are suitable to visualize lesions of especially bone, but also some soft tissue and most cerebral pathologic changes or lesions [4]. Fractures, intracranial haemorrhages and hematomas can be demonstrated either 2- and 3-dimensionally, providing a general ov