Wednesday, 10 August 2016

Breaking bones: identifying skeletal trauma resulting from fatal falls

Samantha Rowbotham is a PhD candidate in the Department of Forensic Medicine (DFM) and runner up in the recent three-minute thesis competition at SPHPM. Recently she completed her mid-candidature review and presented preliminary findings from her PhD on the skeletal blunt force trauma (BFT) resulting from falls at the Victorian Institute of Forensic Medicine (VIFM).

Samantha’s PhD research is investigating the skeletal fracture patterns and fracture morphologies that result from low (≤3m) and high (˃3m) height falls and falls involving stairs.

The research is anticipated to help forensic anthropologists better understand skeletal trauma fracture patterns. While there is extensive literature on soft tissue injuries and falls, there is a dearth of evidence regarding the skeletal BFT, mortality and falls. Falls are the 18th leading cause of death in Australia, yet there have been limited investigations into the skeletal trauma of the various types of fatal falls to date.

“There is a really diverse range of mechanisms that can produce BFT to the skeleton. Falling is one such mechanism and I’m interested in improving our understanding of the skeletal fracture patterns and fracture morphologies resulting from people who have died from three of the most common types of falls,” Samantha said.

Samantha’s PhD study design is novel to anthropological trauma research and introduces an approach that more suitably fits with current medico-legal requirements. Samantha is analysing and interpreting skeletal trauma using post-mortem computed tomography scans of 500 individuals who died from these three types of falls, and contextualising this trauma to detailed National Coronial Information System (NCIS) documentation (police reports, toxicology reports, pathology reports and the Coroner’s findings).

As part of her PhD, Samantha undertook a retrospective review of fatal falls in Victoria from 2005 to 2014. She found that there were 11 different types of falls in Victoria and that more than 50 per cent of the fatalities for falls from high heights, horses, ladders, low heights and stairs were directly attributable to the fall. Approximately 92 per cent of fall victims were elderly (61+ years) and in nearly 87 per cent of cases pre-existing conditions were recorded, including mental and/or physical impairment, emotional trauma, substance affected, or a combination of these.

Preliminary findings of the skeletal BFT resulting from Samantha’s study of low height falls revealed that 78 per cent of fall victims exhibited skeletal trauma and almost half of those cases (45 per cent) exhibited trauma to more than one area of the skeleton. Over 100 classifications of fractures were identified for low height free falls, with linear fractures being the most common fractures seen in the skull; odontoid fractures the most common fracture in the neck and transverse fractures the most common fracture in the rib cage.

“The findings also suggest that the higher the fall, the greater the increase in skull, neck and thoracic fractures, and so a pattern is beginning to emerge as to what sort of trauma is likely to be inflicted by a fall from a low height,” Samantha said.

“I’m hoping this research will assist forensic anthropologists with establishing the circumstances of death in cases where skeletal remains exhibiting BFT are recovered,” said Samantha.

She recently published two papers from her research in Forensic Science International and the Australian Journal of Forensic Sciences.

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