Patients affected by cranial
trauma with
depressed skull fractures and increased intracranial pressure generally undergo neurosurgical intervention. Because
craniotomy and
craniectomy remove skull fragments and generate new fracture lines, they complicate forensic examination and sometimes prevent a clear identification of
skull fracture etiology. A 3-dimensional reconstruction based on preoperative computed tomography (CT) scans, giving a picture of the
injuries before surgical intervention, can help the forensic examiner in identifying
skull fracture origin and the means of production.We report the case of a 41-year-old-man presenting at the emergency department with a
depressed skull fracture at the vertex and bilateral
subdural hemorrhage. The patient underwent 2 neurosurgical interventions (
craniotomy and
craniectomy) but died after 40 days of hospitalization in an intensive care unit. At autopsy, the absence of various bone fragments did not allow us to establish if the skull had been stricken by a blunt object or had hit the ground with high kinetic energy. To analyze bone
injuries before
craniectomy, a 3-dimensional CT reconstruction based on preoperative scans was performed. A comparative analysis between autoptic and radiological data allowed us to differentiate surgical from traumatic
injuries. Moreover, based on the shape and size of the
depressed skull fracture (measured from the CT reformations), we inferred that the man had been stricken by a cylindric blunt object with a diameter of about 3 cm.