Some aspects of forensic medical expertise in determining the severity of health damage in cases of bone fractures in diabetes mellitus and osteoporosis



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Abstract

Background: Skeletal bone fractures are one of the most frequent consequences of mechanical trauma in forensic practice. Diabetes mellitus and osteoporosis affect microarchitectonics of bone tissue and lead to its mechanical failure. In forensic practice when solving expert questions on determination of type, mechanism of trauma, number of traumatic impacts and a number of others, it is necessary to take into account the presence of such diseases.

Aim: To study the strength characteristics of bones in diabetes mellitus and osteoporosis to develop methodological approaches for forensic expert evaluation of fractures in these diseases.

Methods: Modeling of fractures in osteoporosis and type 2 diabetes mellitus was performed on rats. 24 mongrel female rats with body weight of 155-160 grams were selected. The animals were distributed into 4 groups of 6 rats in each group. Group I consisted of intact animals. In group II, obesity and hyperglycemia characteristic of type 2 diabetes mellitus were artificially induced in rats. In Group III rats, posttraumatic osteoporosis phenomena were induced by successive osteotomies of the tibiae. Group IV animals underwent identical osteotomy against the background of obesity and hyperglycemia induced according to the scheme used in group II. 

Results:  In diabetes mellitus, bone becomes sensitive to bending and torsional strains. In osteoporosis, there is a greater decrease in bone strength and elasticity compared to the group with signs of diabetes mellitus. There is a defect in both the mineral component of bone tissue and the organic component. When diabetes and osteoporosis are combined, the most severe bone strength disorders are noted. 

Conclusion: The data obtained on animals characterizing the strength characteristics of bones in the presence of osteoporosis and diabetes mellitus can be extrapolated to humans and used as a motivated justification, allowing experts in the presence of systemic pathology accompanied by bone tissue damage, not to consider fractures as causing harm to health.

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About the authors

Sviatoslav Nikolaevich Zakharov

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia

Author for correspondence.
Email: zakharov.swyatoslaw@yandex.ru
ORCID iD: 0000-0003-0107-9649

Assistant professor of Institute of clinical medicine named after N.V. Sklifosovskii

Russian Federation

Nadezhda Aleksandrovna Mosyagina

Email: mosyaginan@bk.ru

Dmitrii Andreevich Astrakhantsev

Email: wholegore@gmail.com

Vladimir Nikolaevich Nikolenko

Email: nikolenko_v_n@staff.sechenov.ru

Yuri Ivanovich Pigolkin

Email: pigolkin_yu_i@staff.sechenov.ru

Galina Vyacheslavovna Zolotenkova

Email: zolotenkova_g_v@staff.sechenov.ru

Airat Anvarovich Khalikov

Email: airat.expert@mail.ru

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