Vol 9, No 1 (2023)


Forensic medical characteristics of bone fractures of the hand

Indiaminov S.I., Shopulatov I.B.


BACKGROUND: The forensic medical aspects of closed bone fractures of the hands are important in connection with the need to establish the nature, mechanism of occurrence, severity, and duration of these injuries.

AIM: This study aimed to assess the severity of closed bone fractures of the hands based on the features of the formation, course, and outcomes.

MATERIAL AND METHODS: Fractures of wrist bones (n = 24) and metacarpal bones (n = 218) were examined in persons struck by blunt objects.

RESULTS: Scaphoid bone fractures (81.8%) most often occurred on the side of the carpals, and fractures of other carpal bones are detected relatively less frequently (18.2%). With closed fractures of the navicular bone, especially in cases of late seeking medical help, complications such as a false joint and aseptic necrosis can be observed, causing pronounced radiocarpal joint dysfunction. In the metacarpal bones, periarticular fractures of the proximal epiphysis (49.1%) are often noted, followed by intra-articular fractures (26.6%) and periarticular diaphyseal fractures (20.6%). Complications such as finger contractures in chronic metacarpal bone fractures were most observed in intra-articular, comminuted with mixed, and transverse fractures.

CONCLUSION: Isolated uncomplicated closed fractures of wrist bones have moderate severity. Moreover, scaphoid bone fractures, complicated by a false joint and aseptic necrosis, causing severe wrist joint dysfunction, and ultimately joint immobility in a functionally disadvantageous position, according to the criterion of total disability, qualify as severe injury. The severity of the harm caused to the health of complicated and uncomplicated isolated metacarpal fractures can be classified as moderate.

Russian Journal of Forensic Medicine. 2023;9(1):5-17
pages 5-17 views

Morphological changes in the testes of white rats and humans in acute and chronic alcoholic intoxications: Experimental and sectional study

Babanin A.A., Ulanov V.S.


BACKGROUND: This study analyzed the effects of ethyl alcohol and narcotic drugs on male reproductive organs. Practically no studies have examined morphological transformations in the testicles during alcohol intoxication, which, at the current level of ethanol consumption by men of reproductive age, is a social and medical problem that is far from being solved.

AIM: Through short-term and long-term experiments, this study aimed to examine the severity and dynamics of morphological changes in the gonads during alcohol intoxication in mature rats and in comparison with those in individuals who died from alcoholic disease and severe alcohol catamnesis.

MATERIAL AND METHODS: The study examined the testicles of sexually mature rats that were subjected to acute and chronic alcohol intoxications (from 2 weeks to 6 months) and testicles of persons who died in which ethyl alcohol was found in the blood (at least 5 promile) and alcohol catamnesis were noted.

RESULTS: In both experimental and sectional materials, the stroma of the testicles was characterized by severe circulatory disorders with plethora and stasis in post-capillaries and small veins, edema, and perivascular and interstitial sclerosis. The inhibition of spermatogenesis in the sectional material was more pronounced, which indicated that alcohol was the main etiopathological factor in these changes.

CONCLUSION: Chronic alcohol intoxication in both rats and men has damaging effects both directly, with changes in the stroma and testicular parenchyma, and indirectly on the overlying links of the reproductive system (hypothalamus and pituitary gland). The neurotoxic, microangiopathic, and disenergetic effects of ethanol inhibit normal spermatogenesis. Ultimately, the negative effect based on the morphological analysis was observed in the hypotesticular conditions and morphological manifestations of the testicular wasting syndrome.

Russian Journal of Forensic Medicine. 2023;9(1):19-27
pages 19-27 views

Leading causes of death in older people and old age according to medical certificates of death in Moscow

Kakorina E.P., Samorodskaya I.V., Cherniavskaia T.K.


BACKGROUND: The proportion of older people is increasing worldwide. Leading causes of death must be understood for the organization of medical and social care.

AIM: This study aimed to identify and discuss the leading causes of death in older people and old age based on data from medical death certificates.

MATERIAL AND METHODS: From the electronic database of the Main Department of the Civil Registry Office of the Moscow Region (the system of the Unified State Register of Civil Status Records), all cases in which diseases were indicated as the initial cause of death (all codes of external causes, injuries, and poisoning were excluded) were selected. From a total of 109,126 deceased individuals, 90,269 (82.7%) were ≥60 years old. Eighteen groups of initial causes of death were made (95.2% of deaths from diseases); 40,442 (44.8%) medical death certificates were issued by the Bureau of Forensic Medicine.

RESULTS: Five leading causes of death were COVID-19 (24.2%), pathologies associated with cognitive impairment and dementia (21.15%; aged 60–69 years, 6.02%; aged ≥100 years, 63.5%), chronic ischemic heart disease (18.6%), malignant neoplasms (10.7%; aged 60–69 years, 16.7%; aged ≥100 years, 1.46%), and acute cerebrovascular accident (6.2%). The contribution of causes such as acute forms of coronary artery disease, stroke, hypertension, diabetes mellitus, COVID-19, and others is low in older people. Only 30% of the medical death certificates have their part II completed. The probability of filling out part II of the medical death certificate is influenced by age, place of death, place of issuance of the medical death certificates (in the Bureau of Forensic Medicine less than in other medical organizations), and teaching staff. With age, the proportion of MCAs issued by the Bureau of Forensic Medicine is increasing. Medical death certificates often use codes that are not analogous to clinical diagnoses.

CONCLUSION: The contribution of individual causes (and groups of causes) of death changes with age. For a better understanding of the leading causes of death, a multidisciplinary consensus is needed in determining the criteria and validity of the use of the International Statistical Classification of Diseases and Health-Related Problems, Tenth revision, codes.

Russian Journal of Forensic Medicine. 2023;9(1):29-40
pages 29-40 views

Diabetic coma in the mortality of patients with diabetes mellitus

Akimov P.A., Barinov E.K., Terekhina N.A.


BACKGROUND: Statistics on the causes of death of patients with diabetes mellitus do not correspond to real indicators because of the insufficient level of diagnosis at the post-mortem stage of research in most regions of the country.

AIM: This study aimed to statistically analyze the mortality of patients with diabetes as a result of diabetic coma in the period from 2017 to 2020.

MATERIALS AND METHODS: The study examined blood and vitreous body of the eyes from 4444 patients with diabetes mellitus. The levels of glycohemoglobin in the blood and glucose, lactate, and acetoacetate in the vitreous body of the eyes were determined. The diagnosis of diabetic coma was made taking into account previously developed criteria.

RESULTS: A total of 692 (15.6%) patients with diabetes mellitus died of diabetic coma. Diabetic coma-related deaths occupy a much larger percentage of cases than is available in statistical data because of the insufficient implementation of laboratory tests at the post-mortem stage of diagnosis and restricted coding of the cause of diabetic coma-related death of patients with diabetes mellitus. Methods for diagnosing diabetic comas are easy to perform, guarantee high accuracy and reliability of results, and are available for any specialized laboratory.

CONCLUSION: The most common precomatous state (the beginning of the development of hyperosmolar non-ketoacidotic coma), which in combination with coma itself, leads to the highest rates of diabetic coma-related death. In recent years, diabetic coma-related death tended to reduce.

Russian Journal of Forensic Medicine. 2023;9(1):41-48
pages 41-48 views


Features of damage to the ribs by a blade with a defective tip

Gurov V.D., Klevno V.A.


Stab wounds are a common injury in the practice of a forensic pathologist. Such damage often occurs in domestic conditions, for example, in the kitchen during a quarrel, where knives are always at hand. The young, able-bodied portions of the population are frequent victims, which makes the problem socially significant.

Knives that have been used for a long time are rarely in perfect condition; operational defects occur on them. For example, repeated sharpening results in the rounding of the tip of the blade. Moreover, during operation, the tip of the blade can bend or even break off. However, before studying the effects of such blades on flat bones, studying the history of this issue, to familiarize with the work of other scientists, is necessary.

In the literature review, authors of studies on stab-cut injuries focused more on damage to the skin and clothing. Morphological features of skeletal bone injuries and the possibility of identification studies on them until the XXI century were described poorly.

To improve the forensic medical diagnosis of rib injuries caused by blades with point defects based on the study of a complex of morphological features, experimental studies on cadaveric materials are necessary.

Russian Journal of Forensic Medicine. 2023;9(1):49-56
pages 49-56 views


Cavernous sinus thrombosis as a cause of fatal outcomes in forensic medical practice

Muzikin M.I., Ilyasov D.M., Iordanishvili A.K., Barinov E.K.


Cavernous sinus thrombosis is a life-threatening condition resulting from a blockage of the cavernous sinus by a blood clot. This pathology occurs extremely rarely but is a danger to life at any age. Information about deaths from cavernous sinus thrombosis is limited and unclear in the special forensic medical literature.

This study analyzed the results of the forensic medical examination of the corpse of a 35-year-old woman. This work outlines all stages of treatment and observation of the patient. Disease development and progression, which eventually led to a fatal outcome, were described in stages.

The research and results were able to confirm the cause of death. Cavernous sinus thrombosis and other cerebral sinus thrombosis, as a complication of the main, timely undiagnosed, and untreated disease, is a significant problem even in modern multidisciplinary medical institutions and often causes deaths in clinical practice.

Russian Journal of Forensic Medicine. 2023;9(1):57-68
pages 57-68 views

Death from the introduction of Ceftriaxone in the presence of Lidocaine (case report)

Travenko E.N., Porodenko V.A., Surikova A.V.


In clinical and expert practice, pathological processes such as toxic reactions and anaphylaxis may develop following the introduction of the local anesthetic lidocaine; however, information about the death of children is limited and scattered. The morphological signs of these cases are non-specific, which leads to difficulty in interpreting the results of the study and determining the causes of death.

This report described the death of a child following intramuscular administration of ceftriaxone in a 2% lidocaine solution. The results of the primary and commission examination of the corpse and data of repeated pathohistological examinations of a 2-year-old child are presented. The objective expert conclusion about the cause of death following the intramuscular administration of ceftriaxone in a 2% lidocaine solution was toxic effects (overdose) or anaphylactic shock, which requires assessing the sequence of the event and nature of the clinical picture, taking into account the route of drug administration, comprehensive pathohistological and morphological studies, and mandatory forensic chemical determination of the concentration of these drugs in the internal organs and blood.

Morphological signs of an allergic reaction can be verified based on pathomorphological data, including changes in the target organs of anaphylaxis and pronounced hemocirculatory disorders. In our opinion, further in-depth study and systematization of available data are needed.

Russian Journal of Forensic Medicine. 2023;9(1):69-78
pages 69-78 views

Blind penetrating wound of the skull by a nail

Mechukaev A.A., Sarakaeva A.Z.


When investigating various crimes, suicides, and accidents, the question of the capabilities of the human body to preserve vital functions in the presence of an injury may be important. Of particular difficulty is the issue whether a person could perform independent actions despite having a severe brain injury. Thus, the accumulation of practical expert and clinical observations characterizing the body’s capability to perform active targeted actions despite the presence of fatal wounds in various organs is of considerable practical interest.

This study described the morphological features of damage to head structures in a patient hit by a building fastener (a metal nail, 15 cm long) into the cranial cavity. The morphological changes in the anatomical structures along the wound channel had typical features: perforated fractures of the skull with a cone-shaped expanding defect of the inner walls of the perforated fracture. Brain structures were damaged along the wound channel. The stab wound was blind. The possibility of performing complex independent actions in the case of fatal brain damage is possible only with a comprehensive assessment of forensic medical examination data of the corpse and case materials.

Russian Journal of Forensic Medicine. 2023;9(1):79-85
pages 79-85 views

Forensic medical examination in the case of suspicion of inappropriate provision of toxicological care (a case from practice)

Kuznetsov S.V., Reinuk V.L., Litvincev B.S., Molin Y.A., Yatsenko D.S., Kuznetsova A.A.


As an example of practical observation, the basic principles of the forensic medical assessment of the therapeutic and diagnostic processes are demonstrated in the case of suspicion of improper provision of toxicological care in the case of ethylene glycol poisoning. This study highlighted the factors hindering the provision of toxicological care and its forensic assessment.

Factors such as the lack of information from eyewitnesses or the patient himself about the oral intake of a liquid with potentially toxic properties and the possibility of reliably establishing the presence of ethylene glycol in the body only by chemical and toxicological examination can hinder toxicological care and its forensic assessment. Toxicological care, including antidote therapy with ethanol, can and should be used only if there is reliable information or if there is a sufficient possibility of assuming poisoning with ethylene glycol. Owing to the instability of hemodynamic parameters, which are inevitable with oral poisoning with ethylene glycol, the risk of natural complications during the transportation of the patient is obviously higher than when he is left in a specialized hospital with high-tech equipment and round-the-clock supervision.

Cases of ethylene glycol poisoning, in which treatment does not bring improvements to the patient or at least stability of dynamics, do not automatically indicate that the medical care provided was inappropriate (incorrect). In acute oral poisoning with ethylene glycol, even proper medical care does not guarantee the prevention of a fatal outcome.

Russian Journal of Forensic Medicine. 2023;9(1):87-93
pages 87-93 views


An essay on the history of forensic medicine of the Yenisei province to the 200th anniversary of its formation

Karachev A.Y., Karacheva Y.V.


In July 1822, by the corresponding decree of the Emperor, the Yenisei Province was formed as part of five districts, and Krasnoyarsk was approved as the administrative center.

According to the Revision of the Medical and Sanitary Law of September 07, 1913, five positions of county doctors were established in the Yenisei Province, which are entrusted with the performance of forensic and medical and police duties. However, women were not allowed to perform these duties.

The atmosphere of professional relationships and issues of providing material, and scientific and informational content were revealed. From the article, we identified the persons who represented forensic medicine in the course of legal proceedings. Attention was drawn to the respectful attitude toward them and the high status of the civil service rank.

Archival documents allowed us to compare the nature and completeness of the research conducted with modern requirements for expert documentation. The article contains photocopies of the original documents. The authors of the article provide an overview of the history of forensic medicine of the Yenisei Province based on the study and analysis of documents preserved in the State Archive of the Krasnoyarsk Region.

Russian Journal of Forensic Medicine. 2023;9(1):95-106
pages 95-106 views


Formulation of forensic and pathoanatomical diagnoses, selection, and coding of causes of death according to ICD-10, edited by Professor V.A. Klevno and Professor O.V. Zairat’yants

Chochlov V.V.


The article analyzed the book “Rules for the formulation of forensic and pathoanatomical diagnoses, selection, and coding of causes of death according to ICD-10,” edited by Doctor of Medical Sciences, Professor Vladimir Aleksandrovich Klevno and Doctor of Medical Sciences, Professor Oleg Vadimovich Zayratyants.

The review aimed to provide an objective assessment of the information presented in a scientific publication and determine their value for science and practice.

The authors note that this publication is essentially a national guide for doctors in the Russian Federation on the formulation of forensic and pathoanatomical diagnoses, choice and coding of causes of death in accordance with the requirements of the 10th revision of the International Classification of Diseases (ICD-10), and issuance of a medical death certificate to improve statistics on population mortality. The authors noted that the manual contains unified rules for the formulation of forensic and pathoanatomical diagnoses, selection and coding of causes of death, registration of the medical death certificate in accordance with the provision of the Federal Law of November 21, 2011, No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation,” requirements of ICD-10, and orders and guidelines of the Ministry of Health of Russia, and clinical and guidelines of the Russian Society of Pathologists and the Association of Forensic Experts.

With absolute certainty, the book will retain its practical significance for a long time. It complies with all regulatory requirements, significantly simplifies the work of a doctor, and may well become a reference book for a practicing specialist.

Russian Journal of Forensic Medicine. 2023;9(1):107-111
pages 107-111 views

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