An anthropological conundrum

I. AN ANTHROPOLOGICAL CONUNDRUM S UE B LACK, J. S MYTH, ALASTAIR B ENTLEY, CAROLINE E ROLIN, AND P. RANDOLPH-QUINNEY

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n the late winter of 2007, a 92-year-old man (MFB) was found dead in the rear bedroom of his bungalow. He had reportedly last been seen alive that morning. Police found no evidence of forced entry or of theft, nor any of the weapon(s) that had been used by whomever committed the crime. He was lying face down in a large pool of his own blood with a section of the left frontal lobe of his brain on the floor beside him. While the injuries to the soft tissue of his face were not insubstantial, the injuries to the bone were much more devastating than originally conceived. A forensic anthropologist had not been involved in the original postmortem examination and the postmortem images came for anthropological assessment some seven months later when it was clear that an obvious solution to the cause of the trauma (skeletal and soft tissue) was not forthcoming. Unfortunately, the body had been released for burial, and while the calotte had been retained, cleaned, and reconstructed, the remainder of the skull had been interred with the rest of the remains. Much of the analysis, therefore, had to be undertaken based on postmortem images and discussions with the pathologist and the police. Radiographs had been taken, but they did not confer any additional information. This case study will demonstrate that even given a limited amount of bone, a few photographs, and associated radiographs, a forensic anthropologist can describe evidence otherwise not collected. However, this case provides a prime example of the limitations imposed when the anthropologist is not involved from the very beginning: the very best one might be able to contribute is description, rather than an interpretation based on the descriptors. FORENSIC EXAMINATION When fresh and still fleshed, the remains were autopsied. The preliminary external examination revealed the following facts that are relevant to the analysis of the skeletal injuries presented: 399

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• Blood seeping from left ear. • Two faint red abrasions, each about 2mm in diameter on the left side of the forehead 8cm to the left of the anterior midline and 5cm superior to the glabella. • A red abrasion (2.5×1.5cm) on the left side of the forehead, 6cm to the left of the anterior midline and 4cm superior to the glabella. • A red abrasion (0.8×1cm) on the right side of the forehead, 3.5cm to the right of the anterior midline and 5.5cm superior to the glabella. • Purple bruising to the upper left eyelid. • Purple-blue peri-orbital haematoma around the right eye. • An oblique cut (7.4cm in length) extending from the medial end of the left supraorbital ridge to the prominence of the left cheek (around the inner canthus of the left eye). Fishtailing was present at the upper end of the cut with seven stellate punctuate abrasions forming two interrupted curves. • Comminuted fracture of the left nasal bone. The autopsy of the musculoskeletal system and internal organs revealed the following (other non-related features were recorded but are not relayed in this communication): • Tearing of the rhomboid major and minor muscles on the right side. • Extensive bruising across the occipital, frontal, and superior aspects of the inner surface of the scalp. • Extensive comminuted fracturing of the calvarium, most obvious in the parieto-occipital region, but extending to both lateral aspects of the skull. • Gaping fracture extending from the inferior border of the left zygomatic bone extending vertically between the nose and orbit and then vertically through the frontal bone, just left of the midline, into the area of comminution in the parieto-occipital region. Comminuted fracturing of the right supra-orbital ridge and adjacent area of the frontal bone. • Ragged deep sagittal fracture of the base of the skull to the left of the midline passing to the left of the hypophyseal fossa and extending to the junction with the petrous part of the left temporal bone. • Comminuted (ring) fracturing around the foramen magnum. • Extrusion of the left frontal lobe of the brain. • Bilateral comminuted fracturing of the maxilla and comminuted fracturing of the left nasal bone and medial part of the left orbital margin. • Transverse fracture through the upper part of the body of the sternum at the level of the second intercostal space. • Anterolateral fractures of the fourth to eighth ribs on the right side, with no obvious associated bruising.

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The neuropathologist’s report revealed: • Detached region of left frontal lobe measured 6×5cm. • Posterior section of this detached portion showed a fairly clean cleavage plane. • Little underlying neurodegenerative disease. • No well defined haemorrhagic tract. • No evidence of an acute stroke. In summary, the pathologist’s findings were as follows: • Toxicological analysis was negative for alcohol and common drugs. • Death due to severe head injury had resulted in extensive fracturing of almost all major bones of the skull. • There was a “tear” in the skin overlying a gaping fracture to the left side of the nose through which a sizeable portion of the left frontal lobe of the brain had been expelled. • The extent of the fracturing of the skull and facial bones strongly suggested more than one forceful impact; however, there was a small number of relatively minor injuries to the scalp, which was surprising. These gave no clear indication as to how the extensive fracturing was sustained. • The distribution of blood at the locus indicated that the head injury must have occurred within the room in which the deceased was found. There was nothing at the death scene to offer a plausible explanation as to how such a severe head injury could have been sustained as a consequence of an accident, and the medical examiner concluded that MFB was the victim of a fatal assault via a weapon or weapons unknown. • The nature and pattern of the injuries suggested multiple impacts, one of which was likely to have been a blow delivered by a weapon/implement to the left side of the face between the eye and nose. The other injuries were likely due to blunt force trauma but there were no appreciable marks on the skin to help to ascertain how they had been sustained. ANTHROPOLOGICAL ASSESSMENT The calvarial portion of the skull (Figure I-1) and an area associated with the left orbit, maxilla, and nasal region (Figure I-2) were the only skeletal material retained and transferred to the anthropologist for examination, although supplemental information was available from the postmortem photographs and radiographs. Figures I-1 and I-2 show the reconstruction of the skull with anatomical realignment of the skull fragments. These cannot be directly compared with the appearance of the skull at the time of the postmortem when the fragments were in a slightly different alignment. Due to

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Figure I-1. Retained, cleaned, and reconstructed calotte.

Figure I-2. Retained, cleaned, and reconstructed facial elements.

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the sensitivity of this case, we cannot show the original postmortem images, but the subsequent illustrations (Figures I-3–I-8) are representations from the postmortem images and therefore show the more realistic alignment of the fragments. The images make clear that several episodes of trauma had occurred to the skull, and one of the first processes to be carried out was a sequential analysis of individual injuries in an attempt to predict the number of events and the order of their occurrence. The extensive fragmentation of the skull further complicated the interpretation of the injury patterns as a shattered skull behaves differently from one that is intact. Each sequential impact must be analyzed with the pre-existing level of fragmentation borne in mind. At least five identifiable impacts or traumatic events were proposed, and a tentative sequential progression was suggested. The external soft tissue trauma was of limited assistance in the interpretation of the skeletal traumatic events.

Trauma 1 This designation pertains to a circumferential fracture that translates around the skull running continuously from the left temporofrontal region, around the area superior to the external occipital protuberance, to a roughly equivalent position on the right temporofrontal region. This fracture is represented as line “1” in Figure I-3. The sides of the fracture were relatively straight edged and the absence of bevelling supported a possible propagative nature to the fracture. Four possible impact sites were identified along the trajectory of this fracture. These have been labelled as A, B, C, and D on Figure I-3 as passing from the left to the right respectively. The approximate distance between A and B is 18mm and between C and D is approximately 12mm. The approximate distance between A and C is 67mm and between B and D is 61mm. This suggests the possibility of a double impact trauma from the same double-pointed implement. The presence of internal bevelling at contact point B indicates that the implement did penetrate both diploic tables at this point only. This fracture line has been identified as the first to occur and (due to its inhibitory nature on the propagation of other fractures) passes through what is generally regarded as the thickest region of the skull and must have resulted from a trauma(s) of significant impact. It is possible that the full extent of propagation of the fracture did not occur until the second event, but it unquestionably predated the next traumatic event. The fracture dissipates anteriorly both on the right and left sides in the temporofrontal regions (Figures I-4 and I-5), confirming that the majority of the blunt force was applied to the back of the skull. This trauma coincided with some bleeding that was visible into the soft tissues of the occipital region of the scalp.

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Figure I-3. Fracturing of frontal, parietal, and occipital regions. Skull fragments are indicated by the encircled numbers while fracture lines are indicated by the simple numbers. Possible impact points are labelled as A–D and are somewhat exaggerated for the purposes of this illustration.

Trauma 2 The soft tissue damage to the face was fully documented in the pathology report (Figure I-6). It is highly likely that this impact opened up the fracture line labelled “2” in Figure I-3 and the vertical fracture line that passes through the roof of the left orbit and orbital plate of the frontal bone before passing to the left of the hypophyseal fossa and terminating towards the region of the left petrous temporal bone (Figure I-7). The vault aspect of this fracture traverses a relatively para-sagittal course from the frontal to the occipital bone where it intercepts with fracture line number ‘1’ and is halted at the location of fragment D. Therefore fracture “1” most likely predates fracture “2.” All other fractures that subsequently cross the para-sagittal fracture do so in a stepped format (fractures 3, 5, and 6) and thus we surmise that they may have occurred after fracture number “2.” It is not unusual for an upper face fracture to propagate through the region of the orbit and be transferred to the skull base. Although MFB was an elderly male, his bones were not overly thinned or osteoporotic but were of a healthy density given his age. The force to cause such a fracture would most likely have been substantial and may correspond

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Figure I-4. Left lateral view of the vault region.

with the trauma visible to the front of his face. The nature of the soft tissue damage to the front of the face is outside the remit of the forensic anthropologist and is discussed in the pathologist’s report.

Trauma 3 This third set of defects is likely to have occurred prior to the fourth event although the temporal alignment is less certain than for the previous two events. The postmortem photograph showed significant comminuted fracturing around the base of the skull, which is very similar to a ring-type fracture associated with the perimeter of the foramen magnum (Figure I-7). This type of fracture is often caused by high-impact trauma e.g., falling from a height onto the feet or some other form of significant impact, which is of sufficient force to drive the C1 vertebra up into the foramen magnum causing circumferential fracturing (see Chapter 8, this volume). These scenarios were difficult to accept given the location of the deceased and evidence from the scene of the crime. The bungalow contained no great interior heights from which the victim could have fallen.

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Figure I-5. Right lateral view of the vault region.

However, in an attempt to explain this fracture patterning, several other indicators of trauma needed to be considered. MFB displayed tearing to the rhomboid muscles (major and minor) on the right side of his back. These muscles act as connectors between the scapula and the neural arches of the lower cervical and upper thoracic vertebrae. Injury to these muscles generally arises from excessive movement of the upper limb causing them to tear off of their vertebral attachments. A fracture was present across the body of the sternum and also through right ribs 4–8. It is highly unlikely that MFB either fell from a great height either onto his head or onto his feet, but this does not preclude an impact trauma that would have been sufficient to drive his vertebral column upwards into the base of the occipital bone. A mattress was propped up against one wall. It is possible that the victim was swung by his right arm (thereby ripping the rhomboids) and collided, crown first, with the mattress on the wall. This would have cushioned the actual impact point of his skull, but the momentum of the rest of his body could have been transferred up his vertebral column and into the occipital bone, thus manifesting as a comminuted, ring fracture (Figure I-7). This could have manifested in limited damage to the scalp and bones on the top of the

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Figure I-6. Representation of soft tissue damage to the left side of the face.

head and explain the extent of cranial damage in the absence of external indicators. The fracturing seen in the sternum and ribs may support this scenario. The impact was sufficient to propagate a further fracture from the right hand side of the ring fracture up the right side of the occipital bone as fracture line number “4” (Figures I-3 and I-7). This fracture was of significant force and was able to traverse, and propagate beyond, fracture “1.” Fracture “3” predates fracture “4,” but we believe that it may also emanate from the region of the ring fracture but from the left hand side. This is also a powerful fracture which runs between bone fragments 6, 2, and 4, 9 and 12, 10, and 11 and finally 7 and 8 (Figures I-3, I-4, and I-5). As fractures “3” and “4” come into approximation in the region of the upper right parietal bone, there is sufficient tension caused between the two forces of propagation that fracture “4” snapped from its trajectory and took a new right-angled route between fragments 11 and 12 (Figure I-3). Fracture “4” breaches fracture “3” on its new trajectory. It is not clear from the postmortem photographs where fracture “3” commenced and it is highly unlikely to have been a continuation of fracture “9” which seems to have been a relatively weak fracture. Therefore it is likely that indeed fracture “9” terminated in the pre-existing fracture “3.” The only

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Figure I-7. Representation of fracturing at the base of the skull. The “Cs” designate comminuted-fracture fragments located around the foramen magnum.

obvious origin for this fracture is, therefore, from the comminuted region of the ring fracture around the foramen magnum, but this cannot be confirmed from the photographs. It had sufficient force to pass across fractures “1” and “2” before it terminated in what appears to be an emissary foramen on the posterolateral aspect of the right occipital bone (Figure I-5). Fracture “4” has traversed fracture “1” (Figure 3), but it did not extend as far as fracture “2” as it met with fracture “3” passing in the opposite direction. The right-angled change, of course, suggests that the stress between the two propagating forces was sufficient to alter the course of fracture “4” so that it remained on the right side of the skull.

Trauma 4 This incident does not seem to carry the same degree of force as those necessary to have caused traumas 1–3, but it should be remembered that the skull was possibly severely fragmented by this stage. There would have had to

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have been extensive dissipation of stress into previous fracture spaces. This trauma pertains to the proximity of the two areas of abrasion reported on the external region of the scalp. The first abrasion on the left side corresponds with bruising seen on the internal surface of the scalp and corresponds with a region of irregular fracturing that resulted in fragment 14 of the skull (Figure I-4). This fragment exhibits an upwards directed weak fracture line “6” which intersects with fracture line “2” in the para-sagittal region. A downwards fracture, number “9,” passes inferiorly along the sphenotemporal junction and may have terminated in fracture number “3” on the left side of the skull. The fracture on the right-hand side of the skull produced a fragment of bone that was bounded by fractures “4” and “8” (Figure I-5). Fracture “5” appears to have occurred in two steps (Figure I-3), suggesting possible different points of propagation. It is possible that the medial part of fracture “5” is, in fact, a continued propagation of fracture “6” across the sagittal fracture whereas the more lateral part of the fracture runs inferiorly and terminates in fracture “4.” It is difficult to define how this fracture and abrasion pattern may have arisen, but on-going investigations in relation to an object found in the room may lead to a possible solution. Our apologies that no further details can be given at this time.

Trauma 5 Additional injury likely occurred when MFB fell to his final resting position on the floor of the bedroom. It is suggested that as he came to fall face down onto the hard (not carpeted) floor, he would have bounced because he was moderately rotund. Contact with the ground might have caused reflexive flexion and extension of the cervical region. With a pre-existing basal and sagittal fracture, the left side of his skull was effectively hinged, being held in place only by soft tissue structures (Figure I-8). The force of landing might have opened and closed this vertical fracture, which may have behaved like a hinged pair of scissors. This could have cleanly cleaved the left frontal lobe and resulted in its subsequent expulsion through the tear on the skin in the region of the left orbit and in fact this “hinging” may have caused, or significantly extended, the skin tear seen on the front of his face.

CONCLUSION This is an on-going murder investigation and for this reason, details are necessarily vague. MFB clearly died as a result of multiple traumata to his skull, and we propose that at least four traumatic events and the final adoption of the resting position could account for all the fracturing evident on the skull,

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Figure I-8. Frontal view of the reconstructed vault region.

even in the absence of significant skin injury. Alternative theories are very welcome, and the authors would be happy to consider these along with advice and suggestions from experienced forensic anthropologists. This case clearly displays the difficulties faced by the forensic expert when he or she is asked to comment on injuries in the absence of the complete skeleton but must rely only on photographs taken at the time of the postmortem and incomplete skeletal material. It also emphasizes the importance that quality images be taken at the postmortem examination from as many different angles and aspects as possible. The results of the examination might have been better yet had the forensic anthropologist been present at the scene and autopsy. This case illustrates that although far from ideal, the forensic anthropologist can still provide assistance even when the specialist was neither present at the scene nor had access to the remains at autopsy. At the time of writing, this case is still active and so care has been taken to disclose as little identifying information as possible as the case is extremely sensitive. Our apologies to readers if this leaves many unanswered questions or an incomplete understanding of the situation and circumstances. However, the investigative authorities have permitted this communication to proceed in the hope that alternative and perhaps, as yet, unthought-of mechanisms might help explain the trauma inflicted on this elderly gentleman.