Forecast Criteria for Forensic Medical Assessment of the Severity of Injuries in Subcutaneous Fractures of the Lower Limb Bones

Abstract

Currently, to determine the severity of injuries in case of adverse effects of subcutaneous fractures of the lower extremities, several forensic examinations are conducted at the stage of treatment, which may lead to loss of confidence in the results of forensic expert opinion of the victims, accompanied by economic losses. Therefore, predicting the consequences of such injuries is an urgent scientific and practical problem of forensic medicine. The purpose of the study is to develop prognostic criteria for forensic assessment of the severity of injuries in fractures of the femur and tibia. Materials and methods. The object of the research was 180 "Expert conclusions (examination of the case file)" with the establishment of the severity of injuries in victims of road accidents: subcutaneous isolated and fractures of the femur (24; 13.3%), tibia – (64; 35.6%); fractures of these bones as the leading injury in polytrauma – (92; 51.1%). In 120 (66.7%) expert opinions the average degree of severity of bodily injuries was established as favorable consequences of road accidents (main sample). In 60 (33.3%) cases, adverse effects of injury were observed with the establishment of severe injuries (a control sample). Research methods which were used are expert examination of the victim with anthropometric studies; radiation diagnostics; alternative computational forecasting. Results and discussion. According to the results of retrospective analysis of the results of treatment, 25 risk factors for adverse effects of subcutaneous fractures of the femur and tibia were identified. The main ones are: passive participation in a road traffic injury as a pedestrian (87.5% in the main sample and 91.7% in the control); combined trauma (70.8% and 75.0%, respectively), multifracture (66.7% and 95.0%, respectively); age >41 years old (48.3% and 81.7%, respectively) and a frontal collision with a car (51.7% and 70.0%, respectively). Risk factors such as intraoperative misalignment of the fragments of the femur and violation of the terms of postoperative X-ray control (23.8% in the main group and absence in the control group) were relatively uncommon. Conclusion. Numerical values of prognostic coefficients of the most probable factors potentiating adverse effects of subcutaneous fractures of long bones of the lower extremities are established. The most informative are: intra-articular multifracture fracture (prognostic coefficient equals -9; I=1.44); multifragmental diaphyseal fracture (prognostic coefficient equals -7; I=1.20); non-elimination of intraoperative displacement of long bone fragments (prognostic coefficient equals -6; I=1.04); discrepancy of the sizes of a clamp to anatomic sizes of the damaged bone (prognostic coefficient equals -6; I=1,04); violation of the terms of postoperative X-ray control (prognostic coefficient equals -4; I=0.50)