<- Home <- Arhive <- Vol. 16, Issue 2, June 2008

Rom J Leg Med16(2)109-116(2008)
© Romanian Society of Legal Medicine

Accessory bones and growth cartilages: sources of errors in forensic trauma assessment

I. Piciorus, C. Capatina, A. Sirbu, S. Hostiuc

Abstract: Accessory bones and growth cartilages: sources of errors in forensic trauma assessment. Case reports and literature review. The authors report the case of a 19 years old young female, who was the victim of a minor traffic accident (hit on the left shoulder by the mirror of a minibus). A fracture of the left shoulder apex was diagnosed and the shoulder was immobilized in a Dessault dressing. A re-examination of thoracic X-rays revealed that the so called fracture was bilateral and perfectly symmetrical. Taking into account the age of the victim, the radiological aspect present in both shoulder blades was considered to be determined by an incomplete apical ossification. The authors review the variations of the growth cartilage, congenital dysplasias and malformations, anatomical variations of the shoulder blade that could be confused with traumatic lesions. Another category of possible radiological confusions between traumatic injuries and nontraumatic variations is illustrated by another case in which an accessory navicular bone (os tibiale externum) was misinterpreted as a navicular fracture. Again the correct diagnosis was established only after comparing the right and left foot x-ray images which showed the same symmetrical structure in both. Due to the fact that supernumerary bones (sesamoid bones being the most frequent type) represent a rare occurrence in general population, radiological confusions with traumatic injuries can occur. Such errors occur more frequently when children and teenagers are admitted and examined in Emergency Units specialized in adults, and less familiarized with the radiological aspect of growth cartilages or sesamoid bones. An extremely useful criterion for avoiding such diagnostic errors is the presence of a bilateral symmetrical “injury”. Although such diagnostic errors do not have significant medical consequences, they can have serious penal consequences in forensic cases.
Keywords: shoulder blade fracture, incomplete ossification, fracture, growth cartilage, accessory navicular bone

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