title: A simple depressed skull fracture in an old man with Paget disease: forensic implications in a rare case.
abstract: Skull fractures occur when forces striking the head exceed the mechanical integrity of the calvarium. A depressed skull fracture is a break in a cranial bone with depression of the bone into the brain. A depressed fracture may be open (compound), with a skin laceration over the fracture, or closed (simple), when the overlying tissue is not disrupted. The association between simple depressed fracture of the skull and elderly is rare. Paget disease of the bone is a chronic disease characterized by the deposition of abnormal bone tissue, more fragile than normal bone. We report a case of a 92-year-old man who was found supine on the floor in his residence, showing multiple signs of trauma. X-rays and computed tomography scans were performed, showing a simple depressed skull fracture on the right occipital-temporal area and even the characteristics of Paget disease of the skull. The first hypothesis was death due to voluntary homicide. A detailed study of clinical reports, laboratory tests, radiograph scans, and post mortem examination data allowed us to reconstruct the event. Death was finally ruled due to a mild passive trauma, suggesting the unlawful killing of a human without criminal intent, meaning involuntary manslaughter.
authors.affiliation: Department of Anatomy, Histology, Legal Medicine and Orthopedics, "Sapienza" University of Rome, Italy lorenzo_gitto@libero.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Gitto
authors.affiliation: Cook County Medical Examiner's Office, Chicago, USA.
authors.forename: Ponni
authors.initials: P
authors.lastname: Arunkumar
authors.affiliation: Department of Anatomy, Histology, Legal Medicine and Orthopedics, "Sapienza" University of Rome, Italy.
authors.forename: Aniello
authors.initials: A
authors.lastname: Maiese
authors.affiliation: Department of Anatomy, Histology, Legal Medicine and Orthopedics, "Sapienza" University of Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bolino
mesh_terms: D000369:Aged, 80 and over; D003415:Crime; D049429:Forensic Pathology; D016489:Head Injuries, Closed / Q000473:pathology*; D006801:Humans; D008297:Male; D010001:Osteitis Deformans / Q000473:pathology*; D020204:Skull Fracture, Depressed / Q000473:pathology*; D014754:Violence
keywords: Paget disease; autopsy; computed tomography scan; depressed skull fracture; forensic pathology; scene investigation