Compound elevated fracture-reconstruction of an unusual skull injury

Our institute of Legal Medicine was asked to examine a 27-year-old patient admitted to the neurosurgical department after a non-fatal accident (non-observed fall from height) at a construction site. Forensic advice was needed because of unexplainable injuries. By example of this case of a near-to-impalement, we would like to highlight an unusual, clinically frequently forgotten, and forensically thus far not discussed type of skull fracture with outward dislocation of bone fragment(s). These so-called compound elevated fractures of the skull are described occasionally in, mainly neurosurgical, case reports. Knowing its entity and its pathomechanism may be of forensic interest, particularly in order of reconstruction purpose. This article provides a brief review of the literature with special regard to the pathomechanism. In addition, it demonstrates the possible pitfall of computed tomography, or more specifically, the 3D reconstruction. To our knowledge, this is the first forensic report describing this kind of fracture.