Effective diagnosis of cervical fracture using postmortem computed tomography and autopsy findings

A common forensic problem is cervical fractures, which sometimes need to be diagnosed only by physical examination of the body, without imaging or autopsy. Despite reports from clinical practice describing the association between cervical fractures and head injury, we could not find any analysis of autopsy cases. In addition, discussion of the cervical fracture diagnosis by postmortem computed tomography (PMCT) appears limited. This study aimed to examine autopsy and PMCT findings and explore valid methods for the diagnosis. We analyzed autopsy cases of cervical fractures during the 7 years before (2004-2010) and after (2014-2020) the PMCT introduction in our department. In 2014-2020, 67 autopsy cases with cervical fractures were recorded, of which 61 (91 %) were related to blunt injury to the head. Those with cervical fractures had a significantly higher incidence of blunt injury to the head (p < 0.001), particularly "forehead" and "face" injury, which accounted for > 50 % of cases. Of the external forces on the neck, "extension" accounted for 82.1 %. The cervical fracture-positive rate in all autopsy cases increased significantly from 11 (4.0 %) in 2004-2010 to 67 (8.2 %) in 2014-2020 (p = 0.021). From December 2015 to December 2020, when "cervical retroflexion" imaging was actively performed in PMCT, the cervical fracture diagnosis rate increased significantly from 57.1 % in the cervical normal position to 81.0 % with the addition of "cervical retroflexion" position (p = 0.021). Blunt head injury and PMCT in the "cervical retroflexion" position may be useful in the diagnosis of cervical fractures.