Blunt force vs. fall-induced head trauma: a systematic review and methodological framework

Blunt force trauma evaluation is a challenging topic in forensic investigations, frequently associated with violent assaults, homicides, and accidental falls. Distinguishing between injuries caused by direct blows and those resulting from falls is essential for accurate medico-legal assessments. Commonly applied forensic analytical methods demonstrate limitations, necessitating a more comprehensive assessment approach. In this paper a systematic review using PubMed, Scopus and Web of Science databases has been performed. This systematic review explores forensic methodologies for distinguishing between different trauma mechanisms by analyzing injury patterns, fracture characteristics, and advancements in technology. The objective is to evaluate the forensic techniques most commonly utilized by researchers to differentiate between blunt head trauma and fall-related injuries while also establishing a structured approach for the thorough investigation of these complex cases. Recent forensic advancements, including micro-computed tomography (µCT), Finite Element Modeling (FEM), and 3D reconstruction, enhance trauma analysis by providing detailed insights into injury mechanisms. These technologies, combined with imaging modalities such as CT scans and biomechanical modeling, improve forensic accuracy in differentiating trauma etiologies. Conclusion. This review underscores the importance of integrating multiple forensic tools to refine investigative procedures and establish standardized approaches for analyzing complex trauma cases. In addition, a proposal for a schematic flow chart summarizing the post-mortem activities that can be performed in forensic practice, which can be adapted in relation to each case, has been created.