Skull fractures in forensic autopsies: phenomenology and possibilities of biomechanical reconstruction

The assessment of skull fractures is a major issue in the daily work of forensic pathologists. Due to the different kinds of causation and the case-dependent sites of impact, there is a great variety of fracture types. Bone damage resulting from blunt force and ballistic trauma has to be distinguished from lesions induced by heat and those inflicted with sharp-edged weapons. The manifold appearances of skull fractures are considered from the perspective of medico-legal practice with the objective of elucidating the trauma mechanism, which in turn can help to determine the course of events and the manner of death. In particular, this review deals with radiating, circular, diastatic, depressed, compound and comminuted fractures of the cranial vault as well as special forms encountered at the base of the skull such as hinge, circular, contrecoup and impalement fractures. The morphological appearances are illustrated with exemplary photos from the authors' autopsy material. The discussion is primarily focused on possible conclusions to be drawn from the fracture's morphology and location that enable the investigator to reconstruct the causative trauma.