Prescription of fractures of the bones of the nose according to computed tomography in the practice of forensic examination of living persons

Introduction. To clarify the radiological criteria for determining the prescription of fractures of the bones of the nose, based on the data of a forensic medical examination performed using CT. Special attention is paid to the comparative analysis of X-ray signs that make it possible to differentiate an acute fracture from a consolidated injury, as well as to the assessment of the impact of these data on the objectivity of forensic conclusions.

Materials and methods. The study analyzed data from 259 victims with fractures of the nose bones. The patients were examined using radiography and CT with 3D reconstruction. The studies were conducted on the day of admission, 10–14 days, 21 days and 1 month after the injury. The majority of injuries (83.3%) occurred in people aged 21–38 years, more often in men (82.9%). Domestic and street incidents caused 79.3% of injuries, car accidents – 15.2%, falls from heights – 5.5%. Radiological signs included the condition of the soft tissues, the shape and structure of the fracture edges, the presence of hemosinus, the nature of the line of illumination between the fragments, and signs of bone remodeling.

Results. Analysis of CT scans has shown that acute fractures (one day or 3–4 days after injury) have uneven edges and pointed corners, with a clear and contrasting line of illumination up to 1 mm. After 10–14 days, the illumination persists, but becomes less clear and contrasting, and the soft tissue edema regresses. On days 20–21, signs of callus formation appear: smoothing of the edges, blunting of the ends of the fragments and an increase in the width of the lumen to more than 1 mm. By 4–5 weeks, bone callus, sclerotic changes and a local decrease in mineral density are clearly visualized.

Discussion.  Establishing the limitation period of a mechanical injury is important for a forensic medical examination. The problem of diagnosing the prescription of nasal fractures in living persons has not been solved. Traditional radiography is not always accurate, especially 21 days after an injury. CT with 3D reconstruction is more reliable, revealing subtle changes in bone structure and the stage of regeneration. CT distinguishes between acute and consolidated fractures, confirming changes in radiological signs by repair stages. Regulations do not take into account modern methods of radiation diagnostics, which leads to errors. The integration of CT improves the accuracy of the assessment and the objectivity of the conclusions.

CT allows you to dynamically evaluate changes by determining the timing of repair. Radiological signs of fractures correlate with physiological processes. Without these signs, the expert cannot establish a connection with recent exposure.

Conclusion. Computed tomography (CT) improves diagnostic accuracy by differentiating between acute and consolidated fractures. Radiological signs, such as changes in the structure of the edges of fragments and the formation of bone marrow, correlate with the physiological processes of repair. This allows for more accurate dating of injuries, which is important for the legal assessment of incidents. The integration of CT into forensic practice improves the diagnosis and methodology of research. Further developments, including the improvement of the regulatory framework and the introduction of quantitative analysis methods, are promising.

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