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Radiological detection of sharp force skeletal trauma: an evaluation of the sensitivity of Lodox in comparison to CT and X-ray

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Abstract

Victims of violent crime often have evidence of sharp force trauma (SFT) which needs to be examined to accurately investigate these cases. The abilities of CTs, X-rays, and Lodox to detect skeletal SFT defects and the minimum number of impacts were assessed, as were their abilities to macroscopically interpret SFT with the aim of identifying the class of weapon used. Ten pigs were, post-mortem, stabbed using a kitchen knife on one side of the body and chopped using a panga on the other side. They were then scanned and macerated. The number of SFT defects, type of SFT, and minimum number of impacts identifiable osteologically were recorded, as well as when using each imaging modality. CTs were most sensitive for detecting stab and chop defects (56.7% and 78.3%, respectively) and the minimum number of impacts (82.8%), while X-rays were least sensitive (17.2% for stab wounds, 46.5% for chop marks, and 43.5% for impacts). Lodox detected 26.8% of stab defects, 59.3% of chop marks, and 58.4% of impacts. The type of SFT for more than 70.0% of identified defects was correctly classified using all methods, while only Lodox had moderate sensitivities for stab wounds (52.4%). When radiological assessments of skeletal SFT are required, CTs should be performed, but Lodox can be used as an alternative. However, dry bone analyses still produce the best results and should be performed whenever possible. Macroscopic interpretations of skeletal SFT to broadly determine the class of weapon used is possible radiologically.

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Acknowledgements

We acknowledge the assistance of GHB Farms Pty (Ltd.) in Bronkhorstspruit, South Africa, for donating the pig carcasses. The authors thank Ms. Rammekwa from the Central Animal Services at the University of the Witwatersrand for taking the X-rays; Dr. Haagensen and Mrs. Bussy from the Department of Radiology at Wits Donald Gordon Medical Centre for assisting with the CT scanning; and Ms. Reindorp from the Johannesburg Forensic Pathology Services for taking the Lodox scans. We also acknowledge the assistance of Ms Nkosi from Lodox® Systems (Pty) Ltd. for training pertaining to the analysis and interpretation of Lodox scans and to Mr. Matjila, Ms. Loubser, and Ms. Landsman from the School of Anatomical Sciences at the University of the Witwatersrand for assisting with the maceration of the pig carcasses. This research was made possible in part by a grant from the JJJ Smieszek Fellowship. This work is based on the research supported in part by the National Research Foundation (NRF) of South Africa (Grant number: 118149) and the NRF/Deutscher Akademischer Austausch Dienst (DAAD) (Grant number: 117943). Opinions, findings, and conclusions or recommendations expressed are those of the authors and are not necessarily to be attributed to the NRF or DAAD.

Funding

Funding for this research was provided by the JJJ Smieszek Fellowship, National Research Foundation (NRF) and Deutscher Akademischer Austausch Dienst (DAAD). These funding sources however did not have any involvement in study design, collection, analysis and interpretation of data, writing of the report, or in the decision to submit the article for publication.

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Authors and Affiliations

  1. Human Variation and Identification Research Unit (HVIRU), School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa

    Amy Joy Spies, Maryna Steyn & Desiré Brits

  2. Department of Diagnostic Radiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa

    Daniel Nicholas Prince

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  1. Amy Joy Spies
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  2. Maryna Steyn
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  3. Daniel Nicholas Prince
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  4. Desiré Brits
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Contributions

AJ Spies, M Steyn, and D Brits contributed to the study’s conception and design. Material preparation and data analysis were performed by AJ Spies. Data collection was performed by AJ Spies and DN Prince. The first draft of the manuscript was written by AJ Spies, and all authors commented on all subsequent versions of the manuscript. Funding was provided in part by M Steyn and D Brits. The authors read and approved the final manuscript.

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Correspondence to Amy Joy Spies.

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Permission was obtained from the Animal Research Ethics Committee (AREC) at the University of the Witwatersrand (Ethics Clearance Certificate No. 2019/04/27/O), as well as from the South African Department of Agriculture, Forestry and Fisheries (DAFF).

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Spies, A.J., Steyn, M., Prince, D.N. et al. Radiological detection of sharp force skeletal trauma: an evaluation of the sensitivity of Lodox in comparison to CT and X-ray. Int J Legal Med 136, 1417–1430 (2022). https://doi.org/10.1007/s00414-022-02845-7

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