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Forensic evaluation of alleged wrist restraint/handcuff injuries in survivors of torture utilizing the Istanbul Protocol

International Journal of Legal Medicine volume 135, pages 583–590 (2021)Cite this article

A Correction to this article was published on 09 June 2021

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Abstract

Despite being a common form of abuse, there is a paucity of literature describing shackling and wrist restraint injuries among survivors of torture. Forensic evaluation of alleged wrist restraint/handcuff injuries in survivors of torture presents challenges to the evaluator, especially if the injuries are remote and do not leave lasting marks nor neurologic deficits. Thorough history-taking and physical examination are critical to effective forensic documentation. Guidance is provided in The Manual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (Istanbul Protocol), the gold standard for the medicolegal documentation of torture. This guidance relies primarily on physical findings, with less direction provided on how to interpret historical evidence or when historical evidence provided by the patient can be interpreted as highly consistent with alleged injury in the absence of current physical findings. Through a case-based review, we present diagnostic strategies for the evaluation of alleged abuse involving wrist restraints/handcuffs, focusing on skin, neurologic, and osseous injuries. We highlight key findings from both the history and physical examination that will allow the evaluator to improve the accuracy of their expert medical opinion on the degree to which medical findings correlate with the patient’s allegations of wrist restraint injuries.

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Funding

Miriam Y. Neufeld is supported, in part, by National Institutes of Health T32 Training Grant (GM86308).

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Authors and Affiliations

  1. Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA

    Miriam Y. Neufeld, Sarah Kimball, Andrew B. Stein & Sondra S. Crosby

  2. Immigrant & Refugee Health Center, Boston Medical Center, Boston University School of Medicine, 725 Albany Street, Suite 5b, Boston, MA, 02118, USA

    Sarah Kimball & Sondra S. Crosby

  3. Boston University School of Public Health, Center for Health Law, Ethics, and Human Rights, 715 Albany St, Talbot Building 3 W, Boston, MA, 02118, USA

    Sondra S. Crosby

Authors
  1. Miriam Y. Neufeld
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  2. Sarah Kimball
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  3. Andrew B. Stein
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  4. Sondra S. Crosby
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Contributions

Study conception: Sondra S. Crosby, Sarah Kimball

Literature review: Miriam Y. Neufeld, Sondra S. Crosby

Data interpretation: Miriam Y. Neufeld, Sarah Kimball, Andrew B. Stein, Sondra S. Crosby

All authors contributed to manuscript drafting and/or critical review.

Corresponding author

Correspondence to Sondra S. Crosby.

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Conflicts of interest

The authors have no conflicts of interest to disclose

Ethics approval

This study utilized anonymized case studies which, after consultation with the Institutational Review Board (IRB) of Boston University and the privacy office of Boston Medical Center, was deemed not require IRB approval and was deemed to be in accordance with institutional ethical standards.

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Not applicable as cases have been anonymized and no recognizable details have been included

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Not applicable as cases have been anonymized and no recognizable details have been included

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Neufeld, M.Y., Kimball, S., Stein, A.B. et al. Forensic evaluation of alleged wrist restraint/handcuff injuries in survivors of torture utilizing the Istanbul Protocol. Int J Legal Med 135, 583–590 (2021). https://doi.org/10.1007/s00414-020-02451-5

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  • DOI: https://doi.org/10.1007/s00414-020-02451-5

Keywords

  • Handcuff injury
  • Shackling
  • Torture
  • Istanbul Protocol
  • Forensic evaluation