Conclusions

Evidence of antemortem injuries and stress usually remains as permanent osteo-logical features in the bone. If recognized and correctly classified, this evidence can become a critical element in the process of victim identification.

Gonarthrosis
Fig. 21. Age-related gonarthrosis. Age-related, degenerative gonarthrosis is undoubtedly the most commonly encountered abnormality in the distal femur. It first appears as a general increase of bony lipping of the articular margins and can eventually involve all articular surfaces.

The first step is to recognize the anatomic or mechanical causation of the defect to identify individual clinical diagnoses that can perhaps be linked to these defects. The second step is to correlate these findings with the medical histories or medical records of suspected missing persons who match the additional criteria of age, race, sex, and stature.

The ultimate goal in forensic analysis is, of course, to identify the skeletal remains, and more often than not the final identification will be based on dentition or DNA. Sometimes, however, evidence from the postcranial skeleton can provide critical clues leading to putative identification based on clinical history. In some cases, individual features of the knee can provide the investigator with enough evidence to make a positive identification if there is comparative documentation such as a radiograph, computed tomography, or magnetic resonance imaging.

Forensic Radiography

Fig. 22. Injury-related gonarthrosis. When a single specific injury to the knee results in gonarthrosis, the pattern can differ from degenerative changes. A fracture or a significant ligamentous injury can start a series of events that lead to significant arthritic changes in only one joint. This may or may not lead to generalized gonarthrosis.

Fig. 22. Injury-related gonarthrosis. When a single specific injury to the knee results in gonarthrosis, the pattern can differ from degenerative changes. A fracture or a significant ligamentous injury can start a series of events that lead to significant arthritic changes in only one joint. This may or may not lead to generalized gonarthrosis.

Medial Plica

A suprapatellar plica will cause a distinct defect on the medial condyle

Fig. 23. Suprapatellar plica. Trauma or repetitive irritation can produce fibrosis of the plica, which in turn creates distinct scars on the femur (1).

A suprapatellar plica will cause a distinct defect on the medial condyle

Fig. 23. Suprapatellar plica. Trauma or repetitive irritation can produce fibrosis of the plica, which in turn creates distinct scars on the femur (1).

Distal Femur Fabella

Fabella articulation

Fig. 24. Fabella articulation. The fabella articulates with a very small portion of the posterior lateral femoral condyle. This often causes chondromalacia that can lead to a discrete bony lesion (13,14).

Fabella articulation

Fig. 24. Fabella articulation. The fabella articulates with a very small portion of the posterior lateral femoral condyle. This often causes chondromalacia that can lead to a discrete bony lesion (13,14).

Chronic Patellar Dislocation
Fig. 25. Subluxing patella. Evidence of chronic patellar subluxation presents as significant degenerative arthritis on the patellar articular surface (15).
Forensic Radiography

/ Primary site of

/ osteochondritis dissecans

Other common site of lesion

Fig. 26. Osteochondritis dessicans. Osteochondritis dissecans creates a discrete lesion on the tibial articular surface. An area of subchondral bone undergoes avascular necrosis, and degenerative changes occur in the cartilage overlying it. The lesion is usually located on the medial femoral condyle, where weight is born against the medial eminence, but it can occur elsewhere on this articular surface and also on the lateral femoral condyle (16).

Steida Pelligrini
Fig. 27. Pelligrini-Stieda disease. Pelligrini-Stieda disease is characterized by a bony formation that starts in the superior portion of the tibial collateral ligament and can extend to the tibia in severe cases. It is due to previous trauma to the medial capsular structures of the knee (1,17).
Pellegrini Stieda Bone Scan

Fig. 28. Condylar and supracondylar fractures. Condylar and supracondylar fractures of the femur can take many forms, and Neer et al. proposed a useful classification of these (18), which are redrawn here. Severe displaced fractures are now most likely to be treated with open reduction and internal fixation (Left knee).

Fig. 28. Condylar and supracondylar fractures. Condylar and supracondylar fractures of the femur can take many forms, and Neer et al. proposed a useful classification of these (18), which are redrawn here. Severe displaced fractures are now most likely to be treated with open reduction and internal fixation (Left knee).

Open Reduction Internal Fixation Plateau

Anterior cruciate ligament

Fig. 29. Avulsion fractures. Avulsion fractures always occur at the site of attachment of a muscle, ligament, or tendon. By referring to the osteology section, one can determine the associated soft-tissue component of any avulsion fracture (16,19). Three of the most common sites of avulsion fracture are shown here: (A) Posterior cruciate ligament; (B) anterior cruciate ligament; (C) tibial collateral ligament.

Anterior cruciate ligament

Posterior cruciate ligament

Fig. 29. Avulsion fractures. Avulsion fractures always occur at the site of attachment of a muscle, ligament, or tendon. By referring to the osteology section, one can determine the associated soft-tissue component of any avulsion fracture (16,19). Three of the most common sites of avulsion fracture are shown here: (A) Posterior cruciate ligament; (B) anterior cruciate ligament; (C) tibial collateral ligament.

Tibial Fracture

Typical area of meniscal wear

Fig. 30. Meniscal wear. Tears of the menisci create distinctive patterns of wear on the articular cartilage, and in severe cases, these torn menisci can permanently scar the articular surfaces of the bone.

Typical area of meniscal wear

Fig. 30. Meniscal wear. Tears of the menisci create distinctive patterns of wear on the articular cartilage, and in severe cases, these torn menisci can permanently scar the articular surfaces of the bone.

Forensic Radiography
articular margins
What Gonarthrosis
Fig. 31. Age-related gonarthrosis. Age-related degenerative gonarthrosis of the tibia is a very common finding. It generally starts on the outer edge of the articular margins and against the intercondylar eminences. It slowly progresses until the entire articular surfaces are involved.
Forensic Radiography

Fig. 32. Condylar fractures. Fractures of the tibial condyles often heal with displacement. This can change the position of the weight-bearing surfaces to valgus or varus weight-bearing alignment, an increase in joint space, and usually some rotational deformity (20). The most commonly used classification for tibial condylar fractures is that described by Hohl (21).

Fig. 32. Condylar fractures. Fractures of the tibial condyles often heal with displacement. This can change the position of the weight-bearing surfaces to valgus or varus weight-bearing alignment, an increase in joint space, and usually some rotational deformity (20). The most commonly used classification for tibial condylar fractures is that described by Hohl (21).

Posterior Tibial Plateau Avulsion
Fig. 33. Tibial plateau fractures. Tibial plateau fractures are technically just variations of tibial condylar fractures, but they are much more subtle in the clinical situation and are more difficult to recognize and classify (1).

Posterior cruciate

Posterior cruciate

Fig. 34. Avulsion fractures. Just as on the femur, avulsion fractures of the tibia occur at the attachment site of ligaments and tendons. Three of the most common sites of avulsion fractures are shown here: (A) Segond fracture (lateral capsular ligament); (B) Anterior cruciate; (C) Posterior cruciate.

Fig. 34. Avulsion fractures. Just as on the femur, avulsion fractures of the tibia occur at the attachment site of ligaments and tendons. Three of the most common sites of avulsion fractures are shown here: (A) Segond fracture (lateral capsular ligament); (B) Anterior cruciate; (C) Posterior cruciate.

Common Sites Avulsion Fracture

Fig. 35. Osgood-Schlatter disease and tibial tuberosity avulsion fracture. The tibial tuberosity is the insertion site of the patellar ligament, and as such is subjected to stresses from the quadriceps femoris. An overgrowth of bone here can develop following repeated microtrauma to the growing epiphysis. The tuberosity occasionally fractures as a result of forceful contraction of the quadriceps (22,23).

Fig. 35. Osgood-Schlatter disease and tibial tuberosity avulsion fracture. The tibial tuberosity is the insertion site of the patellar ligament, and as such is subjected to stresses from the quadriceps femoris. An overgrowth of bone here can develop following repeated microtrauma to the growing epiphysis. The tuberosity occasionally fractures as a result of forceful contraction of the quadriceps (22,23).

Patella Fracture Patterns
Fig. 36. Patellar injuries. Injuries and stress to the patella can leave significant evidence on the cartilage and bone Patellar fractures sometimes heal without surgical intervention, but the original fracture patterns may remain evident for years (2).
Osteoarthritis

Osteoarthritis

Thank you for deciding to learn more about the disorder, Osteoarthritis. Inside these pages, you will learn what it is, who is most at risk for developing it, what causes it, and some treatment plans to help those that do have it feel better. While there is no definitive “cure” for Osteoarthritis, there are ways in which individuals can improve their quality of life and change the discomfort level to one that can be tolerated on a daily basis.

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Responses

  • orlagh
    Where is the tuberosities?
    8 years ago
  • Janne
    How did forensic radiology begin?
    8 years ago

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