Recognizing Iatrogenic Rib Trauma A Forensic Anthropological Case Study

Abstract

Rib fractures are frequently encountered in forensic casework and may result from a range of mechanisms. Distinguishing among these causes can be particularly challenging when medical history is incomplete and when multiple potential mechanisms are present. This case study documents complex rib fracture patterning in an adult male donor from the Forensic Science Research and Training Laboratory at George Mason University with a reported history of median sternotomy and cardiopulmonary resuscitation, providing a relatively straightforward interpretive context for examining iatrogenic injury. A comprehensive anthropological analysis was conducted using standardized terminology to assess fracture timing, location, and morphology. Fracture location was documented using complementary regional and percentage-based descriptors, and morphological features were evaluated to differentiate antemortem, perimortem, and postmortem injury. Sixteen perimortem rib fractures were identified, along with evidence of antemortem rib trauma and surgical modification of the sternum. Fracture characteristics varied across ribs and included presentations that may be considered “atypical” relative to commonly described rib fracture patterns. Importantly, rather than seeking to establish diagnostic injury patterns, this case study provides a structured, feature-based framework and detailed documentation that can be applied across contexts. The findings highlight the varied nature of rib fracture morphology and the importance of considering prior trauma and surgical history in skeletal trauma analysis.