J Forensic Sci, 2017 doi: 10.1111/1556-4029.13654 Available online at: onlinelibrary.wiley.com
CASE REPORT PATHOLOGY/BIOLOGY
Karen J. Heath,1,2 F.R.A.C.P.; Allan D. Cala,3 F.R.C.P.A.; and Roger W. Byard,1,2 M.D.
Metal Railing Fences and Accidental Death
ABSTRACT: Two cases of accidental deaths caused by the sharp ends of fence or gate posts are reported. Case 1: A 47-year-old man was
found hanging by his ankle in an inverted position on fencing. He had attempted a shortcut to a railway platform by climbing over a metal rail fence. He had slipped and been impaled through his ankle by the sharp end of the fence post, resulting in death from positional asphyxia. Case 2: An 18-year-old male slipped while climbing over a gate and died after being impaled on a spear tip finial, which had lacerated his external iliac vein. Death was due to exsanguination. These cases demonstrate two rare examples of accidental deaths from impalement by the ends of sharp fence posts. Mechanisms of death in such circumstances involve suspension with positional asphyxia and vascular injury with exsanguination.
KEYWORDS: forensic science, fence post, finial, impalement, suspension, positional asphyxia, exsanguination The ends of metal railings forming part of fences or gates may not have a specific finish or may terminate in a decorative finial. Occasionally, the ends may form a sharp spear-shaped projection or have an attached finial also with a “spear head” profile. The purpose of these sharp ends is often to act as a security measure to restrict unauthorized access to an area or yard. Accidental deaths associated with the sharp ends of fence or gate posts are rare but may arise from two major mechanisms: suspension or impalement. The following cases are described to illustrate features of these unusual fatalities. Case Reports Search of the files at Forensic Science SA, Adelaide, Australia, was undertaken over a twenty-year period (1996–2016) for any deaths associated with fence post suspension or impalement. Two cases were identified. Case 1 A 47-year-old man with bipolar disorder and paranoid delusions had recently been admitted to hospital following a suicide attempt by medication overdose. On the day of his discharge from hospital, he had left early and had subsequently been found hanging in an inverted position by his ankle on fencing at a local railway station. It was subsequently determined that he had attempted a shortcut to the platform by climbing on to a cement bollard and then attempting to jump over the fence. During this process, he had apparently slipped and fallen, causing the sharp end of the fence post to pass through the skin of the inner aspect
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Forensic Science SA, 21 Divett Place, Adelaide 5000, Australia. School of Medicine, University of Adelaide, Frome Rd, Adelaide 5005, Australia. 3 Hunter New England Health, Newcastle, New South Wales, Australia. Received 27 July 2017; and in revised form 30 Aug. 2017; accepted 31 Aug. 2017. 2
© 2017 American Academy of Forensic Sciences
of his right ankle and lodge in his shoe, resulting in his suspension upside down. At the scene, the body was hanging from the top of a railing by the right ankle (Fig. 1). The head, neck, and shoulders of the deceased were resting on the ground, with the arms outstretched and the neck hyperflexed (Fig. 2). The left leg was in a flexed position at the hip and the knee, with the left ankle resting on the adjacent concrete bollard next to the fence. There was no apparent disturbance to the adjacent dirt, gravel, or bark and leaf litter surrounding the head and shoulders of the decedent. There was no blood staining of the ground. The top of one of the fence rails had impaled his right ankle (Fig. 3). At autopsy, the body was that of an adult white male showing minimal injuries. The body mass index (BMI) was 32.9. There was intense congestion of the chest, shoulders, neck, head, and upper limbs, with coarse petechial hemorrhages and ecchymoses in the congested areas. The major injury consisted of an area of subcutaneous tunnelling extending from a 130 9 40-mm irregular laceration on the medial aspect of the right shin and ankle to an irregular 90 9 15-mm laceration on the medial aspect of the right foot where the railing tip had passed beneath the skin. There was no significant injury to underlying muscles, nerves, tendons, or blood vessels. Focal areas of minor superficial abrasions and red bruising were present over knees, the left parietal scalp, the upper arms and shoulders, and the chest. Neck dissection showed no injuries. The rest of the autopsy was unremarkable with no other injuries or markings to indicate the involvement of another person. Neuropathological evaluation of the brain revealed no occult injuries. No underlying natural diseases that could have caused or contributed to the death were identified. Toxicological analyses of a specimen of blood obtained at autopsy showed a blood alcohol concentration of nil with therapeutic levels of 7-aminoclonazepam, quetiapine, and aripiprazole. Death was therefore attributed to positional asphyxia complicating suspension upside down from a railing fence. 1
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FIG. 1––The decedent in case 1 can be seen hanging by his ankle on one side of a metal railing fence at a railway station, having dropped his bag on the platform side. FIG. 2––The decedent in case 1 can be seen suspended with his left leg in a flexed position at the hip and the knee, with the left ankle resting on the concrete bollard adjacent to the fence. His neck is hyperflexed.
Case 2 An 18-year-old man slipped while climbing over a gate and impaled himself on a spear tip finial (Fig. 4) (1). He managed to free himself but collapsed soon afterward and died. At autopsy, his jeans were torn in the left groin region (Fig. 5) and soaked with blood. Beneath the defect in his clothing, there was a full-thickness longitudinal 60-mm wound of the left side of the scrotum, 30 mm from the midline (Fig. 6). This was associated with a penetrating wound to the left groin with surrounding bruised and edematous tissue, in keeping with a laceration. The wound was approximately 50 mm wide and extended 150 mm upward and slightly to the left into the musculature of the groin. It was surrounded by a large quantity of blood around the left side of the bladder extending into the left lateral wall of the abdomen and the rectus sheath. This was due to tearing of the left external iliac vein at the junction of the upper thigh and the pelvis, just proximal to the inguinal ligament (Fig. 7). The left external iliac and femoral arteries were intact. Scattered abrasions of the back, legs, and arms, with a superficial laceration to the right forehead region, were in keeping with a fall to the sidewalk and collapse following impalement. An image of this case has been previously published (2). Toxicological analysis showed a blood alcohol level of 0.233% and a vitreous alcohol level of 0.267% with low levels of tetrahydrocannabinol. There were no other significant injuries and no underlying organic diseases, which could lead to death. Death was attributed to exsanguination from laceration of the external iliac vein following impalement on a fence finial.
FIG. 3––The right ankle of the decedent in case 1 showing impalement by the fence spike with the metal tip distorting his runner.
Discussion Positional asphyxia refers to situations where respiration is compromised due to an abnormal position of the body or neck that blocks the upper airway, or to splinting of the chest and/or
HEATH ET AL.
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FENCE DEATHS
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FIG. 4––A section of the gate where the decedent in case 2 had been impaled showing a row of sharp spear head finials. The perspex safety barrier was installed after the death.
FIG. 6––Laceration of the left side of the scrotum in case 2.
FIG. 5––Tearing of the jeans in case 2 (arrow) due to perforation by a fence finial.
diaphragm. It differs from crush/traumatic asphyxia in that there is no significant external pressure on the body from another object or weight (3). A typical example of positional asphyxia is a severely intoxicated individual who collapses and wedges into a narrow space where the neck may also be hyperflexed. An example of crush/traumatic asphyxia is someone who is trapped underneath a vehicle following a rollover (4). Intoxication is not always a requirement for positional asphyxia; for example, obesity is known to be another factor in such
deaths (5) as it may not only interfere with the ability to self-rescue (as may have occurred in case 1 where the BMI was 32.9.), but also independently influence respiratory function adversely. This is noted in obese patients who may be placed in a Trendelenburg position during surgery (6,7). The first case illustrates a highly unusual form of positional asphyxia where the decedent slipped while trying to climb over a fence and became suspended upside down when the sharpened end of a fence post impaled the skin and soft tissue of his ankle and wedged within his shoe. The position is very similar to a case reported by De Dono et al. of an intoxicated, obese 78year-old man who was suspended upside down when his left foot became entrapped in blackberry vines (8). As with the present case, the head was congested with facial and conjunctival petechial (8). Respiration in case 1 would have been impeded for several reasons including hyperflexion of the neck, as shown in Figure 2. Acute neck compression has been shown in cases of hanging to result in very rapid loss of consciousness (9). An anteverted position may also impair respiration because of the weight of the abdominal viscera compressing the chest and diaphragm, as has been suggested in cases of upside down crucifixion (10). Other mechanisms in upside down fatalities have involved cardiovascular responses with decreases in peripheral resistance and a rise in stroke volume leading to increased venous return with resultant cardiac failure (11). Such deaths have also been reported in the context of autoerotic misadventure (12).
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(a)
of sharp fence posts. In case 1, the end had been tapered to a sharp point from the post itself, and in case 2, a spear head finial had been added to the post. In both cases, the sharpened ends were a security feature designed to discourage access at that location. The two mechanisms of death that may occur in such circumstances involve suspension with positional asphyxia and vascular injury with exsanguination and/or air embolism. References
(b)
FIG. 7––Extensive retroperitoneal and soft tissue hemorrhage in case 2 (a) associated with laceration of the left external iliac vein (b).
Impalement injuries more often occur in vehicle crashes or in industrial accidents complicating a fall on site (13–15). Vehicle impacts with fences may result in impalement by fence posts (16). Children are also at risk of impalement injuries from fences, and these may rarely involve falls with significant anorectal, perineal, and genital injuries (17). The assessment of impalement during autoerotic activities may be complicated by removal of the foreign body prior to death, sometimes with concealment by family members (13,18). Very rarely, impalement may be suicidal, and so the manner of death should always be carefully evaluated (19). In case 2, impalement on a spear head finial had resulted in laceration of the left external iliac vein with death occurring due to exsanguination. There was no evidence of air embolism in this case. Cases of nonfatal impalement have also occurred under similar circumstances; for example, an Australian newspaper has reported a 13-year-old girl who was hung upside down by her impaled right leg once she had slipped while climbing over a similar fence (20). In conclusion, the reported cases demonstrate two rare examples of accidental deaths resulting from impalement by the ends
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[email protected]
