A simple depressed skull fracture in an old man with Paget disease: forensic implications in a rare case

Abstract

Skull fractures occur when forces striking the head exceed the mechanical integrity of the calvarium. A depressed skull fracture is a break in a cranial bone with depression of the bone into the brain. A depressed fracture may be open (compound), with a skin laceration over the fracture, or closed (simple), when the overlying tissue is not disrupted. The association between simple depressed fracture of the skull and elderly is rare. Paget disease of the bone is a chronic disease characterized by the deposition of abnormal bone tissue, more fragile than normal bone. We report a case of a 92-year-old man who was found supine on the floor in his residence, showing multiple signs of trauma. X-rays and computed tomography scans were performed, showing a simple depressed skull fracture on the right occipital-temporal area and even the characteristics of Paget disease of the skull. The first hypothesis was death due to voluntary homicide. A detailed study of clinical reports, laboratory tests, radiograph scans, and post mortem examination data allowed us to reconstruct the event. Death was finally ruled due to a mild passive trauma, suggesting the unlawful killing of a human without criminal intent, meaning involuntary manslaughter.