Life threatening chop injuries to the head: Optimising injury interpretation using three dimensional computerised tomography (3DCT) reconstruction of pre-treatment imaging

• Pre – treatment CT imaging currently under used in injury interpretation.
• 3 dimensional reconstruction of CT data can capture injury pattern prior to medical intervention and healing.
• Documents value of this approach in chop fracturing to skull.
• Illustrates that joint reporting by forensic pathology and radiology is effective.

Computerised tomography (CT) is being increasingly advocated to support post mortem investigation of death but the value of using CT data already captured during emergency imaging, prior to treatment of life threatening injuries, remains under recognised and inadequately explored. We demonstrate the value of three dimensional computerised tomography (3D CT) reconstructions of such data, in interpreting the injuries sustained by a male who survived after being subjected to an assault with an axe and whose surface injuries had been debrided and sutured, before any photography was undertaken. The 3D CT images captured most of the scalp, face and skull vault trauma prior to the surgical intervention. Taken with other evidence, this indicated that the victim had received at least four separate blows to the face and head with a sharp chopping weapon; evidence which proved to be centrally important in the subsequent criminal court proceedings. This case also illustrated the effectiveness of joint interpretation of 3D CT reconstructed images in medico-legal casework, by experienced consultants in forensic pathology and radiology and the potential value of reviewing emergency pre-treatment CT imaging in any serious head injury allegedly sustained in an assault. This is likely to be particularly valuable when sharp or blunt weapon damage to bone is suspected.