Traffic accidents involving children and adolescents present complex challenges from both the medico-legal and orthopedic standpoints. Despite the implementation of road traffic safety laws, pediatric road traffic injuries continue to be a significant contributor to mortality rates, physical harm, and hospitalization on a global scale. For children and young people, automobile accidents are considered to be the primary culprit of mortality in developed nations. Even in highly developed nations, trauma is a significant factor in infant mortality. Each age category, from childhood to young adulthood, has its fracture patterns, as their skeletons are considerably different from those of adults. The consequences of traffic accidents extend beyond the immediate physical trauma. The medico-legal aspects surrounding these incidents add another layer of complexity, as legal repercussions may affect the responsible adult or parent, particularly in cases involving child fatalities. To effectively address traffic accidents in children and adolescents, a comprehensive approach is necessary. This approach should involve not only medical professionals but also legal experts and policymakers. Collaboration between orthopedic specialists, medico-legal professionals, law enforcement agencies, and relevant government bodies can facilitate the development and implementation of strategies aimed at prevention, education, the enforcement of traffic laws, and improved infrastructure. By addressing both the medical and legal aspects, it is possible to enhance road safety for children and adolescents, reducing the incidence of injuries and their associated long-term consequences. In this review, we aimed to summarize traffic accidents in children and adolescents from a complex orthopedic and medico-legal approach.

Carbon monoxide (CO) and hydrogen cyanide (HCN) are two common toxic products of combustion. HCN concentrations of fire victims are not routinely determined in most legal medicine services in Romania. We present the case of a room fire victim in which we evaluated the concentrations of HCN and carboxyhemoglobin (COHb), their contribution to the mechanism of death, and the possibility that HCN concentration can be interpreted as vital sign. COHb was determined by spectrophotometry. HCN was spectrophotometrically determined with ninhydrin in postmortem blood samples after its removal with 20% phosphoric acid and uptake into a solution of potassium carbonate. The presence of ethyl alcohol was determined by gas chromatography. The COHb concentration was 6.15%, while the blood HCN concentration was 1.043 µg × mL⁻¹ and the total HCN was 1.904 µg × ml⁻¹. A blood alcohol content of 4.36 g‰ and a urine alcohol content of 5.88 g‰ were also found. Although the fire produced a considerable amount of soot, and there were signs of inhalation of soot particles, the COHb level cannot be interpreted as a vital sign. Toxic concentrations of HCN and total HCN can be interpreted as a vital sign and indicates a contributive effect of HCN in the mechanism of death.

Craniofacial reconstruction often represents a final step in medico-legal identification and is dependent on facial tissue thickness measurements and feature shape estimation. This study’s aim is to create a reliable and readily reproductible method of predicting the maximum nose width (MNW) based on the maximum nasal aperture width (MAW) for a Romanian adult population. A sample of 55 computer tomography (CT) scans consisting of Romanian adult subjects was selected from the database of a neurosurgery hospital. The craniometrics measured consisted of a first measure of MAW and second one of the MNW using 3D systems Freeform Modelling Plus Software. Correlation analysis indicated a moderate link between the MAW and the MNW. Regression analysis showed that MAW and sex form a statistically significant regression pattern (R² = 0.340, SEE (Standard Error of Estimate) = 3.801). The preliminary results obtained provide reliable predictions of MNW for facial reconstruction based on MAW measured on the skull.

The estimation of stature from bones plays an important role in identifying unknown bodies, body parts, or skeletal remains, as it is an important component of the biological profile in forensic identification. The objective of this study is to enhance the development of forensic anthropology in Romania by creating a new regression formula for stature estimation. This can be accomplished from the length of the tibia, taking into account sex and age, for the Romanian adult population. A total of 137 cases from a delimited territory of Romania were included in the study. The length of the tibia and the stature of the individuals were measured before autopsy. Statistical analysis was carried using (Statistical Package for the Social Sciences) SPSS 23. Tibia length showed a high correlation with stature for males, females, and the total sample. Four regression formulae were created for stature estimation of Romanian males, females, and unknown sex. The results of the analysis are impressive and have a good applicability in a forensic anthropological context. The data used in this paper provide reliable results with a large applicability in the future for estimating stature from the tibia length for the Romanian adult population.

Diabetic ketoacidosis (DKA) is a lethal acute hyperglycemic complication of diabetes mellitus (DM) and it represents the initial manifestation of DM in about 15–20% of cases in adults and about 30–40% of cases in children. Postmortem diagnosis of DKA can only be made by applying thanatochemistry. Biochemistry applied postmortem is viewed with skepticism by many practitioners in the forensic field, completely lacking in many forensic services around the world, and especially in the national ones. This article aims to underline the importance of the postmortem application of biochemistry by reviewing the case of a person in the third decade of life who died suddenly at home due to diabetic ketoacidosis (DKA), whose autopsy was performed at an early PMI of approximately 24 h. Routine postmortem examinations (macroscopic, anatomopathological, and toxicological) could not establish a clear cause of death. When attention was turned to biochemical determinations (i.e., determination of glycated hemoglobin, glucose and ketone bodies (acetone, beta-hydroxybutyrate) in the blood, vitreous humor, and cerebrospinal fluid), the identified values clarified the thanatogenic mechanisms by establishing the diagnosis of DKA.

Background: Identifying skeletal remains has been and will remain a challenge for forensic experts and forensic anthropologists, especially in disasters with multiple victims or skeletal remains in an advanced stage of decomposition. This study examined the performance of two machine learning (ML) algorithms in predicting the person’s sex based only on the morphometry of L1–L5 lumbar vertebrae collected recently from Romanian individuals. The purpose of the present study was to assess whether by using the machine learning (ML) techniques one can obtain a reliable prediction of sex in forensic identification based only on the parameters obtained from the metric analysis of the lumbar spine. Method: This paper built and tuned predictive models with two of the most popular techniques for classification, RF (random forest) and XGB (xgboost). Both series of models used cross-validation and a grid search to find the best combination of hyper-parameters. The best models were selected based on the ROC_AUC (area under curve) metric. Results: The L1–L5 lumbar vertebrae exhibit sexual dimorphism and can be used as predictors in sex prediction. Out of the eight significant predictors for sex, six were found to be particularly important for the RF model, while only three were determined to be important by the XGB model. Conclusions: Even if the data set was small (149 observations), both RF and XGB techniques reliably predicted a person’s sex based only on the L1–L5 measurements. This can prove valuable, especially when only skeletal remains are available. With minor adjustments, the presented ML setup can be transformed into an interactive web service, freely accessible to forensic anthropologists, in which, after entering the L1–L5 measurements of a body/cadaver, they can predict the person’s sex.