Well, this one took me down a rabbit hole. This is a 45-year-old pedestrian hit by a car. He has obvious injury to his head that you can see on x-ray, and multiple internal injuries. Nothing particularly unusual there, and I won’t go into details. However, when I looked at the FOBOS image, the hips seemed awfully funny. It looked to me like there was an old healing fracture of the right hip that never got fixed. Why didn’t he get a hip replacement? It looked like it would have hurt. The left hip is obscured by the hand, but also looks a bit funny. Clearly it’s chronic, but just for due diligence I spent awhile trying to make this fit somehow with a recent pedestrian-motor vehicle collision. Then I got his medical records and voila! he has known Legg-Calve-Perthes disease. Of course. That explains why his acetabulum looks so wacky in addition to the femoral head. This is yet another finding I’ve never seen first hand after decades of practice.
It is yet again another example of why it’s so important to get medical records on all cases, even MVAs. We, as forensic pathologists are hampered in that we have a very limited amount of time and resources we can devote to a case. We can’t spend 10 hours per case doing dissection. For me, at a minimum, an autopsy involves eight hours of effort — -1-2 hours for the autopsy dissection, 1-2 hours reading records, 1/2 to 1 hour reviewing slides, 1-2 hours looking at literature and putting everything together, and 1-2 hours writing the report and making diagrams. And, of course, that doesn’t count the umpteen gunshot wound cases or complicated hospital cases that really have a 4-5 hour dissections, or the cases that require testimony (a day of travel and presentation) or deep literature search. When you have 40 or so reports (including externals) to get through in a month, at least five or six are going to require extra work at the table and another couple are going to have a thusand pages of extra stuff to sift through. When you have these cases where the cause of death is clear, you just can’t spend the extra six or seven hours to track down every little thing. But… having the medical records can answer a lot of questions. I try never to sign out a case, even an MVA or GSW, without them. A lot of “I don’t know what this is, but it didn’t kill him and I don’t have time to obsess about it” lesions are cleared up there.
More important, once the question is answered the *next* time you see it, you’ll know. Were I to live to be 120 years old, the next time I see a case like this 40 years from now, I’ll remember this one, and I wouldn’t get it unless I’d read the medical records on this one I do a lot of private consultations, and a common thread I see in reports from other offices are comments about the difficulty of getting medical records in cases where the cause of death is equivocal. As a consultant I find that very sad, since by the time it comes to trial, usually someone *has* managed to get the records, and thus I am much better prepared than the autopsy pathologist. It shouldn’t be that way. States that make it difficult for MEs to get medical records are doing their citizens a grave disservice. I’ve noticed that this seems to have become a bigger problem with the politics surrounding abortion. Some places are balking at providing medical records on women “just in case” it might be used for abortion-related prosecutions, I’ve been told. It hasn’t happened to me, but if that’s the case, it’s very, very sad.
In any case, here’s the radiograph. Look at that right hip. Click on it to make it bigger…
