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Instantaneous Death Due to Transorbital Reverse Penetration of a Screw in an Accidental Fall: Unusual Autopsy Case Report and Review of the Literature

Gioia, Sara MD; Bacci, Mauro MD; Lancia, Massimo MD; Carlini, Luigi MD; Suadoni, Fabio MD

The American Journal of Forensic Medicine and Pathology: March 2014 - Volume 35 - Issue 1 - p 15–19
doi: 10.1097/PAF.0000000000000079
Case Reports

We present a peculiar autopsy case of a transorbital penetrating head injury, in a male worker, after an accidental fall onto a screw not completely stuck into a wooden board.

A 13-cm screw entered the cranium 9.5 cm deep, penetrating with the flat end, a condition defined in literature as “reverse penetration.” The death was instantaneous and caused by a neurogenic shock due to injuries to the brain stem and the right cerebellar hemisphere.

These injuries, enabled by the length of the screw, are generally described in literature as due to nontransorbital penetrations, frequently associated with posterior entry and a large intracranial injury.

The ocular globe has been, furthermore, perfectly preserved thanks to its mobility in the orbit.

Even the dynamic of the incident is peculiar because of the stationary nature of the penetrating object, which the victim actively fell on by accident.

To the best of our knowledge, the matter is therefore a very peculiar mortal case of transorbital intracranial penetration, whose verified injuries and dynamics are absolutely atypical.

The case is now under discussion, and a review of pertinent literature is performed.

From the Section of Legal Medicine, University of Perugia, Perugia, Italy.

Manuscript received September 18, 2013; accepted December 1, 2013.

The authors report no conflicts of interest.

Reprints: Massimo Lancia, MD, Section of Legal Medicine, University of Perugia, Via del Giochetto, snc, Perugia, Italy 06126. E-mail:

© 2014 by Lippincott Williams & Wilkins.