Bones and joints
Beatings and falls can lead to fractures of bones. In the acute setting it is generally possible to diagnose a fracture clinically if no X-ray facilities are available.
Fractures can be caused by a direct blow, in which case the fracture is at the site of the impact, or by twisting or crushing, in which case the fracture tends to be at the weakest part of the bone. The commonest fractures in survivors of torture are of the nasal bones; the radius and ulna (bones of the forearm); the carpal, metacarpal and the phalangeal bones of the hand; the ribs; the transverse processes of the vertebrae, and the coccyx (the bone at the end of the spine, below the pelvis).
If fractures heal well, there will be no way of knowing whether the injury was caused by torture or by accidental causes. However, the fact that an injury can be demonstrated may be corroboration of the individual’s account. It can also be significant if there are multiple fractures at different stages of healing. If the fracture has healed at an angle, or has become chronically infected, this may support an allegation of inadequate treatment at the time of the original injury. If old X-rays are available, new X-rays (if the equipment is available) can help to determine how long ago the injury occurred. The location, contour and other characteristics of a fracture reflect the nature and direction of the applied force.
In the acute phase, local swelling, bony deformity, tenderness and loss of function will be typical findings at the clinical examination. In the chronic phase, various degrees of bony deformity, pain at activity and loss of function may be found.
If a person alleges that a bone was fractured during torture and a callus is palpable, that should normally be sufficient to document. An X-ray would be able to point out the callus formation following fracture.
Many forms of torture involve damaging joints. Indeed the word ‘torture’ comes from the Latin torquere (to twist) because many tortures involved distending and twisting joints.
Suspension is a common form of torture, in which the individual is suspended by the arms or wrists. The body weight distends the shoulder joints, causing pain. In one variant, ‘Palestinian suspension’ (also referred to as Palestinian hanging’), the arms are behind the back, increasing the strain on the shoulder joints and often stretching the nerves running into the arms.
Other forms of joint damage are specific to particular parts of the world. For example, the knees may be forcibly bent backwards around a heavy pestle, causing permanent damage to ligaments; or the thighs may be forced apart, damaging the adductor tendons (tendons running from the muscles that separate the thighs) which may remain tender for a long time afterwards.
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