Certification Programs for Criminalists - Historical Development.

Certification is the process by which individual practitioners of a profession are deemed competent, by a peer review process, to practice that profession. Criminalistics is a rather young profession, and until the recent publicity occasioned by a myriad of television dramas and documentaries, a rather obscure one. There has been little oversight of the profession and little call for such oversight until the 1970s. The calls for oversight primarily came from those outside the profession and with only a peripheral interest in the profession. In response, the profession itself began to consider the development of a process of self-review and to establish certification criteria (a) by which the competence of practitioners could be assessed in a way that would be acceptable to practitioners; (b) equitable to the diverse jobs requirements of various practitioners; useful for external evaluation by users of professional services; and, above all, (c) be a realistic method to evaluate the ability of the practitioner to engage in the professional practice of forensic science. Professional certification of criminalists was first suggested at a meeting of the California Association of Criminalists (CAC) in 1975. This initial proposal was taken to the broader national criminalistics community through the efforts of the Criminalistics Certification Study Committee (CCSC) beginning in 1976. Subjected in 1978 to a national referendum of practitioners, CCSC's proposal was rejected. Undaunted by national rejection, in 1986 the CAC renewed efforts to develop a certification process for its members, which resulted in the offering of the first certification examination in 1989. Since the initial certification examination by the CAC, certification of criminalists has evolved through the activities of the American Board of Criminalistics (ABC). Efforts have been continuously made to refine the process to more closely reflect the demands of the profession. The evolution has been slow, sometimes painful, and not always successful; however, a major revamping of the certification examination process was taking place in 2007.

[Arthroscopic distension irrigation in acute postoperative infection of the knee joint--long-term follow-up]. / Arthroskopische Uberlaufspüldrainage bei akuter postoperativer Kniegelenkinfektion--Langzeitergebnisse.

Between 1983 and 1993, 26 patients, 12 patients from our clinic and 14 referred patients, had to be treated because of a septic knee joint following open ligament repair or subsequent arthroscopic surgery. Immediately after arthrocentesis for synovial-fluid analysis a distension-irrigation system was established under arthroscopic control as described by R.W. Jackson. Three tubes were placed into the knee joint cavity. One was used for inflow and the other two for outflow. Distension was performed by open inflow and closed outflow tubes each second hour for 10 to 15 min. Systemic antibiotics were administered. In 22 aspirated materials the cultures revealed bacteria: mostly staphylococcus aureus (65%). In two cases in which irrigation of the knee-joint infection was performed later than the 10th postoperative day a relapse of the infection occurred and required a complete debridement and synovectomy. During follow-up period three patients underwent second look arthroscopy due to meniscus tear, rupture of an ACL reconstruction and synovial proliferation. 7 +/- 3 (2-13) years after treatment, 24 patients were re-examined, all had x-rays and 11 patients had a MRI of the knee joint additionally. 19 patients showed excellent or good results: no complaints, full ROM, no signs of osteoarthritis on x-rays and nearly normal participation in sports 4 out of 11 patients had signs of cartilage lesion and synovial proliferation. This retrospective study indicates that the distension-irrigation system is successful only in early acute cases of knee-joint infections of postoperative origins.

[Simple elbow dislocation. Comparison of long-term results after immobilization and functional treatment]. / Die einfache Ellbogenluxation. Vergleich der Langzeitergebnisse nach Ruhigstellung und funktioneller Behandlung.

From 1976 to 1985 the treatment used for simple dislocation of the elbow consisted in closed reduction and immobilization for about 3-4 weeks. Since 1985, simple dislocation of the elbow has been treated with closed reduction and immobilization for fewer than 3 days. A group treated by immobilization (20 patients) and a group that underwent functional treatment (24 patients) were both evaluated with regard to elbow motion, instability, isometric flexor and extensor strength of the forearm, and subjective (patient) judgement of the elbow function. An average of 8 +/- 5 years after the treatment 39 elbows were re-examined. In both groups, results were generally good, 22 patients having no residual symptoms or signs. However, 17 did have symptoms: 6 patients had a slight (loss of extension < 10 degrees, loss of flexion < 10 degrees) and 1 patient a moderate decrease in the range of motion (loss of extension > 10 degrees). Some instability was found in 5 patients and strength was slightly decreased in 9. The subjective judgement on their elbow function was very good in 22 patients. At follow-up, no statistically significant differences were found between the two groups. The retrospective study, however, revealed that immobilization for 3-4 weeks more than doubled the time of after-treatment, the period of disability of the elbow, and the period of physical rehabilitation. Therefore, an accelerated functional treatment is recommended for the treatment of simple elbow dislocation: this is more effective, takes less time and is more economical.

[Surgical treatment of soccer player's ankle joint]. / Die operative Behandlung des Fussballer-Sprunggelenks.

In experienced football players spurring and calcifications of the ankle joint's capsule attachments may be found more often than in other sportsmen. Basing on functional and sometimes already established ankle joint instability pain may develop. Out of 374 football players throughout 1989-1992 with injuries to the ankle joint 49 were operated on. These showed chronical instability and radiologically visible alterations in accordance with the imaging of footballer's ankle joint. 40 of these patients could be followed up. 16 exact fibular ligament repairs and 19 reconstructions were performed, 15 tibioventral, 6 talodorsal, 12 fibular and three medial capsule calcifications and spurs were excised, 8 loose bodies removed, three cases of osteochondritis dissecans drilled. After an average follow up of 25.6 months we saw stable ankle joints in all patients with resting local pain in 15 patients, among them 7 load dependent and 6 with slight limitation of dorsiflexion. Sport activity level showed 25 patients improved, 11 equal, one worse and three with changed disciplines.

[Tarsal tunnel syndrome in athletes]. / Das Tarsaltunnelsyndrom beim Sportler.

Pain in the hindfoot due to overuse has many causes. One uncommon cause is the entrapment of the posterior tibial nerve: the tarsal tunnel syndrome. Pain when palpating posterior the medial malleolus and pain in the abductor hallucis muscle are typical symptoms. Application of a local anaesthetic leads to immediate pain relief. The distal motoric latency is prolonged, but not in all cases. First of all, treatment consists of local and oral antiphlogistics, orthopaedic arch-support and physiotherapy. In case of therapy-resistant pain over more than three months period, surgical decompression of the tibial nerve should be performed. In the last three years we treated 18 patients with a tarsal tunnel syndrome: 6 of 8 patients were symptom-free after surgical intervention, whereas only 3 of 10 were symptom-free after conservative treatment.

Differential patterns of PMN-elastase and type III procollagen peptide in knee joint effusions due to acute and chronic sports injuries.

In 38 traumatic knee joint effusions the proteolytic enzyme PMN-elastase (PMN-E) and the repair marker procollagen III aminoterminal peptide (PIIINP) were determined. According to the period between trauma and first aspiration of the effusion, the patients were divided into 3 groups. Group I (17 patients; period between trauma and first aspiration not longer than 72 hours) showed high concentrations of PMN-E (up to 5400 ng/ml) and low concentrations of PIIINP (less than 13 U/ml). Group II (11 patients; aspiration within 4 to 14 days) had mean PMN-E and PIIINP concentrations of 125.6 ng/ml and 52.1 U/ml, respectively. In group III (10 patients, aspiration after 14 days) mean PMN-E concentration was 123.8 ng/ml and mean PIIINP concentration was 63.4 U/ml. Graphic depiction of PMN-E and PIIINP levels in each individual sample as a function of time between trauma and fluid collection revealed highly increasing PMN-E levels during the first 24 posttraumatic hours, followed by rapidly decreasing levels within 72 hours post trauma, and no change after the 4th posttraumatic day. In contrast, PIIINP increased continuously up to the first posttraumatic week and stayed at high levels up to 90 days (end of the observation period). The differential patterns of PMN-E and PIIINP concentration in knee joint effusions may be useful in estimating the period between trauma and first treatment (aspiration of effusion) and should, therefore, be helpful in detecting degenerative lesions, which seem to be characterized by low PMN-E concomitantly with high PIIINP levels.

[Fatigue fractures in sports. Personal experiences and literature review]. / Ermüdungsbrüche im Sport. Eigene Erfahrungen und Literaturüberblick.

Stress fractures are bone fractures, in most cases at the lower extremities, caused by overload. Spondylolysis and -listhesis can be considered as stress fractures, too. During the past 10 years, 67 female and male athletes with stress fractures were treated and followed up until full ability to practice sports was achieved again. Bone scan (technetium 99) and nuclear resonance imaging MRI are devices for an early and exact diagnosis. Stress fractures mostly occur to runners. Conservative treatment includes a training-free interval with painlessness as the most important criteria. Only in rare cases immobilization or surgical treatment are necessary. As prophylaxis it is important to advice the athletes not to ignore overload pain.

[Value of synthetic (Kennedy-LAD) augmentation in replacement of the anterior cruciate ligament]. / Die Bedeutung der synthetischen (Kennedy-LAD) Augmentation beim vorderen Kreuzbandersatz.

In chronically ACL-deficient knees, ACL replacement was performed in 31 cases with an one-third patellar tendon (Brückner-Jones) and in 50 cases with a quadriceps-patellarperiosteum-patellar tendon autograft (Marshall-MacIntosh) augmented with the Kennedy LAD. Anterior laxity measured with the KT 1000 arthrometer revealed a side-to-side difference of less than or equal to 3 mm in 90% (77% without augmentation), a high rate of muscle strength quotient of uninjured to treated knee of about 1 (greater than 1 without augmentation) and early recovery of ability to participate in the same sports as before in 54% of patients (45% without augmentation) demonstrate statistically significant better results of ACL replacement when a synthetically augmented autograft was used.

[Long-term follow up of anterior cruciate ligament reconstruction using autologous tendon graft augmented with alloplasty (Kennedy LAD)]. / Langzeitergebnisse bei vorderer Kreuzbandrekonstruktion mit alloplastisch verstärktem, autologem Sehnentransplantat (Kennedy LAD).

From October 1983 to January 1990 in 493 patients 499 injured anterior cruciate ligaments were reconstructed by a composite tendon graft. The autogenous graft, semitendinosus tendon or quadriceps-patella periost-patellar tendon, both anatomically attached distally, was augmented with the polypropylene braid (Kennedy LAD). In the period of January to November 1984 in 81 patients anterior cruciate ligament replacement was performed. A retrospective 2-years follow-up in 72 patients and a second 5-years follow-up in 67 of those 72 patients was possible. There were 38 patients with an acute rupture and 34 patients with chronic instability. Clinical and instrumented laxity revealed a mean displacement difference of not more than 3 mm in 84% of the patients in comparison of the involved with the normal knee at the 2-years and 5-years follow-up. 80% of strength analyses showed a physiological balance of quadriceps and hamstrings in the 5-years follow-up. In the 2-years follow-up only 41% of patients practiced former sports activities again, whereas in the 5-years follow-up 80% of the patients were able to join former sports. 80 to 100 points of Lysholm score demonstrating good to very good results were reached in 91% of the patients. Especially cartilage damages in cases of chronic instabilities worsened the results mentioned by the patients.

[Therapy-resistant heel pain--an indication for surgery in sports traumatology]. / Der therapieresistente Fersenschmerz--eine Operationsindikation der Sporttraumatologie.

Posterior heel pain can be caused by inflammation or pathology of the achilles tendon, the tendon sheath, the retrocalcaneal and subcutaneous tendoachilles bursa, can be caused by osteophytes or stress fracture of the os calcis and by rheumatoid or metabolic diseases. The majority of patients can be treated successful nonoperatively; however, there is a small group of patients who are refractory to nonoperative managements. In the years 1984 to 422 patients with posterior heel pain were treated conservatively, 26 of these patients were refractory to that management. There were 9 cases of achilles tendinitis and/or tenosynovitis, 7 cases of bursitis, 3 cases of osteophyte of the os calcis. In 7 cases there was seen a combination of these three diseases. The following operative procedures were performed: discision of the tendon sheath, excision of thickened parts by inflammation, excision of degenerative and necrotic pain-producing areas in the achilles tendon, excision of bursa and ostectomy of osteophyte at the posterior-superior angle of the os calcis. The mean follow-up was 2.7 years (range, 1/2 to 5 years). Overall there were 79% good results. In our opinion cases of posterior heel pain refractory to non-operative treatment are an indication of sports surgery, especially in patients who like to continue sports without pain.

[Mobilization in anesthesia and arthrolysis in postoperative knee joint stiffness]. / Narkosemobilisierung und Arthrolyse bei postoperativen Kniegelenksteifen.

Knee joint stiffness first of all calls for physiotherapy, ranging from exercise therapy to a passive-immobilization splint. If no progress can be achieved, narcosis mobilization and brisement modéré should be done. If narcosis mobilization does not yield acceptable results, then surgical dissolution and arthrolysis should be performed. Thirty-seven patients with painless fibrous knee-joint stiffness following ligament reconstructions showed a reduction in mobility of 0 degree-20 degrees-80 degrees on average. After narcosis mobilization, full extension and bending could be achieved in 28 patients. In 9 patients, arthrolysis had to be carried out. At follow-up examination 1/2 to 3 1/2 years later, all 37 patients showed an increase in movement of 0 degree-0 degree-125 degrees on average. The "relative gain," the quotient of achieved and possible gain of movement in percentage, ranged from 88% to 96% on average. Other kind of loss of movement, patient age, or sex had no influence on the results. Twenty-six patients were able to participate in sports again due to the increase in movement potential. In the last few years, we have come to prefer arthroscopical arthrolysis instead of surgical arthrolysis when narcosis mobilization fails.

[Sports fitness following surgical treatment of osteochondrosis dissecans]. / Sportfähigkeit nach operativ versorgter Osteochondrosis dissecans.

A retrospective analysis of 29 patients with regard to their sportive activities after operative treatment of osteochondritis dissecans was carried out. The study included 21 males and 8 females with an average age of 18 years. In 4 cases patients' history revealed a trauma. Osteochondritis dissecans was located in 16 cases in the knee joint, in 12 cases in the ankle joint and in one case in the elbow joint. In 11 cases the articular cartilage was not disrupted, and therefore subchondral focus drilling and autologous cancellous tissue grafting were a sufficient therapy. 10 out of those 11 patients had no complaints during their sportive activities 3 years after this operation. In another 10 cases with an osteochondral fragment, reimplantation was possible. 5 of those 10 patients were free of complaints during sportive activities 3 years later. In 2 of those 10 patients the reimplanted fragments did not become incorporated and had to be removed. 2 out of 8 patients with removal of necrotic fragments and curretage of subchondral bone had no complaints 3 years postoperatively. Best results could be achieved in patients with intact articular cartilage and subchondral lesion. Good results showed patients after reimplantation of the osteochondral fragment. Poor results were found in cases with necrotic osteochondral fragments. Osteochondritis dissecans with an osteochondral fragment should not be further treated conservatively but gives an urgent indication for operation. MRI is very helpful for this decision.

[Functional anatomy of the upper ankle joint]. / Funktionelle Anatomie des oberen Sprunggelenks.

The ankle joint is regarded as a hinged joint with a range of motion of about 60 degrees. The shape of the trochlea tali varies, so the axis of rotation and the compensative movements of the fibula do. The ligamentous stabilizers of the medial side are thicker than the lateral ones. At the other hand, the lateral malleolus is more voluminous than the medial one. The lig. fibulotalare ant. is a reinforcement of the joint capsule, the lig. fibulocalcaneare has no connection to the jointcapsule, the lig. fibulotalare post. is partially running through the joint. In neutral- and plantarflexed position, the lig. fibulocalcaneare forms a groove which takes up the tendon sheat of the peroneal tendson. In dorsalextended position the tendons are pushed laterally by the tense ligament. This mechanism supports the peroneal tendon luxation in dorsal extension.

[Surgical therapy of fibular capsule-ligament rupture]. / Operative Therapie der fibularen Kapselbandruptur.

Different procedures for primary reconstruction of ruptured ligaments in fresh lateral ankle ligament injuries are reported. Selective local anesthsia of the nervus fibularis superficialis and suralis is considered a protective and low-risk method. In our opinion the primary surgical treatment of lateral ankle ligament ruptures is still the most adequate treatment, especially in sportsman.

[Displacement of the tibial tuberosity in retropatellar cartilage damage and recurrent patellar dislocation]. / Die Versetzung der Tuberositas tibiae beim retropatellaren Knorpelschaden und der rezidivierenden Patellaluxation.

In our hospital in the years 1980 till 1986 37 displacements of the tuberositas tibiae were performed in chondropathia patellae and recurrent luxation of the patella. The follow-up examination took into consideration the radiological and clinical findings, the subjective complaints and the ability of going in for sports. These clinical experiences and pressure measurements in the femoro-patellar joint show the best results after the displacement of the tuberositas tibiae according to Blauth. Additionally we recommend an accurate indication for chondropathia patellae and recurrent luxation of the patella and accompanying surgical measures.

[Possibilities of biochemical differentiation of reactive effusions of the knee joint]. / Möglichkeiten der biochemischen Differenzierung von Reizergüssen am Kniegelenk.

1. Differentiation of reaction effusions: Posttraumatic reaction effusions (fresh meniscus or capsular ligament lesion) displayed a greatly enhanced alkaline phosphatase activity, whereas postoperative reaction effusions that were poor and rich in cells had a comparatively high C3c value relative to the total amount of protein. In punctates from patients with patellar chondropathy and primary synovial reaction (no trauma, no postoperative condition) the lowest parameter values of of the entire study were seen. 2. Decision help with regard to therapy: Via determination of the sensitive inflammation parameter PMN elastase (E-a1PI) it is possible to initiate cartilage-protective therapy directly in case of a cartilage lesion of mild inflammatory character (E-a1PI 300-500 ng/ml), whereas in case of severe inflammation (E-a1PI 500-1000 ng/ml) anti-inflammatory drugs should be employed in the first instance. 3. Therapy control: In the follow-up control of reaction effusions the comparison of concentrations of biochemical parameters before and after intra-articular application of drugs offers a possibility of therapy control. Since with increasing inflammatory nature and disturbance of the blood-synovia barrier the concentration of the measured biochemical parameters (with the exception of glucose) increased in the synovial fluid, successful treatment should result in an absence of such an increase in concentration (or, if at all, in an only slight measure).

[Neurophysiological and biomechanical analysis of a gymnastics accident with high transverse paralysis. An example of a sports medicine research study in the area of prevention of sports accidents]. / Neurophysiologische und biomechanische Analyse eines Kunstturnunfalles mit hoher Querschnittslähmung. Beispiel einer sportmedizinischen Forschungsstudie im Bereich der Prävention von Sportunfällen.

The development of preventive provisions is an important topic of sport accident research. We demonstrate the stepwise procedure of judging a provision taking the analysis of a gymnastic exercise. This includes determination of the inner and outer reasons of accidents, the biomechanical conditions of the exercise and leads to mathematical and experimental simulation of the dangerous movement. The specific exercise we studied was the efficiency of a coach in protecting position for the handstand somersault with 1 1/2 breakneck leap. The reaction ability of the coach during the exercise and his force capacity to prevent an accident is explored by a newly developed reaction time analyzer and by a catapult apparatus throwing a dummy. Our results show the inadequacy of the prevention provision of a coach in protecting position for the special gymnastic exercise.

[Synovial chondrosis. Chondromatosis--osteochondromatosis]. / Chondrosis synovialis. Chondromatose--Osteochondromatose.

Clinical and pathological findings as well as diagnosis of Chondrosis synovialis (Henderson-Jones Syndrome) are presented and completed with authors observations. According to relevant literature the treatment should depend on the stage of the disease.