Table 2: Torture Techniques and Related Findings TORTURE TECHNIQUE Acute (single episode) and chronic (repeated episodes of) injury PHYSICAL FINDINGS AND NOTES ON THEIR DETECTION Abrasions, bruises, lacerations, scars; fractures (and, if multiple, some at different stages of healing), especially in unusual locations, which have not been treated Skull fractures, scalp bruising, laceration, cerebral contusions and other intracranial manifestations of trauma; after time, cerebral cortical scars and atrophy Consider cervical spine trauma when facial trauma present Assess nasal bone alignment, crepitation, deviation of the septum; consider plain X-ray, CT scan for the septum. Assess for rhinorrhoea and orbital plate/crista galli fracture Consider fractures of the temporo-mandibular and laryngeal structures. Assess these as part of a detailed neck and facial examination following subcutaneous dissection. At the same time also look for tooth avulsions and fractures; dislocated dental fillings; broken dental prosthesis; bruised tongue; lesions from forcible insertion of objects into the mouth, electric shocks or burns Specific injuries may disclose a shape suggestive of the causative object, e.g. tramline bruising from rods, truncheons or canes Consequences of blunt force injuries to the orbit, including “blow out” fractures (and/or loss of integrity of the globe), conjunctival haemorrhage, lens dislocation, subhyaloid haemorrhage, retrobulbar haemorrhage, retinal haemorrhage Suspension by the wrists (“La bandera”)121 Bruises or scars around the wrists. A chronic linear zone around a wrist or ankle, with few hairs or follicles, is most likely to be a cicatricial alopecia from the prolonged application of a tight ligature. There is no differential diagnosis of spontaneous skin disease for such an appearance Suspension by the neck or arms (e.g., “cross suspension” – spreading the arms and tying them to a horizontal bar; “butchery” – tying the hands upwards together, or one by one) Bruising or scars at the site of binding; prominent lividity in lower extremities; neck trauma (often minimal but may include fractures to larynx) Suspension with the feet upwards and head downwards (“reverse butchery”, “murciélago”) Bruises or scars around the ankles; ligamentous damage, dislocations to ankles or other joints Suspension from a ligature tied around the elbows or wrists with the arms behind the back; or the forearms bound together behind the back with the elbows flexed to 90 degrees and the forearms tied to a horizontal bar (“Palestinian hanging”) Abrasions, bruises, scars around the wrist(s); dislocation of shoulder joint, or ligamentous damage, muscular tears and/or necrosis to upper arm or pectoral muscles; myoglobinuric renal damage or failure Suspension of a victim by the flexed knees from a bar passed below the popliteal region, usually while the wrists are tied to the ankles (“parrot perch”, “Jack”, “pau de arara”) (can lead to cruciate ligament tears) Abrasions, bruises, and/or lacerations, scars on the anterior forearms and backs of the knees; abrasions, bruises to the wrists and/or ankles 121 Note that these various forms of suspension, which may last from between 15 and 20 minutes to hours or days, are often accompanied by various forms of beatings and can result in serious systemic consequences. 47