Fatal neck injuries represent a major challenge in forensic pathology because the anatomical complexity and high variability of neck structures make it often extremely difficult to differentiate true pathological findings from artifacts at autopsy. This topic becomes even more relevant when the forensic pathologist is required to make a pathophysiological evaluation of bone fractures in the absence of soft tissue to support the diagnosis. We report a case of unidentified, stone-covered, skeletonized human remains found within a pit below an abandoned building with bony lesions of the cervical spine and ribs, including a full-thickness fracture of the right lateral mass of the atlas (C1). After a careful study of the fractures was carried out by screening forensic literature and anthropological studies, clinical neurosurgical expertise was called upon to provide a reliable explanation. A rapid and violent twisting of the neck in the opposite direction from the fracture site by an attacker who pinned the victim's torso is the scenario that most likely occurred in our case. This case report shows that the diagnosis of cervical spine injuries in skeletal remains should be the result of a multidisciplinary approach that integrates forensic, anthropological, and clinical expertise.
Keywords: forensic anthropology; multidisciplinary approach; neck injuries; skeletonized.