Using the guides of American Medical Association in the evaluation of permanent losses in muscular skeleton system injuries

Introduction: According to the Turkish Penal Code, weakening/loss in the function of the senses and organs has been described as an aggravating cause. While evaluating the musculoskeletal system, lists of regulations arranged for labor law/social rights can be used. The approach of the AMA (American Medical Association) guideline is that impairment and disability are different definitions and this study has been planned with the idea that this approach is more suitable for evaluating the concepts of "loss of function/permanent weakening of function" belonging to the criminal law of our country. It is intended to be an example for standardization. Materials and Methods: Patients over the age of 18 years with musculoskeletal injuries and a medicolegal evaluation report prepared by our department between 01.10.2016 – 01.10.2019 were included in the study and demographic characteristics, examination findings from forensic reports, injury weights, regulation used, and percentages of losses calculated from the AMA guidelines were recorded in the data form. The relationship between the data was evaluated using the SPSS 24.0 program. Findings: 281 cases were evaluated. The average age was 41.88 ± 16.45, and the M/F ratio was 2.79/1. The cause of trauma was traffic accidents in 63.7% of the cases and blunt trauma in 18.9%. The relationship between threat of life and function was statistically significant (p <0.005). The percentages from the AMA guideline are grouped and 10-50% are defined as "permanent weakening of function" and more than 50% are defined as "loss of function". As a result of the comparison, different results were obtained about the effect of traumatic lesions on function in 63 of 281 cases. For the 190 cases in which the regulation was used in the first assessment, the newly calculated losses were; it was less in 134, more in 32 and equal in 24. A significant difference was found between the regulations used and the percentages of losses obtained from the AMA guidelines (p <0.01). Conclusions: It is inevitable to obtain different results by using different guides for the same patient. There is a need for an arrangement that is suitable for medical development, functional, updatable and acceptable by all institutions for scientific, objective and reliable forensic reports. In this arrangement; applications and examples whose validity and reliability have been accepted should be included, the results of anatomical loss and functional limitation should be evaluated together obtained disability rates should be calculated based on functionality. Key words: Forensic traumatology, permanent weakening, loss, Turkish Penal Code