Elevator accidents, while infrequent, can lead to fatalities and severe injuries [10]. Despite being one of the safest forms of transportation, the high volume of elevator traffic can contribute to serious incidents [2]. According to McCann, 20.5% of elevator passengers were not engaged in work at the time of their accidents, while 20.1% were performing work-related duties, such as clerical, stock handling, and janitorial tasks. Notably, the remaining cases (59.4%) involved construction workers who were in or near elevator shafts [1].

Reconstructing elevator-related accidents is crucial for both safety improvement and legal accountability [4]. The majority of these accidents can often be attributed to inadequate maintenance or malfunctioning equipment [6]. The nature of injuries sustained in elevator incidents varies according to the specific circumstances surrounding each case. Prahlow et al. highlighted that falls from heights were the leading cause of elevator-related fatalities, followed closely by severe asphyxia, crushing injuries, and pressure-related injuries, which placed third [11].

In this case, the cause of death was determined to be severe polytrauma resulting from dragging, compression, and crushing injuries that led to a dislocated skull and multiple thoraco-abdominal injuries, exposing internal organs and viscera. The most plausible scenario suggests that the victim experienced compression between the elevator shaft wall and the elevator, followed by a fall that resulted in further crushing as the elevator descended.

Evidence supporting this hypothesis includes blood found on the wall adjacent to the elevator, facial lacerations, longitudinal bruising on the anterior chest, and multiple fractures identified through PMCT. It has demonstrated not only exceptional sensitivity and specificity in recognizing and classifying various types of fractures, but it also allows for the identification of injuries to soft tissues and organs [12,13,14,15,16].

A systematic review of 15 studies comparing PMCT and autopsy findings in cases of traumatic death indicated an agreement rate ranging from 50 to 100% in determining the cause of death, with enhanced concordance noted specifically in gunshot-related fatalities [17]. Additionally, a subsequent large-scale study revealed an almost perfect correlation between PMCT and autopsy results in the detection of craniofacial injuries and gunshot-related deaths [18]. Thus, PMCT was instrumental in characterizing fractures that would have been challenging to analyze during a standard autopsy, thereby providing critical insights into the dynamics of the accident [19]. Indeed, PMCT has enabled the description and reconstruction of fractures in the craniofacial region and has revealed complex spinal fractures, including a Jefferson fracture and a complete Chance fracture at the D6 level, along with spinal deviation proximal to the fracture.

The autopsy further confirmed the absence of any pre-existing pathological conditions that could have contributed to the victim’s injuries. To maximize data collection, a multidisciplinary approach incorporating PMCT is essential [20]. Nevertheless, the autopsy remains a key component in establishing the cause of death and ruling out any underlying health issues that may have played a role in the injuries sustained.

In conclusion, the circumstances of the accident and the height of the fall significantly influence the severity of injuries and the likelihood of a fatal outcome in elevator incidents. Precise reconstruction of these accidents is essential for forensic investigations, as it aids in understanding the dynamics involved, especially in industrial contexts. Additionally, PMCT has proven to be a valuable, rapid, and non-invasive tool for the documentation and reconstruction of traumatic injuries, enhancing the overall forensic analysis.