Forensic GIT - regional injuries

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1.

6-7 day old clot

starts breaking down

2.

12-15 days old clot

yellowish stained slit, pale brown clot

3.

Accelerating injury

Moving object hits a still head ->

skull picks up momentum first ->
transfers it to still brain
e.g hitting head with hockey stick

15.

Comminuted
fracture.

AKA spider web fracture, a type of

depressed fracture in which the bone
gets broken into multiple pieces that get
driven in the brain underbeath

16.

Common ribs
fractures and
location?

4, 5, 6, 7 and 8th ribs are the most

common. Convex part at the angle.
Bilateral ribs are broke in RTA

17.

Contusions in the
deeper structure
of the brain

Intermediatary contusions

4.

Anterior cranial fossa

fracture

Causes: direct impact, contra-coup

injuries
Result: black eye, leakage ofblood
and CSF from nose

5.

Autopsy findings of
traumatic asphyxia

1. Deeply cyanosed face

2. Blood shot eyes
3. Numerous petechial hemorrhages
4. Demaracting line between normal
and cyanosed parts

18.

Countre-coup
fracture

Fracture that occurs because the head is

not supported and moving. The fracture
occurs opposite and diagonal to the site
of impact. Common in RTA. Fracture can
be depressed, fissured or crushed

6.

Basilar fracture

Fracture on the base of the skull.

Can be simple or complex

19.

Seen in RTA due to the gliding of the

cars

7.

Battle's sign?

Bluish discoloration of the skin

behind the ear due to blood leaking
under the scalp after a skull fracture

Countrecoup
injuries in the
lungs?

20.

laceration and contusion of the brain

8.

Bird feet injury

Common injury to the face seen in

RTA
Due to glasses of the wind screen
injuring the face

Coup and contrecoup injuries are

an example of

21.

CT scan features
of EDH?

9.

Black eye is an
example of?

Contusion

1. biconvex
2. Unilateral
3. On the squamous part of the temporal
bone

22.

10.

A bruise/bluish
appearance and
swelling around the
eye, behind the ear
and temporal region
suggests?

Bleeding in the anterior scalp slides

to appear in the orbit

Decelerating
injury

Moving head hits a still surface -> first

the skull loses momentum -> brain still in
momentum and hits the inner surface of
the skull
e.g motorcyclist hits head against a pole

23.

AKA signature fracture, due to direct

impact of the weapon on the skull

Causes of Extradural
hemorrhage?

Rupture of middle meningeal artery,

diploic veins, dural venous sinus
DOES NOT occur in infants and old
people because their dura is tightly
adherent to the skull

Depressed
fracture of the
skull.

24.

Diastic fracture

There's separation of sutures. Usually

seen in children due to blunt force on the
road, etc

25.

Disparities b/w
spinal injury and
the sypmtoms
produces are due
to the following
reasons

1. Shock waves
2. Temporary cavity effects of high
velocity bullets
3. Mature spinal cord is anatomically
shorter than the axial skeleton
4. Position of the spinal cord within the
spinal canal changes with posture. Injury
and symptoms depend on the victim's
body stance

26.

Ectopic pregnancy

Rupture of fallopian tubes

27.

Femur head
running into
acetabulum+ both
sacroiliac joints
dislocated?

fall on feet, transmission of force up the

legs

11.

12.

Cerebral concussion

- mild and entirely reversible neuronal

injury
- aka STUNNING
- Immediate unconsciousness or
impaired consciousness

13.

Cerebral irritation

A post-concussion complication:
patient lays curled up in bed with
head b/w pillows, irritated by noise
and light, isn't unconscious but not
bothered with surroundings either

14.

Clinical symptoms of
SEVERE cerebral
concussion

1. Pale face
2. constricted pupils
3. Cold and clammy face
4. Loss of control of sphincter so
urinary and fecal incontinence
5. CAN suffer due to inflammation,
compression or syncope

28.

Flail chest/stove in
chest?

Due to broken ribs and sternum

Chest gets sucked in during inspiration
and doesn't come out - paradoxical
respiration

Jefferson's fracture

Fracture of the Atlas due to a vertical

blow on the head with a straight neck

43.

Linear/fissured
fracture

Caused by blunt force with a broad

resisting force like fall injury or RTA.
There are no displacement of bone, the
fracture is a thin line.

44.

Middle cranial fossa

fracture

Causes: direct impact behind the ears,

crush injuries of the head
Result: Leakage of blood and CSF from
the ears (because this is where the
petrous part of the Temporal bone is
found)

45.

Moritz radiating
wave theory

Injury impact on a hollow organ

resulting in propagating waves of
damaging energy traveling through
meridional lines

Four types of
fractures of the
base of the skull

30.

Gaggio's pressure
gradient theory

positive pressure on the site of the

impact of injury and negative pressure
on the opposite side of the injury
because the brain moves towards the
injury

31.

Gliding contusions

Frontal lobe injury due to gliding of the

brain towards the front

32.

Gutter fracture.

Flanking or grazing by the bullet which

produces furrow in the outer table of
the skull

46.

Head injury

anterior displacement of C2 vertebrae,

medulla and pons can be damaged int
he process

Most common cause

of death in road
traffic accident?

47.

Most common
places of scalp
injuries due to fall
are?

1. Occipital protuberance
2. forehead
3. Parietotemporal region

48.

Moving head sudden

arrest results in

countrecoup injury because the the

skull is arrested but the brain is still in
motion hitting the arrested site of the
skull

49.

Non-penetrating
injuries of the
heart?

Blunt force to the heart -> VFib/Valvular

rupture -> sudden death
Cardiac tamponade -> already diseases
heart ruptures due to trauma and blood
accumulates int he pericardium

50.

Paraplegia
(paralysis of the
lower limbs)

damage to the root below the level of

brachial plexus. T2-T3

51.

Pelvis is splayed
open, pubic
symphysis and
sacroiliac joints are
dislocated?

Injury on the anterior part of the

abdomen and pubic area (e.g run over
by a car wheel)

52.

Pitting

Penetrative injury of the spinal cord;

needle is inserted b/w C2-C3 and
twisted to separate the spinal cord from
the medulla. Common method of
infanticide

53.

Pond/indented
fracture.

fracture that occurs in new born due to

their elastic skull. Indentation or simple
buckling of skull. Forcep injury

54.

Pontine measure?

bleeding of Pons seen in Hypertensive

patient

55.

Posterior cranial
fossa fracture

Causes: Impact injury on the back of

the skull
Result: leakage of blood and CSF in the
tissues found in the back of the head

29.

33.

34.

35.

36.

Hangman's fracture

Anterior cranial fossa

Posterior cranial fossa
Middle cranial fossa
Hinge fracture/transverse

42.

Hinge
fracture/transverse
fracture

Fracture runs from side to side on the

floor of the middle cranial fossa
(passes the pituitary fossa in the
process as well)

Holbourn sheer
strain injury

countrecoup lesions causing sheer

strain because local injury pulls apart
different constituents of brain sending
them in different directions

Homocidal cut
throat features

1.
2.
3.
4.
5.
6.
7.
8.

Below the thyroid cartilage, swift

Horizontal
No tentative cuts
Single and deep
No tailing
Carotid and jugular are usually cut
defense wounds on hands
No weapon located

How do you
differentiate
between a
laceration and
incised wound in the
scalp?

Incised would: clean cut, clear cut

through hair bulbs
Laceration: rough edges of the cut,
crushed hair bulbs

38.

How to measure
ICP?

Intraventricular catheter

39.

Hyoid bone fracture

occurs mostly in

Throtlling
in people over the age of 40 because
they're bone has ossified and more
likely to fracture

40.

Intracerebral
hemorrhage

blood-tinged CSF

41.

Intraventricle
hemorrhages most
profound finding

yellow-colored CSF (xanthochromia)

37.

56.

Pregnant females injury in

criminal abortion?

Rupture of the gravid uterus

57.

Punch drunkness syndrome

Neurological symptoms due to

tiny hemorrhages suffered
from boxing

58.

Quadreplegia (all four limbs

paralyzed) is seen when

C4, above the emergence of

the root that supplies the
Brachial plexus

59.

Railway spine

Spinal concussion due to

railway or RTA

60.

Rawling's theory of bony

irregularities

Damage to the frontal and

temporal lobes of the brain
due to the bony nature of the
orbits, sphenoid bone,
cribriform plate

61.

Recovery of Cerebral
concussion that doesn't
result in inflammation or
compression shows which
complications?

1. Retrograde amnesia complete loss of recent

memory pre and post the
injury (duration 15-30 days)
2. Post traumatic automatism
- acting and speaking in
delirious way and not
remembering your behaviour
later
3. Post concussion syndrome
- symptoms of headache,
irritability, loss of hearing,
sight and insomnia

62.

63.

Ring fracture

Russel's theory

- Fracture around foramen

magnum that goes 3-5 cm
outward
- Fall from height falling on
feet -> impact travels up the
spine and affects the base of
the skull
- Falling on the head
- Heavy object falling on the
head
- Violent twisting of the head
potential space created on the
opposite side because the
brain moves towards the site
of the injury

64.

Scalp torn from the head

exposing aponeurosis

Avulsion injury

65.

Spectacle hematoma?

Blood accumulating in the soft

tissue around the eye due to
fracture in the base of the
skull.

66.

Spleen injury death occurs

due to?

Massive internal bleeding

67.

Struck hoop theory

injury due to the change of

shape of skull because of its
elastic nature

68.

Subdural hemorrhage is

Crescent shaped

69.

Suicide cut throat

features

1. Tentative cuts around the wound

(found on wrist or other vital parts)
2. Tail of the wound on the right side
if person is right handed
3. Above the thyroid cartilage
4. Left to right in the right handed
person
5. Gradual shallow to deepening, tail
on the right side
6. Curved
7. Mostly adult males
8. Carotid is usually saved
9. No defense cuts or wounds on
hands
10. Cadaveric spasm seen due to
holding weapon in hand while dying
11. weapon is located

70.

Superior and inferior

pubic rami are
fractures +
dislocation of
sacroiliac joint?

Injury with impact from the side

71.

thoracic vertebrae

less prone to rotational injury due to

additional support by the thoracic
ribcage

72.

Three categories in
which head injuries
are divided into and
studies?

1. Scalp injuries
2. Skull injuries
3. Brain injuries

73.

Three places in the

scalp where blood is
found?

1. B/w aponeurosis and epidermis

2. underneath the aponeurosis
3. Beneath the pericranium

74.

Treatment of EDH?

- good prognosis
- clearance of clot
- Conservative therapy for small clot
with swirl sign
Complications: calcification,
pseudoanerysm, arteriovenous fistula

75.

Undertaker's fracture

Postmortem artifact created due to

keeping the neck on a 13-18 cm block
to examine the neck. It's a tear in the
intervertebral disc C6-C7.

76.

Vacuum theory

Vacuum created on the opposite side

of the injury due to the suctioning
effect created by the movement of
the brain towards the injury

77.

What is meant by
Lucid Interval during
an Extradural
hemorrhage?

Free interval b/w the injury and the

symptoms to appear. Lasts from 2
hours to 7 days.

78.

What is the SWIRL

SIGN in the CT scan
of an epidural
hematoma?

A. It represent fresh, unclotthed

bleeding that appears hyperdense
during the CT scan

79.

Where does extradural hemorrhage take place?

B/w the inner table of the skull and the parietal layer of the dura (periosteal
layer)
They are limited within cranial sutures

80.

Whiplash injury

Hyperflexion/hyperextension injury of the neck. MC in car accidents

Limbs paralysis due to the damage of the nerve at the root of the neck (C4
and C5)

81.

Why does the heart stop if there's severe trauma to the

testies?

Vagovagal reflex (vagus nerve is stimulated by the trauma)