Blunt Force Trauma | Skull Fractures | IC Hem

Question 1

What are the 2 Mechanisms OP of BFT?

Answer 1

• Moving Object strikes –> Body
• Moving Body strikes —> Fixed Object / Surface

Question 2

Definition of Blunt OBJECT

Answer 2

• DOES NOT have a Cutting Edge / Pointy End
• Examples: Hammer, Bat, Plank, Tables etc…

Question 3

What does Severity / Appearance of BFT DEPEND On?

Answer 3

1) AMOUNT of Force delivered to –> Body
- KE of Blunt Object

2) TIME OVER Force Applied

3) REGION STRUCK

4) NATURE of WEAPON
- Specific Pattern
- Defined Edges

5) SPECIFICS of PERSON
- Thicker Clothing
- Hats / Hoodies

Question 4

CLASSIFICATION of BFTs

Answer 4

1) Abrasion = External ONLY

2) Contusion (Bruise)
3) Laceration

Question 5

Definition of “ABRASION”

Answer 5

• SUPERFICIAL Type of Injury
• DOES NOT penetrate the Full Thickness of Skin

Question 6

What is the MECHANISM OP of Abrasion?

Answer 6

1) TANGENTIAL Application of Force, AKA Linear Abrasion i.e. “SCRATCH” - made by fingernails / well-defined edges

2) GRAZE = Friction against BROAD Surface, AKA BRUSH Abrasion

3) COMPRESSION = Impact is VERTICAL TO SKIN / Epidermis gets CRUSHED / PRODUCED PATTERN of Causative Object

4) TERMINAL TAG = Collection of PEELED Epithelium at END of Abrasion

5) POST-MORTEM Abrasion = Produced AFTER Death; During transportation / moving of the body; YELLOW Coloured / DRY as Parchment Paper

Question 7

STAGES of Healing & Repair

Answer 7

1) FRESH = Bright-Red DENT in skin / lymph + blood pooling in it

2) After 12 - 24h = Bright-Red SCAB from DRIED blood + lymph

3) After 2 - 3 Days = REDDISH-BROWN SCAB that’s ELEVATED ABOVE the Skin

4) After 4 - 7 Days = Healing UNDER SCAB causes Peeling from Edges

5) After 7 - 14 Days = Scab FALLS OFF COMPLETELY leaving NO Scar, Just Discolouration

Question 8

Definition of “Contusion” (Bruise)

Answer 8

• EXTRAVASCULAR COLLECTION of Blood into Tissue
• Due to Trauma
• Most are OVAL-Shaped
• Either Superficial / Deep (aka Come-Out Bruises which appear after hrs - days from trauma)

Question 9

What are the Types of Bruises?

Answer 9

• Ectopic
• Tramline
• Patterned
• Suction

Question 10

What is an Ectopic Bruise?

• Give Examples

Answer 10

• Appearing at diff location to injured site, due to blood migration via force of gravity

1) Black Eye = injured site is the forehead / nose / base of skull

2) Battle Sign = Over the Mastoid Process / base of skull

3) Scrotum Bruising (Men) = Fractured Pelvis / Abdominal Trauma

4) Cullen’s Sign = Umbilicus bruising

5) Gray Turner Sign = Flanks bruising via intra + retro-peritoneal haemorrhage

Question 11

What is a Tram-line Bruise?

Answer 11

• Formed by CYLINDRICAL Object - rod, pipe, cane etc…
• 1 STRIKE = 2 BRUISES

Question 12

What is a Patterned Bruise?

Answer 12

• Where bruise resembles the contact surface of the blunt object

Question 13

What is a Suction Bruise?

Answer 13

• aka LOVE BITES = DECREASED pa from suction around the vessel, causing extravasation
• Usually tend to be sexual crimes - at breast / neck

Question 14

What is the Aging of Bruises?

Answer 14

Day 1 - 3 = BLUE-PURPLE - Hemoglobin

Day 4 / 5 = BROWNISH - Hemosiderin

Day 6 / 7 = GREENISH - Biliverdin

Day 7 - 12 = YELLOW-Disappearing - Bilirubin

Question 15

What are the Complications of Bruises?

Answer 15

• Containing 20 - 30 ml of Blood, OR MORE!
• Multiple Contusions may result in death - due to SHOCK
• Gangrene
• Pooled Blood = Good Site for BACTERIAL GROWTH
• Pulmonary Fat Embolism

Question 16

Definition of “Laceration”

Answer 16

• Tears in the skin, mucous membranes, muscles or internal organs
• Due to application of blunt force

Question 17

What are the Characteristics of Lacerations?

Answer 17

• ragged edges
• bruising / abrasion of the edges
• tissue bridges = intact nerves, vessels + tendons
• scarce bleeding
• heal via scarring

Question 18

What are the Stages of Repair & Healing in Lacerated Wound?

Answer 18

1) Inflammation

2) Proliferation

3) Scar Formation + Remodelling

Question 19

What are the Complications of Lacerated Wound?

Answer 19

• Fatal Bleeding (Scalp Trauma)
• Infection
• Pulmonary / Systemic Fat Embolism = Due to crushing of subcut. tissue

Question 20

What are the Types of Lacerated Wounds?

Answer 20

• Star / Stellate
• Teeth Marks = Either Static / Dynamic

Question 21

What are the Types of Skull Fractures?

Answer 21

• Linear
• Pond / Depressed
• Spider-Web
• Ring

Question 22

What are Linear Fractures?, aka PUPPE’S RULE

Answer 22

• aka PUPPE’S RULE
• Where there’s 2 or more linear fractures, from different blows
• The LATTER fracture DOES NOT CROSS the EXISTING fracture line

Question 23

What are Pond / Depressed Fractures?

Answer 23

• Due to blunt objects with a narrow surface
• such as hammer, or an axe

Question 24

What is a Spider-Web Fracture?

Answer 24

• Due to object with a BROADER SURFACE
• Such as the floor / the wall

Question 25

What is a Ring Fracture?

Answer 25

• Around the FORAMEN MAGNUM
• Due to HEIGHT FALL - where force is projected UP THE AXIS of SPINE
• Forcing it BACK UP INTO SKULL BASE

Question 26

What is a Transverse Fracture?

Answer 26

• Linear fracture going from 1 Temporal Bone TO Another

Question 27

What are the 3 Lines on Face of Skull?

Answer 27

Le Forte 1 = Force is UNDER the Nose

Le Forte 2 = Force is BASE (Top) of the Nose, POINTED DOWNWARDS, aka TRIANGLE

Le Forte 3 = Force is BASE (top) of the Nose

Question 28

What are the 4 Types of Intracranial Hemorrhages?

Answer 28

1) Extradural / Epidural

2) Subdural

3) Subarachnoid

4) Intracerebral

Question 29

What’s the DIFFERENCE BTW Epidural / Subdural?

Answer 29

EPIDURAL

• Btw Skull + Dura
• Arterial Bleeding
• NO Crossing
• Lens Shape
• From Direct Injury
• SHORT Bright Period

SUBDURAL

• Btw Dura + Arachnoid
• Venous Bleeding
• CROSSES Cranial Sutures
• Crescent Shape
• From INDIRECT Injury
• LONG Bright Period