W11 - Forensic Aspects of Trauma; Bone and Soft Tissue Tumours Flashcards
Definition and classificaion of injury
Damage caused by accident/attack facilitated by mechanical force
Appearance or method of causation
- abrasion, contusion, laceration, incised wounds, burns
Manner of causation:
- suicidal, accidental, homicidal
Nature of injury:
- blunt force, sharp force, explosive
Biological and physiological variables which determine outcome of injury
a
Blunt Force Injuries
CONTUSION: burst vessels in skin
ABRASION: graze, scratch of skin surface
LACERATIONS: cut, tearing of skin d/t crushing
Factors affecting prominence of contusion
- skin pigmentation
- fat = ⇧fat = bruises more easily
- age: children and elderly
- coag. disorders
Shapr Force Injuries
INCISED WOUNDS:
- superficial sharp force injury caused by slashing
- longer on skin surface than deep
STAB WOUNDS:
- thrusting = depth>surface length
Defensive Type Injuries
Passive = backs of hands and forearms; sliced
Active = sliced incised wounds on palmar aspects
Typical Consequences
Head = skull fractures, depressed, bleeds
•Traumatic SAH d/t rapid rotation, sudden movements = traumatic rupture of base vessels
*distal portion of intracranial vertebral arteries at point where they cross the dura
= unconscious and cardiac arrest
• Diffuse brain injury = immediate and prolonged coma with no apparent mass lesion or metabolic abnormality
* traumatic axonal injury
RTC
- femur
* aortic rupture with ladder-rung tears
Differentiate clinical features of benign vs malignant bone and soft tissue tumours
(b) activity related bone pain d/t weakening; clear margins
+ increased uptake in isotope bone scan
vs
(m) less defined margins, cortical destruction
* unexplained pain, boring nature, night pain, deep swelling
+systemic effects of neoplasia
+neurovasc effects
Appreciation of investigation and the interpretation of investigations in bone and soft tissue tumours
XR
- CT
- ossification and calcification
- ID: nidus in osteoid osteoma
- staging primarily of lungs
- Isotope bone scan
- mets
- freq. neg. in myeloma
- MRI = sensitive to osteosarc.
- specific for lipoma, haemangioma
- can not differentiate for (b) vs (m)
*Biopsy w/ bloods workup and imaging
The natural progression of the bone and soft tissue tumours
a
Metastatic bone disease: common sites, sources,
2º more common than 1º mets
- bone common site after lung and liver
- sources:
1) lung
2) breast (melanoma)
3) prostate
Common sites of mets = vertebra, prox. femur, pelvis, ribs
Sarcoma
Malignant arising from CONNECTIVE TISSUE
- > fascial planes
- > haematogenous spread to lungs
Bone Tumours
Commonly benign but secondaries common
* >50y likely metastatic
(b) osteoid osteoma, osteoblastoma
(m) osteosarcoma
Cartilage-forming tums
(b) ECHONDROMA; OSTEOCHONDROMA
(m) CHONDROSARCOMA
Fibrous tissue tums
(b) FIBROMA
(m) FIBROSARCOMA, MALIGNANT FIBROUS HISTIOCYSTOMA
Vascular Tissue tums
(b) HAEMANGIOMA
(m) ANGIOSARCOMA
Adipose Tissue tums
(b) LIPOMA
(m) LIPOSARCOMA
Marrow Tissue tums
(m) EWINGS SARCOMA*, LYMPHOMA, MYELOMA
* onion skin, long bones, destructive
Commonest 1º malignant bone tums in young and older patients
(young) OSTEOSARCOMA
(older) MYELOMA
Red flags in bone tumours
- deep boring pain worse at night
- # not healing and deterioration
- development of fixed deformity
- continued pain and swelling
Tx of Bone Tums
> CT
Sx: difficult for agressive (b), and cartilage tums
RT
Red flags for Soft Tissue Tums
- deep tumour
- rapid growth, hard, craggy, non-tender
- rapid growth
- recurring post-excision
Scoring for Risk in bone Mets dis.
MIREL’S SCORING
(1) UL, mild pain, blastic lesion, <1/3
(2) LL, mod. pain, mixed lesion 1/3-2/3
(3) peritrochanter, functional pain, lytic lesion
