OBJECTIVE: To explore the general features and the keypoints of forensic medical examination in tumbling injury cases. METHODS: Twenty-eight cases dying of tumbling injury were collected and the locations and features of injury were analyzed. RESULTS: The occiput of head was the common position for the tumbling injury cases. Force, disease and alcohol were the main reasons for tumbling injury. CONCLUSION The injury is mild outside and severe inside from tumbling injury cases. The craniocerebral contrecoup is the significant feature in tumbling injury cases.
Accidental Falls/mortality* ; Adolescent ; Adult ; Aged ; Alcoholism/blood* ; Autopsy ; Cause of Death ; Contusions/pathology* ; Craniocerebral Trauma/pathology* ; Female ; Forensic Pathology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Scalp/pathology* ; Skull Fractures/pathology* ; Young Adult

A teenaged female was found dead in front of a three story building. Blunt force injuries were found mainly in the right upper-posterior part of the body. Autopsy findings revealed basal skull fracture, multiple rib fractures of the right thoracic cage, both scapular fractures and right iliac bone fracture. Additionally, typical so-called 'tramline'bruises were bilaterally noted at buttocks. The hymen was intact, but showed mucosal hemorrhage. After the personal identity was revealed, the police could find a witness who heard the detailed description of the criminal acts from one of the suspects. According to the witness, the deceased was pushed by two other teenaged girls from the concrete fence of the roof floor after the suspects molested the genitalia of the deceased and beat on the buttocks with a wooden stick. Mathematical estimation of the height of fall based on the severity of injuries correlates with that of the three story building. Authors suggest that a careful examination of injury patterns is required to differentiate homicidal falls from suicidal or accidental ones. Furthermore, application of mathematical model might be helpful to estimate the height of falls or correlate the assumed height of fall with severity of injuries.
Accidental Falls ; Autopsy ; Buttocks ; Contusions ; Criminals ; Female ; Floors and Floorcoverings ; Forensic Pathology ; Fractures, Bone ; Genitalia ; Hemorrhage ; Homicide ; Humans ; Hymen ; Models, Theoretical ; Police ; Rib Fractures ; Skull Fractures ; Wit and Humor as Topic

FEM combined with modern computer technology is a mathematical method for stress analysis. It has gradually become a significant experimental tool to explore the functions of biomechanically simulated human body structure and mechanism of craniocerebral injuries. This paper reviewed the features and biomechanical materials of the FEM human head models, materials assignment and their applications in blunt injury, fall, traffic accident. It also explore their merits and values in forensic head injury cases.
Accidents, Traffic ; Biomechanical Phenomena ; Computer Simulation ; Craniocerebral Trauma ; Finite Element Analysis ; Forensic Pathology ; Head/physiopathology* ; Humans ; Imaging, Three-Dimensional/methods* ; Models, Anatomic ; Models, Biological ; Skull Fractures/physiopathology*

Child ; Edema ; diagnostic imaging ; etiology ; Emphysema ; diagnostic imaging ; etiology ; Ethmoid Bone ; diagnostic imaging ; injuries ; Eyelid Diseases ; diagnostic imaging ; etiology ; Humans ; Male ; Orbit ; diagnostic imaging ; Orbital Diseases ; diagnosis ; diagnostic imaging ; pathology ; Radiography ; Skull ; diagnostic imaging ; pathology ; Skull Fractures ; complications ; diagnostic imaging

PURPOSE: Computed tomography (CT) is the standard diagnostic method employed in cases of blunt head trauma, and repeat CT (RCT) scans are very often obtained in order to monitor for acute progression of intracranial pathology. The purpose of this study was to retrospectively evaluate the utility of the routine RCT scans in patients with traumatic brain injury (TBI), and to suggest the guidelines for RCT scans of the head. METHODS: The trauma registry and medical records of patients who were admitted to the emergency department of our university hospital from January 2004 to December 2006 were retrospectively reviewed. All patients admitted with TBI who received RCT scans of head were enrolled in this study. Results of initial head CT scans, indications for RCT (routine vs. neurologic change), and neurosurgical interventions (craniotomy and extraventricular drainage) were recorded. For patients who received worsened or unchanged subsequent RCT scans, the scans were compared and independent predictors of a worsened RCT were identified by stepwise logistic regression. Patients were categorized according to the Glasgow Coma Scale (GCS) as having mild (GCS 14-15), moderate (GCS 9-13), or severe (GCS< or =8) head injury. RESULTS: All inclusion criteria were met in 338 patients. Most (70.7%, n=239) RCT scans were preformed on a routine basis, whereas 29.3% (n=99) were ordered in response to neurological change. One hundred eleven (32.8%) patients showed signs of worsening on RCT, and 62 (13.8%) required neurosurgical intervention. Risk factors associated with worsening on CT evaluations were coagulopathy; skull fracture; multiple lesions; and an initial diagnosis of acute subdural hematoma, acute epidural hematoma, or hemorrhagic contusion. No patient with a mild or moderate TBI without neurological deterioration underwent an neurosurgical intervention after routine RCT. However, of the 48 patients with severe TBI who underwent routine RCT, the repeat scanning led to neurosurgical intervention in 5 patients (10.4%). CONCLUSION: In patients with mild and moderate TBI without clinical deterioration, routine RCT does not alter management and is unnecessary. Nevertheless, conclusions about patients with moderate TBI should be drawn with caution. Routine RCT is unequivocally indicated for patients with severe TBI, because the results sometimes dictate neurosurgical intervention even in the absence of obvious neurological deterioration.
Brain Injuries* ; Brain* ; Contusions ; Craniocerebral Trauma ; Diagnosis ; Emergencies* ; Emergency Service, Hospital ; Glasgow Coma Scale ; Head ; Hematoma ; Hematoma, Subdural, Acute ; Humans ; Logistic Models ; Medical Records ; Pathology ; Retrospective Studies ; Risk Factors ; Skull Fractures ; Tomography, X-Ray Computed

OBJECTIVE: To show imaging findings of inferior orbital fissure (IOF) and groove (IOG) on axial CT scans and to discover their anatomic variations, so as to avoid misdiagnosing them as orbital fracture. METHODS: 25 normal skull were used to investigate the configurations of IOF and IOG. Five skulls were performed axial CT scans. 20 normal orbital axial scans were studied as well. MPR and RT-3D reconstructions were used in this study. RESULTS: Skulls scans and normal orbital images on axial CT showed three sorts of findings: (1) single bony dehiscence between lateral and inferior walls; (2) first type of double bony dehiscence between lateral and inferior walls, among the dehiscence interposing a small bone. The long axis of the small bone was parallel to orbital wall; (3) second type of double bony dehiscence between lateral and inferior walls, but the long axis of the small bone was in anteroposterior direction. Anatomy and variation of three sorts of CT findings were corresponded respectively to: (1) a baseball club-shaped IOF; (2) a "V"-shaped IOF, that is composed of both of lateral and internal ramus, lateral ramus situates between the zygoma and the lateral portion of greater wing of sphenoid, and internal ramus between the maxilla and the internal portion of greater wing of sphenoid, both rami intercross caudally and open upwards in a "V"-shaped configuration; (3) a deep IOG with a protuberant lateral wall. CONCLUSION Familiarity of imaging features on the axial CT scans and understanding of their anatomy of IOF and IOG would be helpful for avoiding misdiagnosis of orbital fracture.
Cadaver ; Forensic Medicine ; Humans ; Imaging, Three-Dimensional ; Orbit/diagnostic imaging* ; Orbital Fractures/pathology* ; Skull/diagnostic imaging* ; Sphenoid Bone/diagnostic imaging* ; Tomography, X-Ray Computed/methods*

The brain and intracranial compartment undergo a multiplicity of physiologic and anatomical changes which influence the type of head injury and response to such injury, especially for those children in first two years of age in whom development of skull and brain is still undertaking. Thus, special attention to recognize and manage these children from such injury seems mandatory. Purpose of this study is to analyze the related causes for the head injury in this age group with various clinical parameters influencing the outcome. A total of 68 children less than two years of age who were admitted to our institution after head trauma were included in this retrospective study. The causes of head injury along with other clinical settings, such as type of pathologies, Pediatric Glassgow Coma Scale(PGCS), age, operation, hypoxia, shock, seizure, anemia, abnormal pupillary response, were reviewed and clinical outcome related with these parameters were analysed. The mean duration of admission period was 15 days and mean follow-up period was 29.4 months. Most common mode of injury was stairway injury(32.3%), followed by in-car accident(19.1%), with suspected child abuse being only 2.9%. Cerebral contusion was the most frequent diagnosis being 43 cases(63.2%), followed by skull fracture in 31(45.6%). For the outcome related to various categories, 5 cases of death were due to diffuse axonal injury or intracranial hemorrhage, but most simple linear fractures were not associated with underlying brain injury. Among those required the operation(18 cases), subdural and/or epidural hematoma were the most common pathology(50%), followed by subdural hygroma and depressed skull fracture. The outcome, however, was not related to type of pathology. Instead, it was rather closely related to the initial PGCS. The PGCS at admission was found out to be the major predicting factor to outcome. In overall, 34/36(94.4%) cases with normal PGCS in these age groups showed good recovery with deaths being 5/7(71.4%) cases of PGCS Anemia ; Anisocoria ; Anoxia ; Brain ; Brain Injuries ; Child Abuse ; Child* ; Coma ; Contusions ; Craniocerebral Trauma* ; Diagnosis ; Diffuse Axonal Injury ; Fever ; Follow-Up Studies ; Head* ; Hematoma ; Humans ; Hypotension ; Intracranial Hemorrhages ; Mortality ; Mortuary Practice ; Pathology ; Prognosis ; Reflex ; Retrospective Studies ; Seizures ; Shock ; Skull ; Skull Fracture, Depressed ; Skull Fractures ; Subdural Effusion

Nasotracheal intubation is usually recommended when surgery in the oral cavity or on the mandible is facillitated by an unobstructed view. If the mouth is to be wired or banded shut after surgery, a nasal tube must be used. Contraindication to nasal intubation include coagulopathy, severe intranasal pathology, basal skull fracture, and presence of a cerebrospinal fluid leak. We experienced a case of blood aspiration during nasotracheal intubation. The patient was admitted for open reduction and internal fixation due to mandible fracture. On preoperative evaluation, specific problem was not noted. During nasotracheal intubation, epistaxis was developed and the aspiration of blood into the lung was occurred, accidentally. Operation was postponed and the patient was transferred to recovery room. In recovery room, a chest x-ray of left lung revealed deerease of volume, increase of interstitial marking, and more opaque finding than right lung. Arterial blood gas revealed pH 7.43, PCO2 44mmHg, PO2 61mmHg. With frequent suction, encouraging expectoration, antibiotic therapy and 0, supplementation by nasal prong, patient was nearly normalized following 5 hours after the episode of aspiration. Carefully, retrial of nasotracheal intubation was done one week later under the preparation of bosmin (Jeil pharmacy) nasal packing and lubricated endotracheal tube. Intubation and the operation was finished uneventfully.
Cerebrospinal Fluid ; Epistaxis* ; Humans ; Hydrogen-Ion Concentration ; Intubation* ; Lung ; Mandible ; Mouth ; Pathology ; Recovery Room ; Skull Fractures ; Suction ; Thorax

The authors analysed 147 cases of basal skull fracture which were treated in the Department of Neurosurgery, Chungnam National University Hospital from January 1989 to December 1992. These fractures are difficult to diagnose by ordinary X-ray examination and are frequently inferred by clinical signs. The clinical features and radiological findings were reviewed. The results of the analysis are summarized as follows : 1) The basal skull fractures were more common in men than women-the ratio being 6 : 1. 2) In decreasing order of cause of basal skull fractures were traffic accidents(77%), fall down, assault and slipping. 3) The minor head injury, Glasgow Coma Scale Score(GCS) of 13 to 15, was 79 cases(54%), the moderate head injury 40 cases(27%) and the severe head injury 18 cases(19%). 4) In decreasing order of clinical features were otorrhea(71%) rhinorrhea(48%) and raccoon eye(33%) etc. 5) In decreasing order of the combined pathologies were skull fracture(55%), subdural hematoma(17%), epidural hematoma(16%) and intracerebral hematoma(12%) etc. 6) The facial nerve, vestibulo-cochlear nerve and optic nerve were the most commonly injured cranial nerve. 7) CSF leakage was noted in 139 cases and among them immediate type was far more common(96%) than the delayed type. 8) The incidence of meningitis was 5.4% and most of them associated with CSF leakage and the prophylatic antibiotic treatment has no effect to decrease infection rate. 9) In decreasing order of the frequency associated injuries were facial bone fracture(47%), clavicle fracture(19%), lower extremities fracture(9%) and upper extremities fracture(7%) etc.
Chungcheongnam-do ; Clavicle ; Cranial Nerve Injuries ; Cranial Nerves ; Craniocerebral Trauma ; Facial Bones ; Facial Nerve ; Glasgow Coma Scale ; Humans ; Incidence ; Lower Extremity ; Male ; Meningitis ; Neurosurgery ; Optic Nerve ; Pathology ; Raccoons ; Skull Fractures* ; Skull* ; Upper Extremity

Serial computed tomography(CT) was done on 168 patients suffering from craniocerebral trauma. The type of initial intracranial lesion in response to primary impact site was evaluated with special reference to the initial Glasgow Coma Scale(GCS), the number of specific CT findings on GCS outcome, and the skull fracture on resultant pathological findings. The development of delayed intracranial lesion, both intra - and extra - dural, was examined by comparing the intial scan with follow-up studies. The conclusions are as follows : 1) The initial GCS has a close relationship to outcome. 2) Initial CT findings(intraventricular hemorrhage, subdural hematoma, cerebral swelling, and subarachnoid hemorrhage) appear to be closely associated with poor outcome. 3) The more the number of intial pathological findings, the poorer the outcome. 4) The CT findings with skull fracture cause much more pathology than those without skull fracture. 5) The frontal lobe is shown to be the most vulnerable contusional site. 6) Delayed traumatic intracerebral hematoma, cerebral edema and cerebral inforction as new lesions encountered on subsequent CT scan have a bad outcome. We conclude that initial and follow-up scan help predict the outcome of patient with craniocerebral trauma, and may be very important in their examination and management.
Brain Edema ; Brain Injuries* ; Brain* ; Coma ; Contusions* ; Craniocerebral Trauma ; Follow-Up Studies ; Frontal Lobe ; Glasgow Coma Scale ; Hematoma ; Hematoma, Subdural ; Humans ; Pathology ; Skull Fractures ; Tomography, X-Ray Computed