Retrospective Analysis on Traumatic Rupture of Intracranial Internal Carotid Artery in 11 Cases / 法医学杂志

Objective To retrospectively analyze the characteristics of the traumatic rupture of intracranial internal carotid artery in order to provide reference for forensic expertise examination and identification. Methods A total of 11 autopsy cases of traumatic rupture of intracranial internal carotid artery were collected. The gender, age, cause of injury, blood loss on the scene, location of internal carotid artery rupture, hardening degree of the rupture of the wall, brain injury, blood ethanol content and cause of death were also recorded. Results All 11 cases died on the scene, of which 7 died from traffic accidents, 2 falls from height and 2 from bare handed injuries. None of the 11 victims suffered serious head and body surface injury. The internal carotid artery rupture in the 9 cases of traffic injury and fall from height injury occurred in the cavernous segment. In all these cases, there were transverse fractures of the middle cranial fossa with the carotid sulcus involved, and minor intracranial hemorrhage and brain contusion. In 2 cases of bare handed injuries, internal carotid artery rupture occurred in the ophthalmic artery segment, accompanied by fatal intracranial hemorrhage and diffuse axonal injury, but no skull fracture. All 11 cases showed full-thickness rupture of the vessel wall, and the long axis of the wounds was perpendicular to those of the artery. Conclusion The incidence of intracranial internal carotid artery rupture in high-energy trauma events such as traffic accidents and high falls deserves attention. Injuries of the cavernous segment or ophthalmic segment might be more common. The main injury mechanism of intracranial internal carotid artery rupture might be that the blood vessels were pulled and the bone fragments caused damage.

Exploring of the Mechanism of Rib Fracture Caused by Landing on Different Parts of the Trunk after Falls from Height Using Finite Element Method / 法医学杂志

Objective To study the mechanism of rib fracture caused by landing on different parts of the trunk using finite element method, and to provide some new techniques and new ideas for the reconstruction of the whole process of falls from height. Methods The finite element method was used to study the rib fracture of human security model THUMS4.0 caused by landing on different parts of the trunk. Then the model was compared with actual cases and the mechanism of rib fracture caused by falls from height was analyzed from a biomechanical point of view. Results There were some differences in the stress and strain distribution as well as the rib fracture sites when different parts touched the ground. Ribs on both sides of the body were fractured when the front of the trunk touched the ground, and the fractures were mainly located in the junction of the ribs and costal cartilage and the midaxillary line area. When the right anterior part of the trunk touched the ground, rib fracture occurred first on the side that touched the ground, and rib fractures were mainly located in the area from the right midaxillary line to the posterior axillary line, and junction of ribs on both sides and costal cartilage. When the back of the trunk touched the ground, the fracture sites were mainly located on the back of the ribs on both sides. When the right posterior part of the trunk touched the ground, multiple rib fractures were likely to occur in the parts that touched the ground. The plastic strains were mainly concentrated at the fracture sites, while the von Mises stresses were not only concentrated at the fracture sites, but also at other sites. Conclusion There are some differences in rib fracture location sites and injury mechanisms when different parts of the trunk touch the ground.

Analysis of falling height and trauma in 246 cases of fatal fall / 中国法医学杂志

Objective To analyze the characteristic of trauma in 246 fatal falls. Methods We collect 246 cases of fatal falls from Pudong district of Shanghai from 2005 to 2014, and then analyze the characteristics of trauma by using different parameters. Results The height in suicides by fall is higher than accidents by fall (25.7m:13.98m). In all fatal falls, head has a higher possibility in suffering trauma than other body regions (75.2%), while neck has a lower possibility (6.5%). The possibility of head trauma in accidents by fall is higher than suicides by fall (89.4%:75.2%). Conclusion Comparing with suicides by fall, victims in accidents by fall have lack of protection from limbs. Besides, the low rate of ifnding neck trauma suggests legal physicians should be more careful in examining this area.

Postmortem MSCT Analysis and Identification of Fall from Height：One Case Report / 法医学杂志

Objective To explore the application value of postm ortem m ulti-slice spiral com puted tom og-raphy (MSCT) in cases of fall from height through observing and analyzing the injury features of the fall and reconstructing the process of the fall based on the the above procedure. Methods One real fatal case due to fall from height was fully exam ined using MSCTand three-dim ensional reconstruction tech-nique. Analyzing the m anner and cause of death through com bination of MSCTand system ic autopsy was also im plem ented. The differences betw een autopsy and MSCTin getting inform ation of injuries were com pared. Results Fractures involving m ultiple body regions and liver rupture were found through MSCTand three-dim ensional reconstruction. The autopsy got the sam e results w ith im ageological exam i-nation. The case of death was deduced to be fall leading to system ic polytraum a. Conclusion Applica-tion of MSCTcan be used as the com plim entary for traditional autopsy in the analysis of injury m anner of fall from height.

Differences in Thoracolumbar Burst Fractures by Falls from Height with Associated Foot and Ankle Fractures

STUDY DESIGN: This is a retrospective clinical study. OBJECTIVES: To know how the associated foot or ankle fracture influences the fracture pattern in the thoracolumbar burst fractures caused by falls from height. SUMMARY OF LITERATURE REVIEW: There were few studies on how the foot or ankle fracture influences the thoracolumbar fracture caused by falls from height. MATERIALS AND METHODS: We reviewed 46 subjects, who underwent surgery due to burst fracture of the thoracic or lumbar region, caused by fall accidents, from May 2004 to October 2008. Among them, we defined 19 cases that had associated foot or ankle fractures as group A, and the other 27 cases as group B. We analyzed the differences of radiological and clinical findings, and functional outcomes between the two groups. RESULTS: The falling heights were higher in group A than in group B (P<0.01). Thoracolumbar junction (T11-L2) was the most common location involved in both groups, but group A had more fractures on the lower lumbar region (L3-5), relatively (p=0.03). Kyphotic deformity was more severe in group B (p=0.01) but there were no significant differences in the wedge angle, amount of canal compromise, compression rate of anterior column between both groups (p=0.08, 0.46, 0.76). More segments were fused in group B (P=0.04). Neurologic deficit was more common in group B (p=0.03), but there were many complications related with foot or ankle fractures in group A (38%).There was no significant difference in the final clinical outcome between both groups (Pain scale p= 0.48, Work scale p=1.00). CONCLUSIONS: In patients who had burst fractures in the thoracic or lumbar region associated with foot or ankle fractures, there was a tendency to increase the incidence of lower lumbar fracture, relatively. The neurologic deficits were less common in this group of patients, but there was no difference in the functional outcome.

Bilateral Wrist Fracture-Dislocation by Fall from Height : A Case Report

Wrist fracture-dislocation including perilunar injury is an uncommon high energy trauma, especially cases occurred simultaneously on bilateral wrist have been quite rarely reported in the orthopaedics literature. We encountered a case of open transtriquetral dorsal perilunar dislocation on right wrist and transstyloid dorsal dislocation on left wrist by fall from height. We performed open reduction and percutaneous K-wire fixation with interosseous ligament repair for both wrist. On the left wrist, flexion-extension arc, radio-ulnar deviation arc, grip strength were recovered satisfactorily at 1 year after the injury. On the radiographs, there were no intercarpal instabilities and scapholunate angles were within normal range. But clinical results on right wrist were dissatisfied by septic arthritis sequelae, and patient complained discomfort at motion. We report this unusual pattern of injury with review of the relevant literature

Responsibility and liability in cases of suicide by patient in hospital premises.

It is not uncommon to see that a few patients commit suicide in hospital premises. What would be the responsibility and liability of Hospital Manager in such situations? In the light of increasing incidents of such suicides in hospital premises, all pros and cons of such situations are discussed in length. A few settled and unsettled cases are discussed with an aim to create a debate on the issue and settle it squarely.

Clinical Features of Craniocerebral Injury in Children

The present study involves 667 patients of craniocerebral injury under 15 year old who were admitted to the Department of Neurosurgery, Yonsei Medical College and Wonju Christian Hospital from January, 1982 to December, 1983. The results of which were analyzed and evaluated as follows. 1) The proportion of male to female was 2 to 1, and one third of patients was from 2 to 7 years of age. 2) The most frequent cause of injury was traffic accident : crash injury by truck and taxi and the next was fall from height and which were the causes of three quaters of all the craniocerebral injury of children. 3) Accidents were most frequent in May, and their frequent hour was from 3 P.M. to 4 P.M. 4) In 546 cases(81.9%), the consciousness was lost at the moment of the accident, and the duration was considered to be correlated with the clinical severity. Vomiting was observed in 353 cases(52.9%), and the early seizure attack accured in 31 cases(4.6%). 5) On admission, 631 patients were G.C.S. 8 and over, 25 patients were G.C.S. between 5 and 7,11 patients were G.C.S. 3 or 4. Two thirds of mortality cases were observed in G.C.S. under 7. 6) On plain skull films, skull fracture was observed in 292(43.8%) cases. Among those, depressed skull fracture was observed in 57 cases, and compound comminuted depressed fracture in 21 cases. By brain CT scan, abnormal hemorrhagic density was observed in 126 cases(18.9%), which involves 65 cases of epidural hematoma and 14 cases of subdural hematoma. In 47 cases, the hemorrhagic density was observed in intracerebral, intraventricular or intracerebellar region. 7) Associated injury accompanied by head injury was observed in 102(15.3%) cases, and mandible fracture, with or without tooth fracture, clavicle fracture, femur fracture, tibia fracture in order of frequency. It is considered that associated injury was one of the major causes of long term hospitalization and complication. 8) Total mortality rate was 3.1%, and the postoperative mortality was 6.9%.