Trends of maxillofacial trauma at Tertiary Care Hospital in rural area of southern Punjab.

A four years retrospective study from was conducted to analyze the pattern and magnitude of maxillofacial trauma in medico-legal cases coming to the casualty of a rural hospital of Punjab. The study revealed that out of 1237 medico-legal cases 130 (10.5%) suffered maxillofacial trauma. The commonest age group prone to maxillofacial injury was between 16-30 years. Male preponderance was quiet evident (6:1). The commonest cause of such injuries was road traffic accident including 83.1% of the total cases. Soft tissue was the most common type of maxillofacial trauma (52.3%). Most common bones involved were nasal bone and mandible (18.5% each) and the commonest associated injury was involvement of limbs (30.0%). Most common weapon involved was blunt (90.8%). Drawing public attention and awareness towards the traffic rules especially use of helmets by the motorcyclists and separation of pedestrians from motor vehicles could possibly reduce the number of maxillofacial trauma cases.

Abdominal organ involvement in blunt injuries.

Visceral injuries of the abdomen following blunt trauma present a great medico-legal problem to the forensic experts. Thus the doctor should remain alert to the development of signs and symptom after blunt trauma to the abdomen in vehicular accident otherwise he may be charged of negligence. Among 55 fatal cases of blunt abdominal injury, maximum number of cases belongs to the age group 20-29 yrs. Males were the predominant victims with ratio 4:1. It was found that road traffic accidents by heavy vehicle like bus; car and truck were responsible for 70% of blunt abdominal injuries. Among 55 cases of blunt injury, the incidence of the involvement of liver, spleen, small intestine, kidney, stomach and urinary bladder were 67%, 30.91%, 18%, 10.9%, 9.09%, 5% cases respectively. Genitals were found injured in 3% cases of blunt injury abdomen. For Blunt Injuries of Abdomen majority of the cases i.e. 78.18% were of accidental, 18.18% were homicidal and 3.6% suicidal in nature. Immediate cause of death was shock and hemorrhage and in those cases where death was delayed, cause of death was septicemia.

Victim profile and pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents.

The present research aims to highlight the pattern of thoraco-abdominal injuries sustained by the victims of fatal road traffic accidents (RTA) in Manipal, South India. The study is an autopsy based observation of thoraco-abdominal injuries in victims of fatal road traffic accidents during 1999 – 2003. Road traffic accidents accounted for most of the injury related deaths (77%) during the study period. A male preponderance (86%) was observed with a male-female ratio of 6:1. Individuals in the age group of 21 to 50 years formed the most vulnerable (83%) group. External thoracic injuries were more common than internal thoracic injuries in the thoracic region. In the abdominal region, internal injuries were more common than external injuries. Lungs (61%) and kidneys (23%) were the most commonly involved organs in the thoracic and abdominal regions respectively. Majority of the victims were two wheeler occupants (35%) followed by pedestrians (23%). The study indicates the pattern of thoraco-abdominal injuries sustained along with the trend of road traffic accidents in the region.

Trends of Maxillofacial Trauma at Adesh Institute of Medical Sciences and Research, Bathinda, Punjab.

A four years retrospective study from April 1, 2007 to March 31, 2011, was conducted to analyze the pattern and magnitude of maxillofacial trauma in medico-legal cases coming to the casualty of Adesh Institute of Medical Sciences and Research, Bathinda, a rural area of Punjab. The study revealed that out of 1237 medico-legal cases 130 (10.5%) suffered maxillofacial trauma. The commonest age group prone to maxillofacial injury was between 16-30 years. Male preponderance was quiet evident (6: 1). The commonest cause of such injuries was road traffic accident including 83.1% of the total cases. Soft tissue was the most common type of maxillofacial trauma (52.3%). Most common bones involved were nasal bone and mandible (18.5% each) and the commonest associated injury was involvement of limbs (30.0%). Most common weapon involved was blunt (90.8%). Drawing public attention and awareness towards the traffic rules especially use of helmets by the motorcyclists and separation of pedestrians from motor vehicles could possibly reduce the number of maxillofacial trauma cases.

Study of road traffic accidental deaths (RTA) in and around Bastar Region of Chhattisgarh.

To analyze the magnitude of head injury in fatal RTA cases, present study was conducted in the department of Forensic Medicine Toxicology, Govt. Medical College, Jagdalpur (Chhattisgarh) in 2009 calendar year. The present study was undertaken on 105 victims of RTA who died due to head injuries, which autopsied at GMC, Jagdalpur (C.G). Most of the accidents occurred in the afternoon hours (12: 01 - 18:00). There was a clear male dominance (88.57%). The most affected age was middle age (21-40 yrs) & most commonly affected age group is 21-30 yrs. Vehicular occupants were commonly affected (63.80%) & amongst them two wheeler occupants most commonly involved. Fissure fracture of the skull was commonest (45.71%) & parietal region of head was mostly involved region of the head (27.61%). Among the intracranial hemorrhages, subdural hemorrhage (SDH) was commonest (31.42%). In relation duration of survival time 59.04% of victims died within 24 hrs of fatal accident.

Floating thromboembolism: a case report.

Medico legal autopsies are conducted in cases of sudden unexpected deaths, primarily to establish the cause of death. In cases where deaths have occurred in apparently healthy individuals, deaths under suspicious circumstances or who have sustained injuries, pulmonary embolism forms the principal cause of sudden unexpected death. Pulmonary thromboembolism (PTE) is caused when thrombi are detached from the deep vein of the lower leg. The most important causes for incorrect diagnosis are failure to suspect Pulmonary Embolism, and the protean nature of the disease. Presentation is often “atypical”. Signs and symptoms are frequently vague and nonspecific and rarely “classic”. In more than 95% of cases, venous emboli originate from deep leg vein thrombi above the level of the knee. Most pulmonary emboli (60 to 80%) are clinically silent because they are small. Remarkable differences actually exist concerning the point of origin and the final localization, as well as the size and age of thromboemboli, the presence or absence of pulmonary infarction, and the underlying pathology. This paper highlights a rare case of a young individual with minor injuries who succumbed to pulmonary thromboembolism.

Fatal burn injuries in accidental vehicular crush a medicolegal study.

Vehicle explosions result deadly fires which causes loss of many lives. This study explores the way of identification of sixteen fatal burnt bodies following a vehicular crush where identification was so difficult because of incineration of few cases. The victims were mainly of lower socio-economic, under graduate, bachelor group and businessmen by profession. The common age group was 21-30 years with a male and female ratio 9:1. Urban was the place of incidents and that too at 10 pm at night in the month of December with heavy truck as offending vehicle was the classical features of this study. From the observations and analysis of the incident with due consideration of environmental factors, vehicular conditions like operation of old ill maintained vehicles in high speed in a restricted area, in coordinated functioning of various traffic control agencies at night etc, certain aetiologies are elicited and their preventive measures are suggested.

Road traffic injuries and deaths among patients seen at the emergency department of King Hussein Medical Center in a one-year period

Estimate the frequency of road traffic injuries and deaths among patients seen at the Emergency Department of King Hussein Medical Center. The medical records of Patients with road traffic injuries and deaths who evacuated to the Emergency Department of King Hussein Medical from January to December 2006 were reviewed. Arround 120977 patients were seen during the study period. Seven hundred and seventy two [0.63%] patients had road traffic injuries. Among those [75%] were males and 25% females. The patients' ages range between 2 and 70 years. A total of 147[19%] injured patients were admitted to the hospital, 289[76%] patients were treated as outpatient and 36[5%] cases of death. The study shows the magnitude of deaths and injuries among patients evacuated to the Emergency Department of King Hussein Medical Center after exposed to road traffic injuries. It also emphasizes that RTIs can be prevented through action at all levels of road traffic system

Fracture of the temporal bone: A tomographic v/s autopsy study.

The present study was conducted in the Dep’t. of Forensic Medicine & Toxicology, SMS Medical College Jaipur (Raj), in the period from 15 Dec. 2001 to 4 April 2002. With the aim to find out the correlation of X-ray (Skull), CT scan (Head), Surgical intervention findings with the autopsy findings in the cases of acute Head trauma. Total of 140 cases of acute head trauma were selected irrespective of age, sex, religion caste etc. who had been admitted in Neurosurgery dep’t. And X-ray, CT scan head and /or surgical intervention had been done, subsequently died & autopsy was performed. X- ray skull gave batter information on fracture of skull than CT Scan, particularly when the fracture is located on the vault or base of skull and is of linear variety [1]. 27 cases of fracture of the temporal bone were specially studied, out of these 140 cases. All these cases had the features of triad, indicating of fracture of petrous part of temporal bone i.e. CSF Otorrhoea 14(51.1%), 7th nerve palsy 9(33.3%), serve middle ear bleeding 18(66.6%) & conducting hearing loss 5(85%). The plain X-ray demonstrated the fracture of temporal bone in 21 cases (79%) and the CT Scan demonstrated their in 24 cases (88%) Longitudinal fractures are common in 18 cases (66%) and procedure of choice for their demonstration is lateral tomography, Transverse fracture alone was uncommon (2 cases) and can only be demonstrated in anterior posterior tomographic projections and is usually associated with occipital fractures. CT Scan Examination give better information in detection of fracture of temporal bone as well as the type of fracture [2] which is essential for planning the surgical intervention or treating the patient conservatively in order to avoid the complications like, persistent CSF otorrhoea, posterior meningitis or even death.

A review of pedestrian traffic fatalities.

Pedestrians injured in automobile accidents constitute one of the most frequent serious problems in management for emergency room surgeons. The incidence of deaths in pedestrians is significantly higher than in other road users. This study attempted to analyse the pattern of injuries sustained by 129 pedestrians in road traffic accidents. It was found that the pedestrians were the commonest group of victims involved in fatal road accidents comprising 28.7% of all cases. 83.7% cases were males. There were two peaks of incidence in relation to age; one at childhood (20.9%) and the other in elderly (19.37%). Cars and heavy vehicles were the commonest offending agents comprising 41.9% and 31.8% respectively. The pedestrians themselves were at fault in 43.4% cases. Head injury was seen in 80% cases; followed by lower limb fractures (42.6%), and chest injury (38.8%). The cause of death was head injury in 56.6% cases followed by thoraco-abdominal injuries in 8.5% cases and multiple injuries in 7.8% cases.

Fatal gastro-intestinal bleeding: A complication following spinal injury.

On 30.08.2003, a 20-year-old boy met with a vehicular accident and sustained spinal injury and left upper limb fracture. He was immediately hospitalized and seemed to recover well after treatment for a period of 15 days, when just before discharge he suddenly had hematemesis and bleeding per rectum and succumbed within another 24 hours. The case is discussed in detail.

A postmortem study of blunt cardiac injuries.

35 cases of blunt cardiac trauma following vehicular accidents brought for autopsy to the morgue of Regional Institute of Medical Sciences, Imphal have been studied to find out types of cardiac injuries, their association with sternal and rib fractures, mechanism of causation, risk factors, etc. It was observed that 48.57% of the cases with blunt cardiac trauma had associated sternal and rib fractures. Maximum number (60%) of the cardiac rupture was seen in run-over cases. 40% of the cases had injury to the right ventricle. All the injuries were located on the anterior surface of the heart. In one (2.86%) case, laceration of the right atrium without any external injury of the chest region was observed. In assessing blunt cardiac trauma victims in vehicular accidents, knowledge about the commonest sites, types and degrees of injuries as has been highlighted in the present study will be of great help in a timely intervention.

Fatal road traffic accidents, study of distribution, nature and type of injury.

During one year study period medico legal autopsies were conducted on 950 cases of fatal road traffic accidents at the mortuary of SRN Hospital, MLN Medical College, Allahabad. M/F ratio 3:1. 33.68% of cases were in the age group of 25-44 years. Pedestrians were most vulnerable accounting for 35.79% of total fatalities followed by motorized two wheelers 30.53%. Heavy Vehicles were found to be mostly involved 58.52% of cases and most accidents 83.05% occurred on highways. Majority of cases sustained multiple injuries. Primary impact injuries were recorded in 455 cases and pedestrians 36.26% were mostly affected followed by pedal cyclists 20.88%. 505 cases sustained secondary impact injuries and pedestrians and motor cyclists were primarily involved. Of 697 secondary injuries, 29.99% were sustained by motorcyclists followed by pediastrians 22.67%. Mostly lower extremities 27.39% and pelvis 25.99% received the primary impacts; the head and neck 55.62% the secondary impacts, while secondary injuries were mostly located in the lower extremities 28.38%. Largest number of injuries were recorded in lower extremities 804 number, followed by head & neck 748 number. Vehicle occupants mostly sustained thoracic injuries. In majority of cases, the site of initial impact of the responsible vehicle was frontal (45.14%) followed by rear (25.83%) and side (7.01%). In 179 cases (22.02%) site of responsible vehicle were not known.

Pattern of fatal head injuries due to vehicular accidents in manipal.

Head injury is an important cause of mortality worldwide as head is the most vulnerable part of the body involved in fatal road traffic accidents. The present study was undertaken on 100 victims of Road Traffic Accident who died due to injuries sustained to the head, which were autopsied at Kasturba Medical College, Manipal over a period of 3 years between January 1995 and December 1997. Most of the accidents had taken place in the afternoon hours (12.01 - 18.00 hrs). There was a marked male preponderance (89 %). The most vulnerable age group to accidents was found to be 21 to 30 years. Both pedestrians and occupants were equally involved. Two-wheeler occupants were most commonly involved. Head injury was present in 82 % of cases with skull fracture in 62 %. Fracture of the vault was found in 38 %, base of the skull in 34 % and both in 28 % of cases. In most of the cases, fissured fracture was found (57 %). Among intra-cranial haemorrhages, subdural haemorrhage was found in 77 % and subarachnoid haemorrhage in 55 % of cases. Contusions and lacerations of brain were found equally in 35 % of cases.

Estudo epidemiológico dos pacientes com traumatismo da columa vertebral e déficit neurológico, internados no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP / Epidemiological study of patients with spinal cord injuries and neurologic deficit, admitted in the Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo

Os autores apresentaram estudo epidemiológico basedo na análise dos caso com lesöes traumáticas da coluna vertebral internados no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da FMUSP de 1982 a 1987. Dos 428 pacientes 94,3% eram do sexo masculino, estando predominantemente na faixa etária de 21 a 30 anos. O nível mais freqüênte da lesäo foi na regiäo cervical, com déficit neurológico do tipo completo. Os tipos de acidente ou violência mais freqüentes foram os ferimentos por arma de fogo e a seguir os acidentes de tránsito. A freqüência de óbito foi de 21% principalmente por problemas respiratórios