Regional Injuries
Regional Injuries
Regional Injuries
1) Definition of head injury: a morbid state, resulting from gross or subtle structural changes in the
scalp, skull, and/ or the contents of the skull produced by mechanical forces.
2) Types of Skull fractures
1. Fissured fracture
2. Depressed comminuted fracture
3. Comminuted fracture
4. Elevated fracture
5. Blow-out fracture
FISSURED # DEPREESED #
6. Expressed fracture
7. Pond fracture / indented fracture
8. Gutter fracture
9. Ring fracture
10. Hinge fracture
11. Diastatic / sutural fracture
12. Perforating fracture
13. Crush fracture
14. Contre-coup fracture
15. Heat fracture Ring fracture
16. Cut fracture
I. Fissured fracture (Linear #)
Cause:--low-velocity impacts, with a large area of contact between the head and impact object—
1 Whole thickness/ inner table/ outer table
2 Linear thread like # in straight or curved line
3 Continue over sutures and bones
4 Impact with hard rough, flat surface- ground, plank
eg. a fall to pavement.
II. Depressed fracture or fracture ala signature /signature fracture
Cause:--High-velocity impacts, with a small area of contact between the head and impact object
1. Heavy localized force
2 Local depression- wedging of fragment with radiating fracture lines
V. Pond fractures:--
Infants / children- inadequate calcification- yielding bone
1 ‘ping pong ball dent’
2 Depression at site of impact
3 Inner table no # but outward table might show cracks at peripheral rim
3) COUP LESION –Injury is located beneath the area of impact—directly from impacting force.
1. Lucid interval
2. Ipsilateral mydriasis
3. Contralateral paresis
Medical emergency
A. CT without contrast
B. Evacuate via burr holes
SDH SAH ICH
2. Subdural haemorrhage (SDH)
3. Subarachnoid haemorrhage (SAH)
4. Intracerebral haemorrhage (ICH)
5. Intraventricular haemorrhage (IVH)
In final form—is recognized by slurred speech, defective memory, slow thought process, stiff limbs,
ataxia, broad-based gait, expressionless face like parkinsonian-like facial appearance and dementia
– Subdural
– Subarachnoid
– Intracerebral
– DAI
– Focal ischemic lesions
– Dissecting aneurysms
– Cortical atrophy
– Thinning or tears of corpus callosum
– Loss of neurons from cerebellum and substantia nigra
7) Flail chest
Multiple rib fractures usually due to a severe blunt trauma causes this flial chest,
and is often associated with pulmonary injuries such as hemothorax and pneumothorax.
During expiration intrathoracic pressure becomes positive and the flail segment bulges.
8) Cardiac Tamponade
This is also called as Commotio cordis- cardiac concussion
Causes
1. Traumatic Lacerating and penetrating injuries into pericardium or heart as well as non-
penetrating wounds of Heart
2. Pathological—between 7 to 10 days after Myocardial infraction
The exact injury mechanism that causes whiplash injuries is forceful sudden hyperextension followed by hyper
flexion of the cervical vertebrae, this double movement being known as the whiplash.
A whiplash injury may be the result of impulsive retracting of the spine, mainly the ligament: anterior
longitudinal ligament which is stretched or tears, as the head snaps forward and then back again causing a
whiplash injury.
Severe neck pain, concussion to spinal cord may also occur
Most of the injuries happen in C-5 and C-6.
Fatal contusion or laceration of the spinal cord may occur without fracture of spine
Head restraints prevent hyperextension of neck to certain degree
MLI—automobile accidents who have no head restraints
10) Puppe`s Rule
The course of second fracture will be interrupted by
the earlier fracture
MLI—To determine the sequence of multiple blunt
force injuries of the skull as well as to determine the
sequence of gunshot wounds or blows of the skull.