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FP > DiMaio - Blunt trauma wounds > Flashcards

DiMaio - Blunt trauma wounds Flashcards

1
Q

5 elements that affect the severity, extent and appearance of blunt trauma injuries

A
  • Amount of force delivered to the body
  • Localisation on the body
  • Amount of time that the force is delivered
  • Nature of the weapon
  • Extent of body surface over which the force is delivered
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2
Q

4 mains categories of blunt force injuries

A

Fracture
Laceration
Abrasion
Contusion

But also:
Avulsion

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3
Q

3 main types of abrasion, with examples for each of them

A

Patterned (ex: fall on a grill)
Impact (crushing abrasion)
Scrape/brush (ex: road rash)

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4
Q

4 mains stages of healing of abrasions

A

Scab formation
Epithelial regeneration
Subepithelial granulation and epithelial hyperplasia
Regression of granulation tissue and epithelium

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5
Q

What is a contusion/bruise?

A

Hemorrhage into soft tissue due to rupture of blood vessels caused by blunt trauma

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6
Q

Name factors that affect the size of a contusion

A

Age
Sex
Condition of health
Type of tissue struck

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7
Q

2 main types of forces that cause lacerations

A

Shearing
Crushing

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8
Q

3 elements that allows distinction of a laceration from an incised wound

A

Irregular borders
Tissue bridges
Abraded or contused borders

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9
Q

Why are there tissue bridges in lacerations?

A

Different strength of the soft tissue, so blood vessels and nerves resist a higher shearing stress

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10
Q

If a tangential blow causes a laceration, give 2 caracteristics that could help determine the direction of the blow

A

Undermining of the skin flap on the side of the direction of the blow

Other side (where blow was coming): beveled and abraded

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11
Q

What is an avulsion?

A

Type of laceration where force is oblique, so ripping of skin and soft tissue

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12
Q

Fractures may be caused by direct or indirect forces. What are the 3 main types of fractures due to direct forces?

A

Penetrating (gunshot wound): high force, small area

Focal: small force, small area (transverse fracture)

Crush: large force, large area (comminuted)

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13
Q

The bone is weaker to tension or compression forces?

A

Tension

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14
Q

What are the 2 main types of fractures observed in severe impact injuries?

A

Tension wedge: blow on a bone, causing tension on the opposite site of impact, then radiate back at 90 degree angle, giving rise to wedge of bone

Oblique

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15
Q

6 types of fractures due to indirect forces

A

Traction
Angulation
Rotational
Vertical compression
Angulation + compression
Angulation, rotation and compression

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16
Q

What kind of fractures in traction fractures?

A

Transverse

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17
Q

What kind of fractures in angulation fractures?

A

Transverse

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18
Q

What kind of fractures in rotational fractures?

A

Spiral

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19
Q

What are the four categories of pelvic fractures?

A

Anterior-posterior compression
Lateral compression
Shear
Complex fractures

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20
Q

What kind of fractures in an anterior-posterior compression of pelvis?

A

Pubic symphysis diastasis + bilateral separation of sacroiliac jointss

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21
Q

What kind of fractures in an lateral compression of pelvis?

A

Pubic rami fractures

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22
Q

What are the main clinical characteristics of the fat emboli syndrome?

A

Progressive pulmonary insufficiency
Mental deterioration
Fever
Petechial rash (conjunctivae and chest+ axillae)

+/- tachycardia, thrombocytopenia and renal failure

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23
Q

Main cause of fat emboli

A

Long bone fracture

But don’t forget soft tissue injury

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24
Q

What distribution and kind of wounds in blunt force defence wound?

A

Mostly abrasion and contusion, rarely laceration and fracture

Back of the hands
Wrist
Forearms
Arms

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25
Q

What are the main injuries of the head seen in blunt force injuries?

A

Scalp injuries (laceration, abrasions, contusions)
Fractures
Brain contusion
Subdural hematomas
Epidural hematoma
Intracerebral hemorrhages

26
Q

What are the 2 main injuries seen in acceleration/decelaration injuries of the head?

A

Subdural hemomatoma
Diffuse axonal injury

27
Q

What are the main types of maxillary fratures?

A

Dentoalveolar
LeFort1
LeFort2
LeFort3
Sagittal

28
Q

What is a dentoalveolar fracture?

A

Fragment of maxilla + teeth

29
Q

What is a LeFort1 fracture?

A

Transverse fracture of the maxilla, above the apices of the teeth through:
- Nasal septum
- Maxillary sinuses
- Palatine bone
- Sphenoid bone

30
Q

What is a LeFort2 fracture?

A

Also known as pyramidal

Same path posteriorly, but curves upward near the zygomatic-maxillary suture, through inferior orbit rim onto the orbital floor, through medial orbital wall and across nasal bones and septum

31
Q

What is a LeFort3 fracture?

A

High transverse fracture of the maxilla that goes through the nasofrontal suture, through medial orbital wall and frontozygomatic suture, across the arch and through the sphenoid

32
Q

Name some factors that affect the generation of a skull fracture

A
  • Amount of hair
  • Thickness of the scalp
  • Configuration and thickness of the skull
  • Elasticity of the bone at the point of impact
  • Shape, weight, consistency of the object impacting or impacted by the head
  • Velocity at which either the blow was delivered or the head strikes the object
33
Q

What is the average ft.lb required to cause a simple fracture of the skull?

A

33.3 to 75 ft.lb

Head weight: between 5 to 11 pounds
X
6 feet tall = 60 ft/lb = enough if fall from height

34
Q

T or F: there is an absolute correlation between the severity of brain injury and the production of a linear fracture

A

IT IS NOT ABSOLUTE:
- You can have linear fractures without brain damage
- You can have brain damage without fractures

35
Q

Characteristics of the velocity and impact surface of a linear skull fracture

A

Low velocity
Large area of contact between the head and impacting object (ex: fall on pavement)

36
Q

When you have an impact at low velocity with a large area of contact between the head and impacting object, you have linear fractures. What happens if you have a highest velocity?

A

Circular fracture around the impact site (extreme inbending at the time of impact)

37
Q

What are the conditions to cause a depressed skull fracture?

A

Object with large amount of kinetic energy, but small surface area (ex: hammer blows)

38
Q

2 impact mechanisms that can cause a type 1 hinge fracture

A

Tip of the chin
Lateral side of the head

39
Q

3 impact mechanisms that can cause a ring fracture

A

Impact on top of the head
Fall on the buttocks
Impact on the chin

40
Q

Where is the typical location of contrecoup fractures?

A

Anterior cranial fossa

41
Q

What are the 2 main divisions of the cervical vertebrae?

A

C1-C2 (with occiput): bound together by ligamentous bands, no intervertebral disks

C3-C7: presence of intervertebral disks

42
Q

In what kind of trauma is atlanto-occipital dislocation frequently seen?

A

Pedestrian struck by MVH or occupants of MVC

43
Q

What is the main mechanism that cause a fracture of the anterior arch of C1? And lateral bodies? An posterior arch?

A

Anterior: Hyperextension

Lateral:
Lateral loading

Posterior: hyperextension + axial loading

44
Q

What are the 5 main types of fractures of the lower cervical spine (C3-C7)

A

Flexion distraction:
- Disruption of posterior ligament + anterior displacement of a vertebra

Flexion compression:
- Same, but with fracture/compression of a vertebra

Extension distraction:
- anterior disruption at the disc, with posterior displacement of vetebrae

Extension compression:
- Same, but with fracture of the posterior element of the vertebral bodies and increases anterior separation at the disk space

Vertical compression: compression and fracturing of a vertebrae

45
Q

What is the most frequently encountered traumatic lesion of the brain?

A

Brain contusions

46
Q

Which part is the most vulnerable to contusion: sulci or gyrus?

A

Sulci

47
Q

What are the main locations of brain contusions?

A

Frontal lobes (orbital and anterior surface)
Temporal lobes (anterior tip)

48
Q

What are the 6 types of brain contusions

A

Coup
Contrecoup
Intermediary coup
Fracture contusion
Gliding contusion
Herniation contusion

49
Q

T or F: coup contusion are less frequent than contrecoup contusions

A

True!

50
Q

What are intermediary coup contusions?

A

Contusions in the deep structures of the brain (white matter, basal ganglia, copus callosum, brainstem) and along the line of impact

** are said to be seen only in falls

51
Q

What are gliding contusions?

A

Hemorrhagic lesions within parasagittal white matter in superior cerebral areas; frequently bilateral

Frequently seen in association of DAI

52
Q

T or F: brain contusions are more frequent than lacerations in infants?

A

False!

Mostly lacerations to the white matter

53
Q

What part of the brainstem is mostly susceptible to lacerations?

A

Jonction between pons and medulla –> avulsion

Occurs with violent hyperextension of the head and neck

54
Q

T or F: epidural hematomas are frequent in the elderly population

A

False: dura is very adherent in elderly people!

55
Q

What is the main blood vessel that is injured in epidural hematomas?

A

Meningeal arteries

Mostly the

56
Q

T or false: a fracture is almost always seen in epidural hematomas

A

True! 90-95%!

Mostly the squamous portion of the temporal bone

57
Q

How does death occur in epidural hematomas?

A

Displacement of the brain with compression of the brainstem

58
Q

How does the post-mortem fire-related epidural hematoma develops

A

Shrinking of the dura, with blood exsudation from the dura

59
Q

T or F: subdural hematoma are often found with skull fractures

A

False!

60
Q

Which one is most frequent in falls: DAI or subdural hematoma?

A

Subdural hematomas

61
Q

What is the period that distinguished an acute, a subacute and a chronic subdural hematoma?

A

Acute : < 72h
Subactute: 3 days to 2-3 weeks
Chronic: > 3 weeks

62
Q
A

FP (15 decks)

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