W11 - Forensic Aspects of Trauma; Bone and Soft Tissue Tumours Flashcards
Definition and classificaion of injury
Damage caused by accident/attack facilitated by mechanical force
Appearance or method of causation
- abrasion, contusion, laceration, incised wounds, burns
Manner of causation:
- suicidal, accidental, homicidal
Nature of injury:
- blunt force, sharp force, explosive
Biological and physiological variables which determine outcome of injury
a
Blunt Force Injuries
CONTUSION: burst vessels in skin
ABRASION: graze, scratch of skin surface
LACERATIONS: cut, tearing of skin d/t crushing
Factors affecting prominence of contusion
- skin pigmentation
- fat = ⇧fat = bruises more easily
- age: children and elderly
- coag. disorders
Shapr Force Injuries
INCISED WOUNDS:
- superficial sharp force injury caused by slashing
- longer on skin surface than deep
STAB WOUNDS:
- thrusting = depth>surface length
Defensive Type Injuries
Passive = backs of hands and forearms; sliced
Active = sliced incised wounds on palmar aspects
Typical Consequences
Head = skull fractures, depressed, bleeds
•Traumatic SAH d/t rapid rotation, sudden movements = traumatic rupture of base vessels
*distal portion of intracranial vertebral arteries at point where they cross the dura
= unconscious and cardiac arrest
• Diffuse brain injury = immediate and prolonged coma with no apparent mass lesion or metabolic abnormality
* traumatic axonal injury
RTC
- femur
* aortic rupture with ladder-rung tears
Differentiate clinical features of benign vs malignant bone and soft tissue tumours
(b) activity related bone pain d/t weakening; clear margins
+ increased uptake in isotope bone scan
vs
(m) less defined margins, cortical destruction
* unexplained pain, boring nature, night pain, deep swelling
+systemic effects of neoplasia
+neurovasc effects
Appreciation of investigation and the interpretation of investigations in bone and soft tissue tumours
XR
- CT
- ossification and calcification
- ID: nidus in osteoid osteoma
- staging primarily of lungs
- Isotope bone scan
- mets
- freq. neg. in myeloma
- MRI = sensitive to osteosarc.
- specific for lipoma, haemangioma
- can not differentiate for (b) vs (m)
*Biopsy w/ bloods workup and imaging
The natural progression of the bone and soft tissue tumours
a
Metastatic bone disease: common sites, sources,
2º more common than 1º mets
- bone common site after lung and liver
- sources:
1) lung
2) breast (melanoma)
3) prostate
Common sites of mets = vertebra, prox. femur, pelvis, ribs
Sarcoma
Malignant arising from CONNECTIVE TISSUE
- > fascial planes
- > haematogenous spread to lungs
Bone Tumours
Commonly benign but secondaries common
* >50y likely metastatic
(b) osteoid osteoma, osteoblastoma
(m) osteosarcoma
Cartilage-forming tums
(b) ECHONDROMA; OSTEOCHONDROMA
(m) CHONDROSARCOMA
