FORENSIC MEDICINE

HEAD INJURIES

KING FAISAL UNIVERSITY

COLLEGE OF MEDICNE

YEAR: 2011

NAME: Qasim Hussain AL-Haleimi

AC: 207002113
Content:

 Introduction

 Scalp Injuries

 Skull Fractures

 Brain damage

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 Introduction:

Of all regional injuries, those of the head and neck are the most common and most important in forensic
practice.

Importance because:

 The head is the target of choice in the great majority of assaults involving blunt trauma.

 When the victim is pushed or knocked to the ground, he often strikes his head.

 The brain and its coverings are vulnerable to degrees of blunt trauma that would rarely be lethal if
applied to other areas.

Head Injuries is divided in to:

-Scalp injuries

-Skull injuries

-Brain injuries

-Facial injuies

Sometimes facial injuries are classified as a separate category.

  Scalp Injuries:

All types of wounds can occur in the scalp as abrasion, laceration, & contusion.

Examination of the scalp injuries usually requires shaving the area around the injure.

Anatomy of the scalp:

Layers of the scalp:

The scalp consists of 5 layers.

These layers arranged from superficial to deep can be remembered from the letters of the scalp:

1) S Skin: It is thick, hairy and contains numerous sebaceous glands.

2) C Connective tissue: It is dense fibro-fatty layer. Its fibrous septa uniting the skin to the
aponeurosis. All nerves and vessels of the scalp are present in this layer
with free anastomosis between the vessels.

3) A Aponeurosis: It is the tendon of the occipitofrontalis muscle.

It is separated from the periosteum of the skull by a space called the subaponeurotic space.

It is a continuous space closed at the margins of the scalp.

4) L Loose areolar tissue: It consists of loose fibrous bands occuping the subaponeurotic space
and extending from the aponeurosis to the periosteum. It contains few small arteries and some important
emissary veins. These veins are valveless veins connecting the scalp veins with the skull diploic veins and
the intracranial dural venous sinuses.

5) P Pericranium (outer periosteum of the skull): It is loosely attached to and easily separated from
the skull bones. It is continuous with the inner periosteum at the sutures and so there is a separate space
between the pericranium and each skull bone.
 A. Abrasion of the scalp: Less common than other sites of the body, always needs shaving the hair
of the scalp to be appearent, & sometimes missed, minimal or no bleeding.

A. Bruising of the scalp:

-Hair should be removed

-Marked swelling is common.

-Usually mobile under graphite

A. Lacerations of the scalp:

Lacerations of the scalp bleed profusely, and dangerous and even fatal blood loss can occur from
an extensive scalp injury. Laceration can resemble incised wound due to thin scalp and tightly fixed to the
bony skull.

 Skull fractures:

It is rarely the skull fracture itself that is a danger to life, but the concomitant effect of transmitted force
upon the cranial contents.

Anatomy:

 The anterior fontanelle closes hnctionally between 9 and 26 weeks after birth, though is not
tightly sealed until about 18 months.

 The posterior fontanelle closes between birth and 8 weeks of age.

  Suture lines close by interdigitation during childhood and osseous fusion occurs irregularly at
variable dates during adult life.

 The cranium varies in thickness in adults and varies from place to place, thin plates being
reinforced by stronger buttresses, such as the petrous temporal, the greater wing of the sphenoid,
the sagittal ridge, the occipital protruberance and the glabella.

 Thickness is widely variable from 0.5 to 1.5 cm.

 Thin areas lie in the parietotemporal, lateral frontal and lateral occipital zones.

Mechnism:

General principle theory is that the force applied exceed the ability of the skull to absorb.

Child skull have more ability to distort but good elasticity

Brain injuries may occur without underlying bony fracture.(& Vice Versa is true).
Types of fracture: (see the graph next to description)

1. Ring Fracture:

In the posterior fossa around the foramen magnum and are most often caused by a fall from a height
onto the feet. Energy is transmitted from the fall through leg, pelvis, & spinal cord to the base of the
skull.

2. Linear Fracture:

These are straight or curved fracture lines, often of considerable length. They may involve the
inner or outer table, but commonly traverse both. They may extend downwards into the foramen
magnum, across the supraorbital ridges, or into the floor of the skull. A common basal linear fracture
is one that passes across the floor of the middle fossa, often following the petrous temporal or greater
wing of the sphenoid bone into the pituitary fossa.

In children and young adults, a linear fracture may pass into a suture line and cause a 'diastasis' or
opening of the weaker seam between the bones. This is most often seen in the sagittal suture between
the two parietal bones.

In the child abuse, a linear fracture of a parietal bone may reach the sagittal suture and continue
across it into the opposite plate.

3. Pond Fracture:

A descriptive term for a shallow depressed fracture forming a concave 'pond'. So common in infants.

4. Hinge Fracture:

In motorcycle accident separating the base of the skull in to two half.

5. Mosaic spider’s web Fracture:

A comminuted depressed fracture may also have fissures radiating from it, forming a spider's-web or
mosaic pattern.

6. Depressed Fracture:

Focal impact causes the outer table to be driven inwards.

Many factors affect the outcome of skull fracture include:

-The area affected.

-Thickness of the skull and other layers at the side of energy.

Force needed to produce skull fracture is estimated to be about 5 foot-pounds (73 N).

Outcome of the fracture is mainly: -Infection (Meningitis, & brain abscess) or -Hemorrhage.
 Brain damage: Mainly either infection or later on epilepsy.

1. Trumatic epilepsy:

A late effect of a depressed skull fracture may be 'traumatic epilepsy'. This is of great
medico-legal significance because it may result in lifelong neurological disability for which
very large monetary compensation may be awarded. It usually manifests as tonic and clonic
fits, which may be difficult to differentiate from idiopathic epilepsy, if the injury occurred
in early life. When fits begin within weeks, or a year or two of a major head injury in a
mature person who had never had fits before, the diagnosis is easier, but all cases need
expert neurological examination. It can develop from 2weeks up to 2 years after the impact.
In open fractures it develops quickly & with infection is also quickly.

2. Infections: Infection can gain access via skull fractures:

 Direct spread through a compound fracture, especially where there is a contaminated scalp
injury.

 Spread from the nasal cavity when a fracture of the cribriform plate has allowed
communication with the anterior fossa.

 Spread from fractures that involve a paranasal sinus, such as the frontal or ethmoid, or
from the mastoid air cells or middle ear cavity. A history of leakage of cerebrospinal fluid
from the nose or ear must alert both clinician and pathologist to the possibility of
communicating basal fractures.

THE END