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HEAD INJURY

HEAD INJURY. By - Dr. RAJA RUPANI. DEFINITION. Head injury is 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 .

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HEAD INJURY

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  1. HEAD INJURY By - Dr. RAJA RUPANI

  2. DEFINITION Head injury is a morbidstate, resulting from gross or subtle structural changes in the scalp, skull, and/or the contents of the skull, produced by mechanical forces. The blunt force may result in injury to the contents of the skull, either alone or with a fracture of the skull. The extent and degree of an injury is not necessarily proportional to the amount of force applied to the head.

  3. SCALP The thickness of scalp in adult is variable, ranging from a few mm to 15 mm. Most wounds are caused by blunt force to the head, like falls or blows Wounds are contusions or lacerations.

  4. SCALP

  5. CONTUSIONS OF SCALP May occur in the superficial fascia, in the temporalis muscle or loose areolar tissue Contusions in the superficial fascia appears as localized swelling and are limited in size because of dense fibro-fatty tissue of the fascia. Extensive hematoma spreads beneath galea (Sub galeal hemorrhage) Deeper bruising occurs in fibrous galea Infected wounds may result in thrombophlebitis (through emissary veins)

  6. Bruising of the scalp is better felt than seen Its firm edge feels like depressed fracture A scalp wound by a blunt weapon frequently resembles an incised wound and as such the edges and ends should be carefully examined with a magnifyinglens.

  7. LACERATIONS OF SCALP If the scalp is lacerated by a blow, blood is driven out of the vessels due to compression and considerable bleeding occurs With further blows, blood is projected about the scene With repeated blows, blood is splattered over assailant Flat surface or object causes ragged split (linear, stellate or irregular) Temporal arteries spurt freely, as they are firmly bound and unable to contract and a fatal blood loss can occur

  8. LACERATION OF SCALP

  9. AVULSION OF SCALP Involves large are of scalp Occurs in : - traffic accident - hairs entangled in machinery

  10. Avulsion of scalp

  11. INJURIES TO FACE Bleeding is more in facial wounds

  12. EYES Blunt trauma on the eye causes a) Permanent injury to : - cornea - iris - lens b) Vitreous hemorrhage c) Detachment or rupture of retina d) Traumatic cataract

  13. BLACK EYE(PERIORBITAL BRUISING) It is caused by: 1.Direct blow in front of orbits, bruising lids. 2.Injury to the forehead, the blood tracking down under the scalp. 3.Fracture in the anterior cranial fossa, the blood leaking through cracked orbital plates.

  14. Black Eye

  15. NOSE May be bitten or cut off due to sexual jealousy or enemity. 2. A blow may cause nasal bleeding due to partial detachment of mucous membrane EARS A blow may produce - 1.Rupture of the tympanum 2.Deafness 3.Labyrinth may injured

  16. FACIAL BONES A blow often fractures the nasal bone and also ethmoid bone with radiating fractures into supraorbitalplates, if the force is severe. A blow may fracture maxilla and malar bone. Pulping of face may result from striking with a heavy stone. The mandible is fractured by a blow from a fist, stick or by fall from height. A heavy blow on the jaws drives the condyles against the base of skull producing a fissured fracture. TEETH A fall or a blow with a blunt weapon may cause fracture or dislocation of teeth, with contusion or laceration on lips or gums and bleeding from the sockets.

  17. SKULL The outer table is twice the thickness of inner. In young males,the thickness of - Frontal and parietal bone = 6 to 10 mm Occipital bone =15 mm. Temporal bone = 4 mm. Skull is thicker in midfrontal, midoccipital, parieto-sphenoid and parieto-petrous buttresses.

  18. Force required to fracture a cadaver skull – Covered by an intact,hair-bearing scalp = 400 to 600 pounds per square inch Empty human skull = 25 inch-pounds energy is sufficient to

  19. MECHANISM OF FRACTURE OF SKULL 1.FRACTURE DUE TO LOCAL DEFORMATION A local impact will drive inwards a piece of bone,shaped a cone like indentation At the apex, the inner table will get streched & fractures first. If the force continue to act,fracture of outer table follows complete fracture line runs from the central point radially. At the periphery of indentation the convexity of the bend is outwards,the outer table fractures first.

  20. LOCAL DEFORMATION

  21. 2.FRACTURE DUE TO GENERAL DEFORMATION Whenever the skull is compressed laterally, the vertical and longitudinal diameters are increased (and vice versa) due to which parts of skull at distant get bulged and may fracture by bending. The head may be compressed between a) two external objects,such as the ground and a wheel of a car b) an external object and spinal column

  22. FRACTURES OF SKULL A. Direct injuries may be caused by: 1. Compression- as midwifery forceps or crushing of head under the wheel of a vehicles. 2. An object in motion striking the head e.g. bullet, bricks, masonary, machinery, dagger, etc. 3. Head in motion striking an object, as in falls and traffic injuries. B. Indirect injury occurs from fall from height and landing on feet or buttocks.

  23. Types of Fractures of Skull 1.Fissured Fracture 2.Depressed Fracture 3.Comminuted Fracture 4.Ponds or Indented Fracture 5.Gutter Fracture 6.Ring or Foramen Fracture 7.Perforating Fracture 8.Diastatic or Sutural Fracture

  24. FISSURED FRACTURE These are linear fractures as cracks in the bone Involving the inner table or outer table or both. They are caused by forcible contact with a broad resisting surface like – the ground an agent having a broad striking surface fall on the feet or buttocks.

  25. Runs parrallel to the direction of force . May start at the counter pressure, e.g., in the bilateral compression. The line of fracture runs parallel to the axis of compression. Fracture line tends to follow an irregular course and is usually no more than hair's breadth.

  26. Linear fractures do not tend to cross bony buttresses, such as glabella, frontal and parietal eminance, petrous temporal bone, and occipital protuberance. They tend to cross points of weakness, such as frontal sinuses, orbital roof, parietal and occipital squama. Fracture lines stop when the energy dissipates or when they meet a foramen, a suture or a preexisting fracture.

  27. OSSA TRIQUETRA : In skull, small portion of brim ossify from irregular independent centres and remain for variable period of time as small bone know as OSSA TRIQUETRA

  28. FISSURED FRACTURE

  29. FISSURED FRACTURE

  30. FISSURED FRACTURE

  31. DEPRESSED FRACTURE They are produced by local deformation of the skull. The outer table table is driven into diploe, the inner table is fractured irregularly. Also called “fracture a ala signature” (Signature fracture) as their pattern often resembles the causing weapon or agent . Caused by blows from heavy weapon with small striking surface e.g. stone, sticks, axe, chopper, hammer etc.. When a hammer is used ,the fracture is circular or an arc of a circle, having the same diameter as the striking surface.

  32. DEPRESSED FRACTURE

  33. DEPRESSED FRACTURE

  34. COMMINUTED FRACTURE It has two or more intersecting lines of fracture which divide the bone into three or more fragments. They are caused by fall from height on hard surface, vehicles accidents and from blows from weapons with broad striking surface, e.g. heavy iron bar, thick sticks, etc. When there is no displacement of the fragment of fragments, it resembles a spider's web or mosaic.

  35. COMMINUTED FRACTURE

  36. COMMINUTED FRACTURE

  37. POND OR INDENTED FRACTURE This is simple dent of the skull – d/t - an obstetrics forceps blade, - a blow from a blunt object or - forcible impact against protruding object. They occur only in skulls which are elastic i.e, skull of infants. Fissured fractures may occur in outer table around the periphery of the dent.

  38. POND FRACTURE

  39. POND FRACTURE

  40. GUTTER FRACTURE They are formed when part of thickness of bone is removed so as to form a gutter, e.g, in oblique bullet wounds.

  41. GUTTER FRACTURE

  42. RING FRACTURE It occurs in the base of skull The anterior 1/3 is separated at its junction with the posterior 2/3. It runs at about 3 to 5 cm. outside foramen magnum and passes forward through the middle ears and roof of the nose The skull is separated from the spine.

  43. It occurs due to : 1.Fall from height 2.Blow to the vertex 3.Blow on the chin 4.Sudden violent turn of head

  44. PERFORATING FRACTURE These are caused by firearms and pointed sharp weapons like - daggers knives or axe. The weapon passes through both the table of skull leaving a clear-cut opening, the size and shape of which corresponds o the cross-section of the weapon used.

  45. PERFORATING FRACTURE

  46. PERFORATING FRACTURE

  47. DIASTATIC OR SUTURAL FRACTURE Seperation of sutures, due to a blow on head with blunt weapon. Occurs only in young persons

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