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Concept Answers to Traumatology
1- Define Injury, Hurt, Wound & Trauma
Injury: According to Sec 44 PPC it is harm whatsoever illegally caused to any person body mind reputation & property.
Hurt: According to Sec 332 PPC causing of pain, harm, disease, infirmity injury, impairing, disabling or dismembering any organ or part of body without causing death.
Wound: No legal definition of wound in Pakistan but may be damage to living tissue.
Truma: It is injury caused by a forceful energy inflicted on a living tissue. This includes emotional & mental stress resulting in a disorder.
2- Give Essentials of Wound production.
· Force/energy
· Weapon/object
· Body/tissue
· Contact b/w force & body tissue
3- Give Rate of Transfer of Energy in Wound production.
Rate of transfer of energy = per unit transfer of energy per unit area per sec.
4- What is the importance of Time in Severity of a wound.
If time duration is decreased there is increased transfer of energy /sec so more severe wound. & vice versa.
5- What are the factors effecting severity of an Injury.
· Amount of energy is proportional to wound production
· Nature of object causing wound
· Resistance & architecture of tissue. It includes
1. inter cohesion, forces of cells of that tissue
2. elasticity of the tissue : More elasticity less damage
· movement of part struck
· time period over which energy is discharged
6- Classify injuries on the bases of Medical grounds & on the bases of causative weapon.
1. Medical classification
· Close wounds: where whole thickness of the skin has not gone. e.g. Bruise, abrasion
· Open wound: in this whole thickness of skin is gone.
2. Classification based upon type of Weapon used
Þ by blunt weapon
Þ by sharp weapon
Þ by pointed weapon
Þ by fire an arm weapon
Þ but thermal weapon
Þ by electrical weapon
Þ chemical burns
7- What is a blunt weapon?
When a brooder surface of a weapon is used to harm the body by coming in contact
8- Define Bruise & how will you estimate its age.
Unbroken surface injuries to the skin and subcutaneous tissue called by striking of blunt weapon causing crushing of b.v and effusion of blood in tissue.
Age estimation is by following method
o Fresh : Red
o 1 day : Violet
o 2 – 4 days : Blush Black
o 5 – 7 days : Greenish
o 7 – 10 days : Yellow
o 14 – 15 days : Normal
9- One difference between bruise & abrasion.
In bruise no damage to the skin but only b.v of area are compressed resulting in extra escalation of blood into tissue. In abrasion damage to the superficial epidermis and some blood comes out.
10- Give features of a post-mortem bruise.
In post mortem bruise
§ No tissue sueeling
§ No color change
§ Ep. Is not abraded
§ Well defined sharp margin
§ No extrication of blood in skin
§ Restricted to bony prominences
§ Within 2 hours after death
§ No tissue reaction.
11- Name types of Abrasion & their mechanism of production.
Three type of abrasion have been reported.
Þ Moving abrasion: it gives evidence of direction by pick up or heaping of epidermis at far end e.g. grazes & scratches.
Þ Friction abrasion: it is caused by pressure upon skin by some ligature mark movement that is marked by rope in hanging or strangulation &lash with whip.
Þ Imprint abrasion: it is an abrasion pattern of impactions object is stamped on body when a force is applied at or meet at the right angle to the skin surface e.g. when impact of design of motor vehicle radiation on the skin.
12- How age of Abrasion is estimated.
o Fresh : Bright red + blood oozing out along with lymph
o Scab formation : 24 hour
o Brownish scab : 2 – 3 days
o Repithelisation + shading of scab : 1 week
o Complete healing : 2 weeks
13- Types of lacerations with mechanism of production.
· Split laceration : It is produced due to sudden compression between two hard objects e.g. weapon + underlying bone on the area like scalp, chin, eyebrow.
· Stretch laceration : Breach of skin due to overstretching slightly away from point of contact e.g. In industrial and vehicle accidents when part of body get trapped or when a bone is bent and broken end bone causes traction strain over skin.
· Laceration because of grinding by weight: localized pressure by heavy weight causing tear and separation skin from the underlying tissue i.e. deploying of skin.
· Tear: overstretching by irregular penetrating object e.g. broken glass/bottle.
· Cut laceration by heavy edged weapon such as chopper on hatchet.
14- Characteristics of Split lacerations. How split laceration differs from an incised wound.
Characteristic of split laceration:
· Breach of tissue ……. Edges look cleancut as in incised wounds.
· External hemorrhage minimal due to crushing of vessels
· Bruising of edges and surrounding tissue
· Elements such as hairs or denudation of hairs present in wound
· Crushing of hair bulb
Diff. b/w split laceration & incised wound
1- Hair bulb : These are cut in incised wound & crushed in split laceration
2- Tissue tags : These are present in laceration in the bed of wound
3- In split laceration bruising of edges is present
15- Define Cut laceration.
· It is caused by heavy edged weapon such as chopper on hatchet. It has features of both sharp edged & blunt weapon injuries.
It has cleancut margins but bed of wound is lacerated due to thick surface of weapon though edges are sharp.
16- Give characteristics of an incised wound. Importance of tailing.
· Involvement of clothes
· Clean regularly cut margins
· Smooth and clear cut bed
· Cutting of hair bulb
· Length greatest dimension and is broader then weapon i.e. if length is more it would be incised wound if depth is more it would be a stabbed wound.
Tailing tells us about the direction in which weapon is run.
17- Compare Suicidal cut throat from Homicidal cut throat.
| Suicidal Cut Throat |
Homicidal Cut Throat |
| Left side of the neck in right handed person & vice
versa. Commonly above thyroid cartilage. |
Usually on the sides, commonly below Thyroid cartilage. |
| Marked by Hesitation cuts. |
No such cuts. |
| Gradual deepening & shallowing with tailing on right in
right handed persons. |
Bold cut at commencement. No tailing. |
| Main wound may contain many cuts. |
Main wound usually deep & solitary. Parallel cuts maybe
present. |
| Slopped down. |
Slopped up, if any. |
| Often accompanied with wounds on wrists or
vital parts somewhere. |
Other severe injuries. |
| No cuts on hands. |
Frequently 'defence wounds' are present. |
| Carotid artery may escape damage. |
Carotid artery & jugular vein maybe cut. |
| Weapon usually present in hands or near the
body. |
Weapon maybe absent. |
| Scene of crime maybe a quiet place. |
Anywhere. |
· A suicidal wound is complex because person is afraid and a homicidal wound is a single deep wound · Multiple hesitations cuts on the throat in suicidal cuts but in homicidal cuts a single large cut present on throat.
· One or two deep lethal wound in suicidal and in homicidal a single deep lethal wound.
· In suicidal wound the direction of wound is obliquely downward and weapon may remain in the hand due to cadaver spasm.
In homicidal cut throats no such finding.
18- Difference between Incised & Stab wounds.
Incised wound Stab wound
1 Produced by object with sharp cutting edge Produced by pointed object
2 It may be anywhere on body Anywhere but may be on chest & abdomen
3 Linear or spindle in shape Depend upon the type of weapon
4 Longer then deep but often gapping Depth greater then length and breadth
5 Clean Cut Variable
6 Usually perfuse Hemorrhages may be present
7 Bruising not present Abraded or bruised due to thrusting force
8 Free from foreign bodies Foreign bodied may be present
19- Characteristics of a Stab wound.
· Produced by a pointed object
· May be anywhere but usually on chest & abdomen
· Shape depends upon nature of weapon
· Margins depend upon nature of weapon, inverted at entry
· Depth greater then length and breadth
· Abraded or bruised due to thrusting force or if the weapon is not quite sharp
· Foreign bodies may be present
· Hemorrhage may be present
20-Characterictics of defense wounds.
It is produced by immediate &instinctive reaction of victim to save himself i.e. raising forearm or by grasping weapon. usually present
on upper limb.
20- Write a note on Self-Inflicted injuries.
· Multiple
· In accessible
· Superficial
· Parallel
· Superimposed
· Tailing
· Non-involvement of clothes
*******************
by
Sahir Shafiq
Roll no: 93 (3rd year)
Session: 2002-03.
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