Regional injuries, types of scalp injuries with details of scalp anatomy, types of skull fractures, coup and counter coup injuries, mechanism of skull fractures.

1. Regional Injuries
Dr. Sunil Duchania
MBBS (MAMC), MD (LHMC)
Certification in Medical Negligence in India
Founder- Forensic Extracts
Founder- SABAL Medico legal Consultancy
Former President RDA LHMC, Delhi
Vice-President FORDA, India

12. When a moving object impacts the
stationary head, coup injuries are typical,
while countercoup injuries are produced
when the moving head strikes a
stationary object.

21. TYPE OF SKULL FRACTURES

25. Closed fracture
With a closed fracture, also called a simple
fracture, the skin that covers the fracture area
isn’t broken or cut.
Open fracture
Also known as a compound fracture, an open
fracture occurs when the skin is broken and
the bone emerges.

32. Base Skull Fracture

34. Gutter Fracture

38. Puppe's rule

39. As early as 1903, it was pointed out by Puppe that it is possible to
determine the sequence of injuries in skull fractures caused by blows
to the head: the second fracture ends at the point where a break in
cohesion is already present.
This finding was confirmed by tests carried out by other forensic
pathologists. It soon became clear that the rule also applies to
gunshot fractures.
In the case of gunshot injuries, it is even possible to make more
detailed statements.
However, the applicability of Puppe's rule is limited by incomplete
ossification or ossification disorders.
The priority rule is also found in English-language literature, but
without the name of the author who first described it.

53. Punch Drunk Syndrome
Punch drunk syndrome also known as dementia
pugilistica, is an illness experienced by many athletes
who experience severe or repeated concussions.
Punch drunk commonly manifests in shaking hands,
dementia, declining mental ability (such as memory),
tremors, loss of coordination, and speech impediments.

56. A lucid interval is a temporary improvement in
a patient's condition after a traumatic brain
injury, after which the condition deteriorates.
A lucid interval is especially indicative of an
epidural hematoma.
An estimated 20 to 50% of patients with
epidural hematoma experience such a lucid
interval

71. "Cervical acceleration–deceleration" (CAD) describes the
mechanism of the injury, while the term "whiplash associated
disorders" (WAD) describes the injury sequelae and symptoms.
Symptoms:
Pain and aching to the neck and back, referred pain to
the shoulders, sensory disturbance (such as pins and
needles) to the arms and legs, and headaches.
Whiplash is usually confined to the spine. The most
common areas of the spine affected by whiplash are
the neck and middle of the spine. "Neck" pain is very
common between the shoulder and the neck.

77. The exact injury mechanism that causes whiplash
injuries is forceful sudden hyperextension followed by
hyper flexion of the cervical vertebrae, mainly
spraining the nuchal ligament and the Anterior
Longitudinal Ligament respectively.
A whiplash injury may be the result of impulsive
retracting of the spine, mainly the ligament: anterior
longitudinal ligament which is stretched or tears, as
the head snaps forward and then back again causing
a whiplash injury.

78. A whiplash injury from an automobile accident is called a cervical
acceleration–deceleration injury. Cadaver studies have shown that as
an automobile occupant is hit from behind, the forces from the seat
back compress the kyphosis of the thoracic spine.
which provides an axial load on the lumbar spine and cervical spine.
This forces the cervical spine to deform into an S-shape where the
lower cervical spine is forced into a kyphosis while the upper cervical
spine maintains its lordosis.
As the injury progresses, the whole cervical spine is finally hyper-
extended.

79. For the last 40 years, vehicle safety researchers have been designing and
gathering information on the ability of head restraints to mitigate injuries
resulting from rear-end collisions.
As a result, different types of head restraints have been
developed by various manufactures to protect their occupants from
whiplash.
Head restraint — refers to a device designed to limit the rearward
displacement of an adult occupant's head in relation to the torso in order
to reduce the risk of injury to the cervical vertebrae in the event of a rear
impact.

80. The most effective head restraint must allow a backset motion of less
than 60 mm to prevent the hyperextension of the neck during impact.
Integrated head restraint or fixed head restraint — refers to a head
restraint formed by the upper part of the seat back, or a head restraint
that is not height adjustable and cannot be detached from the seat or
the vehicle structure except by the use of tools or following the partial
or total removal of the seat furnishing".

93. IPC: Homicide and suicide
S 44 IPC: Any harm whatever illegally caused
to any person in body, mind, reputation or
property
S 299 IPC: Culpable homicide
S 300 IPC: Murder
S 302 IPC: Punishment for murder
S 304 IPC: Punishment for culpable homicide
not amount to murder
S 304-A IPC: Causing death by rash or
negligence (Punishment up to 2 years
imprisonment or fine or both)
S 304-B IPC: Dowry death

94. S 305 IPC: Abetment of suicide of child
or insane person
S 306 IPC: Abetment of suicide
S 307 IPC: Attempt to murder
S 308 IPC: Attempt to commit culpable
homicide
S 309 IPC: Attempt to commit suicide

95. Whiplash injury is caused by-
a)Acute hyperextension of spine
b)Hyper flexion of spine
c) Fall from height
d)Blow on the vertex

96. Which of the following wound resembles incised wound?
a)Grazed abrasion
b)Split laceration
c) Imprint abrasion
d)Avulsion laceration

97. Fracture-ala signature’ is: (AIIMS MAY
2006)
a) Gutter fracture
b) Depressed fracture
c) Ring fracture
d) Sutural separation

98. Gutter fracture is due to
a) Oblique bullet wound
b) Fall from height
c) Sharp weapon
d) Osteoporosis

99. Which of the following skull fractures is called a
motorcyclist’s fracture?
a) Ring fracture of base of skull
b) Hinge fracture of base of skull
c) Comminuted fracture of skull
d) Depressed fracture of skull

100. Pathologically speaking, what is a coup
and countercoup injury?
A bruise
A fracture
Necrosis
A stroke

101. Which of the events is the cause of the
greatest percentage of cases of adult head
injury?
Falling from height
Motor vehicle accidents
Sports like soccer
Gunshots

102. A CT scan can show all types of head
injury.
True
False

103. Concussion is...
Skull fracture
Tingling sensations in the arms and
legs
Temporary loss of normal brain
function due to a hard blow on head
Low back pain

104. Concussion does not always result in loss
of consciousness immediately after the
blow on the head. But it can be identified
with...
The person's speech is slurred
The person vomits
The person does not remember the injury
All of the above