Primary Impact Site Research Articles

Fatalities Following Fall from Heights Presented to Three Medico-Legal Units in Sri Lanka

Introduction: Fall from heights is a common form of unintentional injury. The objective of this study is to determine the pattern of injuries, risk factors, and safety measures employed in relation to such falls.Methods: Data was collected from cases of fatal falls presented to the medico-legal units at Kandy, Peradeniya, and Panadura in Sri Lanka from 2005 to 2016.Results: In the sample considered the majority were males (93%) between 41-60 years (49%). Most were accidental (88%) and 41% sustained injuries by falls from trees. The commonest region of injury was the head and neck (71%) with the site of primary impact being the same. The most common injuries in the head, thorax, and abdomen/pelvis were skull fractures (60%), rib fractures (84%), and liver lacerations (59%), respectively. The main skull fracture was linear (67%), with the commonest site being the temporal (36%) and occipital (36%). With increasing height, the frequency of injuries to the thorax, abdomen, pelvis, and limbs also increased. Most (68%) died after being brought to hospital. Alcohol consumption was estimated as 10% in the sample considered.Conclusion: None had been using any safety equipment. This study underscores the importance of protective devices for people who work at heights to prevent fatalities. Compliance can be further enhanced by creating awareness among the vulnerable groups.

Pattern and Distribution of Injuries from the Fall from the Height in Fatal Cases in a Tertiary Care Hospital, Chennai

Background: The second leading cause for the injury related deaths is fall from height. The injuries fatalitiesdepends on the height of fall and its impact surface. Landing position is also considered as an important parameter.Aim: The aim of the study is to study the pattern and distribution of injuries from the fall from height in fatal cases.Methodology: This study includes 100 cases of victims brought to the tertiary care hospital with the history of fallfrom the height. The cases were brought from the accident site or after death as a consequence of fall in this tertiarycare hospital. During autopsy all the relevant details like basic details and the injury details like dimensions,injurytypes and the primary impact site were taken. Blood and urine examination were done for finding alcohol anddrugs. Data entered in MS excel and analysis done in SPSS 23 software. P value <0.05 is considered to be significant.Results: Majority of the study participants belongs to 31-40 years of age group(30%) followed by 41-50 years of age(18%). Male predominance was observed in our study (90%).34% were daily labours. The most common externalinjury is abrasion noted in 90% of the study participants. The most common primary impact site was head (50%)followed by backside (12%).Conclusion: Fall from heights cause significant morbidity and mortality. It is important to create awareness amongthe workers and to provide safety gears for the persons working in construction sites.

A prospective cross-sectional study on the cases in a tertiary care hospital about the patterns of head injury caused by falling from heights

One of the most common injuries and death in India are caused by falling from heights. Although a majority of these bereavements are accidental and are due to a slip from higher altitudes like multi storey buildings, trees, construction sites, etc., alcohol consumption also plays a vital role. In such occurrences of death due to falling from heights, head injury is a very common phenomenon and it complicates the investigation procedure for the investigators and the medico legal experts to arrive at a conclusion because these injuries impersonate the injuries sustained from other accident cases like a road accident per say. Due to the absence of eyewitness in most of these cases, a detailed analysis on the pattern and the nature of the injuries is required to arrive at a conclusion. These injuries sustained vary owing to the site of impact and the stature from where the victim had fallen and the critical answer to the medico legal queries lies in a detailed autopsy of the victim’s body and a thorough examination at the scene of occurrence. On the account of a comprehensive study insufficiency in Tamilnadu, a modest attempt was made to analyse the pattern of head injuries sustained on the victims of fall from different heights and is presented as a cross- sectional study.The case study on the fatal incidents of fall from height was recorded and analysed statically in a sampling of one hundred cases which was subjected to detailed autopsy in a tertiary care hospital. In this analysis the nature and pattern of injuries, data regarding the nature of fall, the site of primary impact, period of survival and a detailed examination of head injuries were all noted. The statistical analysis was carried out using Microsoft Excel 2009.From the analysis, it is observed that the maximum number of fall from height cases seemed to be from the age group of 31 years ~40 years (30%) and males contributed to a majority of these cases (90%). Amongst head injury cases, 82% of the cases had intracranial haemorrhage and 10% had facial bone fractures. In the 82% of cases, 76% of cases had both subarachnoid haemorrhage and subdural haemorrhage. Also skull fracture was seen in 40% of the cases and the base of the skull fracture was noted almost equally in 37% of the cases. Injuries to head and cervical spine constituted to the salient features of primary head impacts, SAH alone is rare in such cases.On the account of observation and analysis, it is noted that most of these cases were accidental in nature (93%) and Males (90%) in the age group of 31-40 years were in highest number (30%). Cranial injuries with subarachnoid and subdural haemorrhage seemed to be the most common cause of death amongst victims falling from heights. Also skull fracture were seen in 40% of the cases and base of skull fracture noted almost equally in 37% of the cases. While SAH alone in rare in these cases, injuries to head and cervical spine were the key impacts of primary head impacts.

Subdural and epidural hematoma occurrence in relation to the head impact site: An autopsy study

Blunt head injury is a major public health and socioeconomic problem causing death and disability particularly among the young population throughout the world. The purpose of the present study was to evaluate if the impact site is correlated with the subdural and epidural hematoma occurrence. A retrospective analysis of consecutive autopsy cases submitted to our Department during a 5-year period was performed. The basic criterion for inclusion in the study was death due to blunt head injury. The recorded variables included the circumstances of death, the existence, and location of head injuries, the primary impact site, age, gender, and toxicological results. A total number of 683 fatal head injury cases was recorded, with most of them being male (74.1%). In 424 cases (62.1%) fatal head injuries were due to road traffic accidents. Fall (from height or on the ground) was the cause of death in 220 (32.2%) cases followed by inflicted impact-assault in 26 (3.8%) cases. A subdural hematoma was found more frequently (26.9%) than epidural (5.0%). Epidural hematomas were found only under the primary impact site, whereas subdural hematomas were coup, contrecoup, or bilateral. An epidural hematoma was found to be almost 5 times more frequent in cases in which a subdural hematoma was present. A higher proportion of subdural, as well as epidural hematoma, was found when the site of impact was the temporal region, followed by the parietal one. Sex did not exert any influence on the probability of subdural and epidural hematoma, whereas for age, a 10% increase in the probability of subdural hematoma occurrence was observed with 10-year age increase.

Injury Patterns of Pedestrians Collided with Motor Bicycles Admitted to Teaching Hospital Karapitiya

Introduction: Road traffic accidents involving the pedestrian are very high. This study was conducted to identify the socio-demographic characteristics, injury patterns, risk factors of pedestrians collided with motor bicycles. Methodology: The pedestrians who get admitted to the Teaching Hospital Karapitiya following collision with motor bicycles were included. Results: Total numbers of 432 pedestrians were included. Majority (50%) were over 50 years. The commonest primary impact site was the legs (51%) and the commonest injury was the compound fractures (19%). The majority (34%) did not have visible primary impact injuries.65% had the primary impact injuries and those were placed 20cm to 30cm above the heel. Abrasion is the commonest injury present on other anatomical areas of the body. Vision and hearing problems are the risk factors of the pedestrians over the age of 70 years (29%).The pedestrians (56%) had collided with motor cycles while crossing the road. The majority of accidents (67%) had occurred during the afternoon. Conclusion: Elder pedestrians with vision and hearing problems collide with motor cycles. The common primary impact injury was found on the legs and often there were no visible injuries. The majority of the accidents occurred in the evenings while crossing the road.

Diffuse white matter response in trauma-injured brain to bone marrow stromal cell treatment detected by diffusional kurtosis imaging

Diffuse white matter (WM) response to traumatic brain injury (TBI) and transplantation of human bone marrow stromal cells (hMSCs) after the injury were non-invasively and dynamically investigated. Male Wistar rats (300–350 g) subjected to TBI were intravenously injected with 1 ml of saline (n = 10) or with hMSCs in suspension (∼3 × 106 hMSCs, n = 10) 1-week post-TBI. MRI measurements of T2-weighted imaging and diffusional kurtosis imaging (DKI) were acquired on all animals at multiple time points up to 3-months post-injury. Functional outcome was assessed using the Morris water maze test. DKI-derived metrics of fractional anisotropy (FA), axonal water fraction (AWF) and radial kurtosis (RK) longitudinally reveal an evolving pattern of structural alteration post-TBI occurring in the brain region remote from primary impact site. The progressive structural change is characterized by gradual disruption of WM integrity at an early stage (weeks post-TBI), followed by spontaneous recovery at a later stage (months post-TBI). Transplantation of hMSCs post-TBI promotes this structural plasticity as indicated by significantly increased FA and AWF in conjunction with substantially elevated RK at the later stage. Our long-term imaging data demonstrate that hMSC therapy leads to modified temporal profiles of these metrics, inducing an earlier presence of enhanced structural remodeling, which may contribute to improved functional recovery.

Contrecoup Head Injury

AbstractContrecoup injuries comprise a group of focal brain injuries that occur at areas distant from the point of impact. It has been hypothesized that patients with contrecoup injuries would have a worse outcome because of the diffuse nature of injury. At Nilratan Sircar Medical College, Kolkata, 74 patients presenting with contrecoup injuries over a period of 1 year were prospectively analyzed. Site of primary impact was determined by clinical and CT scan criteria. The age, modes of injury, Glasgow coma scale (GCS), site of injury, pattern of injury, and mortality were analyzed. Delayed presentation of contrecoup injury in patients who deteriorated over time was also noted in imaging. The presence of contrecoup injury implies that the traumatic forces have dissipated into the brain, and from the biomechanisms explained, the brain is likely to have suffered greater damage than the case in coup injury alone. The present study shows that the presence of contrecoup contusions is associated with a poor prognosis across all GCS and age categories.

Fall from Heights – Pattern of Injuries

Deaths due to fall from heights are common in the State of Kerala. Majority of the cases are falls from tall trees and buildings. The present study was conducted in the Department of Forensic Medicine, Medical College, Trivandrum. The objective was to find out the nature and pattern of injuries sustained to the victims of fall from heights. Effort was made to find out the height of fall by visiting the scene of occurrence. The site of primary impact was identified from the analysis of injuries, statements of witness and records of the police. Majority of the cases were accidental falls. Of the 100 cases studied, accidents constituted 98%. There were only two cases of suicide. Most of the victims were active laborers in the age group of 20-60 years and the height of fall varied from 5-10 meters. Maximum number of primary head impacts were also noted in this group. Apart from injuries to skull and brain, involvement of cervical spine was a common feature. Visceral injuries were a common feature in trunk impacts. Buttock impacts were characterized by fracture of pelvis and spine. Leg impacts showed fracture of leg bones and spine.

Death is due to Hemorrhagic Shock as a Result of Cranio-Cerebral Trauma-Accidental

Deaths due to fall from height, form an important area of study due to diversity of the injuries sustained, complexity of the patterns involved and various phenomenon's associated there with. The medico-legal autopsy aims at deciding whether the death was attributed purely to the height. It also helps in ruling out the various contributing factors like drugs, alcohol and co-existing natural disease. The study of pattern of external and internal injury may together indicate the primary site of impact and height from which the fall has occurred. The determination of actual or probable anatomical site of primary impact may be useful in reconstruction of the events, which led to fatal falls. Presence of multiple blunt force injuries makes it hard to differentiate between falls induced injuries and those that have been inflicted before the fall and often disagreement predominates regarding the height at which death results. Thus a careful study of total injury pattern is of vital importance in every case. In the difficult scenario of assessing the manner of death, meticulous autopsy in combination with visit to the scene of occurrence that includes observation of ground nature and presence of any intervening object is of extreme help.

Coup and contrecoup head injuries: Predictors of outcome

Coup and contrecoup contusions comprise a group of focal brain injuries. The pathogenesis of the two are different, the outcome in the two would therefore be expected to be different. However there are no studies in literature comparing outcome in coup-contrecoup injuries. At NIMHANS, Bangalore, two hundred and ninety eight consecutive cases presenting with coup and contrecoup injuries over a 2-year period were retrospectively analyzed. They were divided into three groups: Coup injuries with intraparenchymal injury (n = 129), contrecoup injuries (n = 84) and coup-contrecoup injuries (n = 85). The groups were comparable with respect to age and GCS. Site of primary impact was determined by clinical and CT scan criteria. The mortality rates in each group were compared with respect to age, GCS and CT pattern. Significance was calculated using the chi-square test. There was a statistically significant difference in mortality between patients with coup injuries and patients with contrecoup (p < 0.005) and coup-contrecoup injuries (p<0.001). There was no significant difference in mortality between contrecoup and coup-contrecoup injuries (p = 0.1). Mortality in patients aged less that 60 years and patients with GCS > 8 was significantly higher in patients with contrecoup and coup-contrecoup injuries. Presence of a contrecoup component on CT scan may portend a worse outcome in head injuries and may warrant closer monitoring and more aggressive management of these patients.

Correlation between skeletal trauma and energy in falls from great height detected by post-mortem multislice computed tomography (MSCT)

Fatal falls from great height are a frequently encountered setting in forensic pathology. They present – by virtue of a calculable energy transmission to the body – an ideal model for the assessment of the effects of blunt trauma to a human body. As multislice computed tomography (MSCT) has proven not only to be invaluable in clinical examinations, but also to be a viable tool in post-mortem imaging, especially in the field of osseous injuries, we performed a MSCT scan on 20 victims of falls from great height. We hereby detected fractures and their distributions were compared with the impact energy. Our study suggests a marked increase of extensive damage to different body regions at about 20 kJ and more. The thorax was most often affected, regardless of the amount of impacting energy and the primary impact site. Cranial fracture frequency displayed a biphasic distribution with regard to the impacting energy; they were more frequent in energies of less than 10, and more than 20 kJ, but rarer in the intermediate energy group, namely that of 10–20 kJ.

Carbohydrates Are Good for You!

The upper airways carry air to the lungs and are therefore the primary impact site for environmental particulates, including potential pathogens. The complex structure [1] of these airways provides a protective barrier including elements of both the acquired and innate immune systems [2]. The epithelial cells also facilitate the clearance of material landing on the airway. Damage to this protective barrier, for example in asthma, can result in a loss of function or structural integrity and associated local mucosal activation [3]. A number of studies have shown that epithelial repair in normal airways involves the rapid and autonomous migration of the surrounding cells to cover the damaged area [4]. In this article we look at the microscopical investigation into the essential role of cell surface carbohydrates, called glycoconjugates, on these repair processes.

Frequency of Laryngeal and Hyoid Bone Trauma in Nonhomicidal Cases Who Died After a Fall From a Height

A retrospective study was carried out on 93 autopsy cases who died after a fall from a height. For each case, following parameters were reported: age, sex, manner of death, estimated height of fall, ground type, estimated site of primary impact, type of laryngeal and hyoid bone trauma, presence of associated local trauma in the neck and cephalic region. Mean age of the studied population was about 33 years. Sex ratio (men/women) was 1.8. Mean height of fall was about 15 m. Manner of death was, respectively, suicide and accident in 70 and 23 cases. The type of ground was concrete in 94% of the cases. The site of primary impact was, respectively, head, front of the body, back of the body, feet/lower limbs, and lateral body in 31, 26, 19, 12, and 5 cases. Cervical soft tissue bruising without laryngohyoid fractures was found in 5 cases. Laryngohyoid fractures were found in 5 cases. These fractures could be explained by direct impact of the neck structures against the ground. The mechanism of these fractures could also be indirect fractures due to high muscle strains on the hyoid bone or thyroid cartilage due to cervical hyperflexion or hyperextension or secondary to mandible or cervical vertebral column fractures.

Spatiotemporal Pattern of Neuroinflammation After Impact‐Acceleration Closed Head Injury in the Rat

Inflammatory processes have been implicated in the pathogenesis of traumatic brain damage. We analyzed the spatiotemporal expression pattern of the proinflammatory key molecules: interleukin-1β, interleukin-6, tumor necrosis factor-α, and inducible nitric oxide synthase in a rat closed head injury (CHI) paradigm. 51 rats were used for RT-PCR analysis after CHI, and 18 for immunocytochemistry. We found an early upregulation of IL-1β, IL-6, and TNF-α mRNA between 1 h and 7 h after injury; the expression of iNOS mRNA only revealed a significant increase at 4 h. After 24 h, the expression decreased towards baseline levels, and remained low until 7 d after injury. Immunocytochemically, IL-1β induction was localized to ramified microglia in areas surrounding the primary impact place as well as deeper brain structures. Our study shows rapid induction of inflammatory gene expression that exceeds by far the primary impact site and might therefore contribute to tissue damage at remote sites.

Phospholipase C-dependent phosphoinositide breakdown induced by ELF-EMF in Peganum harmala calli

With the aim of examining the response of plant cells to extremely low frequency (ELF) electromagnetic fields (EMF), we investigated the behaviour of the phosphatidylinositol 4,5 bisphosphate (PtdIns 4,5-P 2) molecule (the precursor of the phosphoinositide signal transduction cascade) by exposing callus cells from Peganum harmala to 50 Hz, 1 gauss EMF for 10 min and by examining the level and the fatty acid composition of PtdIns 4,5-P 2 after the exposure. Our results evidenced a statistically significant decrease in PtdIns 4,5-P 2 concentrations and a different involvement of the constituting fatty acids in the induced breakdown. The manipulation of the lipid-based signalling pathway by phosphoinositide-phospholipase C (PI-PLC) inhibitors (i.e., neomycin, U-73122 and ET-18-OCH 3) seems to support the hypothesis that, as in animals, also in plants, the cell membrane is the primary impact site of ELF electromagnetic stimulus and that this interaction could probably involve the activation of PI signal transduction pathway including a heterotrimeric G protein.

In-situ detection of micrometeoroids and orbital debris: The PIE experiment on MIR

During the last few years, investigation of impact features found on material retrieved after exposure to space for a long period of time, in low earth orbits, has provided us with a great deal of data on the particulate environment, either natural or man-made. The PIE detection device presented here has been deployed outside the Kvant-2 module attached to the Russian MIR station, between June 1996 and April 1997. Part of the experiment uses a detection technique similar to the one used in previous experiments flown on LDEF and MIR. Passive sensors are composed primarly of stacked thin metal foils (gold and aluminium). According to the size of the particles, they are either decelerated or fragmented upon high velocity impact. The size of holes or impact craters give information on the size or shape of the impacting particles. Samples have been retrieved for laboratory analysis. Comparison with data from LDEF, EuReCa, HST and previous experiments on MIR provides insight in the long term evolution of small particle population and in the debris environment of a permanently manned station. Some of the samples show evidence of secondary impact cratering: an attempt is made to locate the origin of the primary impact site. Some results about the possible origin of the impactors are provided by the chemical identification of particle remnants inside the craters.

Surface analysis with keV polyatomic projectiles

Bombardment of solids with polyatomic projectiles (e.g., Cs 2I +) results in high secondary ion (SI) yields. For projectiles of 5–30 keV, SI yields as high as 10% have been observed; they are up to 50 times higher than those obtained with equal velocity monoatomic ions. Our data show that the SI yields increase with the mass of the projectile and its velocity. The SIs are identified by TOF-MS in an event-by-event counting mode, allowing the study of sputtering phenomena in the limit of a single projectile-target interaction. Moreover, the SIs emitted from a single primary ion impact can be acquired in a coincidence mode, i.e., the masses which are desorbed together from a primary impact site can be identified.

2.2.7 Measurements of Impact Ejecta Parameters in Crater Simulation Experiments

Ejecta parameters such as masses and velocities as a function of ejection angle have been determined in impact experiments performed with a light gas gun. Impact plasma detectors and secondary targets mounted around the primary impact site served for the detection of secondary particles.