Skull fracture and hemorrhage pattern among fatal and nonfatal head injury assault victims - a critical analysis

Abstract

Abstract:Background: The global incidence of fatal head injuries as the result of assault is greater than the number of non-fatal cases. The important factors that determine the outcome in terms of survival of such head injury cases include the type of weapon used, type and site of skull fracture, intra cranial haemorrhage and the brain injury. The present study aims to highlight the role of skull fractures as an indirect indicator of force of impact and the intra cranial haemorrhage by a comparative study of assault victims with fatal and nonfatal head injuries. Methods: 91 head injury cases resulting from assault were studied in the Department of Forensic Medicine, IMS, BHU Varanasi over a period of 2 years from which 18 patients survived and 73 cases had a lethal outcome. Details of the fatal cases were obtained from the police inquest and an autopsy while examination of the surviving patients was done after obtaining an informed consent. The data so obtained were analyzed and presented in the study. Results: Assault with firearms often led to fatality whereas with assault involving blunt weapons the survival rate was higher. Multiple cranial bones were involved in 69.3% cases while comminuted fracture of the skull was common among the fatal cases. Fracture of the base of the skull was noted only in the fatal cases and a combination of subdural and subarachnoid haemorrhage was found in the majority of the fatal cases. Conclusions: The present study shows skull fractures to be an important indicator of severity of trauma in attacks to the head. Multiple bone fracture, comminuted fracture and base fractures may be considered as high risk factors in attempted homicide cases.

Traumatic skull fractures in children and adolescents: A retrospective observational study

“…The type and site of skull fracture and the associated intracranial haemorrhage can affect the ultimate outcome of patients with TBI. The presentation of intracranial haemorrhage is very closely related to the skull fracture [12,13]. Although paediatric head trauma has been extensively studied, there are only a few reports from developing countries about the patterns of traumatic skull fracture (TSKF) [14,15].…”

Biomechanical behavior of brain injury caused by sticks using finite element model and Hybrid-III testing

“…5 It is clear that the type of weapon used in assault plays a significant role in the prognosis. 6 The sticks are often used as a weapon in the civilian assault in China or other firearm-prohibited countries. While it loads on head, the external mechanical load is transferred into the head and causes the internal biomechanical response, and eventually resulted in brain injury.…”

Understanding blunt force trauma and violence in Neolithic Europe: the first experiments using a skin-skull-brain model and the Thames Beater

“…2012: 835; Wedel & Galloway 2014: 33). Cranial fractures are more often indicative of intentional violence than post-cranial trauma (Lovell 1997: 149; Chattopadhyay & Tripathi 2010: 102; Schulting 2012: 224; Fibiger et al 2013: 191). Certain fractures, however, are often discounted as the result of accidentally incurred trauma (Lovell 1997: 150; Ortner 2003: 121; Freeman et al 2014: 64).…”