1. Head injuries

3. II – Skull. III- Meninges . IV- Brain
I -Scalp injuries (stretched skin)
II – Skull.
III- Meninges .
IV- Brain

5. Infection is dangerous why???
Cut and contused wounds in the scalp
What is the problem?

6. II -SKULL INJURIES Factors governing fractures of the skull: 1- Force
2- Striking surface area( hammer – chair)
3- Position of the head (supported or not)
4- Site of the blow:
The weakest points are the squamous and temporal bones

7. Types of skull fractures: -
1-Skull fractures due to blunt instruments.
Fissure – depressed – comminuted
2- Skull fractures due to sharp instruments
chipped - cut - cut comminuted

8. 1-Fissure fracture (linear fracture)
- Blunt instrument with wide sticking SA and low momentum.
It starts at the point of impact.
It extends parallel to the line of force.
The fissure may run into sutures
Multiple blows may produce multiple fissures, but a second fissure will end when it reaches the first fissure
Fissure fractures may be alone or they may accompany other types of fractures.

10. Types of Fissure Fracture.
Polar fracture:
Ring fracture
Thermal fracture

11. 2-Depressed fracture
Caused by blunt instrument with small surface area and medium force
Depressed localized fractures:
It takes the shape of striking surface
Usually small in size
May be accompanied with fissure fracture

14. 3- Depressed comminuted fracture:
heavy blunt object having a wide Surface area and high momentum
car accidents,
fall from height.

17. Dangers of depressed fractures: -
1- Cerebral laceration
2- Intra cranial hemorrhage.
3- Cerebral compression.
4- Intracranial infection.
5- Subjecting the patients to a decompression operation, this leaves a bony gap and permanent infirmity.

19. 2-Skull fractures due to sharp instruments
A- Sharp and light instrument e.g. knife
Cut fracture
Chipped F tangentially causing removal of the outer table.
B- Sharp and heavy instruments

20. Injuries produced by an axe
1- The blade of an axe  cut fracture.
2-If the blade passes tangential to the outer table; chipped F
3- The cut may be triangular if the striking is done with angle
4-The striking with the head of the axe localized DF.
5- The handle of the axe fissure fractures.

22. FRACTURES OF THE BASE These are usually fissure fractures
Fracture Anterior fossa  eye
Fracture Middle fossa  ear
Fracture posterior fossa  neck

23. HEALING OF SKULL FRACTURES
A- Healing of fissure fracture
The edges are glued by serous exudates in one week
Smoothening of the edges in about 2-3 weeks
Complete closure with osseous in 3-4 months
B- Healing of depressed / comminuted fracture (no bone)
C- Healing of cut fractures. As those of fissure fractures

24. Sepsis
Appears in the skull in the form of bone erosion affecting either the outer, inner or both tables within 4-6 weeks. Bone erosion indicates that the cause of death is possibly septic intracranial complications - meningitis, brain abscess or sinus thrombosis

25. III- INJURIES TO MENINGES
1- Extradural hemorrhage (Traumatic)
2- Subdural hemorrhage
* Traumatic → A- acute
B-Chronic (pachymeningitis haemorrhagica )
* Pathological (hypertension- Blood Disease ---)
3- Subarachnoid hemorrhage:
4- Intracerebral hemorrhage:
A- Traumatic: Coup injury or Contre-coup
B- Pathological

27. IV- BRAIN INJURIES A- CONCUSSION : * Definition * C/P
* Fate of concussion
1- Complete uncomplicated recovery
2- Death
3- Compression

28. Lucid interval Definition: Mechanism : Medico legal importance
Treatment of concussion : observation. No morphine

29. B- COMPRESSION
Definition
Mechanism Stage of irritation Stage of paralysis
Clinical picture : Victim is conscious  gradually  drowsiness  blurring of vision  severe headache (mainly occipital). Then- Fever effortless central vomiting High blood pressure  slow full pulse  coma  death

30. Causes of cerebral compression
1- Intracranial hemorrhage.
2- Pressure by fragments of bone
Treatment of compression

31. Conjugate deviation of both eyes On the opposite side
The following are lateralizing signs of compression, which are diagnostic to the compressed side:
On the side of hemorrhage
The pupils are unequal constricted (more on affected side)
Conjugate deviation of both eyes
On the opposite side
Exaggerated reflex of the other side
Hemiplegia occurs on the contra lateral side

33. C- brain contusion d- brain laceration Both contusion and laceration can occur in cases of coup or contre-coup lesion.

34. Differences between concussion and compression
Mechanism
Loss of consciousness
Pulse BP
Reflexes
Vomiting
Pupils
Signs of lateralization
Treatment

35. SEQULLAE & COMPLICATIONS OF HI
1- Post traumatic amnesia or retrograde amnesia
2- Post traumatic automation
3- Post traumatic neurosis
4- Korsakoff's psychosis
5- Personality changes:
6- Jacksonian epilepsy
7-Septic complications
8-Permanent infirmity