1. بسم الله الرحمن الرحيم

2. Injury to special organs

3. Objectives 1- To know the types and complicationof trauma to the neck 2- to know the difference between homicidal and suicidal cut throat. 3- To know the types andcomplication of trauma to the chest. 4- To know the types and complication of trauma to the abdomen. 5- To know the types and complication of trauma to the pelvis. 6- To know the types and complicationof trauma to the limbs.

4. 1-Neck injuries The most common types of neck injuries are:- A- Blunt trauma(closed wound):- Causing abrasions and contusions(eg: strangulation, hanging,and throttling) B- sharp trauma(Cut or opened wound):- From the front cut wound / from the back cut nape.``

5. Differentiation Between Homicidal and Suicidal Cut Throat Homicidal C. T. Suicidal C. T.  History of quarrel  The body may be found indoor or outdoor.  Furniture usually disturbed.  History of emotional troubles or chronic disease.  The body usually found indoor, may be in front of a mirror.  Furniture not disturbed. 1. Circumstantial evidence:

6.  Signs of resistance++  No other methods.  The hand of the victim may grasp hair or fibers from the assailant  Blood is found on the back of the victim's clothes  No  Other methods of attempts suicide (cut wrist).  The hand of the victim may grasp the knife (cadaveric spasm)  Blood is found in front of the victim's clothes. 2. Examination of the body:

7. 3. Examination of the wound:  Low down in the front of neck  Transverse  Deep all through  Absent  High up in the neck  Oblique from left to right in right handed person.  The beginning is deep and the end superficial  Present at the beginning of the wound. Site Direction Direction Depth Depth Hesitation marks marks

8.  Cut at the same level like the deep tissues  Cut at high level than tissues Skin Skin  Assailant finger prints may be found.  As regards finger prints, blood stains 4. Examination of weapon

9. Deep incised wounds to the neck may be either suicidal or homicidal. In this case, the multiple superficial incised wounds (hesitation marks) are signs of a suicide.

10. The boy’s neck wounds were superficial and did not contribute to death

11. Deep incised wounds of the neck. There are no hesitation marks. This was a homicide

12. Causes of death in cut throat 1. Reflex vagal inhibition (neurogenic shock). 2. Severe hemorrhage (external). 3. Asphyxia (blood trickle into the trachea). 4. Venous air embolism. 5- Transection of the spinal cord in cut nape. 6- delayed causes:- a)Edema of the glottis. b)Aspiration pneumonia.

13. 2-INJURIES TO THE CHEST 1. Penetrating chest injuries = Open: a. Penetrating wounds of the lungs and pleura: They may result in haemothorax or pneumothorax or obstruction of trachea or bronchi by blood. Delayed death from bronchopneumonia or empyema. b. Penetrating wounds of the heart: May involve the muscle only, may penetrate into one of the heart chambers or may transfix the heart. The cause of death is shock (neurogenic), hemorrhage, cardiac tamponade (200-250cc can interfere with contractility)or infection.

14. c. Penetrating wounds of the large blood vessels and esophagus:- Large vessels e.g. superior vena cava, pulmonary artery or aorta  profuse hemorrhage. Penetrating wound of the esophagus may be followed by fatal mediastinitis.

15. 2. Non penetrating chest injuries = Closed: a. Injuries of chest wall: - Abrasions, bruises, simple fracture. - Fracture of the sternum (uncommon), due to direct impact e.g. steering wheel impact injury. b. Injuries of the lungs - Lung lacerations. - Lung contusions.

16. c. Injuries of the heart - Cardiac lacerations. - Traumatic rupture and cardiac tamponade may occur. - Cardiac contusions. d. Injuries of large blood vessels Rupture of the aorta caused by direct or indirect thoracic trauma, it may be partial rupture (involve the intima only) or complete rupture.

17. Complications and sequelae of chest injuries 1- Pneumothorax: Open pneumothorax : open wound in the chest wall. Closed pneumothorax wound in the lungs. Open and closed penetrating wound of the lung.

18. 2. Hemothorax. 3. Chylothorax. 4. Cardiac tamponade. 5. Interstitial emphysema. 6. Arterial air embolism 7- cardiac arrythmias.

19. The arrows point to some of the ten stab wounds to the inside left chest wall. The victim was stabbed at least ten times through the single large wound of the chest.

20. There were multiple stab wounds in the left lung

21. 3-INJURIES TO THE ABDOMEN I. Penetrating = opened abdominal injuries They are caused by pointed weapons e.g. knife or bullets. a. Solid organs. b. Hollow viscera. II. Non penetrating = Closed abdominal injuries Closed abdominal injuries are caused by blunt force and occur in accidental falls, in traffic accidents and in cases of assault and homicide when the abdomen has been kicked or struck by blunt weapons.

22. 1- Injuries of the abdominal wall. 2. Injuries of the stomach and intestines: a. Forces of compression:  contusions or lacerations. b. Traction forces: -Rupture at the junction of the fixed and mobile parts e.g. at the duodeno - jejunal junction.

23. Tear of the mesentery and mesenteric vessels  intra- peritoneal hemorrhage and infarcts of the intestine. c. Bursting forces: -Rupture of the stomach is at the lesser curvature. - Rupture of the intestine usually involve the ileum.

24. The difference between traumatic and pathologic rupture of the intestine Pathological rupture Traumatic rupture of a disease (typhoid) Of a traumahistory absent may be presentInjury to the abdominal wall Usually regularIrregularrupture Not bulgingBulging through rupture (due to increase the intra abdominal pressure.) mucosa Pathological ulcers may be found in the rest of intestine The rest of the intestine is normal Intestinal wall

27. 3. Injuries of the spleen: It may cause rupture spleen which may be intracapsular or extracapsular N.B:intracapsular rupture spleen has a medicolegal importance. 4. Injuries of the liver: - contusions or lacerations. 5. Injuries of the pancreas.

29. 6. Injuries to the kidneys - Non penetrating injuries: contusions or lacerations, injury of the renal pedicle  renal infarction. - Penetrating wounds of the kidneys e.g. bullets, pointed weapons.

30. Complications of abdominal injuries 1. Shock: either primary (neurogenic) or secondary (hematogenic). 2. Internal hemorrhage: hemorrhage from a laceration of the spleen is usually rapid and copious if compared to hemorrhage from the liver. 3. Peritonitis. 4. Paralytic ileus.

31. 4-Injuries to the pelvis Fracture pelvis  extraperitoneal rupture of the bladder. When the bladder is distended  intraperitoneal rupture. Rupture of female uterus specially gravid uterus.

32. 5-Injuries to the limbs Causes: 1. Direct violence  comminuted, and frequently compound fractures. 2. Indirect violence such as twisting  the bone is broken in a region distant from the site of force. They are usually simple fractures, and less likely to be comminuted. 3. Crushing injuries to the limbs  crush syndrome  renal failure.

33. Complications of limb injuries 1. Hemorrhage. 2. Fat embolism. 3. Pulmonary embolism. 4. Acute tubular necrosis due to necrosis of the muscles  oliguria, anuria, later renal failure (crush syndrome). 5. Infection: pyogenic infection, gas gangrene or tetanus.

34. Fractured bones may not match the external with the site of impact

35. Patterns from the vehicle may be found. The arrows outline a headlight on this man’s leg.

36. Thank you

37. Stab wounds

38. Stab wound of the arm from defending herself. The entrance is on the lower right.

39. Defensive wound

40. Incised wound of the neck, caused by a saw.

41. Multiple hesitation marks and deep incised wounds in this suicide. The cause of death was from cutting the neck.

44. Internally, there was a laceration of the lung

45. The most important injury was a transected the aorta

47. Blunt trauma to the buttocks may not be easily detected. Incisions into the buttocks should be performed to adequately evaluate the degree of trauma. See next photo

48. The buttocks were incised and blood in the soft tissues revealed. Microscopic sections may be helpful in determining the age of the trauma.