Traumatic Injuries of the Organs of the Abdominal Cavity: Adult and Pediatric

In this chapter we will review the traumatic injuries to the organs of the abdominal cavity, which will include the esophagus, stomach, duodenum, jejunum, ileum, mesentery, appendix, colon, liver, gallbladder, and spleen.  Although, much of the esophagus is within the thorax, for the sake of continutiy, it will be discussed with the gastrointestinal tract, most of which is located within the abdomenal cavity.  There will also be a discussion, in a general sense, of the mechanisms of injury to the abdominal organs when the abdomen is subjected to blunt force trauma.  We will first review the surface anatomy, as well as the anatomy of the abdominal cavity.  The foundation of thought behind reviewing the anatomy is based on the fact that an understanding of the surface anatomy will give you some insight into what you can anticipate internally during your external examination.  It will also give you a grasp of the dynamics involved which produced the external and internal traumatic injuries. Since this educational blog may also be used by medicolegal investigators, police officers and attorneys, who for the most part have little knowledge of anatomy, such a review may help them in having a better understanding of the relationship between the blunt force trauma applied to the victim and their injuries.

Traumatic Injuries of the Organs of the Abdominal Cavity- Adult and Pediatric

Blunt Force Traumatic Injuries of the Chest

In this chapter we will discuss traumatic injuries to the chest wall and the thoracic viscera.  Chest wall injuries include the skin, subcutaneous tissue, intercostal musculature, ribs, sternum, and parietal pleura.  Thoracic visceral injuries include two main categories: (1) mechanical injuries of the respiratory system, which will include diaphragmatic rupture.  The inclusion of diaphragmatic rupture is due to the fact clinically it presents with symptoms analagous to pneumothorax.  (2) mechanical injuries of the cardiovascular system, which will include the mediastinum.  This is primarily due to the fact the most common cause of a widen mediastinum is aortic rupture.  We will also discuss the mechanisms of chest injury.  Prior to a discussion of the blunt force traumatic injuries of the chest and mechanisms of chest injury, we will review the anatomy of the thorax.

Blunt Force Traumatic Injuries of the Chest

The Oculomotor Systems-Cranial Nerves III, IV And VI

In this chapter we will discuss the organization of the ocular motor system and how visual information guides eye movements.  This review will inclucde the function of the six extraocular muscles, the neuronal control systems, which keep the fovea (that part of the retina responsible for sharp vision) on the object of interest, the neuronal systems for saccadic eye movements (they shift the fovea rapidly to a visual target in the periphery of the visual field), and the neuronal systems, which control smooth pursuit (keeps the image of a moving target on the fovea), vergence (move the eyes in opposite direction so the image is still and stablizes the image when the object moves or when the head moves), vestibulo-ocular movements (these hold images still on the retina during brief movements and are under the control of the vestibular system), and optokinetic movements (these hold images during sustained head rotation and are driven by visual stimuli).  We will review disorders of the neuromuscular junction and their effect on ocular muscles, as well as some of the myopathies which involve ocular muscles.  We will first review the morphogenesis of the CNS to gain some understanding of the origin of the cranial nerves (CN) III, IV, and VI and the extraocular muscles.

The oculomotor systems CN III, IV, & VI

Sharp Edged and Pointed Instrument Injuries

In this article we will discuss those injuries produced by sharp-edged instruments, incised wounds, and pointed instruments with a sharp-edge or edges, stab wounds.  This will be followed by a review of those injuries produced by instruments, which do not have a sharp-edge, but have a blunt point, such as found in barbecue forks, dinner forks, screwdrivers and scissors.  Chop wounds and impaled injuries will be discussed.  Mechanism and manner of death will then be reviewed.  Fundamental concepts such as cardiac tamponade will be explained, as well as the function of various cellular structures, such as neutrophils, monocytes and lymphocytes, in the inflammatory reaction to trauma.  There is a detailed review of the chronological histologic features of dating of incised and stab wounds, the purpose of which is to show there is sound scientific basis for the histologic dating of these injuries.

Sharp Edged and Pointed Instrument Injuries

Cranial Nerve II/Visual Pathway

In this article we will first discuss the embryology and anatomy of the visual pathway (the physiologic process by which we are able to see the world around us).  It is believed that once you have an understanding of the embryology and anatomy of the visual pathway, you will have a better comprehension of why some of the injuries produce the changes in vision they do.  You will note that there is some repetition in both the illustrations and written text.  This was done with the intent of the reader gaining a clearer understanding of the intricacies of the visual pathway.

FORENSIC NEUROPATHOLOGY

Blunt Force Traumatic Injuries

In this article we will review the gross and microscopic appearance of Blunt Force Traumatic Injuries and the mechanisms, which causes them.  We will discuss abrasions, contusions, lacerations, fractures, compression and hemorrhage.

Blunt Force Traumatic Injuries

Cranial Nerve 0 & 1

Cranial nerves (CN) are those nerves, which arise from the brainstem with the exception of CN I and II, the nuclei (site of origin) of which are located in the forebrain and thalamus respectively.  The forebrain consists of the cerebrum, thalamus, hypothalamus and the limbic system.  The CNs are not considered part of the central nervous system (CNS) but are part of the peripheral nervous system (PNS) with the exception of CN O, CN I (olfactory nerve) and CN II (optic nerve).  This article is devoted to CNs O and I.

cranial nerve 0 and 1

Identification of Skeletal Remains

Now that we have reviewed the fundamentals of human anatomy, as well as various measurements and indices applied to skeletal remains we can apply this knowledge to the identification of skeletal remains.

Identification of Skeletal Remains

ANTHROPOLOGIC LANDMARKS OF THE SKULL MEASUREMENTS AND INDICES

This article is devoted to the utilization of the anthropologic landmarks of the skull in the determination of the various measurements and indices, which are then used as a foundation for identification.  It also includes important anatomic landmarks of the upper and lower extremities, clavicle, scapula, sternum and pelvis, which are also utilized to determine the measurements and indices to aid in identification of skeletal remains.

Anthropologic Landmarks Skull

Skull Fractures

There are several types of skull fractures, which include linear skull fractures, depressed skull fractures, comminuted and multiple skull fractures, expressed skull fractures, contracoup fractures, ping pong fractures (pond fractures), birth fractures, infant skull fractures, diastatic fractures, and growing skull fractures.  In this article we will explore the embryological development of the skull, as well as, how these fractures arise and manifest themselves.

skull fractures II