A forensic evaluation of impalement injuries

Acute vertical deceleration injury: A case of cranial impalement

In forensic science and in modern times, impalement is a rare event. When this occurrence involves the head, it is even more unusual since this region is very small compared to the rest of the body. Although impalements are rare, they represent scenarios that must be treated with great care by forensic pathologists. They may involve a mixture of blunt and penetrating wounds, and the injuries observed at autopsy must be interpreted correctly. For this reason, if possible, the interconnection between the body and the impaling object should be maintained until the autopsy table. In this report, it is presented a case of cranial penetrating trauma that occurred after a suicidal fall from a great height with impact on the railing below, by reporting both the on-site scene inspection and autopsy data. The critical forensic issues that may arise in the practical management of such cases are discussed, starting from the fact that there is still no clear and unambiguous definition of impalement.

Thoraco-abdominal impalement injury with an iron rod: A case report

INTRODUCTION AND IMPORTANCE

Impalement thoracoabdominal injuries are potentially life-threatening due to the associated bleeding and multiple visceral injuries. They are uncommon and often result in severe surgical complications, requiring prompt treatment and extensive care.

CASE PRESENTATION

We present a 45-year-old male patient who fell from a 4.5-meter-high tree and landed on a Schulman iron rod stick, which pierced the patient's right midaxillary line, exiting from his epigastric region and leading to multiple intraabdominal injuries and right pneumothorax. The patient was resuscitated and immediately shifted to the operating theater. The main operative findings were moderate hemoperitoneum, gastric and jejunum perforations, and liver laceration. A right chest tube was inserted, and injuries were repaired with segmental resection, anastomosis, and colostomy procedure with uneventful post-operative recovery.

CLINICAL DISCUSSION

Providing efficient and prompt care is crucial for patient survival. This includes securing the airways, providing cardiopulmonary resuscitation, and aggressive shock therapy to stabilize the patient's hemodynamic status. The removal of impaled objects is strongly discouraged outside the operation theater.

CONCLUSION

Thoracoabdominal impalement injury is rarely reported in the literature; appropriate resuscitative care, prompt diagnosis, and early surgical intervention may minimize mortality and improve the patient's outcomes.

A Non-Fatal Impalement Injury to the Right Thorax: A Case Report

Impalement injuries secondary to motor vehicle collisions are rare. Reviewing the systematic approach to treating these injuries can benefit the surgical community. This case report discusses the presentation and management of a 32-year-old male who was involved in a high-speed, roll-over motor vehicle collision. The car struck a chain-link fence, and the unrestrained passenger sustained a fence post impalement injury to his right thorax. He was alert and oriented when emergency services arrived. He was extricated rapidly and transported to our level-one trauma center, where he received definitive operative management. The patient survived the injury and was discharged home. This case highlights key points in the systematic approach to impalement injuries, including minimal handling of the impaled object, expedient transfer to the local trauma center, emergent operative intervention, vascular control prior to removal of the foreign object, and aggressive irrigation and debridement of the wound.

Causes of fatalities in motor vehicle occupants: an overview

Injuries from motor vehicle collisions are frequently encountered in routine forensic practice. While the most common lethal events involve blunt force trauma with injuries to the head and neck, chest, abdomen, pelvis and limbs, review of the literature and case files shows that a wide variety of other fatal situations can occur that may involve sharp force and penetrating trauma, incineration, drowning, asphyxia, organic diseases and combinations of these. The following overview details potential factors that may contribute to death following vehicle crashes.

Pre-Hospital and In-Hospital Management of an Abdominal Impalement Injury Caused by a Tree Branch

In South Korea, most patients who visit trauma centers with abdominal injuries have blunt trauma, and penetrating injuries are relatively rare. In extremely rare cases, some patients are admitted with a long object penetrating their abdomen, and these injuries are referred to as abdominal impalement injuries. Most cases of impalement injuries lead to fatal bleeding, and patients often die at the scene of the accident. However, patients who survive until reaching the hospital can have a good prognosis with optimal treatment. A 68-year-old female patient was admitted to the trauma center with a 4-cm-thick tree branch impaling her abdomen. The patient was transported by a medical helicopter and had stable vital signs at admission. The branch sticking out of the abdomen was quite long; thus, we carefully cut the branch with an electric saw to perform computed tomography (CT). CT revealed no signs of major blood vessel injury, but intestinal perforation was observed. During laparotomy, the tree branch was removed after confirming that there were no vascular injuries, and enterostomy was performed because of extensive intestinal injury. After treating other injuries, the patient was discharged without any complications except colostomy. Abdominal impalement injuries are treated using various approaches depending on the injury mechanism and injured region. However, the most important consideration is that the impaled object should not be removed during transportation and resuscitation. Instead, it should only be removed after checking for injuries to blood vessels during laparotomy in an environment where injury control is possible.

Conservative management of abdominoperineal impalement trauma - A case report

INTRODUCTION

Adult perineal impalement injuries are uncommon and notorious for their complex injury pattern and risk of massive pelvic bleeding. They present a challenge for the treating physician as there is no consensus about the optimal treatment in the existing literature. In most cases patients need operative intervention.

CASE PRESENTATION

In this article the authors present a case report of a 63-year old man with an impalement injury in the left gluteus, who was managed conservatively.

DISCUSSION

With the recent trends towards conservative management of abdominal penetrating trauma, increased morbidity and costs associated with nontherapeutic laparotomy, conservative management of impalement injuries in hemodynamically stable patients should be considered. Accurate determination of the impaling object trajectory path is vital for the decision and aids to answer two important questions: Did the impaling object enter the peritoneal, retroperitoneal or pelvic cavity? Is there an injury that will require an operation?

CONCLUSION

Abdominoperineal impalement injuries have high mortality, but those patients, who manage to reach hospital alive, can sometimes be manages conservatively, as shown in our case report.

Difficulties in the Management of Impalement Injuries Sustained in Rural India

Impalement injury is said to occur when a blunt force causes a long object to penetrate a body part resulting in retention of the object in situ. We report two unusual cases of impalement from rural India: one, chest impalement by a hunting spear and the other, an extremity impalement by a rotatory tiller blade. Thoracic impalement injuries are very rare, and there is only one other published report of chest impalement by a spear (trident) in the modern era. There are only two published reports of extremity impalement by a rotatory tiller blade. We also describe the difficulties encountered in their management. Patient-1 sustained accidental impalement to the right hemithorax by a spear used for hunting wild boars, leaving a meter long shaft protruding from his body. This necessitated his transfer to the hospital on the cargo bay of a pickup truck and also precluded complete radiological investigations before surgery. In addition, the reversed barbed tip of the spear made the extraction difficult. Patient-2 sustained impalement through the right knee by a rotatory tiller blade which bound him to the machine. The blade had to be disconnected from the shank assembly of the tiller to extricate him. Due to the proximity of the blade to the popliteal vessels, vascular control was necessary before extraction. Both the patients took several hours to reach the hospital as the accident occurred in remote rural areas. However, both had a successful outcome after surgical removal of the impaled object by a multidisciplinary involvement. We also have reviewed the published literature and given our suggestions for the management of these unusual and difficult injuries.

Seat belt asphyxia as a lethal mechanism in motor vehicle crashes

A 28-year-old driver was found dead in his car after impact with a truck. At the scene he was seated in the driver's seat partially hanging out of the vehicle with the sash component of the seatbelt tightly pressed into his neck. At autopsy there was evidence of neck compression with bilateral conjunctival petechial hemorrhages and fracture of the right superior horn of the thyroid cartilage. Limb fractures and internal injuries were not associated with significant hemorrhage. There was no evidence of brain trauma. Death was, therefore due to neck compression from the seatbelt demonstrating an additional rare lethal mechanism that may be encountered in vehicle crashes. External bruises and abrasions may not be present around the neck due to padding from clothing, however conjunctival petechiae and neck injuries are supportive of the diagnosis.

An unusual patterned injury from homicidal craniocerebral impalement with a metal chair leg

A 26-year-old young man died shortly after he had suffered craniocerebral impalement from a metal chair leg during an affray at an airport bar. At autopsy a 25 mm diameter circular wound was present in the left parietal region with protruding brain tissue. Death was due to craniocerebral trauma from a penetrating injury to the head. Examination of the chair used in the assault showed a metal chair with smeared blood on the front right leg that matched the blood group of the decedent. The fatal wound had been inflicted by the assailant with the victim leaning forward while kneeling on the floor. The assault had produced an unusual circular patterned defect in the left parietal bone with dimensions corresponding to the chair leg. The location of the defect and the use of a chair leg were two very unusual features in this homicide.

Gluteal, abdominal, and thoracic multiple impalement injuries: A case report on management of a complex polytrauma

RATIONALE

Historically, traumatic injuries include penetrating and blunt lesions. Impalement injury represents one of the rarest and potentially dramatic forms of penetrating trauma. If patient reaches hospital alive and is hemodynamically stable, there is a good chance that patient overcomes the traumatic event. However, non-removal of foreign body represents the cornerstone in initial treatment of this type of patients.

PATIENT CONCERNS

A stable 55-year-old woman was admitted to the Emergency Department after falling out of a tree onto a wooden fence. One fence pole transfixed left gluteus, left abdominal wall, left abdominal cavity, and left thoracic wall by transdiaphragmatic way.

DIAGNOSIS

Due to patient stability, a chest-abdomen CT scan with contrast medium was performed. It showed multiple parietal and visceral traumatic penetrating injuries from a foreign object.

INTERVENTIONS

After primary and secondary advanced trauma life support (ATLS) assessment, patient underwent successful surgery.

OUTCOMES

Patient was discharged on 9th postoperative day in good general clinical condition.

LESSONS

Impalement injury represents a rare and potentially lethal traumatic event. Unstable patients rarely reach Emergency Department alive. On the contrary, stable patients have a good chance of successful treatment, if they are quickly taken to tertiary Trauma Center. In this case, chest X-ray and Focused Assessment with Sonography for Trauma (FAST) represent useful diagnosing investigations, although CT scan remains gold standard. Conservative treatment is not possible, while thoracoscopy/laparoscopy/laparotomy is/are mandatory.

An Unusual Case of Homicide by Impalement With a Battering Ram

Impalement injuries occur when a large foreign body traverses or penetrates a body cavity or extremity. Nowadays, impalement injuries are uncommon and are usually a consequence of a fall onto a blunt object or a road accident. The authors report a case of a woman found dead in her apartment, seemingly killed by a firearm injury to the abdomen. However, after the autopsy was carried out, it became clear that the injuries had the features of an impalement. After the inquiry, the murder weapon was identified as a battering ram, used by the robbers to break into the house of the woman. This is the first case ever described in literature where a battering ram has been used to impale someone. This case emphasizes the importance of an accurate description of injuries, also with photographs, in order to achieve effective recognition of the wound patterns as they may correspond to specific and unusual weapons.

Suicidal head impalement with a hydraulic press machine - occupation-related suicide in a psychiatric patient

A 63-year-old mechanic, diagnosed with schizophrenia, was found next to a hydraulic press used for removing car wheel bearings. He was in a sitting position, bent towards the machine, with his head placed between the piston and the pressing plate. His flexed left arm was resting on the lever beneath the machine pedestal, and on the right side there was a power switch that was still in the "on" position. His right arm was beside his body, but away from the machine. On the pressing plate, beneath the decedents head, was a piece of bloody cloth. Blood spatters were present on the left hand and left trouser leg. At autopsy there was a gaping laceration in the right temporal area extending to the right ear lobe, where a piece of helix was missing. This missing tissue was found on the inner surface of the left temporal bone. The temporal lobes and brain-stem were destroyed along the wound trajectory but there were no brain contusions present. There was blood aspiration in both lungs, but all other findings were unremarkable. Death was attributed to the fatal head injury that resulted from the low-velocity penetration of the hydraulic press piston. While the cause of death was self-evident and undoubted, the manner of death required medico-legal investigation. The protective cloth that had been placed on the pressing plate, a medical history of schizophrenia, and the absence of any defensive injuries, all led to the conclusion that this was a case of a rather unusual suicide, which could be regarded as related to the decedents occupation.