Forensic Medical Examination in Case of Traffic Accident
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Forensic medical examination in case of traffic accident Transport trauma is a complex of mechanical injuries made to a person by external or internal parts of a moving car or those, which occur while thrown up from moving transport. Traumatism is a homogeneous traumas origin of people who has the similar work and living conditions. Transport traumatism classification: I Ground: 1. Wheel: non-rail (automobile, motorcycle, trolleybus); rail (tram, railway). 2. Non- wheel: caterpillar (tanks, caterpillar tractors); non- caterpillar (lifts, escalators). II Underground III Air: 1 Propeller: aircraft; helicopter. 2 Jet-propelled: aircraft. IV Water: above-water; underwater. All injuries, which arise during the traffic trauma can be divided into 3 main groups: 1) specific; 2) characteristic; 3) not characteristic. Specific injury – contact injuries reflecting form, drawing, size of the car parts (imprints of protector, headlights), which arise because of the road incident and help to identify type and sometimes even car model. Characteristic injury have features, peculiar to automobile trauma or characterize its mechanism. Not characteristic injury that can be observed because of a blunt trauma of any origin and denote due to its features the stroke by a blunt subject or falling of body on a hard surface (bruises, abrasions, fractures of the bones, lacerations of internal organs). Automobile trauma is a complex of mechanical injuries, which can get drivers, passengers, pedestrians because of the transport traffic. Сlassification automobile traumas (according Solokhin A.O.): 1) collision of moving car with pedestrian; 2) run-over by a wheel of a car; 3) as a result of falling out from a moving car; 4) trauma inside the automobile; 5) as a result of squeezing of the body between the car and other objects or ground. 6) combined types automobile traumas. Every kind of car trauma consists of separate, consecutive short phases, when arise injuries because of the stroke, body concussion, squeezing, straining and friction. Automobile trauma collision of moving car with pedestrian The I Phase – collision (primary stroke) of parts of a car front surface (abrasions of various form, bruises, contused wounds, bumper-fracture); The II Phase – fall of the body onto a car, because of a primary stroke at shin level, below body centre of gravity, person falls on a cowl, hits against a windshield because of what appear injuries of a head, trunk, the upper extremities (abrasions, bruises, contused wounds of soft tissues, skull cup and basal skull fracture, direct and indirect fracture of ribs; The III Phase – throwing of the body aside, falling on ground (abrasions, bruises and tear-contused wounds of soft tissues); The IV Phase – body sliding on the ground, under such circumstances can be observed few mechanisms of traumatic action – stroke and friction (multiple abrasions elongated striated configuration (drag marks)). Long-lasting dragging is sometimes accompanied by friction wear of cloth fabrics, buttons, and upper parts of shoes, leather and bone, profound smearing of clothes with mud, removal and turning of clothes inside out. Bumper-fracture this is specific (contact) injuries, that is, fracture of the tibia and fibula of one or both legs. After the stroke by a passenger car, bumper-fractures are located at level of the top or middle third of a shin and after the stroke by a lorry bumper – they are in area of a thigh. It, as a rule, transversal-splinter fracture (when the speed of a car = 50 km/h.) with big enough diamond-shaped fragment of wrong form at the side of a stroke. From the side look a fragment has triangle form, base of which is turned to the force side. Because of deformation of displacement can arise transversal or slanting fracture (when speed is above 60 km/h). Medico-legal aspect of “Bumper-fracture”: it is specific (contact) injuries of automobile trauma, in particular by collision of moving car with pedestrian; its localization can indicate the type of transport vehicle (passenger car or lorry); shows position of a victim in the moment of trauma; its morphology makes its possible to define direction of stroke; in obedience to the morphological features of this fracture, it is possible to define the speed of transport in some way. Trauma sustained from run-over by a wheel of a car Due to this kind of transport traumatism we can distinguish five phases: I phase is a primary contact of moving wheel with the body - blow; II phase is gradual displacement of body in the direction of a car motion – friction; III phase roll of the body – friction and strain; IV phase run over of the body – squeezing and strain; V phase is dragging of body – friction. These phases not always take place in such sequence, that depends on the speed of movement, road surface, position of a victim, etc. The most important specific sign of a run are imprints of drawing a protector wheel, which can be found out both on clothes and on the body of victim. They look like contaminations (on a body, on clothes), or injuries (bruises, abrasions). These imprints can be positive (as stratifications which correspond protuberant parts of protector) and negative, which reproduce the drawing of deepening's of bruises. Medico-legal aspect of imprints: an imprint of protector is the specific sign of wheel move through a body; helps to define position of body in the moment of move; indicates a type and model of a car and sometimes and on a concrete car, that made a move through a body. Trauma inside the automobile Such trauma arises up in the moment of collision of cars between itself or with other transport vehicles, immobile objects, when a car turns over during motion, and also because of sharp acceleration of motion or sharp braking. When takes place collision of two cars, moving towards each other or because of a move of a car on some immobile object, the body of a victim as a result of inertia motion is displaced forward. The basic mechanism of formation of injuries here is a stroke against the salon or booth of car or concussion of body. Because of a stroke against device corymbs, frame of windscreen and other details of booth, driver become a lot of abrasions, bruises, hammered wounds with the fragment fractures of bones of cerebral and facial skull. For a passenger sitting on a front seat, there can be injuries of neck because of a stroke against glove compartment. Because a windscreen or doors was broken up, a driver and also the passenger of front seat on face, head, neck, hands has numerous scratches and cut wounds with a lot of wreckages of glass around and on clothes. Because of the stroke, the driver become injuries of upper and lower extremities, namely lacerated wounds of fingers, dislocations and fractures of metacarpus bones. More frequently passengers have the hammered wounds of hands, fractured of bones of forearms, collar-bones. Lower extremities are injured mainly because of knees blows against device corymbs. Thus appear abrasions, bruises, hammered wounds, fractures of knee caps, rupture of cruciform connection of knee-joints, and also fractures of thighs, injury of joints, fractures of pelvis bones. In the moment of sharp change of rate of car movement a driver and passengers have characteristic fractures of spine (in a jugular separation at the level of VI and the VII vertebrae and in lumbar at the level of IV and the V vertebrae). .