Volume 03 Issue 02-2023
26
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
02
P
AGES
:
26-31
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
The article reflects the data of an expert assessment of blunt abdominal trauma in a fall from a height. It is especially
important to find out the circumstances of the injury in order to have an idea of possible damage to the hollow and
parenchymal organs of the abdominal cavity. According to the conducted studies, when falling from a height,
characteristic damage was established, depending on the height of the fall.
KEYWORDS
Blunt, trauma, abdomen, organs, abdominal, cavity
INTRODUCTION
Research Article
PECULIARITIES OF FORENSIC MEDICAL ASSESSMENT OF LIVER, SPLEEN
AND KIDNEY DAMAGE DURING A FALL FROM HEIGHT
Submission Date:
February 17, 2023,
Accepted Date:
February 22, 2023,
Published Date:
February 27, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue02-06
O.I. Khvan
Republican Scientific And Practical Center Of Forensic Medical Examination Of The Ministry Of Health Of The
Republic Of Uzbekistan
A.N. Don
Tashkent State Dental Institute, Uzbekistan
Kh.Kh. Yakubov
Tashkent Pediatric Medical Institute, Uzbekistan
T.K. Nasyrov
Tashkent Pediatric Medical Institute, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 02-2023
27
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
02
P
AGES
:
26-31
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
From the standpoint of forensic science and practice, a
fall from a height is one of the most difficult types of
injury. A fall from a height and the resulting damage in
forensic medicine are considered as a kind of impact of
hard blunt objects. This is primarily due to the variety
of types of falls, circumstances and conditions of injury,
that form numerous polymorphic injuries [1,2,3].
According to statistics, a fall from a height has firmly
taken the second place in the structure of fatal injuries
after a car injury (up to 40% of all cases of fatal injury)
and has held this position to date [4,5,6].
From the point of view of forensic medical
examination, one of the most complex and difficult to
diagnose types of injuries are injuries resulting from a
fall from a height. At the same time, it should be noted
that the biomechanical aspects of injury in a fall from a
height, in comparison with other injuries, have not
been studied enough from a forensic medical point of
view [2,7,8]. Until now, many aspects of this problem
remain unexplored [9, 10, 11].
In connection with all of the above, expert practice
requires a number of issues to be resolved, which
indicates the need to develop differential diagnostic
criteria for the forensic medical assessment of injuries
resulting from a fall from a height [12,13,14].
The purpose of the study: to investigate the nature of
damage to the liver, spleen and kidneys when falling
from a height.
Material and methods of research : we analyzed the
injury as a result of a fall from a height based on the
data of 417 expert opinions of the Tashkent city bureau
of the SME of the State Healthcare Institution of the
Khokimiyat of Tashkent and 176 case histories of
patients who were promptly and conservatively
treated in hospitals in Tashkent. Of 593 cases of injuries
to the abdominal organs, retroperitoneal space and
anterior abdominal wall, 85 underwent a forensic
examination due to a fall from a height, which
accounted for 14.3% of all examinations (593).
The age gradation of the victims varied in a wide range
from 5 to 88 years.
The distribution of cases of falls from a height
depending on the type is presented in Table 1.
Table 1
Quantitative characteristics of falling from a height depending on the type
Kind of fall
Quantity
Abs .
%
On the feet
19
22.4
On the head
5
5.9
Volume 03 Issue 02-2023
28
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
03
ISSUE
02
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:
26-31
SJIF
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FACTOR
(2021:
5.
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5.
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)
(2023:
6.
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)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
On the side surface
22
25.9
To the back surface
9
10.6
To the front surface
19
22.4
On the flight of stairs
5
5.9
Not indicated
6
7.1
Total
85
100
It follows from the table that most often contact with
the impact surface occurred in a horizontal position
(flat) - 58.8 % (50) of cases, much less often - on the legs
and extremely rarely - on the head.
The fall occurred from various levels, both from
residential premises and other structures.
By season, the largest number of cases of falling from
a height was noted in the summer period - 35
observations (41.2%); somewhat less - in autumn 25
(29.4%), in spring - 16 people (18.8%); in winter - 9
(10.6%).
By the time of day, the following picture was revealed.
Most often, the fall was recorded in the daytime (13-18
hours) - 24 cases (28.2%). 22 cases (25.9%) fell in the
evening (19-24 hours). Approximately the same fall
occurred at night (0-6 hours) - 12 (14.1%) and morning
hours (7-12 hours) - 11 (12.9%). It should be noted that in
16 cases (18.8%), even the approximate time of the fall
was not recorded in the directions and decisions of the
investigating authorities.
Among the identified injuries, abrasions were noted in
49 cases (73.1%), the form of which was indicated in 46
cases (93.9%), the presence of a crust - in 3 (6.1%), the
condition of the bottom - in 45 (91.8% ), exfoliation of
epidermal scales - in 5 (10.2%); bruises - in 46 (68.7%),
wounds - in 34 (50.7%), of which the nature of the edges
and ends was indicated in 31 observations (91.2%), walls
- in 4 (11.8%), bottom condition - in 27 (79.4%); fractures
were detected in 61 cases (91.0%), of which in 58 (95%)
they were noncomminuted, in 4 (6.5%) - comminuted,
in 7 (11.4%) - fragmentary, in 23 (37%) .7%) - comminuted-
fragmentary, while the nature of the edges is indicated
in 55 cases (60.4%), the plane - in 34 (37.4%). Only in 6
cases (9%) damaged bones were removed for
additional examination.
On the part of the internal organs, lung damage was
detected in 48 victims (56.5%), heart - in 8 (9.4%), brain
- in 43 (50.6%), liver - in 8 (9.4%) ), kidneys - in 11 (12.9%),
spleen - in 10 (11.8%), intestines - in 5 (5.9%), large blood
vessels - in 9 (10.6%), torn ligamentous apparatus - in 45
(52.9%). Signs of general concussion of the div were
found in 61 people (71.8%).
Volume 03 Issue 02-2023
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OCLC
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1121105677
Publisher:
Oscar Publishing Services
Servi
The nature of the impact surface was reflected in 15
cases (37.5%), of which the ground cover was in 9 cases
(60%), asphalt - in 4 cases (26.6%), snow cover - in 1 (6.7%
), and on frozen soil - in 1 (6.7%). The presence of
protruding parts on the impact surface was noted in 3
cases (7.5%).
At a further stage of the study, we analyzed 29 cases of
falling from a height and damage to the kidneys, liver
and spleen.
When falling from a small height to 1 метра11 victims,
kidney injury was characterized by kidney bruises (8
victims,
72.7%)
accompanied
by
subcapsular
hemorrhages (3 victims, 27.3%), ruptures of the kidney
parenchyma (1 victim, 9.1%), hemorrhages into the
perirenal tissue (2 victims, 18.2%) and detachment of
the upper pole of the kidney (1 victim, 9.1%).
In cases of falling from a great height,
more than 1 м11
victims among 11 suffered a kidney contusion based on
the presence of erythrocytes in the urine (hematuria),
in 3 victims, subcapsular hematoma was detected
during ultrasound studies. Also, among this category of
victims, ruptures (2 victims) and rupture of the kidneys
(1 victim) were recorded.
To hemorrhages under the capsule were often focal,
and the ruptures rarely had a large extent (sometimes
up to 5 смand up to a depth 1,5 см). In one case, there
were several breaks.
For example, when falling from a height, 3
метровmultiple ruptures of the parenchyma at the
hilum of the right kidney with the presence of an
extensive retroperitoneal hematoma were noted.
A more severe injury to the kidneys (combined with
signs of concussion of the div) occurred in cases of
hitting the rear surface and torso (back) on hard
ground after a fall from a height of 3 meters. Later it
was found that the kidney was torn into 3 parts, there
was also a transverse rupture of the kidney in the
region of the hilum in the middle segment.
For concussion of the div (with indirect exposure to
a traumatic factor), the following kidney damage is
characteristic: subcapsular hemorrhages and ruptures,
ruptures of the capsule and parenchyma (from single
to multiple), extending radially from the gate area,
usually of moderate size. A severe injury to the kidneys
during a fall from a height occurred in cases of hitting
the hard ground with the back surface of the div.
I would like to note that in the presence of pathological
changes in the kidney (hydronephrosis, pyonephrosis,
kidney anomalies, chronic pyelonephritis) preceding
the injury, damage to the kidney occurs with minor
impacts - the so-called spontaneous rupture of the
kidney.
IN 8 (17.0%) cases, when falling from a height, liver
damage was characterized by the presence of
subcapsular hemorrhages without violating the
integrity of the capsule in this place, ranging in size
from 3.0 x 1.0 cm to 8.0 x 1 cm, but, as a rule, with
pronounced ruptures of the parenchyma in the
underlying layers.
The next stage of our work was the study of damage
to the spleen when falling from a height, which
occurred among 10 victims.
The morphology of damage to the spleen during a fall
from a height depends on the conditions of the fall, the
place of the initial landing, and the height of the fall. In
the majority (80%) of the cases we studied, the
predominant mechanism for the formation of damage
to the spleen was concussion of the div, without
direct impact of the traumatic object on the spleen. In
these cases, the study of the spleen in 2 victims
Volume 03 Issue 02-2023
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International Journal of Medical Sciences And Clinical Research
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VOLUME
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ISSUE
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P
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26-31
SJIF
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(2021:
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(2022:
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(2023:
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)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
revealed subcapsular hemorrhages with subsequent
rupture of the capsule in the area of the gate, more
often in severity and volume inadequate to the general
trauma of the div. Patients applied at different
periods of time after injury (from 7 to 30 days).
The mechanism of formation of damage to the spleen
in - inertial. At the moment the div hits hard ground,
the spleen continues to move by inertia, which leads to
a sharp stretching of its ligamentous apparatus, which
prevents further displacement of the spleen and
damage in the area of the gate.
When falling from a height on parts of the div in the
projection of the spleen, the surface of solid ground
acts as a blunt object with an unlimited impact surface.
When falling from a height in persons without a fatal
outcome, breaks of varying severity are formed on the
diaphragmatic surface of the spleen (hit by the left side
surface of the div), on the visceral surface, or
multiple cracks on both surfaces of the spleen,
randomly located, usually superficial (due to the
hydrodynamic effect).
Thus, when falling from a height in persons without a
fatal outcome, the severity of spleen damage does not
always depend on the height of the fall. It should be
noted that according to the literature data in lethal
cases, there is a dependence of the degree of damage
to the spleen on the height of the fall.
Based on the foregoing, it can be concluded that it was
revealed that when falling from a height, concomitant
injuries with fractures of the upper and lower
extremities, chest, and pelvic bones are often
observed. Of all cases of falling from a height, 34.1% had
some kind of damage to the liver, spleen and kidneys.
When falling from a height, characteristic damage was
established, depending on the height of the fall. The
nature of damage to the kidneys, liver and spleen
reflects the type of deformation that the organ
experienced at the time of a fall from a height, and the
resulting zones of compression and stretching of the
parenchyma. Therefore, the morphological features of
lesions may indicate a specific mechanism of their
formation.
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Oscar Publishing Services
Servi
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