Multiple injuries

  • The establishment of lifetime damage
  • Multiple injuries may have different origins. In cases of injury of the same item multiple times with different strengths get damaged with different morphological features (for example, repeated blows with a hammer with unequal power formed in different places bruises, wounds, fractures). Analysis of multiple damages is reduced essentially to solve several issues, including one or more items was injured. Polymorphism damage does not give grounds for judgment about promiscuity damaging objects, because the action of the same tools you may experience different in its mechanism of injury (for example, by a blow from a cutting knife may experience bruising, blade - stab and cut wounds). At the same time, a similar morphology of damage (for example, multiple cut wounds) can be caused by several, including unequal objects (knives, glass and others). In this connection it is necessary the thorough and comprehensive study of defects and damage, identification of their individual features.
    Significant difficulties in the examination of multiple damages is the sequencing of their application, that practically is both a definition of limitation of their application.
    If abrasions, bruises or wounds originated through a wide intervals of time, their sequence can be distinguished on the basis of histological study, evaluating the severity of the reaction of inflammation and healing.
    In the analysis of the sequence of application of the RAS sometimes focus on the degree of bleeding (the wound later, less bleeding). Damage of a large vessel is reflecting a reduction of peripheral arteries and subsequent injuries do not cause normal bleeding, and the surface may not even bleed at all and they are regarded as inflicted posthumously.
    If, after the occurrence of surface damage, the injured large vessel, the previously started bleeding from surface damage, you may lose reception.


    Fig. 79. The sequence of education of the wound channels chest with gunshot injuries (explanation in the text).

    Stab, stab, gunshot wounds of the chest, accompanied by pneumogenerator, cause a shift of the light in the direction to its root - upward and to the middle. If it was damaged and easy, then the wound channel in a light is shifted towards the wound channel in the chest wall. Subsequent damage to have a correspondingly smaller displacement or even be straight (Fig. 79).
    Cutting tools in some cases may repeatedly be corrupt one and the same body area. If incised wounds inflicted own hand in the same place, at the ends of wounds see additional cuts ("scoring"), which together with the structure of the bottom of the wound you can determine the sequence of their application. If the wounds are crossing each other, then at their edges are detected with the ledge offset longitudinal axis of the wounds that had been inflicted later (Fig. 80).


    Fig. 80. The sequence education incised wounds (a, b).

    In cases of repeated blunt solid objects, accompanied by injuries of bones, fractures caused primarily differ from fractures of the same bones, resulting from the subsequent impacts. Fragments of bones (long, tubular, flat, spongy) have specific properties of a surface of a break, showing the strain that caused the fracture. In case of repeated exposure fragments of bones come into interaction with each other their surfaces fractures. There phenomena slip and herniation before surgery fragments into each other. Formed fractures in another place of the same bones of the following additional types of destruction will not have (Fig. 81).


    Fig. 81. Additional destruction in the area of primary broken ribs with repeated exposure. 1 - initial; 2-repeated exposure.

    Crack the bone, formed later, do not cross cracks, which occurred earlier.
    Repeated contact of fragments of bone surfaces of their kinks causes kind of effect grinding and sassofonista them all, that can testify, for example, when rib fractures of long-lasting respiratory movements (including at the intensive care unit).