jiafm-35-1 - forensic medicine

J Indian Acad Forensic Med. Jan-March 2013, Vol. 35, No. 1 ISSN 0971-0973
n. Contusion of right psoas muscle. Fracture of
the left pubic bone.
o. Comminuted fracture of the body of the
sacrum with fracture dislocation of the right
sacroiliac joint.
Case 3: Male, 30 years
On External Examination:
a. Swelling, visible deformity and compound
fractures and dislocation of both ankle joints,
Talus and Calcaneum of both sides.
On Internal Examination:
a. Diffuse subdural and subarachnoid
haemorrhages over both cerebral
hemispheres with blood clots at the base of
the brain.
b. Contusions of diaphragm of varying sizes on
both pleural and peritoneal surfaces.
c. Displaced fracture of 7 th , 8 th and 9 th rib in
midaxillary line of left side of the chest with
subjacent contusions.
d. Displaced fracture of 3 rd rib at costochondral
junction of right side of the chest.
e. Evidence of thoracotomy on left side.
f. Both lungs collapsed and show contusions
at the hila with penetrating laceration seen
on lower lobe of left lung of size 2cm X 1 cm
parenchyma deep.
g. Hemoperitoneum with 1000 ml of blood
drained and 200 gm of clot removed.
h. Multiple contusions seen on the coils of
intestine and mesentery.
i. Multiple lacerations on anterior and posterior
aspect of the right and left lobe of the liver
ranging between 3.4 cm X 2.5 cm
parenchyma deep to 2.5 cm X 1.2 cm
parenchyma deep.
j. Both kidneys showed presence of perirenal
haematoma and right Kidney laceration.
k. Complete fracture dislocation of cervical
spine at 2 nd and 3 rd cervical vertebra level.
l. Fracture dislocation of lumbar vertebrae at
4 th and 5 th level.
Case 4:
On External Examination:
a. Swelling, visible deformity and compound
fractures and dislocation of lower ends of
both Tibia and Fibula of both legs, Talus and
Calcaneum of both the foot.
On Internal Examination:
a. Displaced fracture of ribs from 2 nd to 7 th rib
of right side and 3 rd and 4 th ribs of left side of
the chest anteriorly in midclavicular line with
contusion of subjacent intercostal muscle.
b. Bilateral haemothorax of about 1500 ml of
fluid blood.
c. Tearing of pleura at sites subjacent to the
displaced fractures of ribs.
d. Roughly triangular penetrating laceration
1cm X 1cm X 1cm deep on posterior aspect
of upper lobe of right lung.
e. Multiple contusions of size ranging from 3
cm X 2 cm to 1 cm X 1cm on both upper and
lower lobes of both lungs.
f. Multiple contusions of size ranging from 3.2
cm X 2 cm to 1.8 cm X 1 cm on the coils of
intestine and mesentery.
g. Bilateral perirenal haematoma.
h. Complete fracture dislocation of the lumbar
spine at the level of 3 rd and 4 th lumbar
vertebra.
i. Fracture dislocation of the cervical spine of
2 nd and 3 rd cervical vertebra with contusion
of underlying cervical spinal cord.
j. Comminuted fracture of the body of the
sacrum with fracture dislocation of the right
sacroiliac joint.
The cause of death was common in all
the victims and was given as “Death due to
haemorrhage and shock as a result of
multiple injuries to internal organs and
multiple skeletal fractures due to blunt direct
and transmitted trauma (Unnatural).”
Discussion:
Falls from a height present a great
challenge to trauma services. In children, they
are most commonly due to accidents, while in
adults; they are attributed to suicide, accident or
crime. The nature and magnitude of the injuries
occurring due to falls depend on the height of
the fall, the nature of the contact surface, and
body orientation on impact, body mass, the
victim’s ability to distribute the impact forces
efficiently, and the victim’s age. [8, 9]
The highest incidence of fall from height
occurs at construction site followed by fall from
public buildings. Fall from height is the most
common cause of fatal injuries and single
biggest cause of work place deaths. On an
average majority of fall related deaths happens
in construction industry with remaining spread
across other industries. [10]
In majority of falls, vertical landing with
feet first is common and next common being
with the head first. [11]
In this case report, 4 victims died in a
single incidence of a fall from height in a
temporary made elevator at a construction site
of a Hospital. All the victims were male between
the age group of 30 to 40 years. The manner of
death was accidental in nature.
The medico-legal autopsy findings
revealed a common pattern of injuries in all the
victims. All the victims showed open fractures of
bones of lower extremities and feets. This can
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