. 342 .
Chinese Journal of Traumatology 2012;15():342-346
Forensic medical study on morphology and formative
mechanism of blunt head injury
LI Hong-wei, CHANG Hong-fa, YU Yong-min, DAI Guo-xin and YIN Zhi-yong*
【Abstract】 Objective: To study the patterns and
morphologic characteristics of blunt head injury and analyse
its formative mechanism in attempt to provide references
for medicolegal expertise.
Methods: The statistical analysis was done in terms of
gender, age, as well as the nature, pattern, location, and
feature of the injuries.
Results: Among the 202 cases of head injury-induced
death, 124 were male and 78 female with the age ranging
from 1-81 years. Death caused by homicide was dominant
(106, 52.5%), followed by suicide (49, 24.3%) and accident
(44, 21.8%). The majority of suicide-induced death were by
B
lunt head injury, refering to the injuries impli-
cated in the scalp, skull or brain caused by
blunt outside force, is one of the most important
and frequent mechanical injury and cause of death in
forensic pathology and clinical medicine. It constituts
the top position in violence-incurring-death.1-3 By statisti-
cal analysis of real cases, we try to elucidate the mor-
phology and formative machanisim of blunt head injury.
METHODS
Source of data
The data of 202 cases, coming from the Chongqing
Official Files of 2009-2011 Death Cases Elicited by Blunt
DOI: 10.3760/cma.j.issn.1008-1275.2012.06.005
Public Security Bureau Evidence Identification Center
of Chongqing, Chongqing 400021, China (Li HW, Chang
HF, Yu YM and Dai GX)
Institute of Surgery Research/Daping Hospital, Third
Militeray Medical University, Chongqing 400042, China (Yin
ZY)
*Corresponding author: Tel: 86-13983128386, Email:
zyyin@cta.cq.cn
The paper was supported by the National Natural Sci-
ence Foundation of Chin a (31170908, 31271006,
81072504 and 30800243), the Natural Science Founda-
tion of Chongqing of China (CSTC2009AB0208) and the
Key Projects Foundation of the Ministry of Public Security
(2009 ZDYJCQSJ007).
falling from height, and traffic crash was responsible for
majority of unexpected death cases. The morphology and
pathogenesis of the injuries varied according to differences
on the mode, magnitude, and orientation of the outside force
giving rise to blunt injury as well as the character of
vulnerants.
Conclusion: Studies on the morphology and its forma-
tive rationale of blunt head injury will offer easy access to
medicolegal expertise on the mode and character of the injury.
Key words: Brain; Head injuries, closed; Cranioce-
rebral trauma; Forensic medicine
Chin J Traumatol 2012;15(6):342-345
Head Injury, consist of gender, age, event nature, inves-
tigation on the scene, as well as autopsy results.
Analytic methods
The databank was established using Epidata 3.0
software. The gender, age, event nature, morphology
and location of the injury, and vulnerant were statisti-
cally analysed with Excel software.
RESULTS
General data
Among the 202 dead cases elicited by head injury,
124 were male and 78 female with the age ranging from
1-81 years. Death caused by homicide was dominant
(106, 52.5%), followed by suicide (49, 24.3%) and ac-
cident (44, 21.8%). The majority of the suicides were
by falling from height, and traffic crash was responsible
for majority of unexpected dead cases. The vulnerant
modality is mainly by falling from height and blunt ob-
ject blow (Table 1).
Cause of death
In this series, there were 167 head injury-induced
dead cases (82.7%) and 35 other injuries-induced dead
cases (17.3%). The cause of death were hemorragic
shock, compression by cerebral hernia, posterior cra-
nial fossa bleeding, great vascular rupture at the cra-
Chinese Journal of Traumatology 2012;15(6):342-345 . 343 .

nial base, direct injury to the bulbus medullae, second- Type and feature of scalp injury
ary infections, etc. The variance of the mode, magnitude, speed, and
direction of the violence, as well as the texture and na-
Table 1. Gender, age and vulnerant modaility
ture of vulnerants (sharp or blunt, soft or hard, shape,
Vulnerant modaility
Male/ etc) resulted in different types of scalp injuries (Table 2).
Age(year) High Blunt Labour Traffic
Female Total
fall bl ow accident accident
<6 4/3 5 2 0 0 7 Type and feature of skull injury
0 0 15
Skull injuries are mainly divided into cranial injury,
6-8 5/10 6 9
basional injury and whole skull burst. The morphologic
18-40 35/18 28 21 2 2 53
features are listed in Table 3.
40-65 48/32 43 31 3 3 80

>65 32/15 21 18 0 8 47 Type and feature of meningeal and brain injuries

Total 124/78 103 81 5 13 202 The type and feature of meningeal and brain injuries
are listed in Table 4.

Table 2. Type and feature of scalp injuries

Type Case (n) Main manifestations
Scalp abrasion 95 Violaceous skin often asociated with contusion

Scalp contusion 124 Irregular wound deep to skull, often associated with abrasion

Intrascalp bleeding 114 Localized bleeding

Subscalp bleeding 7 Infiltration and diffusion, or accumulation to form hematoma

Subgaleal bleeding 75 Extensive hemorrahage

Scapl avulsion 7 Part or total abruption between scalp and skull

Subperiosteal bleeding 13 Generally located at one piece of skull

Table 3. Type and feature of skull injuries

Type Cases(n) Main manifestations
Cranial injury
Pressure mark on osseous surface 4 Only osseous surface involved,manifested by local introcession

Defect of osseous surface 12 Partial bone defect

Linear fracture 103 Straight linear,arc or irregular types

Collapsed fracture 30 Conus shape with the tip stretching into intrcranium, varied degrees of

excavation; or showing scaphoid,corniform

Poroid fracture 1 Full-thickness skull penetration with bone chips entering to intracranial cavity

Comminuted fracture 68 Varied sizes and shapes of bone chips; hair seen in crack of wounded skull

Basilar skull fracture

Intrasinal bleeding 9 Bleeding in the ethmoid sinuses and sphenoid sinus without basal fracture

Combind fractures of calvaria and basion 29 Linear fracture dominant

Indirect fracture 47 Nondirect violence-caused linear or comminuted fractures of cranial base

Contrecoup basilar skull fracture 21 Frequently occurred at thin bone lamella

Skull burst 19 Extensive comminuted fractures of skull

. 344 . Chinese Journal of Traumatology 2012;15():342-346

Table 4. Type and feature of meningeal and brain injuries

Type Case (n) Main manifestations

Extradural hematoma 14 Most being monolateral hematoma and located at ipsilateral wounded head

Subdural hematoma 39 Most located at dorsal cerebral hemisphere with the diameter of several centimeters and

thickness of 1-2 cm

Subarachnoid hemorrhage 86 Hemorrhage located at brain contusion area, presenting as spot or lamellar shape or

diffusibility, dissymmetry distribution and sludged blood seldom

Brain hemorrhage 31 Often seen in frontal and temporal lobes

Brain contusion 97 Superficial contusion: red or brown scattered bleeding points at cerebral convolution;

wedge-shaped contusion: varied sizes of wedged bleeding points with the bottom towards

meninges and the top extending to subcortex; diffused contusion: diffused brain bleeding,

cortex laceration associated with subarachnoid hemorrhage

Brain edema 78 Flattened and widened cerebral convolution, shallow cortical sulci with alba swelling and

contracted ventricular system

Traumatic cerebral hernia 19 According to different parts, classified as tentorial herniation, tonsillar hernia, and subten-

torial hernia

DISCUSSION Cerebral hernia secondary to epidural or sub-

Gender, age and injured mode
The result displayed that head injuries are often
caused by high falls, blunt blow, and tumble. Any age
stage may happan and majority of the wounded are
young male patients. Different age groups have differ-
ent traumatogenic modalities. Falling-from-height injury
is often seen in infants,4 so is in youths; while blunt
injury is common in juveniles. For aged people, the in-
cidence of head injury is lower than that in young people
owing to reduced social activities.
Etiology of head injury-elicited death
Hemorrhagic shock Since the scalp, skull, and
brain tissues injured simultaneously in open cranioce-
rebral injury may cause a large quantity of blood shed
out of the body, it may lead to hemorrhagic shock or
even death. In this series, 37 cases died from high fall
injury-induced hemorrhagic shock.
Cerebral hernia secondary to traumatic cere-
bral edema After traumatic cerebral edematization,
intracranial pressure increases. Cerebral hernia may happan
when cerebralspinal fluid pressure is over 180 mmH2O. In
this series, there were 78 cases of cerebral edema
among 202 cases of head injury.
dural hematoma Simple epidural or subdural he-
matoma is often caused by traumatic injury. There were
14 cases of extradural hemorrhage and 39 subdural
hemorrhage in this series. Extradural hemorrhage is
often from the middle meaningeal artery, while subdu-
ral hemorrhage is mainly from the bridging vein.4,5 Hip-
pocampal herniation may happen when bleeding vol-
ume is over 100 ml. Patients may die from secondary
brain-stem injury and central function failure.
Subarachnoid hemorrhage There were 86 cases
of subarachnoid hemorrhage in this series, acounting
for 42.6% of all cases of head injuries. The bleeding
points were generally located at cerebral contusion
areas. When the cortex vein and pia mater membrane
were subjected to contusion, blood flowed into subarach-
noid space to form diffused subarachnoid hemorrhage
of pavimentum cerebri.
Relationship between head injury and force-bear-
ing mechanism
Among the 202 cases of head injury, 103 belong to
acceleration injury and 99 to decelaration injury. The main
menifestations consisted of scalp abrasion or contusion,
skull linear or comminuted fracture, and brain contusion.
Our results demonstrate that simple force-bearing factor
has little effect on the severity of head injuiry.
Chinese Journal of Traumatology 2012;15(6):342-345
Several key points in medicolegal expertise on
head injury-induced death
The predilection sites for typical traumatic brain he-
morrhage are the frontal lobe, white matter of temporal
lobe; wheareas for spontaneous brain hemorrhage
(hypertension) are more often in the basilar part.5,6 Sub-
arachnoid hemorrhage is prone to be misdiagnosed as
traumatic one. The formmer is often implicated in basi-
lar artery branch’s bifurcation and pathological exami-
nation shows cerebrovascular disturbance or brain
tummor; the latter is usually implicated in the main stem
of artery, and has a history of mechnical violence injury.7
When patients have head injury and preexisted brain
disease, attention should be paid to distinguish their
respective pathogenesis and pathology as well as the
relationship with death. An overall and detailed identifi-
cation is necessary so as not to overlook preexisted
cerebrovascular diseases.8
In this series, 3 patients were not found obvious
cephalofacial injury or skull fracture, but later was found
severe brain injury. Therefore we would like to emphasize
the importance of conventional exploratory craniotomy.
During the process of criminal case investigation,
accurate and rapid assessment of vulnerant is vital to
identify the case. In blunt head injury, the morphologic
signs of scalp, skull and brain injuries are generally
reflect the morphologic features of vulnerant, which is
helpful to the identification of injury instruments and
modalities.
. 345 .
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(Received January 28, 2012)
Edited by SONG Shuang-ming