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Pontomedullary lacerations in falls from a height--a retrospective autopsy study
Authors:Zivković Vladimir  Nikolić Slobodan  Babić Dragan  Djonić Danijela  Atanasijević Tatjana  Djurić Marija
Affiliation:University of Belgrade - School of Medicine, Institute of Forensic Medicine, Belgrade, Serbia. vladinmejl@yahoo.com
Abstract:
Brainstem pontomedullary laceration (PML) in falls from a height appears as isolated cases and usually in feet-first impacts with a ring fracture. The aim of this study was to determine the frequency of PML in falls from a height, as well as the frequency of concomitant head and neck injuries. Out of 261 cases, PML was present in 40. An impact to the chin, as well as a feet- or buttocks-first impact, most often led to PML owing to transmission of the impact force. Also, a lateral, frontal, or posterior head impact, with subsequent hinge fracture, as well as the frontoposterior hyperextension of the head associated with an upper spine fracture, could be possible mechanisms of PML in falls from a height. The jawbone and other facial bones act as shock absorbers, and their fracture diminishes energy transfer toward the skull and protects the brain and brainstem from injury.
Keywords:forensic science  forensic pathology  brainstem injury  pontomedullary laceration  falls from a height  skull base fracture  impact area
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