Ölümle Sonuçlanmayan Travmatik Kafa Kemik Kırıklarının Adli Tıbbi Değerlendirilmesi

Year 2024, Volume: 46 Issue: 6, 912 - 922, 07.11.2024

Ümit Şimşek , Bahadır Saka , Tuğrul Kılıboz , Neslihan Polat , Ömer Seyda Köse , Kenan Karbeyaz

https://doi.org/10.20515/otd.1544663

Abstract

Kafa kemik kırıkları, orijinleri gereği, adli tıp pratiğinde karşılaşılabilen olgulardır. Sunulan çalışmada, kafa kemik kırıklı olgulara ait demografik verilerin, yaralanma özelliklerinin, kemik kırığına eşlik eden klinik bulguların ve olguların adli raporlarının değerlendirilmesi ve litaretürle paylaşılması amaçlanmıştır. Çalışmada, 01.01. 2014- 31.12.2023 tarihleri arasındaki 10 senelik zaman dilimde, Anabilim Dalımıza başvuran ölümle sonuçlanmayan travmatik kafa kemik kırıklı olgular çalışmaya dahil edilmiştir. Olgulara ait, hastane evrakları, soruşturma evrakları retrospektif olarak incelenmiştir. Olguların, % 75,6’sının erkek olduğu, yaş ortalamasının 37±9,6 olduğu belirlenmiştir. Kafa kemik kırıklarının % 56,2’sinin trafik kazası sonucu meydana geldiği, en sık frontal kemiğin kırıldığı (n=206, % 53,4), olguların % 54,1’inin lineer kırık şeklinde olduğu belirlenmiştir. Çalışmamızda, kafa kemik kırıklarının en sık erkeklerde, genç erişkin yaş grubunda, en sık trafik kazası nedeniyle, frontal kemikte lineer kırık şeklinde olduğu belirlenmiştir. Elde edilen bulgular literatürle uyumlu bulunmuştur. Kafa kemik kırıkları ile ilgili adli rapor düzenlenirken, yaşamsal tehlike ve kırığın hayat fonksiyonlarına etkisi ile ilgili belirleyici olması bakımından, kırığın yeri, ne tür bir kırık olduğu, kırığın sayısı önem taşımaktadır.

Keywords

kafa kemik kırığı, adli rapor, trafik kazası, adli tıp

Forensic Medical Evaluation of Non-Fatal Traumatic Head Bone Fractures

Abstract

Head bone fractures are encountered in forensic medicine practice due to their origin. In the present study, we aimed to evaluate the demographic data, injury characteristics, clinical findings accompanying bone fractures and forensic reports of cases with skull fractures and to share them with the literature. In this study, cases with non-fatal traumatic skull fractures that did not result in death admitted to our department during the 10-year period between 01.01.2014 and 31.12.2023 were included in the study. Hospital documents and investigation documents of the cases were retrospectively analyzed. It was determined that 75.6% of the cases were male and the mean age was 37±9.6 years. It was determined that 56.2% of the skull fractures occurred as a result of traffic accidents, the most common fracture was the frontal bone (n=206, 53.4%) and 54.1% of the cases were linear fractures. In our study, it was determined that skull fractures were most common in males, in the young adult age group, most commonly due to traffic accidents, and in the form of linear fractures in the frontal bone. The findings were consistent with the literature. When preparing a forensic report on skull fractures, the location of the fracture, the type of fracture and the number of fractures are important in terms of determining the life threat and the effect of the fracture on life functions.

Keywords

head bone fracture, forensıc report, trafıc accıdent, forensıc medıcıne

References

• 1. Pakiş I, Sav AM. The importance of pathological findings after head trauma in forensic medicine I. Türkiye Ekopatoloji Dergisi, 2004;10(1-2), 27-30.
• 2. Egemen E, Börcek AÖ. Approach to Head Trauma. Journal of Intensive Care Medicine, 2013;11(1), 1-12.
• 3. 3.Şimşek M, Kaya M, Hiçdönmez T, Süslü TH, Gergin YE. Research of Epidemyological and Prognostic Factors on Cranial Fractures Depends Trauma.Türk Nöroşirürji Dergisi. 2013;23(1): 12-7.
• 4. Levi L, Guilburg JN, Linn S, Feinsod M: The association between skull fracture, intacranial pathology and outcome in pediatric head injury. Br J Neurosug 5:617-625,1991.
• 5. Şimşek O, Hiçdönmez T, Hamamcıoğlu MK, Kılınçer C, Parsak T, Tiryaki M, Kurt I, Çobanoğlu S. Pediatric head injuries: a retrospective analysis of 280 patients. Turkish Journal of Trauma & Emergency Surgery 11:310-317, 2005
• 6. Baiden F, Anto-Ocrah M, Adjei G, Gyaase S, Abebrese J, Punguyire D, Moresky RT. Head injury prevalence in a population of injured patients seeking care in Ghana, West Africa. Frontiers in neurology, 2022;13, 917294.
• 7. Davis RL, Robertson DM. Cerebrospinal trauma. Chapter 19. In: Textbook of Neuropathology. Third ed Baltimore, Maryland: Williams & Wilkins, 1997; 1179-1232.
• 8. Lemole M, Behbahani M. Retrospective Study of Skull Base Fracture: A Study of Incidents, Complications, Management, and Outcome Overview from Trauma-One-Level Institute over 5 Years. Journal of Neurological Surgery Part B: Skull Base, 2013;74(S 01), A239.
• 9. Işık HS, Bostancı U, Yıldız Ö, Özdemir C, Gökyar A: Retrospective analysis of 954 adult patients with head injury: an epidemiological study. Turkish Journal of Trauma & Emergency Surgery 2011;17:46-50.
• 10. Adeleye AO, Ogun MI. (2017). Clinical epidemiology of head injury from road-traffic trauma in a developing country in the current era. Frontiers in neurology, 2017;8, 695.
• 11. Tsai YC, Rau CS, Huang JF, Chang YM, Chia KJ, Hsieh TM, Hsieh, C. H. The association between skull bone fractures and the mortality outcomes of patients with traumatic brain injury. Emergency Medicine International, 2022;(1): 1296590.
• 12. Karbeyaz K, Gündüz T, Balcı Y. Forensic medicine approach to bone fractures in the framework of the new Turkish penal code. Turkish Journal of Trauma & Emergency Surgery 2010;16 (5):453-458.
• 13. 13.Çelik C, Ata U. About Medicolegal Evaluation of the Effects of Bone Fracture/Dislocation on Life Functions. The Bulletin of Legal Medicine, 2022;27(1):93-101
• 14. Çeliksöz AH, Emiral E, Doğan B, Şimşek Ü, Karbeyaz K. Evaluation of bone fractures in forensic qualified cases. Journal of Forensıc Medicine, 2020;34(3):134-140
• 15. 15.Türk Ceza Kanunu’nda Tanımlanan Yaralama Suçlarının Adli Tıp Açısından Değerlendirilmesi Rehberi https://www.atk.gov.tr/tckyaralama 24-06-19.pdf Erişim 30.07.2024
• 16. Bilgin NG, Dokgöz H, Kar H. Comparison of Judicial Reports Prepared According to the Old and New Turkish Penal Code. The Bulletin of Legal Medicine, 2006;11:64-70.
• 17. Altun G, Azmak D, Yılmaz A, Yılmaz G. Characteristics of forensic cases applied to the Emergency Department of Trakya University Faculty of Medicine. The Bulletin of Legal Medicine, 1997;2:62-6.
• 18. Koylu S. Karbeyaz, K. The Evaluation of the Relationship Between Alcohol and Forensic Cases Admitted to Eskişehir Osmangazi University Faculty of Medicine Department of Forensic Medicine. Osmangazi Journal of Medicine , 2018;41, 216-225.
• 19. Seviner M, Kozacı N, Ay M, Açıkalın Akpınar A, Çökük A, Gülen M, Acehan S, Karanlık Genç M, Satar S. Analysis of Judicial Cases at Emergency Department. Cukurova Medical Journal, 2013:38;250 - 260.
• 20. Yıldırım A. Trauma Profile and Characteristics of Intentional Injuries in Pediatric Forensic Cases Who Admitted to Emergency Service: A Retrospective Analysis. Klinik Tıp Pediatri Dergisi, 2016;8(3), 34-39.
• 21. Kılınç BB, Kök AN, Şener MT. Causes and Consequences of Childhood Physical Traumas: Retrospective Analysis of Forensic Cases. Turkiye Klinikleri Journal of Pediatrics, 2023;32(2):75-82.
• 22. Küçük E, Günel C. Demographic Characteristics of Forensic Investigation in Emergency Service 2016;Sakarya Medical Journal, 6(2):100-5
• 23. Altun G, Azmak AD, Yılmaz A, Yılmaz G. The characteristics of the cases which admitted to Emergency Department of Trakya University Medical Faculty. Bulletin of Forensic Medicine, 1997;2(2), 62-66.
• 24. Adeleye AO, Ogun MI. Clinical epidemiology of head injury from road-traffic trauma in a developing country in the current era. Frontiers in neurology, 2017;8, 695.
• 25. Çırak B, Berker M, Özcan OE, Özgen T. An Epidemiological Study of Head Trauma: Results of Treatment. Turkish Journal of Trauma & Emergency Surgery 1999; 5(2): 90-92
• 26. Akgül M, Burulday V. Evaluation Results of the Cases Applied to the Emergency Unit with Cause of Head Trauma. The Journal of Kırıkkale University Faculty of Medicine 2016; 18(3), 134-138.
• 27. Carson HJ. Brain trauma in head injuries presenting with and without concurrent skull fractures. Journal of Forensic and Legal medicine 2009;16:115-120.
• 28. Yagmur F, Celik S, Yener Z, Koral F, Yaman T, Sezer Y, Kandemir E. Head Trauma–Related Deaths Among Preschool Children in Istanbul, Turkey. The American Journal of Forensic Medicine and Pathology, 2016;37(1), 35-39.
• 29. Lee KS. Estimation of the incidence of head injury in Korea: an approximation based on national traffic accident statistics. Journal of Korean medical science, 2001;16(3), 342-346.
• 30. Bekman MZ. Head Traumas. Turkiye Klinikleri Journal of Internal Medical Sciences, 2007;3(5), 35-43.
• 31. Jha S, Yadav BN, Karn A, Aggrawal A, Gautam, A. P. Epidemiological study of fatal head injury in road traffic accident cases: a study from BPKIHS, Dharan. Health renaissance, 2010;8(2), 97-101.
• 32. Değirmenci B, Akar T, Demirel B. Evaluation of Mortal Traffic Accidents in Terms of Forensic Medicine Gazi Medical Journal, 2015;26(4):143-47.
• 33. Karbeyaz K, Balcı Y, Çolak E, Gündüz T. Characteristics of Traffic Accidents in Eskişehir Between 2002 and 2007. Turkiye Klinikleri Journal of Forensic Medicine and Forensic Sciences, 2009;6(2), 65-73.
• 34. Svider PF, Johnson AP, Folbe AJ, Carron MA, Eloy JA, Zuliani G. Assault by battery: battery‐related injury in the head and neck. The Laryngoscope, 2014;124(10), 2257-2261.
• 35. Keleş A, Alkaş GB, Kadı G, Aslaner MA, Bildik F, Kılıçaslan İ, Demircan A. The Characteristics of Assaulted Victims Presented to A University Emergency Department: Can Head Trauma İn Male Patients Be Considered A Clue For Assaults? Turkish Journal of Trauma & Emergency Surgery, 2022;28(12):1690-5.
• 36. Fornari MJ, Badolato GM, Rao K, Goyal MK, McCarter R, Donnelly KA. Violent injury as a predictor of subsequent assault-related emergency department visits among adolescents. Journal of Adolescent Health, 2023;72(6), 972-976.
• 37. Dumitru M, Vrinceanu D, Banica B, Cergan R, Taciuc IA, Manole F, Popa-Cherecheanu M. Management of aesthetic and functional deficits in frontal bone trauma. Medicina, 2022;58(12): 1756.
• 38. Çökük A, Kozacı N, Ay MO, Açıkalın A, Seviner M, Satar S. Evaluation of Head Trauma Cases in the Emergency Department. Cukurova Medical Journal, 2013;38(1), 63-71.
• 39. Avşar A, Okdemir E, Keten A, Karanfil R. Tree falling related death. Dicle Medical Journal, 2015,42(3), 331-334.
• 40. Ongel K, Katırcı E, Uludağ H, Mergen H, Uzun E, Kişioğlu AN. Examination of the cases of falling from height according to the publications Tıp Araştırmaları Dergisi: 2008;6 (3) :175 -180.
• 41. Nelson EL, Melton LJ 3rd, Annegers JF, Laws ER, Offord KP: Incidence of skull fractures in Olmsted Country, Minnesota. Neurosurgery 15:318-324, 1984
• 42. Doctor VS, Farwell DG. Gunshot wounds to the head and neck. Current opinion in otolaryngology & head and neck surgery, 2007;15(4), 213-218.
• 43. Menezes JM, Batra K, Zhitny VP. A Nationwide analysis of gunshot wounds of the head and neck: morbidity, mortality, and cost. Journal of Craniofacial Surgery, 2023,34(6), 1655-1660.
• 44. Çırak B, Güven M B, Kıymaz N, Işık S. Cranial Gunshot Injuries and Treatment Approaches. Turkish Journal of Trauma & Emergency Surgery, 2000; 6(4): 241-243.
• 45. Kır MZ, Ketenci HÇ, Başbulut AZ, Özsoy S. Evaluation of Deaths Due to Gunshot Injuries in Erzurum. Journal of Forensic Medicine.2012;26(1):27-37.
• 46. Dündar AS, Altın İ. Cases Under the Age of 18 who Are Determined to Have Died due to Firearm Injury at Şanlıurfa Forensic Medicine Branch Directorate Examination. Phoenix Medical Journal, 2023;5(3), 206-210.
• 47. Yaman O, Dağlı AT, Güvercin AR, Kuzeyli K. Gunshot Wound to Head. Journal of Nervous System Surgery, 2014;4(2), 69-73.
• 48. Karbeyaz K, Gündüz T, Akkaya H, Urazel B, Kökçüoğlu MA. Watch out for judicial reports; Eskisehir experience. Sted/Sürekli Tıp Eğitimi Dergisi, 2012;21(5), 292-296.
• 49. Yoganandan N, Pintar FA. Biomechanics of temporo-parietal skull fracture. Clinical Biomechanics, 2004;19(3), 225-239.