A forensic evaluation of impalement injuries

Abstract

Impalement injuries transfix a victim in an inescapable or helpless position. A study was undertaken at Forensic Science SA from 2002 to 2016 of all impalement deaths. There were six vehicle accidents (M:F=5:1; age 14-67 years, average age 38.5 years) involving impalements with a tree branch ( n=2; groin and chest), a metal pipe ( n=2; leg and head), a metal bridge railing (groin) and a metal fence post (chest). Two cases (both males, aged 47 and 18 years) had slipped on fences/gates, with impalements of the ankle and groin. A case of suicide (male, aged 80 years) was impaled through the head on a bolt fixed to the floor. A homicide case (male, aged 27 years) involved impalement through the chest by a spear from a spear gun. In certain cases (e.g. with anogenital injuries), differentiating accidental from inflicted impalement injuries may be difficult. In equivocal cases, adequate scene evaluations with photographic documentation are required prior to autopsy, ideally with the object available for examination.

Conservative management of abdominoperineal impalement trauma – A case report

“…Impalement injury is the penetration of the organism by an object such as pole, hook, stake or spear, by complete perforation of a central body mass. Transfixion and immobilization are also important components [ 3 ]. Clinical definitions have ranged from transfixing a body cavity or extremities by a rigid object of variable size to have a foreign body penetrate and embed in a body part with the object still remaining in the wound, to being suspended by the impaling object [ 3 ].…”

“…Transfixion and immobilization are also important components [ 3 ]. Clinical definitions have ranged from transfixing a body cavity or extremities by a rigid object of variable size to have a foreign body penetrate and embed in a body part with the object still remaining in the wound, to being suspended by the impaling object [ 3 ]. In our case, there was no complete perforation of the central body mass, but the object was long, narrow and still remained in the wound and also penetrated pelvic-abdominal cavity.…”

“…Adult perineal impalement injuries are even more uncommon, there are several vital organs that could be damaged in pelvic cavity, thus they usually present with complex injury patterns and risk of massive pelvic bleeding [ 2 ]. In many cases, impaled patient dies at the scene [ 3 ], but the ones who manage to reach the hospital alive and are hemodynamically stable have a good chance of overcoming traumatic event. There are no accepted guidelines in managing of those injuries in the existing literature, therefore, they present a rare challenge for the treating surgeon.…”

Gluteal, abdominal, and thoracic multiple impalement injuries

“…Impalement injury is one of the most spectacular and potentially dramatic rare forms of penetrating trauma. [2,3] In many cases, impaled patient dies at the scene. [3] Patient who manages to reach hospital alive and is hemodynamically stable has a good chance of overcoming traumatic event.…”

“…[2,3] In many cases, impaled patient dies at the scene. [3] Patient who manages to reach hospital alive and is hemodynamically stable has a good chance of overcoming traumatic event. However, non-removal of foreign object represents the cornerstone of initial treatment, as possible vascular lesions remain compressed by object in situ, thus avoiding irrepressible hemorrhages.…”