Reverse-Penetrating Head Injury Caused by Falling on Sharp-Edged Stone: A Case Report

Abstract

Penetrating injury is usually caused by a traumatizing object when it moves from its place of rest?that is, fired from a weapon, falls from the height, hurled from hand, or flown by wind?to reach and penetrate the static subject. These injuries are potentially life threatening, which can occur in military as well as in civilian societies. However, a case of reverse-penetrating cranial injury was encountered, when a 4-year-old male child fell from height, hitting his head against sharp-edged stones on the ground. The parts of the stones were retained in the epidural space after fracturing the cranial vault and were undetected by CT scan head. Thus, reversely, the subject moved toward the static object and caused injury. The medicolegal implications of such a trauma are high in a geographical region where mobs and police resort to stone pelting.

Penetrating head injury by stones: a case series and review of the literature based on the type of injury

“…The potential energy which is dependent on the weight of the object (head) is more important than the kinetic energy in type II injury. 14 The same result is reflected in the outcome as 43% of type I injury patients had mortality compared to less than 6% of type II injury patients. The factors responsible for the severity of the PHI are kinetic energy, velocity of moving object, weight, shape of the object, depth of penetration, infective nature of the foreign body, etc.…”

“…The factors responsible for the severity of the PHI are kinetic energy, velocity of moving object, weight, shape of the object, depth of penetration, infective nature of the foreign body, etc. 14,19 In general, patients with PHI due to stones had less number of complications compared to PHI patients due to other causes. No early complications of seizures and infection were noted after surgery in this review however late complications cannot be ruled out as there was no long-term data on these patients.…”

“…The wound was graded as per the scale from the operative findings noted. The clinical grade of the patient was classified according to the Glasgow coma scale score as either severe (GCS 3-8), moderate (GCS 9-12), or mild (GCS [13][14][15]. The outcome of the patient was noted based on the Glasgow outcome scale (GOS) at the end of the 6-month follow-up.…”