Understanding Bodily Injuries: Wounds to Fractures

Injuries

Injuries are any attacks on the human body caused by mechanical agents. They can occur in the skin (wound), subcutaneous tissue (contusion), muscle (strain), articulation (dislocation), or bone (fracture).

Wounds

A wound is a loss of continuity of the soft parts of the body as a result of trauma (shock cut).

Based on Skin Appearance

  • Open: Separation of soft tissues.
  • Closed: Internal injuries.

Based on Wound Complication

  • Simple: Affects the most superficial skin and does not impact major organs.
  • Complex: Large and deep, with heavy bleeding, usually involving muscles, tendons, vessels, and internal organs.

Based on the Instrument Caused

  • Incisive: Characterized by sharp edges and clean entry.
  • Blunt: Caused by the impact of a blunt object, resulting in irregular borders with tissue breakdown and loss of substance.
  • Grinding: Surface damage to the skin, generally not deeper than the epidermis (friction).
  • Clicking: Deeper than wide wounds.
  • Erosive: Affects deeper tissues, abrasive affects the dermis.
  • Features: Clean input with burning around the powder due to crossing raw tissues (gunshot wound).

Factors of Wound Severity

  • Depth
  • Location
  • Extent
  • Gross wound
  • Wound with bleeding
  • Untreated wound

Severity Level of Injury

  • Entertainment (within 6 hours): Outermost layer of skin involved with no serious factors.
  • Severe (after 6 hours): Involving some factors of gravity.

Infected Wounds

If a wound has not begun to heal within 48 hours, it is likely infected.

Identification:

  • Inflammation, redness, and warmth around the injury.
  • Increased pain and ulceration at the wound site.
  • Presence of pus (white blood cells and microorganism remains) inside or suppuration of the wound.
  • Inflammation and sensitivity of the lymph nodes in the neck, armpit, or groin.
  • In advanced infection: fever, sweating, thirst, tremors, and drowsiness.

Specific Wound Locations

Head Wound

Any cut to the scalp (highly irrigated, bleeds a lot) presents a large amount of capillary surface. It may be part of a more serious injury like a fractured skull.

Eye Wound

Often caused by direct glass fragments or friction with paper. All eye injuries are serious due to the danger to the victim’s vision.

Identification:

  • Visible wound and/or appearance of blood.
  • Partial or total vision loss.
  • Intense spasms in the eyelids.
  • Filtration of blood or fluid from the wound.

Contusions (Bruises)

Internal mechanical trauma produced by the impact of the body against a surface, where there is no loss of skin or mucosa continuity, but involvement of subcutaneous tissues.

Assessment of Contusion Intensity

  • First-degree: Involvement of the skin surface with pain and ecchymosis (blue discoloration due to broken capillaries).
  • Second-degree: Involvement of deeper tissues with intense pain and hematoma due to rupture of larger blood vessels.
  • Third-degree: Extensive involvement of subcutaneous tissues with intense pain, hematoma, and necrotic tissue.

Sprain

Momentary separation of joint surfaces produced by stretching or distention of ligaments, usually after a forced movement, which may result in partial or total rupture of tissues.

Evaluation

  • First-degree: Excessive tissue distention without rupture.
  • Second-degree: Partial ligament or muscle breakage.
  • Third-degree: Complete ligament breakage.

Dislocation

Sudden partial or complete displacement of joint ends, separating them from their natural position within the joint cavity.

Evaluation

  • Complete Luxation: Complete separation, leaving the joint cavity empty.
  • Subluxation: Partial displacement with contact between joint surfaces, less obvious deformity.

Fractures

Loss of continuity of a bone.

Severity Factors

  • Bone broken
  • Type of rupture (complete or incomplete)
  • Displacement of the bone, potentially damaging organs, vessels, and nerves
  • Exteriorization of the fracture (risk of infection)

Evaluation Based on Fracture Line

  • Transverse: Straight line break.
  • Oblique: Diagonal break.
  • Spiral: Spiral break.
  • Comminuted: Break into small fragments.

Evaluation Based on Location

  • Diaphyseal: Rupture of the long bone.
  • Epiphyseal: Break at the bone ends.
  • Articular: Affects articular cartilage.

Evaluation Based on Intensity

  • Complete: Break affects both cortical layers.
  • Incomplete: Affects only one cortical layer.

Evaluation Based on Infection Risk

  • Closed: No contact between bone and outside.
  • Open: Contact between bone and outside.