Morphological features of hemorrhages in the soft tissues of intercostal spaces in rib fractures

BACKGROUND: Practical observations show peculiarities of hemorrhages in rib fractures: immature cellular forms are often found in the cellular infiltrate. In nonobvious conditions and when it is crucial to determine the duration, such a polymorphic cellular infiltrate can be mistakenly considered as the result of a post-traumatic inflammatory reaction, affecting the assessment of the duration of the injury.

AIM: To study the composition of the cellular infiltrate in hemorrhages in rib fractures, taking into account their morphological features in cases of various causes of death at different periods after injury.

MATERIALS AND METHODS: A retrospective analysis of cases and an analysis of personal observations of deaths of individuals of different age and sex groups with different causes of death, but with anamnestic data of chest injuries, and of cases of isolated chest injury, aimed at forensic histological examination, were performed. The study sample was divided into main study groups according to established time intervals based on anamnestic data of brief circumstances of the case indicated in the referral documents (“those who died at the scene,” “chest injuries as a result of resuscitation measures,” “victims who lived up to 6 hours,” “victims who lived up to 12 hours,” and “victims who lived up to 24 hours”). The forensic (histological) examinations of deceased individuals with fractured pelvic bones and fractured skull bones and examinations of those with hemorrhages in soft tissues with stab wounds of the chest were compared. Additionally, the comparison sample included deaths of people of both sexes, and different age groups and with various causes of death in different periods after injury. From this sample, subgroups similar to those in the main study were formed for comparison.

RESULTS: Analysis showed that in most victims who died at the scene of the incident, immature cellular forms were found in hemorrhages in the soft tissues of the intercostal space, which gradually decreased over time. Morphological study and analysis of hemorrhages into soft tissues showed no immature cellular forms in traumatic hemorrhages of other locations in all comparison groups.

CONCLUSION: Notably, immature cellular forms in the polymorphic cellular infiltrate and hemorrhages in soft tissues from the intercostal space are not a reactive post-traumatic process and cannot be used to estimate the time and duration (survivability) of the injury. Moreover, the preservation of immature cellular forms in the hemorrhage area has been found to change over time with their gradual decrease by 12 hours.