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INJURIES

By Dr. Naveen
Injuries
 -hurt or harm
 -Usually applied to damage inflicted to the
body by an external force.
Brief Review: INJURY CLASSIFICATIONS
A: According to causative factors
• Mechanical injuries (or physical injuries)
• Thermal injuries
• Chemical injuries
• Miscellaneous injuries ( i.e., electrical injuries
etc.)
B: According to severity of the injuries
 Simple
 Grievous (deadly or not)
C: Medicolegal classification
 Suicidal
 Homicidal
 Accidental
D: According to time inflicted:
 Antemortem wounds
CLASSIFICATION OF WOUND

Types of bodily injuries


A.Classification of Injuries
according causative factors
1. Mechanical or Physical injuries
____produced by application of
mechanical force.
1) Abrasion 2) Bruise or contusion
3) Laceration 4) Incised wound 5)
Punctured wound 6) Fracture or
dislocation of a bone,tooth or joint
7) Firearm wound
Handcuffs
2. Thermal injuries (due to
application of heat or cold)
3.Chemical injuries (I.e. acids or
alkalies etc.)
4. Miscellaneous injuries ( I.e.
Electrical injuries etc.)
B. Classification according to
severity of the Injuries

1. Simple
2.Grievous which may or may
not be dangerous to life
C. Medicolegal classification of
Injuries

1) Self-inflicted or suicidal
2) Injuries inflicted by others or
Homicidal
3) Accidental injuries
4) Defence wound
D. Classification in relation to
moment of Death

1) Antemortem wounds
2) Postmortem wounds
Mechanical injuries
ABRASION
Definition: In an abrasion there is
damage or destruction of the
superficial epithelial covering of
skin (epidermis) or mucus
membrane ,due to impact with hard
,blunt and rough object or weapon.

There may be loss of


continuity of the epidermis
(denudation of cuticle) or the
mucus membrane.
Causative agent or Weapon

Hard blunt or hard blunt and


rough ,or pointed end of an object or
weapon. Example:stone, stick, needle
or any other weapon ,or rough
surface of any other material.
Mode of production
Abrasions are produced by the
impact of the above materials,when
friction is caused between the object
and the epidermis due to the impact.
The direction of force causing the
friction may be horizontal (as in
scratches or grazes)or tangential or it
may be more or less perpendicular
(as in pressure or imprint abrasion).
Features of Abrasions
Abrasions are superficial
injuries. But often there is
accompanying injury to the
subcutaneous or still deeper
tissues. At the site of abrasion,
there may be oozing of lymph and
sometime very slight oozing of
blood.
The lymph or blood which oozes
out, and the denuded epithelial
debris,dry up within a few hours
to form a scab. Abrasions heal
without formation of permanent
scars.
Types of Abrasions
 SCRATCHES or LINEAR Abrasions
• SCRATCHES or LINEAR
Abrasions

A scratch or linear abrasion, caused


by horizontal or tangential movement of
the pointed end of an object will be
wider at the starting point than at the
ending point. In this type, the denuded
cuticle heaps up at the terminal point.
• SCRATCHES or LINEAR Abrasions

From a scratch, the type of weapon


and the direction of application of force or
the relative position of the victim and the
assailant can be known. The direction of
the force is from the wider side to the
narrower side of the scratch. The position
of the assailant is at the wider side of the
scratch i.e.,opposite the side of heaping
up of the denuded cuticle.
• GRAZES or SLIDING Abrasions
These occur due to horizontal or tangential
friction between the epidermis and wider part of
the rough surface of an object, weapon or
ground.
These abrasions are more commonly seen in
road traffic accident cases, where the victim
after being knocked down by a vehicle, falls on
the ground with motion ,resulting in horizontal
friction of the skin against the ground.
• GRAZES or SLIDING Abrasions

In this type of abrasion also, the


starting part is wider and deeper with
narrowing and thinning at the terminal
part.
From grazes also, the direction of
application of force can be asserted.
• PRESSURE Abrasions
These are the result of more or less
perpendicular application of force on the body
surface. The extent of friction is less and is
directed towards the depth of the body.
The size and shape of the abrasion depends
on the part of the weapon or object coming in
contact with the body. Abrasions on the ligature
marks around the neck in case of hanging are the
examples of pressure abrasions.
From pressure abrasions, the type of the
weapon used, can be said.
•IMPRINT or PATTEREND
Abrasions
In case of pressure abrasion,the
design of the weapon with its shape
may be left imprinted on the abrasion.
These are imprint abrasions.
From the design imprinted on the
abraded area,the weapon of offence
can be guessed. Example- abrasion
caused by tyre of a wheel.
Medicolegal importance of
abrasions

1. From abrasion, the type of the


weapon used, can be said.
2. From linear or graze abrasion, the
direction of application of force and
the relative position of the victim and
the assailant can be known.
3.From abrasions,time of assault can be
roughly assessed.
When fresh, an abrasion is red with
evidence of oozing of serum and a little
blood.
By 8-24 hours, there is a reddish scab
formation. By 6th day, it is blackish and it
starts falling off from the margins.
4. Abrasions sometime give indication about
the specific type of offences committed.
Nail scratches in the neck of a dead body
may be indicative of manual strangulation or
throttling may be indicative of killing by
smothering.
5. Abrasions may be produced on the
vulnerable sites of the dead body during
shifting of the body to the mortuary. These
postmortem abrasions may be mistaken as
antemortem abrasions.
These abrasions are present mostly
against the vulnerable bony prominences.
These are yellowish,parchmentised and
slightly translucent when dried, do not have
oozing, scab formation or color change, as
are seen in antemortem abrasions.
BRUISE OR CONTUSION
Definition: In bruise or contusion
there is ecchymoses or effusion of
blood in the subcutaneous or
submucus tissue due to
extravasation of blood, due to
rupture of capillaries, caused by
application of hard blunt force.
In bruise, there is no solution or
breach of continuity of the
covering skin but the epidermis
may occasionally be abraded.
Features of bruise
When fresh a bruise is reddish in color,
slightly raised above the surrounding area, is
painful and tender and may or may not have
denudation of the covering cuticle.
Gradually, it changes in color and
subsides by two weeks.
It is usually roundish or takes the shape of
the striking part of the weapon.
Along with rupture of the capillaries. There
is damage in the soft tissue. But the skin is
usually spared because skin tissue is quite
tough.
Type of weapon
Impact with hard blunt
weapon produces bruise.
Example- stone, stick. Impact
by a stick or rod will cause two
parallel linear bruises along the
two margins of the impact, with
a pale gap intervening, the
breadth of which corresponds
with the diameter of the stick
From this kind of bruise, the type of
the weapon used, can be known.
Factors which influence the
formation and appearance of
a bruise

1. Quantity of force used- A greater force is more


likely to cause a bruise.
2. Quality of force- A hard blunt force will cause a
bruise, but a soft blunt force may not.Thus, striking
with a stone will produce a bruise, but covering the
part of the body with a rug before hitting with a stick
may not produce a visible bruise. No bruise may be
apparent externally, because the impact being
soft,there may not be any rupture of capillaries
underneath the skin.
But it may cause deep bruise or haematoma adjacent
to the bone because, the applied force causes the soft
tissue to strike the hard bone, resulting in the rupture
of the capillaries and venules there.
3. Site of application of force
A greater force may even not produce any bruise
on the anterior wall of the abdomen due to toughness
and yielding force absorption capacity of the tissue
there.
But bruises are easily produced against a bony
prominence, say malar prominence because the
capillaries in the subcutaneous tissue rupture easily in
between the bone underneath and the hard blunt force
applied on the surface.
4. Sex
Females bruise easily due to delicacy of
tissue in them including the vessels, and also
due to more subcutaneous fat in them. Vessels
present in the fatty tissue are more likely to be
ruptured on application of force than the
vessels present in the tough fibromuscular
tissue.
5. Age
Infants, young children and very old persons
bruise more easily than young adults. In
infants and young children, it is due to delicacy
of tissue including vessels and more amount of
subcutaneous fat.
6. Certain pathological conditions
Persons suffering from some disease
(example- leukaemia vitamin ”K” deficiency ),
bruise easily without application of much force.
These persons may even develop
haemorrhagic spots without application of any
force.
7. Complexion of the person
A bruise appears more prominent in a fair
complexioned person. In dark-skinned persons,
it may not be well appreciated.
1. Shifting of bruise or appearance of a bruise at a site
away from the site of impact.
When extravasation occurs at a site where the
tissue is so tough and tissue space is less that, the
extravasated blood cannot be accommodated there,
the blood settles down to a lower level where tissue
is loose.Gravity helps such shifting of extravasated
blood. Example – When ecchymosis occurs in the
subcutaneous tissue on the forehead due to impact
over there, the blood cannot accumulate there due
to lack of loose tissue at the subcutaneous level
there. Gravity shifts the extravasated blood from the
forehead to the loose tissue of the eyelid, giving rise
to bruise on the eyelid or “black eye”, as this is
otherwise known .
PATTERNED bruise
The design on the surface of the weapon may
be imprinted on the bruise. Such a bruise is
called a patterned bruise.
Example – bruises caused by a cycle chain
or motor vehicle grill. A bruise caused by the
roundish end of a weapon is circular in shape.
When caused by the margin of the circular end
of the weapon, it is crescent shaped. If caused
by the body of a rod or stick then two parallel
lines of bruises appear with a gap in between,
which is roughly equal to the breadth of the
weapon.
Medicolegal importances of
Bruise
1. Bruises are generally considered as
simple injuries. But multiple extensive
bruises, distributed all around the body
can be the cause of death .
2. Patterned bruises tell about the type
of weapon used.
3. From bruise, time of assault can be ascertained.
A fresh bruise is slightly above the surface of the
surrounding area; it is slightly warm. When fresh, a
bruise is reddish in color.
Within a few hours it becomes bluish and remains
bluish for about up to three days.
By 4th /5th day, it appears brownish due to
persence of haemosiderin pigments at the site of
extravasation. By 5th /6th day, the bruise appears
greenish due to presence of haematoidin pigments.
After this period,it becomes yellowish due to the
presence of bilirubin and it continues to be yellowish
which gradually fades away and clears out by the end
of the second week.
4. False bruise or bruise like lesion
may be produced by application of
some chemical or plant juice like,
that of semicarpus anacardium, to
bring false charge of assault
against somebody. However they
can be differentiated easily.
Differences between bruises and lesions
produced by chemicals or plant juices

Features Bruise False bruise or bruise like lesions


Shape regular irregular
Swelling slight no swelling
Abrasion over the area may be present not present
Cause mechanical force chemicals or plant juice
Extravasation of blood
present in the subcutaneous tissue not present
Chemical test of skin scrapping
detects nothing
detects the chemical or the plantjuice used
5. Like abrasions, bruises at some
particular parts of the body may be
indicative of some particular type of
offences , e.g., bruises near the private
parts of a woman may be indicative of
sexual offence having been committed on
her, forcefully.
LACERATIONS
Definition:
In laceration there is breach of
continuity of tissue involving depth
more than the covering epithelium of
skin or that of an organ.
Lacerations are caused due to
impact by hard blunt and rough
weapons or objects.
Features
Shape – Usually irregular.
Margin – Irregular.
Floor – Tags of tissue may be seen passing across the
floor .
Dimensions – length or length and breadth both are
more than the depth of the injury .
Foreign substances at the site of laceration – Many of
these injuries being sustained on roads or due to fall
etc., often the lacerations gave dust or such
materials adhered to their floors . These foreign
materials may sometime help to find out the place of
occurrence of the injury or assault.
Medicolegal importance of the lacerated wounds

1. From a laceration some idea about the


causative agent may be formed.
Sometimes the shape and the design of
the weapon may be known from the
wound . If the circular of spherical surface
of a weapon strikes the body
perpendicularly then a circular wound will
be produced. If the margin of a circular
surface strikes , a crescentic laceration
will be there.
If the length of a cylindrical
weapon strikes the body then a
linear laceration will be produced. If
the end part of such a cylindrical
weapon is used then a “Y” shaped
wound will be caused. The design
of a tyre may get imprinted on the
avulsion laceration when a person
is run over by a vehicle.
2. Foreign substance like dust, sand,
gravel etc. present on the wound will
speak about the site or place where the
injury was sustained.
INCISED WOUNDS

Incised wounds are cuts or slashes


produced by the sharp edge of a
weapon like, knife, razor, sword etc.
Mode of infliction
By drawing or sawlike movement of
the weapon on the body surface when the
weapon is rather light like, a knife or razor,
by striking the sharp edge on the
body when the weapon is heavy or
moderately heavy like, axe,sword etc.
Features of incised wounds
1. Shape – The shape of an incised wound
is elliptical or it is spindle shaped. It may
be oval if the wound gaps much. .
The shape of the incised wound may
change in its curvature due to elasticity,
creases and cleavages of the skin and the
direction of the underlying muscle.
217
2. Length of the wound - Length of
an incised wound is greater than
breadth and depth.
Length of the wound does not
correspond with the length of the
blade of the weapon when the
incised wound is caused by
drawing or sawing. It may
correspond when the wound is
caused by striking.
3. Breadth – Breadth of an incised wound
primarily depends on the thickness of the
effective part of the blade i.e., the
thickness of the blade at that level upto
which the edge of the weapon has gone in
the tissue.
But the breadth depends much on the
elasticity of the skin of the area and
direction of the fibres of the muscle
underneath the skin,in relation with the
length of the wound.
If the underlying muscle fibres
are cut across their length then,
contraction or shortening of the cut
muscle fibres on both sides of the
incised wound will cause widening
of the gap (bread) of the wound.
This does not happen if the
muscle fibres not cut across or if
the fibres run along the length of
the incised wound.
4. Angles - The angles at both ends of
the incised wound is sharply defined.
5. Margin – Margins of an incised
wound are well defined, cleanly cut and
sharp.
6. Floor – Floor of the wound is also
sharply cut and divided.
7. Haemorrhage – As the vessels are
also sharply cut,there is excessive
external haemorrhage.
If the haemorrhage is from a
vein then bleeding occurs in drops,
which is stellate in appearance.
If it is from the arterial source,
then there is spurting effect and the
bleeding occurs in jets .
8. Hesitation cuts – These are also
termed “tentative cuts”.
These are multiple superficial
cuts placed around the beginning
part of the main wound, in cases of
suicide.
These superficial tentative or
hesitation cuts indicate hesitation or
indecisive state of mind of the
suicide, before he finally inflicts the
deep fatal wound on his own body.
9. Defence wounds :
These are in most occasions , incised wounds
though abrasions; bruises, lacerations or
punctured wounds also may be sustained in
defence for self protection.
Defence cuts may be persent on the palmar
aspects of the hand if, when attacked with a
sharp cutting weapon, the victim holds the blade
of the weapon to escape the assault.
In such a case there may be incised wounds on
the palmar aspects of more than one finger, but
all of them are expected to be in one line, if the
blade of the weapon is single edged.
Medicolegal aspects of incised
wound

1. Incised wounds are usually suicidal, then homicidal


and only occasionally accidental.
Suicidal incised wounds are usually placed in front
and sides of the neck or sometimes in front of the
wrists, to cut the radial artery to bleed to die.
2. Direction of application of force – From the tailing
and bevelling, the direction of application of force can
be known.
3. Cause of death – In case of incised
wound there is excessive external
bleeding. Death therefore in many
cases occur due to haemorrhage and
shock. In case of cut-throat injury,
death, in addition, may occur due to
axphyxia due to choking of the
respiratory passage by blood.
CHOP WOUNDS
Chop wounds are incised
wounds produced by striking with
sharp cutting, heavy or moderately
heavy weapons, like axe, sword
etc.
These wounds are
comparatively deeper and broader
than the incised wounds produced
by drawing or saw like movement
of light sharp cutting weapons.
Abrasions or contusions may
be produced at the margins due to
friction with the surface of the thick
and heavy blade. These
wounds usually have bevelling
also.
Bevelling – When a sharp cutting
heavy or moderatily heavy weapon
is used (striking) tangentially or at
an angle to the body, then there is
flapping at one margin of the
wound at the cost of the other
Medicolegal importance of the
chop wounds

1. Chop wounds are mostly homicidal


in nature.
2. Sometimes the length of the
weapon used can be said.
PUNCTURED OR STAB WOUND

Definition:
Punctured or stab wounds are
deep wounds produced by the
pointed end of a weapon or an object,
entering the body.
Depth is the greatest dimension of
punctured wound.
Causative Weapon :
Punctured wounds may be caused by
the tip of a knife, arrow, needle.
Punctured wounds may also be caused
by an object or weapon having no pointed
end, e.g., blunt end of an iron rod.
The pointed weapon may or may not
have sharp edge. Example: spear (have
pointed end but may or may not have
sharp edge), needles (have pointed end
but no sharp edge), end of an iron rod (not
pointed or sharp edged).
Varieties of punctured wounds
1. Perforated wound.
Here part of the weapon passes through
the whole thickness of any part of the body,
e.g. when the tip of a weapon enters the body
through anterior surface of the chest and exits
out through the posterior surface of the chest.
In a perforated wound there will be two
outer or external wounds with a single strike,
(a) wound of entrance, the wound through
which the weapon enters the body and
(b)wound of exit, through which the tip of the
weapon comes out of the body.
2. Penetrated wound.
Here the wound terminates inside a
body cavity or viscus, e.g.peneterating
wound ending inside the abdominal or
chest or cranial cavity.
3. Punctured or stab wound without
causing penetration to a body cavity or
without perforating the whole thickness
of the body.
Here the tip of the weapon terminates
inside the body except in a body cavity.
Features of punctured wounds

1.Shape
The shape of the wound of
entrance in case of stab wound
depends mostly on the shape of the
weapon or shape of the edge of a
weapon.
When a double edged pointed weapon is
used, the external wound is elliptical, spindle
shaped or slit-like in appearance.
In spindle shaped or elliptical wounds
produced by double edged weapon, both the
margins and angles will be sharp, clean and
well-defined.
When a single-edged pointed weapon is
used, the external wound will be triangular or
wedge-shaped.
In wedge-shaped wounds produced by
single-edged pointed weapons two margins
and one angle will be sharply defined.
2. Margin
When stabbed with double-edged sharp
cutting pointed weapon, both the margins of the
elliptical external wound will be clean cut,
regular, sharp and well defined.
When caused by a single-edged sharp
cutting pointed weapon, the wedge shaped
external wound will have two long, clean cut,
regular, well defined margins with one short
irregular margin.
When caused by pointed or blunt ended
weapon without any sharp edge, then the
margin will be irregular, uneven with abrasion,
contusion and even tears.
3. Depth
Depth is the greatest dimension of a
punctured wound. The depth of the wound
usually depends on the length of the
weapon or the blade of the weapon upto
which it enters in the body.
If the whole length of the blade of the
weapon enters the body, then surrounding
the wound of entrance there will be a
contusion or abrasion due to friction or
pressure by the hilt or blade-guard of the
weapon.
If the whole length of the weapon does not
enter the body then, there will not be any hilt
mark in the form of abrasion or bruise. In such
cases, the depth of the wound will not
correspond with the length of the blade of the
weapon.
Similarly, in case of a perforated wound,
when a part of the weapon comes out through
the wound of exit, the depth of the wound will
not give the length of the blade of the weapon
even though, hilt mark may be present around
the wound of entrance indicating that, whole
length of the blade has passed through the
tissue.
4. Hilt mark
Most of the sharp cutting pointed weapons
have a hilt or hand guard in between the butt
and the blade, so that,during use the hand
will not slip down over the blade of the
weapon and get injured.
When in a stab wound, the whole length of
the blade is pushed inside the body then the
hilt strikes against the skin around the wound
of entrance and keeps its mark over there in
the form of abrasion or occasionally in the
form of bruise.
Thus, hilt mark has two
importances. If there is abrasion
due to hilt around the wound, we
can say that, that wound is the
wound of entrance and that the
whole length of the blade of the
weapon was pushed inside the
body and the weapon has a hilt.
5. Haemorrhage
In case of stab wound internal
haemorrhage is more than the external
haemorrhage due to injury to internal
vessels.
The extent of internal haemorrhage
may not be guessed untill the body is
dissected open.
6. Injury to the internal organs
In stab wounds, injury to the vital
internal organs is more common and is
the real danger. Stab wounds over the
head, neck, chest or abdomen are
obviously more dangerous due to
possible injury to the vital organs.
7. Examination of punctured wounds require
extra vigil, because, these wounds have
greater depth which cannot be examined
from outside and because, punctured
wounds are expected to cause injury to the
vital organs of the body and extensive
internal haemorrhage.
The depth and direction of the track of
the wound should not be attempted from
outside with the help of a probe. Such an
attempt may cause further extension of the
depth or extension in a new direction
during probing.
If the victim is living, then the depth and
direction of the wound should be examined
on the operation table, so that, danger of
further damage or additional haemorrhage
will not be there. If the person is dead, then
depth and direction of the track should be
examined during dissection of the body.
As a doctor, it is very important to a victim
who is living to examine and treat with all the
haemorrhagic tissues and organs around the
track of the punctured wound, or the victim
may die of the haemorrhage.
Medicolegal importances of
stab wounds

1. About the nature of the injury


Generally speaking, stab wounds are
most commonly homicidal, next in
occurrence suicidal and lastly accidental.
有刃
刺器种类

有刃
无刃
Homicidal stab wounds are usually more
than one in number, all are quite deep,
may be located anywhere on the body,
including self unapproachable parts. In
homicidal cases, the covering clothes
usually bear corresponding cutmarks or
tears. Defence wounds and marks of
resistance may be present on the body.
Foreign materials like foreign scalp hair or
shirt-button etc. may be found in the tight
grip of the hand of the victim in a state of
cadaveric spasm. The weapon of offence
may not be available on the spot.
Suicidal stab wounds are located
on the approachable parts of the
body, more commonly over the left
side front of chest, neck and lower
abdomen. The main wound may
be only one. The covering
clothes may not bear
corresponding cut marks as that
may be partly removed from the
area while doing the act. The
weapon may be held in the hand in
a state of cadaveric spasm, or it
No defence wounds or marks of
resistance will be present on the body,
but some self-inflicted incised wounds
may be present on the other approachable
parts of the body. The place of
occurrence will not be disturbed and it
may be a secluded place, not
approachable to others. Sometimes a
suicidal note may be left behind by the
suicide. In some cases the suicide
might have tried some other method
before stabbing himself to death.
Evidence in support of this may be
2. From the shape and size of
the external wound and the
depth, the type of the blade of
the weapon used can be said.
3. Differences between Incised,
Punctured and Lacerated
wounds
Points Incised wounds Punctured wounds Lacerated
wounds
1.Weapon responsible
Sharp edge. Pointed or elongated. Hard,blunt and
rough
2. Site Suicide often is on the neck,front of wrist, head;
homicide is anywhere. Suicidal often is on the chest
(cardiac area) and abdomen. Anywhere, but fatal ones
are on chest,abdomen and head
3. Mode of production By drawing, sawing or striking
By pushing the pointed end By
fricton,stretching or compression
4. Different dimensoins Length is the greatest Depth is the
greatest Length and breadth are greater than depth
5. Margin Cleanly cut, smooth, sharp and well defined Usually
clean cut and well defined but may be irregular Irregular,
uneven,ragged
6. Floor or depth of the wound Cleanly cut . Tapering, cleanly
4. Differences between Suicidal,
Homicidal and Accidental
wounds
Points Suicidal Homicidal Accidental
1. Type Mostly incised sometimes stab
Mostly stabs, and lacerations Mostly lacerated
2. Site Accessible parts of body. Anywhere on the body. Anywhere
3. Number Usually only a few Multiple May be of any number
4. Severity One or two severe All may be severe Nothing specific
5. Hesitation wound Present Absent Absent
6. Defence wound Absent Present Absent
7. Clothes Usually spared Bears corresponding tear or cut
Will have corresponding tears
8. Weapon Usually present Usually absent Usually present
9. Suicidal note Present Absent Absent
10. Sign of struggle Absent May be present Absent
11. Motive or cause Present Present Absent

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