Mechanical
Injuries
Objectives
• To know about injuries and its type
• To know the law of the land
• To know about mechanical injuries
• To document injuries and make an injury
report
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Injury
Medical Definition: Injury/Wound
• Clinically:
– It is the breach of the natural continuity of any tissue
(skin or mucous membrane)
– It can also be defined as damage to any part of the
body due to the application of mechanical force
• Legal definition:
– Any harm caused illegally to a person that is to his
body, mind, property or reputation
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Classification
Injury
Nature of Injuries Time of
Severity Causative Factors
(Medico-legally) Infliction
Simple Suicidal Antemortem- Mechanical or physical
Grievous Homicidal recent or old injuries
Accidental Postmortem Thermal injuries
Defense wounds Chemical injuries
Fabricated or self- Miscellaneous injuries
inflicted wounds
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Causative Factors
kinetic injuries Non-kinetic/non-motion
injuries
Mechanical or Thermal Chemical Miscellaneous
physical injuries injuries injuries injuries
Electrical injury
Cold Heat Irritation Corrosion Radiation injury
Blast injury
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Mechanical or
physical injuries
Blunt force Sharp force
trauma trauma
Abrasion Incised
Bruise or wound
contusion Stab wound
Lacerated wound Chop wound
Firearm wound
Fracture/dislocati
on of bone, tooth
or joint
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Grievous hurt
• According to Muluki Aparadh (Sanhita) Ain, 2074 Chapter 14 ‘Kutpit
wa angabhanga sambhandhi kasoor’ Article number 192, It is said to be
grievous hurt when:
1. Permanent privation of vision
2. Permanent privation of smelling power of nose
3. Permanent privation of hearing capacity of ears
4. Permanent privation of talking power of tongue
5. Cutting breasts of female to loss of function
6. Emasculation in male and infertility in female due to injuries
7. Fracture and dislocation of joints of spine, hands and legs leading to
disability
8. Not being able to involve in occupation due to physical assault (asakchyam)
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Grievous hurt
• If found guilty of causing grievous hurt:
– He/she will be punished with up to 10 years of
imprisonment with up to 1 lakh fine
– If one of the twin organ is damaged then
punishment will be half of grievous hurt
– If the individual recovers and functions properly
from grievous hurt then the punishment will be up
to 3 years imprisonment with Rs. 30,000 fine
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Simple hurt
• According to Muluki Aparadh (Sanhita) Ain, 2074
Chapter 14 ‘Kutpit wa angabhanga sambhandhi
kasoor’ Article number 191:
– Any form of physical assault (other than grievous hurt)
– If it is considered physical assault if:
• If any bodily pain is caused.
• If disease is transferred.
• If any form of physical disability (asakta) is caused.
• If found guilty of this:
– He/she will be punished with up to 3 years of
imprisonment or up to Rs. 30,000 fine
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• According to Muluki Aparadh (Sanhita) Ain, 2074 Chapter 14
‘Kutpit wa angabhanga sambhandhi kasoor’ Article number 193:
• Acid or any other form of liquid or poisonous substance can’t be
used to make someone ‘kurup’.
• If found guilty of causing this in face he/she will be punished by
imprisonment from anywhere in between 5 years to 8 years and fine
from Rs. 1 lakh to Rs 5 lakh.
• If found guilty of causing this anywhere else in the body he/she will
be punished by imprisonment from anywhere in between 3 years to
5 years and fine from Rs. 50,000 to Rs. 3 lakhs.
• The total sum of the fine will be given to the survivor.
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Mechanical Injuries
Blunt
Tangential
Abrasion Intradermal Bruise Laceration Incised
bruise wound
Mechanical Injuries
Blunt force injuries
• Factors affecting blunt force injuries:
– Amount of force delivered to the body
– Body region involved
– Amount of surface over which force is delivered
and time over the force is delivered
– Nature of the weapon
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Abrasion
• Destruction of the skin, which usually involves the
superficial layer of the epidermis and papillary dermis by
friction against rough surface
• Types:
1. Scratch/linear abrasions:
• Abrasion with length but no significant width
• Caused by sharp or pointed object passing through the skin
• For example: fingernails-throttling, sexual assaults and child abuse
2. Grazes (sliding/scrape/grinding abrasion):
• Due to movement between skin and rough surface
• Caused by horizontal or tangential friction
• Uneven, longitudinal, parallel lines (direction)
• For example: RTA
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• Brush burn: involves a large surface area, no true scab is formed
– Example: back (caused by the violent rubbing against a surface,
dragging)
• Friction burn:
– Element of thermal damage is present
– Extensive, superficial, reddened and excoriated area with little or no
linear marks.
• Pressure abrasion:
– Caused by the direct impact or linear pressure of the rough object over
the skin,
– Crushing of the superficial layers of the skin and is usually directed
inwards. Eg- nooses or ligatures in hanging and strangulation
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• Impact abrasion (imprint/contact/patterened):
– Caused by the impact with a rough object, when the force is applied at
or near 90 degree of the skin surface.
– It is usually seen over bony prominences where thin layer of the skin
covers bone.
• Imprint abrasion: brownish and parchmentized (hanging), bicycle chain,
serrated knife
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Age of abrasion
Time Presentation
Fresh Bright red, oozing of serum and blood
12-24 hours Lymph and blood dries up leaving a
bright red scab Polymorphonuclear
cell infiltrates (scab formation)
2-3 days Reddish brown scab
4-7 days Dark brown to brownish black scab
Epithelium grows and cover defect
under the scab (epithelial
regeneration)
After 7 Scab dries and falls of leaving a de-
days pigmented area
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Differential diagnosis
• Postmortem insect bites (pale brown, dry with
irregular margins and arranged in linear
tanner), vital reactions are absent
– Dry skin of scrotum & vulva exposed to open air
– Decubitus ulcers, excoriations of skin by diaper
rash
– Postmortem abrasions
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Differences
Features Ante-mortem abrasion Postmortem abrasion
Site Anywhere on the body Usually, over the bony
prominences
Color Bright red Yellowish, translucent
and parchment like
Exudation More, scab slightly raised Less, no scab
Vital reaction Present absent
Healing process May be evident Not seen
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Medico legal importance of abrasion
• Site of impact and direction of force
• Nature of injury (simple /grievous)
• Causative weapon connection
• Age of injury
• Character and manner of injury known from its
distribution
• For example:
– Throttling- crescentic abrasions which are made by
fingernails usually found on neck
– Smothering- mouth and nose
– Sexual assault- abrasions found on the breasts, genitals,
inside the thigh and around the arms
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Circumstances of Abrasions
• Accidents and assaults
• Abrasions on the face or body of the assailant -
struggle
• Abrasions may be found in the palmer aspect of
the hand in a conscious person while falling and
puts hands to save himself
• Alcoholics tend to fall backwards and strike the
occiput on the ground
• Hysterical women- accessible areas (front of the
forearm of over the face to fabricate charge of
assault)
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Contusion/Bruise
• Effusion or extravastation of blood into the
tissue due to the rupture of blood vessels,
usually capillaries
• Caused by blunt trauma
• Types (include)
– Intradermal
– Subcutaneous
– Deep
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Features
• Margins are blurred
• When large vessels are contused hematoma is
formed
• Fresh bruise may appear swollen and slightly
raised above
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Factors influencing the contusion
• Site/type involved - soft, lax and vascular
tissues- face, scrotum and eyelids
• Large bruises:
– firm and fibrous tissue covered by thick dermis
(abdomen, back, scalp, palms and sole)
• Overlying bony prominences
• Boxers and athletes- bruises are less seen due
to good muscle tone
• Chronic alcoholics and aspirin intake
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Factors influencing the contusion
• Age (children and elderly due to delicate skin and
softer tissues)
• Sex (Women- tissues are more delicate and
subcutaneous fat is more)
• Color of skin (fair skin than dark)
• Natural diseases, are more prominent in people
suffering from atherosclerosis, scurvy, leukemia,
hemophilia, bleeding diathesis, Vitamin K and
prothrombin deficiency
• Ectopic bruise (appearances of the bruises at the site
other than the site of the injury, e.g. black eyes)
• Patterned bruise (tram line bruise), suction bruise
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Age of bruise
Time Presentation
Fresh Red (oxygenated blood)
Few hours to
Blue (deoxygenated blood)
3 days
4th day Bluish black to brown (Hemosiderin)
5th and 6th day Greenish (Biliverdin)
7th to 12th day Yellow (Bilirubin)
2 week Normal
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• Delayed bruising: in deep bruising, they
become visible after some time or days.
• Migratory or ectopic bruising does not tell
about the exact site of impact (black eyes)
• Patterned bruising provides a manner of
infliction.
• Spontaneous bruising may be taken for
inflicted by others.
• Hypostasis and bruises may be mistaken.
• Fingertips bruises are clues for criminal
cases
• Love bite is a suction bruise
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Medico legal importance
• Age of injury
• Patterned injury
• Nature of injury
• Difference between contusion and hypostasis
• Character and manner of injury
– Bruises or contusion present over the arm may be sign of
the restraining a person
– Small bruises present over the inner aspect of the thigh of
the women indicates sexual abuse
– Bruises found in soft tissues in a child such as in cheeks
and trunk and multiple bruises in various stages of healing,
six penny bruises indicates- child abuse
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Laceration
• They are the split or tears of the skin, mucous
membrane, muscles or internal organs which
are caused by the application of blunt force to
large area of the body, which crush or stretch
tissue beyond the limit of their elasticity.
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Types
• Split lacerations:
– It occurs when the soft tissues are sandwiched between a
hard underlying deeper structure and the agent applying the
force.
• Stretch laceration:
– It results due to heavy forceful frictional impact by a blunt
force exercising localized pressure with pull.
• Avulsed laceration:
– These are produced when sufficient force is delivered at an
acute angle to detach a portion of traumatized surface from
its attachment.
– Flaying Scalp lacerations can look like incised wounds
upon cursory examination.
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• When the scalp is shaved and the wound
examined more carefully, the characteristics of
a laceration will be evident
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Characteristics
• Margins: Ragged, irregular and uneven
• Site: bony prominences
• Bruising and abrasion
• Edges (indicates direction)
• Depth of wound
• Soiling of the wound
• Hair bulbs- crushed
• Hemorraghes- less ( vessels are crushed and tom
irregularly)
• Shape ( correspond with the weapon or object)
• Gaping: due to the pull of elastic and muscular tissues
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Medico-legal Importance
• Cause of injury/ shape of blunt weapon
– blunt round end (hammer)- stellate laceration
– blunt object with an edge (hammerhead)- crescentic
laceration
– long, thin objects like pipes or sticks-linear or elongated
lacerations
• Objects with flat surfaces produce- irregular, ragged or
y-shaped lacerations
– Nature of injury (simple/ grievous)
– Accidental/homicidal/suicidal injury
• Foreign matters on the wound give clue about the object causing it
• Skin flaps which overhang the cut margins - direction of force
applied
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Incised wound
• It is a clean-cut wound through tissues (usually
the skin and subcutaneous tissues including
vessels).
– Example: objects used- sharp cutting end or point -
knife, box cutter, glass, scalpel or razor
• The wound is longer than it is deep
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Characteristics of Incised wound
• Margins are clean cut, well defined and usually
everted and free from contusions and abrasions
• Width is greater than the edge of the weapon
• Shape- spindle-shaped
• Depth and direction- usually deeper
• Hemorrhage- vessels are clean cut
• Bevelled cuts- if the blade of the weapon enters
obliquely, tissues will be visible at one margins
and other margins will be undermined
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Medico-legal significance
• Tailing - Direction of wound
• Nature of weapon - Sharp Manner
• Hesitation /tentative cuts (suicidal motive)
• Defense cuts (homicidal motive)
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Stab wound
• Produced from penetration with long narrow
instruments having pointed ends into the
depths of the body, which are deeper than its
length and width
• For example: Knife
– Puncture wound: When soft tissue involved
(Superficial penetration)
– Penetrating: Terminating in organ or cavity.
– Perforating wound: Through and through wound
that is having entry as well as an exit.
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Characteristics
• Margins are clean usually no abrasion or
bruises over the margins but patterned abrasion
may be seen due to the hilt guard of the knife
striking the skin
• Length is slightly less than width of the
weapon because of stretching of the skin
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Characteristics
• Breadth is more than thickness of the blade due to
gaping
• Depth is greatest
• Direction- horizontally, vertically or obliquely
• Shape- slit shaped or gape depending on their
locations and their orientation
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Patterns of wound
• Single edged weapon- wedged shaped, tear drop, fish tail (v-
shaped)
• Double edged dragger- spindle shaped
• Spear- circular wound
• A pointed square weapon - cross shaped or stellate shaped.
• Broken bottles- cluster of wounds of different sizes and shapes
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• Screw driver- slit like stab with square ends
and abraded margins.
• Closed Scissors - flat z shaped wound
• Ice picks- small, rounded or slit like wounds
• Fork- clusters of 3-4 wounds depending upon
number of prongs.
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Medico-legal significance
•Shape and size of weapon
•Direction of force
•Degree of force
•Manner
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Chop wounds
• Chop wounds are sharp force injuries produced
by a sharp, heavy weapon resulting in a sharp
penetrating injury caused by the sharp edge
combined with crushing injuries caused by the
heavy weapon.
– Deep gaping wound.
– Combination of blunt and sharp force injury.
– Margins are sharp and may show abrasion, bruising
and some laceration with severe injury to the
underlying organs.
– Dimensions of wound correspond to cross section of
the penetrating blade.
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Medico legal importance
• Most of the injuries are homicidal
• Few are accidental
• Rarely suicidal
• Causative weapon
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Firearm is any instrument or device designed to propel a
projectile by means of expansive force of gases generated by
combustion of an explosive substance.
Injury Documentation
• Type
• Size
• Site
• Location
• Age, Area, numbers
• Orientation
• Direction
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• If possible photographic documentation.
• Proper documentation will give an idea about the
distribution of injuries in the body, that can help
determine:
– The most probable mechanism of injury (Fall or
Assault)
– Correlate with history.
– Relative position of victim and assailant.
– Handedness of assailant (Right handed or left-
handed).
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Injury Report Writing
• Except in cases of insurance, the requisition letter
for the injury report should be brought by police.
• An injury report is a legal document, which is
valuable evidence in court.
• The injury report will only be valid in court as
evidence only if it is filled according to a format
specified by Janaswastha.
• If the format is not followed the court can
consider the report invalid.
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Injury Report Writing
• Registration Number
• Police office sending for examination with the
date and reference number
• Information about the examinee (name, age, sex,
occupation)
• Name of accompanying police personnel
• Date, time and place of examination.
• Consent
• Identification marks (Huliya)-at least 2.
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Injury Report Writing
• Type of weapon/object used:-
1. Blunt force
2. Sharp force
3. Pointed objects
4. Projectile
5. Heat
6. Chemical
7. Others (Specify) Condition of the patient at the
time of examination
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Injury Report Writing
• A brief history about the incident (how and when the
injuries were produced, alcohol, use of weapons?):-
• Medical history of the examinee:
• General
• Physique and vitals:-
• Degree of Consciousness:
• Injuries: (Type, Size, Site, Location, Age)
• Type of injury:
– Simple
– Grievous (Angabhanga)
– Others remarks
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Injury Report Writing
• Severity (Explain the severity in terms of an
existing condition and possible complication)
• Investigation and reports (for example X-ray, USG,
Blood, Urine etc)
• Treatment provided (briefly)
• Referral (Where and Why?)
• Follow up (if necessary)
• Re- Examination (Whether case needs information
about grade of disability )
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Injury Report Writing
• Opinion: (Condition of the inee, the rity of the
injury, age of the injury and possible causative
objects should be considered to frame opinion)
• The report should be made in 2 copies.
– 1st copy is handed to the ce (not the victim or the
family members)
– 2nd copy is for hospital records
• According to Muluki Aparadh (Sanhita) Ain, 2074
Chapter 14 ‘Kutpit wa angabhanga sambhandhi
kasoor’ Article number 89
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Injury Report Writing
• No medico legal document should be falsified
or such circumstances should not be created,
if done will result in imprisonment for 5 years
and Rs. 50,000 fine.
• If that false document results in lifelong
imprisonment of the alleged it will result in
imprisonment for up to 7 years with Rs.
70,000 fine.
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References
• Pekka Sauko, Bernard Knight. Injuries. Knight’s Forensic Pathology.
2004; 3(461)
• Krishna Vij. Blunt Force injuries. Textbook of Forensic Medicine and
Toxicology. 2014: 202-213
• Krishna Vij. Sharp Force injuries. Textbook of Forensic Medicine and
Toxicology. 2014: 214-223
• Gautam Biswas-Review Of Forensic Medicine And toxicology
• MulukiAparadh (Sanhita) Ain, 2074 Chapter 14 ‘Kutpit wa
angabhanga sambhandhi kasoor’ Article number 89
• According to Muluki Aparadh (Sanhita) Ain, 2074 Chapter 14 ‘Kutpit
wa angabhanga sambhandhi kasoor’ Article number 191
• According to Muluki Aparadh (Sanhita) Ain, 2074 Chapter 14 ‘Kutpit
wa angabhanga sambhandhi kasoor’ Article number 192
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