Injuries
Dr. Kumarjit Sarkar
MBBS, MD(FMT)
Senior Resident
Dept of FMT
COM&JNMH, Kalyani
CONTENT OF THE PRESENTATION
• Definitions
• Mechanical Forces vs Physical properties of injuries
• Classification of Mechanical Injuries
• Abrasion
• Bruise/Contusion
• Laceration
Definition
• Injury : Sec 44 IPC/ BNS 2(14):
• Any harm
• Whatever illegally
• Caused to any person
• In body
• Mind
• Reputation
• Or Property
• Wound:
• Clinically: any injury where there is breach of continuity of skin or
mucous membrane
• Medicolegally: Wound and injury is same, but wound any lesion when
there is any causative violence (breach of skin may be present or
absent)
Mechanical Forces and Physical
Properties of Substances
•Elasticity (tendency of stressed material to regain its unstressed condition
•Plasticity (tendency to remain in stressed condition)
•Viscosity (resistance to change in shape when stressed)
Classification of Mechanical Injuries
• 1) Mechanical or Physical Injuries:
A) Blunt force trauma:
Abrasion
Bruise/Contusion
Laceration
Fracture
B) Sharp Force Trauma
Incised Wound
Chop Wound
C) (Pointed) tip of an object
Stab/Punctured (Incised or lacerated)
a)Penetrating
b)Perforating
D) Firearm Injuries:
Rifled firearm
Smooth bore firearm
Country made firearm
• 2) Thermal Injuries:
A) Due to heat (General effects):
Heat Pyrexia (Heat stroke)
Heat Exhaustion (Heat Collapse)
Heat Cramps (Miners Cramp)
Local Effects
Burns (Flame/dry heat)
Scald (Hot water/moist heat)
B) Due to Cold:
Generalised: Hypothermia
Localised:
Frost bite (dry cold)
Trench foot (wet cold)
• 3) Chemical Injuiries:
A) Corrosion: Strong acid and alkalis
B) Irritation: Weak acid and alkali, plant or animal extract
• 4) Miscellaneous Injuries:
A) Electrical Injuries B) Radiation Injuries
C) Lightning Injuries D) Blast Injuries
• Based On nature of Injury: (Legally)
Simple
Grievous
• Based on the manner of infliction: (Medicolegal)
Suicidal
Homicidal
Accidental
Fabricated or self-inflicted wounds
• Based on time of Infliction:
Antemortem
Postmortem
ABRASION
• An abrasion is a type of mechanical injury characterized by
destruction of superficial layer of skin (epidermis) or mucus
membrane resulting from blunt force or impact.
• These are two dimensional (only length & breadth with no depth)
injuries.
• It heals rather rapidly in a few days with out leaving any permanent
scar
•They are usually not life threatening although they are painful.
•They heal without scaring.
•Bleeding/Exudation is slight and leads to crust/scab formation.
•Might be associated with bruising and laceration
• Types:
i) Scratches
ii) Grazes (Sliding, Scraping, Grinding)
iii) Pressure abrasion- Ligature mark in hanging, strangulation & bite
marks
iv) Impact abrasion- (contact or imprint) Tread of tyre, pattern of
radiator grill
• 1) Scratch or linear abrasion:
• These are produced by sharp objects like finger nails, thorns, pins etc
.
• The superficial layer of skin is heaped up in front of the offending
object.
• Finger nail abrasions are CRESCENT shaped, wider to start and
narrow at the end.
• 2)GRAZE(SCRAPING /SLIDING /BRUSH BURN/GRINDING ABRASION):
These are produced due to frictional movement of skin over wider rough
surface or object.
Direction of the movement will be indicated by collection of peeled up
epithelial tissues at the ends of the longitudinal parallel lines or furrow.
Friction burn
• 3) IMPRINT (IMPACT, CONTACT, OR PATTERN) ABRASION :
• These are produced due to forceful impact of skin with a rough object
without any frictional movement.
• LARGER FORCE, OVER A SMALLER PERIOD OF TIME
• eg: Tyre marks abrasion , cycle chain abrasion etc
• 4) PRESSURE (FRICTION OR CRUSHING) ABRASION:
• These are produced due to direct impact of skin with a rough object
accompanied with slight movement.
• SMALLER FOR A LARGER PERIOD OF TIME
• eg: Ligature mark in case of hanging, strangulation
• Patterned abrasion = Impact abrasion + Pressure abrasion
• AGE OF ABRASION: Color of scab
Fresh- Bright Red: 12 – 24 h
Brownish Red: 2-3 d
Epithelial lining under the scab: 4-7 d
Scab dries & falls off: after 7 days
ANTE MORTEM V/S POSTMORTEM ABRASION
• FEATURE ANTE MORTEM POST MORTEM
BLEEDING Bleeding surface seen Complete absence of bleeding
SCAB Forms within a day or two Not forming
SITE Any where in body Over bony prominences
(due to hardening and drying of underlying skin)
Importance of abrasions •
• Always reflects the site of impact.
• Often indicates the causative agent.
• Often indicates the direction of impact.
• Helps in determining the time of injury.
MEDICOLEGAL ASPECTS:
• Nature of injury
• Site of impact
• Direction of force
• Ext. sign of int. injury
• Patterned abrasion-identifies object
eg) eliptical/circular,2-4 marks –teeth bite with bruised intervening space
• Nature of crime from the site of abrasion
a) Neck-throttling
b) Around mouth &nose-smothering
c) breast, genitalia
&thighs-sexual assaults
d) Site of Crime-presence of mud, grass, straw etc
CONTUSION/BRUISE
• Extravasations of blood into the tissues spaces due to the rupture of
subcutaneous & sub epithelial capillaries caused by blunt trauma
Minor trauma cause large bruises in areas where tissues are loose and
vascular
Eg-face ,scrotum, vagina
Moderate violence produce small bruise if tissues are strongly
supported, fibrous and covered with thick dermis
Eg-scalp, palm, sole, abdomen
TYPES OF BRUISES
• PATTERN BRUISE: Typical pattern with the imprint of offending
weapons like cycle chain or whip, muzzle of fire arm etc.
• PARALLEL BRUISE: Usually caused by light flexible weapons like
cane, stick causing two parallel line with intervening depressed
ischemic zone.
• Deep( percolated , delayed , migratory or ectopic ) :
• Usually shows up by 24 to 48 hrs
• Site of appearance is not always at the site of violence.
• When extravasations occurs at the site, where tissue is tough and
tissue space is very less, blood gravitate downs to lower level where
the tissue is loose, depending on the disposition of the tissue plane,
line of least resistance and obeying the law of gravity ,will show up
externally , away from the site of violence.
Bruise thigh - Fracture pelvis
Bruise over ankle - Kick on calf muscle
Bruise in neck - Fracture jaw
Grey Turner Sign & Cullen sign: Acute Pancreatitis, ruptured ectopic
pregnancy
Black eye/ Racoon eye: Anterior Cranial Fossae Fracture Battle Sign: Middle Cranial Fossae Fracture
• AGE OF BRUISE:
• At first –Red (Oxy Hb)
• Few hours to 3 Days- Blue (Deoxy-Hb)
• Bluish-Black to brown(Haemosiderin)-4th day
• Greenish (Haematoidin)- 5-6 days
• Yellowish (Bilirubin) – 7-10 days
• Normal (Phagocytosis- pigment removal) - 2 Weeks
ARTIFICIAL BRUISE
➢By applying juice of irritant plant like calotropis, marking nut
(Semecarpus anacardium), Chitra (Plumbago zeylanica), Lal Chitra
(Plumbago rosea)
➢Site – accessible areas if self inflicted
• MEDICO LEGAL IMPORTANCE:
i) Patterned Bruise indicates- type of weapon used- whip, chain,
cane, vehicle
ii) Age of injury- By colour change
iii) Degree of violence- By size
iv) Character & manner- When arms are grasped, bruising in scapular
region, in manual strangulation, in sex violence, in case of fall in
sand, gravel or mud etc
ABRASION IS SUPERIOR!! AS FOR CONTUSION
➢Size may not correspond to size of weapon
➢May visible only after days
➢May appear away from site of injury
➢Don’t indicate direction of application of force
LACERATED WOUND
• a type of mechanical injury
• which results from application of blunt force
• on the surface of skin, mucus membrane, or deeper structure like sub
cutaneous tissue, muscles , internal organs etc
• due to STRETCHING, SPLITTING, TEARING, CRUSHING or GRINDING
beyond the limits of their elasticity.
Features of lacerations
• MARGINS- ragged, irregular, uneven
• DEPTH- present bridges of irregular torn fibrous tissue (at the BASE of
the wound), blood vessels, & nerves.
• Hair bulbs crushed, hairs driven deeply into wound
• SOILING
• DO NOT BLEED MUCH
• Loss of some amount of tissue
• Beveling & undermining
• Types of Lacerated wounds:
• Split (Incised looking wound)
• Tear
• Avulsion
• Stretch
• Cut
SPLIT LACERATIONS/ INCISED LOOKING LACERATED WIUND
• where subcutaneous tissues are very less and the blunt force impact
produces a gap in the skin due to splitting of the tissue at the site of
impact.
• Crushing of skin between 2 hard objects
• Margins of these type of lacerated wound may appear to be cleanly
cut on naked eye examination
• Therefore any wound over such area of the body must be examined
under hand lens for a correct opinion regarding the nature of wound.
• Stretch laceration –
• when blunt force impact causes overstretching of the skin and
underlying tissues which is more or less fixed and stretched beyond
their elasticity.
• Commonly seen in cases of traffic injuries involving pedestrians,
motorcyclist when knocked down and dragged by a vehicle
• Avulsion laceration/Flaying:
• This is a special type of stretch laceration where a portion of the skin
with subcutaneous tissue is stripped off longitudinally from the
underlying muscle tissue by grinding compression .
• When sufficient shearing force delivered at an acute angle to detach a
portion of surface tissue or viscus from its attachments.
• Shear strain:
• Strain which is produced in body by forceful alteration of its shape,
but not its volume.
• It causes two parts of a body in contact with each other to slide
relatively to each other in a direction parallel to their plane of
contact.
• Tear laceration:
where tearing of skin and soft tissues occur from localized pressure or
impact against irregular or blunt object .
e.g. Fall over rough projected object, blows by broken glass bottle
• Cut laceration :
these are produced by not so sharp rather blunt edges of heavy cutting
weapon like axe, chopper.
Here skin margins ,though cut, are found to be somewhat irregular and
uneven, hairs not cut but some of them forced in to the depth of a
wound.
MEDICOLEGAL IMPORTANCE
•Shape and size not usually related to causal.
•Rarely self-inflected.
•Trace evidence in wound (rust or dirt).
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