INJURY

CHAPTER: 5 INJURY

1. Define injury and classify in detail

2. Describe abrasion in detail with medico legal aspects
3. Define fire arm injury, fire arm and classify fire arm
4. differentiate entrance wound and exit wound
5. Write note on shot gun wound
6. Define Thermal injury with estimation of burns
7. Describe Burn and Scald
8. Describe Grade of burn
9. Differentiate Ante mortem burn and Post mortem burns
[Link] Sun stroke and heat stroke
[Link] Pugilistic attitude or Boxing attitude
[Link] Defense wound
[Link] Hesitational cuts
[Link] Fabricated wound
[Link] Regional Injury
[Link] Cerebral contusion
[Link] cerebral concussion
[Link] Punch drunk syndrome of Boxer injury
[Link] Bumper injury
[Link] Assault
[Link] Battery
[Link] Hurt and Grievous hurt
[Link] Injury Report

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Definition: According to section- 44 IPC injury is defined as any harm or damage caused to any
person in body, mind, reputation or property by another human being illegally with bad intention
known as injury.

Wound: clinically it means any injury where there is broken /rupture or torn of natural
continuity of skin or mucous membrane, it include any lesion, external or internal, caused by
violence, with or without breach of continuity of skin.

In Medicoleagal practice, the term 'wound’& ‘injury’ are synonymous

CLASSIFICATION OF INJURIES/WOUNDS

Injuries are classified in many ways such as:

I. BASED ON CAUSATIVE FACTORS: It is classified in following groups:-

1. Mechanical/physical injuries
2. Thermal injuries
3. Chemical injuries
4. Miscellaneous injuries

II. BASED ON MANNEROF INJURY OR MEDICOLEGAL CLASSIFICATIONS

1. Suicidal injury
2. Homicidal injury
3. Accidental injury
4. Defense wounds
5. Fabricated wounds

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III. BASED ON TIME OF INFLICTION OR INJURIES IN RELATION TO
DEATH
1. Ante mortem injury ( recent or old)
2. Postmortem injury

IV. BASED ON NATURE OF INJURY/ LEGAL CLASSIFICATION

Whether the given injury is hurt or grievous hurt or likely to cause death.

1. Simple injury :- Healed within a week, No scar formation, No permanent

deformation
2. Serious injury (life threatening injury) :- It takes more than 10 days for healing,
Scar formation present Permanent deformation present
3. Grievous injury (Serious nature injury) It carries under sec 320 IPC. In this
injury-
 Permanent privation of sight of either eyes, Hearing,
 Privation of body parts,
 Destruction of any organ,
 Permanent disfiguration of face and head,
 Fracture and dislocation of face & head,
 Depriving of male masculine power (testes power)(emasculation) (by
damaging sexual organ)

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1. MECHANICALINJURIES: -produced by physical violence.

• Abrasion,
• bruise, or contusion,
• Laceration wounds,
• Fracture/ dislocation of bone, tooth or joint.
• Incised wound,
• Chopped wound
• Stab wound (punctured wound)
• firearm wounds

2. THERMAL INJURIES:

• Due to heat: e.g.- Burns & scalds

• Due to cold: e.g.- hypothermia, frost bite & trench foot.

3. CHEMICAL INJURIES: due to application of Acids & Alkalis, plants or

animal extracts.

4. MISCELLANEOUS INJURIES:

• Electrical
• Radiation- x-ray, UV radiation, radioactive substances.
• Lightning injuries
• Blast injuries (explosion)

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Weapons-Section 324 & 326 IPC Weapon is define as- any instrument or mechanical devices
which when used in a hostile manner to cause injury or bodily harm or to cause
death.
Types of weapon:

1. Blunt weapon- ghota, thapa, belan, hammer, stick, stone, fist, Hunter.

They Produce- Abrasion, contusion, Laceration, Fracture & dislocation.

2. Sharp weapon- with a sharp cutting edge & sharp splitting edge knife, scalpel, razor,
axe, hatchet, scissors, blade, razor, axe, saw, crow, bar, sword.

They Produce-incised, chopped & stab wound.

3. Pointed weapon- needle, arrow, ice- peeker, knife, and dagger.

They Produce- penetrating wound

4. Fire arm- riffles, Guns, revolver, Pistol.

They Produce-Entrance & exit wound.

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 I. MECHANICALINJURIES: -produced by physical violence.

ABRASION:

Abrasion:- it is a type of mechanical injury involving cuticle superficial epithelial layer of skin
usually the epidermis & papillary dermis which removed or destroyed by application of some
rough or hard object. Abrasion may be the only external indication of serious internal damage

Types of abrasion-

• Scratch/ linear abrasion—it is caused by a sharp or pointed object passing across the
skin such as – finger nail, thorn or pin. Finger nail abrasion is seen in throttling, sexual
assault. Abrasion over inner aspect of thigh, genitalia, breast, and lower abdomen may
indicate sexual assault. Abrasion over lips, mouth & nostril indicate suffocation.

• Graze abrasion-(sliding/ scrape/ grinding abrasion)- caused by horizontal friction

between the skin & hard rough surface which shows uneven, longitudinal parallel lines
which indicate direction of force. It is seen in (RTA) road traffic accidents particles of
glass, gravel, dirt embedded in such wounds.

• Pressure abrasion- (crushing/ friction abrasion)- it is caused by direct impact or linear

pressure of a rough object over the skin resulting in crushing the superficial layer of the
skin & bruising underneath. e.g.- ligature in hanging & strangulation.

• Impact/ contact abrasion- it is caused when force is applied perpendicular to the skin&
cuticle bears the imprint of the object. E.g.- imprint of bicycle chain, imprint tyre of
moter vehicle, teeth bite mark.

Age of abrasion: it produces minimum bleeding & heel rapidly within 1-2 weeks and leaves no
permanent scar.

Circumstances of abrasions: usually abrasions are seen in accidents & assaults.

Medicoleagal importance: abrasion gives an idea about site of impact & direction of force &
helpful in connecting with causative weapon, injury scene of crime, character & manner of injury
known from its distribution: in throttling, smothering sexual assault abrasion found on face ,
mouth, nose, throat, breast, genitals, inside the thigh and around the arm. Abrasion over inner
aspect of thigh, genitalia, breast, and lower abdomen may indicate sexual assault. Abrasion over
lips, mouth & nostril indicate suffocation.

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 BRUISES/ CONTUSION
definition:- it is a type of mechanical injury characterized by patch of discoloration caused by
extravasations of blood in tissues commonly in subcutaneous/ sub epithelial tissues due to due to
rupture of blood vessel usually capillaries as a result of blunt force injury or pressure. In bruises
there is no loss of continuity of the overlying skin& the lesion is observed through the overlying
intact skin as bluish-purple discoloration &swelling of the involved area, while a contusion is a
bruise with in a organ or tissue. Such as- muscle, liver or mesentery.

Causes: bruises caused by-application of blunt force such as - any hard & blunt weapon, stick,
iron-bar, kicks, and blows and by compression like pressing finger.

Classification: Bruise is classified in to three types depending on its situations:

• Intradermal- bruise- lies in the immediate sub epidermal layer & hemorrhage sharply
defined
• subcutaneous, - it is situated in subcutaneous tissue in fatty layer caused by blunt
object& appear as dark red swelling soon after injury.
• deep bruise- bleeding to the deeper subcutaneous tissue appears at the surface after
hours to 2-3 days called delayed bruising
Age of bruise: Bruises takes about 2 weeks to clear. it is extremely variable and only a general
guideline to interpreting age of bruises. Normal color change& start at the periphery &extends in
ward to Centre.

• Fresh bruise color is red,

• few hours to three days- blue color,
• 4-5 days bluish black to brown,
• 5-6 days green,
• 7-12 days –yellow,
• 2 weeks normal color.
• Complications:
• multiple contusions can cause death from shock & internal hemorrhage
• Gangrene & death of tissue can result.

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 • Bacterial infection, especially by clostridia can occur.
• Pulmonary fat embolism may occur.

Medico legal importance:

• Age of injury can be determined by color changes
• Degree of violence may be determined from their size.
• Patterned bruises may connect the victim & the object/weapon, e.g.-chain, whip, or
ligature.
• Nature of injury- simple or grievous.
• Bruises may be fabricated by applying juices of marking nut or calotropis to incriminate
others, or in defense of a crime
• Character & manner of injury may be known from its distribution: bruises on body parts
from finger, nails of struggle, throttling, strangulation, sexual assault

Bruises are of lesser value than abrasions because:

• Their size may not correspond to the size of the weapon

• They do not indicate the direction in which the force was applied
• They may become visible after few hours or even 1-2 days after injury.
• They may appear at a distance away from the actual site of injury. It may not
indicate the point of trauma.

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 Lacerated wound
Definition- laceration is the tearing or splitting of skin, mucous membrane, muscles or internal
organs caused by crushing force & produced by application of a blunt force to a broad area of the
body. If the blunt force produces extensive bruising & laceration of deeper tissue, it is called
crush injury.
Types of laceration:
 Split laceration- it is occurs when soft tissues are crushed between hard deeper structures
& object applying the force. Scalp laceration occurs due to tissue crushed between the
skull & some hard object.
 Stretch laceration- result from a heavy forceful frictional impact of blunt forces they are
seen in run over by motor vehicle, kicking & in compound fracture
 Avulsion or grinding compression- it is produced by shearing force delivered at an
oblique angle to tear off a portion of traumatized skins surface or tissue/ organ from their
attachments. It is commonly seen in road traffic accidents& commonly occurs in legs.
Like- Amputation injuries, decapitation injuries in which head separates from the body.
 Tears- tearing of skin & subcutaneous tissue can occurs from lacerated impact by some
hard irregular object like- car door handles, broken glass bottles.
 Cut laceration- it is a heavy sharp edged laceratio0nj causes a deep & wide cut over the
body tissue.
 Lacerated wounds produces permanent scar on healing.
Complications:
 Laceration may cause fatal bleeding leading to shock & death.
 Systemic fat embolism may occurs due to crushing of subcutaneous tissues
Medico-legal importance:
 the type of laceration may indicate the cause of injury & shape of blunt weapon
 nature of injury- may be simple or grievous
 Manner of production- like accidental, homicidal, suicidal, foreign matter in wound
may give clue about the objects.

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 Incised wound (Cut/ slash/ slice)
Definition: incision is a clean cut wound through the tissues (usually the skin &
subcutaneous including blood vessel) which is more long than deep, & caused by a
sharp edged instrument.
Such as- knife, box cutter, glass, razor or scalpel.
Medico-legal importance:
 Indicates the nature of weapon
 Give an idea about the direction of force
 Nature of injury- simple or grievous
 Position & character of wound may indicate manner of production- e.g.-
suicide, accident or homicide (hesitational cut), defense wound, self-
mutilation.

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 CHOP WOUND

Definition: chopped wound are deep gaping wounds caused by a blow with the
moderately sharp cutting edge of a heavy weapon applied with a significant
degree of force. A chop wound is considered a combination of blunt & sharp
force injury.
Weapon used: Axe, meat cleaver, hatchet.
Character: margins are sharp, & may show abrasion, bruising & some laceration
with severe injury to the underlying organs.
Medico-legal importance:
 Most of the injuries are homicidal & inflicted on the exposed portion of the
body. Like- head, face, neck, shoulder & extremities.
 Few are accidental due to machinery
 Wounds reveal clue regarding the causative weapon.

STAB- WOUND/ PUNCTURED WOUND

Definition: stab wounds are produced from penetration with long narrow
instruments having pointed ends into the depth of the body which are deeper
than its length & width.
Weapons used: knife, pieces of glass, scissors, dagger, screwdriver, pens, ice picker
or fork.

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 Concealed punctured wound

Definition: These are punctured wounds caused on concealed parts of body, such
as – nostrils, fontanellae, axilla, vagina, rectum, inner canthus of eye, nape of
neck, caused by slender instruments such as ice picker or knives with thin
blades. Fatal penetrating injuries can be caused without leaving any easily
visible external marks or bleeding.
Types: clinically stab wound are two types
1. Penetrating wound— in penetrating wound weapon enters in to the
body cavity & producing only one wound. E.g. –wound of entry.
2. Perforating wound-- in this wound weapon after entering in to one side
of the body will come out through the other side & producing two
wound.
Wound of entry is longer & with inverted edges.
Wound of exit is smaller with Everted edges in this wound tip of
weapon emerges out of the body.
Medico-legal importance-

• shape of wound may indicate type of weapon

• depth of wound indicate force of penetration

• broken fragment identify the weapon

• Position, number & direction of wound indicate manner of production like-

suicidal, homicidal or accidental.

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 DIFFRENTIATE INCISED, LACERATED, PUNCTURED WOUND

INCISED WOUND LACERATED PUNCTURED

WOUND WOUND
DEFINATION Clean cut wound Tearing of skin Through skin &
through the tissue. It is & subcutaneous deep tissue.
produced by sharp tissue Produced when
cutting instrument such force is delivered
as- knife, razor, blade, along the long axis
sword, scalpel, chopper, of narrow or pointed
Axe object into the deep
of body

Site Any site Usually on bony Usually chest &

prominence Abdomen

Margin Smooth edges are Irregular margin Regular & clear cuts
regular, clean-cut margin

Size Length greater than Length is greater Depth is greater

width & depth than depth than lenth & width

Shape Linear Irregular Linear

Depth Cleanly cut up to depth Irregular with Much more depth

varying depth

Hemorrhage Profuse & external Less & More & internal

internal

Bones May be cut Fractured bone Punctured bone

Produce by Scalpel or sharp object Blunt instrument Sharp instrument

Foreign body Absent Usually present May or may not

present

Repair Very easily Take more time Take Maximum

time

Medico legal Suicidal , Homicidal, DO DO

importance Accidental

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 CAUSE OF DEATH-

1. Primary cause (immediate or direct)

 Hemorrhage

 Shock

 Injury to the vital organs

 Hemorrhage-may be internal (concealed) & external (visible) it produces

syncope from the loss of blood, Hypoxia & Death.

 Shock- In shock death from paralysis or sudden stoppage of hearts action

due to excessive stimulation of peripheral sensory nerves or reflex vagal
inhibition from severe injury.

 Injury to the vital organs- Heart, Lungs, Brain produce sudden death

2. Secondary cause (Remote or indirect cause)

 From complication of injury it self

 From complication of surgical treatment.

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 Examination of an injured person

In such cases note the following by medical men-

 Nature of wounds- incised, lacerated, or punctured

 Total numbers of wounds.

 Position of body

 Size of wound- Length, breadth, depth & direction

 Edge of wounds

 Any foreign body present in the wounds

 Hemorrhage& its amount& blood clots

 Blood stains on the floor nearby.

 Inflammation & other sign of tissue repair

 Wounds- Ante mortem or post mortem, simple, Dangerous or grievous

 Cuts & stains on garments

 Mode of death- suicidal, homicidal, accidental

 Cause of death.

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 Fire arm injuries

Definitions

 Ballistics: it is the science of projectile motion and conditions

affecting that motion.

 Forensic ballistics: science which deals with the investigation of

firearms, ammunition and the problems arising from their use.

 Bullet: (little ball) bullet is the projectile of a rifled firearm that leaves
the muzzle when it discharges. it is made of soft metal lead with
antimony /tin added to provide hardness

 Cartridge: cartridge is one unite of ammunitions. It consists of : -

• Cartridge case with percussion cap containing primer.

• Propellant charge ( gun powder) –( it consists 75% Potassium

nitrate, sulfur 10%, 15% Charcoal)

• Projectile ( bullet/ pellets)

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 Fire arm injuries

Fire arm injuries: these are produced by projectiles discharged from firearms and present
the characteristics of lacerated wounds but the character varies according to the

 Nature of the projectile

 Velocity of the projectile at the moment of impact

 Distance of the fire arm from the body at the time of discharge

 Angle of impact.

Characteristics- They generally produce two wounds or apertures

 Entrance wound

 Exit wound

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 Fire arm

Fire arm: Any instrument or device which is designed to propel a projectile or

discharges a missile) by the expansive force of gases generated by burning of an explosive
substance.

It consists of various parts:

 Barrel – it is a hollow metal cylinder in which the propellant charge is placed. It is

long in rifles and shotguns, and short in revolvers and pistols. The lumen is known
as bore.

 Long barreled Fire arm- riffles, Guns

 Short barreled Fire arm- revolver
 Smooth-Bored fire arm-Pistol
 Butt/grip- Rear portion of stock in a shoulder arm.

 Action- it consists of a bolt, a striker and a trigger.

Classification of firearms:

Fire arms are classified into two categories depending on the type of barrel:

I. Rifled weapons

• Rifles: o.22, single shot, lever action, bolt action, pump action, auto loading.
• Revolvers: swing out, break top, solid frame.
• Pistols: single shot, auto loading.
• Machine guns.

ii. Smooth bore weapons (shotguns)

• Single- shot
• Bolt action
• Double barrel
• Pump action

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• Lever actions
• Country made fire arms (katta) are mostly 12 bore smooth bore weapons.

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 Differentiate entrance & exit wound.

ENTRANCE WOUND EXIT WOUND

Size of Smaller than the diameter of bullet as Larger than the bullet as
wound the bullet enters the skin like a drill the Missile has lost its
velocity & there force
Tears the tissues around

Bleeding Less More

Clotting Turned in & may be carried in to Turned out

fibers wound

Edges Inverted as bullet enters Everted & torn as bullet

comes out

Fat No protrusion out side Protrude Out side

Abrasion or Present Absent

bruces

Burning ,Bl May be present around the wound Absent

ackening

Tissues May be cherry red due to CO of Absent

explosive gases

Skull Clean cut Cone like excavated

appearance

Metal ring May be Seen around the wound Absent

Grease Present Absent

collar

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 Shot Gun wounds-

 Star shaped wound- from contact fire

 Irregular wound- from near fire

 Circular wound with irregular margin- from close fire

 Multiple small pellet pattern-from distant fire

Nature of the projectiles-

• Large bullets cause greater damage

• Round bullets cause larger wound

• Conical bullet cause extensive laceration

• Modern high velocity bullet may pass straight & direct through the body without
deviation in these cases wounds entry & exit are both round & similar in appearance
without any bruising or laceration of surrounding parts powder sometimes produces
frightful laceration of internal organs.

Velocity of the projectile at the moment of impact-

High velocity bullets shows- clean, circular, punched out aperture without any deviation.
Track of bullet wider & deeper

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 THERMAL- INJURY

Thermal- injury:-injury that result from the effects of systemic and/or localized exposure
to excessive heat or cold

 Injury Due to cold- Frost bite, trench foot, Immersion foot.

 Injury Due to Heat- Burns scalds.

Death due to cold

Death from cold by exposure of excessive cold (frost bite). It may be homicidal & accidental.
Accidental in heavy drunkards & homicidal as in infanticide & may produce death from cold.
Body temp reduced 15-200 f below normal

Clinical features:-
 Erythematous patches on skin,
 Heart action feeble, pulse weak.
 Stupor, coma & death.

Causes of death:- Reduced supply of O2 to tissue because Hb is unable to part with O 2 at low
temp.

Postmortem appearance:-
 Skin pale with irregular dark red patches on more exposed part.
 Brain congested c ventricle filled with serum
 Hearts full of blood both side
 Other organ are congested
 RM- well marked
 PM- lividity- well marked (brain congested)

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 Death due to heat

Death due to heat- Burn& scalds produced by heat.

Burn -is produced by dry heat. E.g.- flames away hard articles.

Scald -is produced by moist heat. E.g.- steam

Heat produced have injurious effect on external or internal surface of body which produce
destruction and pathological changes in body tissues & death may occur from exposure
to excessive heat.

Cause of caused by- Fire, electricity, chemical, sun burns, and steam.
Factory heat, engine heat, badly ventilated warm room.

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 DIFFERENCE BETWEEN BURN & SCALD

DEFINATION BURN SCALD

PRODUCED Burn by dry heat. Like flame Scald by moist heat

BY like vapors

Cause Flame vapors

Blister Blisters may not be found Blister form

invariable

Cloths Burning of cloths Wetting of cloths

Not burn

Color of skin Black marks of burns White(Bleached)

Site of burn At & above the site of flame At & below the site
of application of heat

Skin Dry & shriveled Moist & sudden

bleached

Scar Thick & contracted Thin & less

contracted

Vesicles At the circumference of burnt area On the whole area

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Grades of burn

1. Partial thickness- involvement of epithelial element & deeper part of hair

follicle, sweat gland, sebaceous gland.
2. Full thickness- destruction of all thickness of epithelial element & dead skin will
separate into 2-3 weeks showing red granulation.

Degree of burn

1st degree:- simple redness present caused by – flame, liquid of slight temperature, mild
irritant chemical, hot solid articles.
2nd degree:- in this vesicles are produced by highly heated solid / liquid or prolonged
exposure of heat.
3rd degree:- burn result from content with lightly heated metal or prolonged exposure of
flame or fluid above 1000c temp.
4th degree:- burn in this stage destroy nerve ending with absence of pain.
5th degree:- destruction of muscle & soft tissue (charring)
6th degree (fatal stage):- (charring) destruction of bone.

Estimation of burn

Head & neck - 9% = 0 9%

Trunk - 18% * 2 = 36%
Upper limb - 9% *2 = 18%
Lower limb - 18% * 2 = 36%
Perineum - 1% = 01%
100%
Clinical features of burn:-
 Burning
 Redness
 Blister of skin
 Destruction of skin

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 DIFFERENCE BETWEEN ANTI-MORTEM & POSTMORTEM BURN

ANTI-MORTEM POSTMORTEM BURN

Line of Present Absent

redness

Blister or Contain serous fluid with high protein Contain air No-protein &
vesicles & chlorides chloride

Infection Pus & sloughing NIL

Enzymes Shows of increase in enzyme action Does not show increase

enzyme action

Inflammatio Present Absent

n

Hyperemia Present Absent

Thrombosis Present Absent

Car boxy HB Present Absent

in blood

Healing Granulation NIL

Soot in upper Present Absent

reparatory
tract

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 SUN-STROKE/ HEAT STROKE

Sun-stroke/ Heat Stroke:-It is usually caused by exposure to excessive heat of sun &
characterized by-

 Vertigo, Giddiness, Nausea, Vomiting

 Face Flushed, Unconsciousness,

 Pupil Dilated Pulse Full& Bounding

 Rapid rise of Temperature& death may occur within 5 minutes.

Post mortem appearance:- Rigor Mortis & post mortem Lividity well-marked

Medico legal importance:- Accidental.

PUGILISTIC ATTITUDE (BOXING ATTITUDE

Pugilistic attitude (Boxing attitude):- This condition is present after death in Thermal injuries
due to Burn. After exposed to great heat Posture of Dead body shows specific appearance of:-

 Flexion of Legs at hip &knees.

 Arm flexed at elbow & held in front of the body as commonly found in BOXERS.

It occurs due to coagulation of protein of muscles which causes contraction

Medico Legal- Suicide Homicide, Accident, Fabricated, Defense

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WOUNDS

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 II. MEDICOLEGAL CLASSIFICATIONSMODE OF DEATH –

Differentiate Suicidal, Homicidal & Accidental wound.

SUICIDAL WOUND HOMICIDAL ACCIDENTAL
WOUND WOUND

Position of On the front exposed No fixed side usually Anywhere.

wound portion-neck , chest on vital part (HEAD&
CHEST)

Site In left side in silent room Disturbed surrounding Any site

Weapon Around the body Absent Present

present

Arrangemen Arranged Irregular Regular or

t Irregular infixed
direction

Nature of Usually incised clean cut Lacerated Incised or

wound wound Lacerated

Number of Multiple Multiple Single or Multiple

wound

Cloths No Damage Damage Damage

Hesitation Present Absent Absent

mark

Direction of Rt. Hand person Lt. side Any direction Any direction
wound
From above down ward

Defense Defense. wound Absent present Absent

wound

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 Defense wound

Definition- Defense wounds are the wounds of extremities, which result from the
immediate & instinctive reaction of the victim toward off an attack.

Types- they are classified into two types-

1. Active defense injuries- they are seen when the victim tries to seize the weapon & the
injuries are sustained on grasping the weapon. Injuries are located on the palm, ginger &
thumb

2. Passive defense injuries – these are seen when the Vitim raises the hands or arms for
protection & located on the ulnar surface of forearms, wrists & back of hands.

Therapeutic / diagnostic wound

Therapeutic wounds are produced by medical personnel during the treatment of the
patient, e.g.- surgical wounds on the chest & abdomen for insertion of tubes for drainage,
laparotomy incision, tracheotomy & thoracotomy incision.

Hesitation cut

Hesitation cut:-These are the cuts which present in suicidal case & these are having
characteristic like- Incised wound, they are superficial not deep they are multiple in
numbers.

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 Fabricated injury/wound

Definition: Fabricated injury also known as factious or fake or forged

wounds. Fabricated wounds produced by a person on his own body with
(self -inflicted) or by another person on him (self- suffered) with his consent
with an intention to impose false charge on others. In this attempt he may
inflict multiple superficial injuries according to his prepared story.

Motive: The reasons for fabricating injuries are:

 To bring a charge of rape by a women

 Charge an enemy with assault or attempted murder
 Convert simple injury into grievous injury
 By prisoners, to bring a charge of beating against officers
 Destroy evidence of certain injury which connect a person
with crime
 For false robbery or attack by policeman / watchmen
 By soldiers & prisoners to escape difficult task
 For the purpose of insurance frauds.

Types of fabricated wounds: fabricated wound are mostly incised some

time stab or burns. Chop wound may be seen on little finger of left
finger. Burns are seen on left upper arm superficially. For fabricated
wound commonly used objects are – knife, razor, glass piece,
scissors & icepick. Fabricated wounds are found commonly on the
following parts of the body: top of the head, neck, outer side of left
arm, front & outer side of thighs, front of the chest,& abdomen.

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 III. DIFFERENTITE ANTIMORTEM & POSTMORTEM WOUND

(DEATH SIGN WOUND)

ANTIMORTEM WOUND POSTMORTEM WOUND

Wound Before Death Wound After Death

Hemorrhage Present Absent

Marks of Blood Stream mark present Absent

bleeding

Staining of Present Absent

blood

Clotting of Present Absent

blood

Gap between Present Absent

edges

Mark of Present Absent

inflammation

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 Regional Injuries

Definition: - Regional injuries consists of injuries sustained to various anatomical region of the
body such as head injury, chest injury, abdominal injury, pelvis injury etc. In India head injury is
the leading cause of morbidity and mortality.

Black eye

Black eye is a type of injury of eye in which bruising of eye lid occurs at periorbital area. It is
also called as periorbital hematoma. It is caused by –
 direct trauma
 Blood shifting downward from an injury on frontal area of scalp
 Blood entering the orbit behind or above due to fracture in the orbit- commonly due to
fracture of floor of anterior fossa of skull.
 Spectacle hematoma-It is a type injury of eye due to fracture of base of skull in which
hemorrhage occurs in soft tissue around the eyes in eyelids of both eyes. It is called
spectacle hematoma or raccoon eyes or black eye on both sides.

Cerebral Contusion

Definition:- Cerebral contusions are the circumscribed area resulting from

extravasation of blood in traumatized area of brain. Contusions are produced as a
result of shearing forces within the brain tissue at the moment of impact. In almost
all cases, there is some degree of subarachnoid hemorrhage.

Classification:
 Contusion hemorrhages
 Contusion necrosis
 Contusion tears

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 Cerebral Concussion/ stunning brain shock

Definition:- It is defined as a transient paralytic state due to head injury which

is of instantaneous onset, does not show any evidence of structural cerebral injury,
and always followed by amnesia from the actual moment of the accident. It occurs
due to acceleration/ deceleration of head.

Classification

 Grade I- No loss of consciousness

 Grade II- Loss of consciousness but for less than 5 minutes.
 Grade III- Unconsciousness for more than 5 minutes associated with
memory loss for more than 24 hours.
Medicoleagal importance – It may be confused with punch drunk syndrome or
drunkenness. Retrograde amnesia- patient is unable to recollect the event that leads
to accident or injury.

Punch Drunk Syndrome or Boxer’s injury

Definition: - It is chronic changes induced in brain by repeated minor injury, It is

also called boxer’s injury. During boxing repeated blowing in overhead induce
traumatic encephalopathy known as “punch drunk syndrome”. It is characterized
by decline in speed and coordination, slurring speech, defective memory, slow
thought, stiff limbs, unsteady gait, parkinsonian like dementia, etc. This condition
resembles like drunken person.

Bumper injury or Bumper fracture:

Definition:- It is type of injury which occurs in road traffic accident (RTA) which
is caused by vehicle to pedestrian in which victim is trucked by front of the
vehicle , then the person may sustain bumper injuries on legs with damage to skin
and fracture of bone usually tibia fracture commonly occurs.

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 MEDICO-LEGAL ASPECT OF INJURIES/ LEGAL ACTION

 Trauma: A body wound or shock produced by sudden physical injury, from violence
or an accident.

 Assault—According to Sec. 351 IPC - An assault is every attack or threat or attempt

to apply force to body of another person in a hostile manner. It does not matter
whether it injuries him physically or not. Shaking of head or showing of fist at a
person in hostile manner will constitute an assault. It may be common or with an
Intent to murder. Section 352 to 358 IPC deals with punishments for various types of
assault. (Section 299 to 377 IPC deals with offences affecting the human body)
Imprisonment up to 10 year & fine.

Medico Legal- Suicide, Homicide, Accident, Fabricated, Defense.

 Battery: it is the actual application of force to the body. It is an assault brought to

execution. Battery need not require body -to -body contact. Any volitional movement,
such as throwing an object towards another can constitute battery.

 Hurt: According to section 319 IPC hurt is defined as any bodily pain, disease or
infirmity caused to any person.

It is two types:

A. Simple

B. Grievous

A. Simple hurt – it is a type of injury which neither extensive nor serious, and
which heals rapidly without leaving any permanent deformity or disfiguration.

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B. Grievous hurt- according to sec. 320 IPC Grievous hurt comprises of eight
clauses

1. Emasculation: Deprivation of a male of his masculine vigor by cutting of

penis, or by causing injury to testes or spinal cord at the level of L3—L4
vertebrae resulting in erectile dysfunction.

2. Permanent privation of sight of either eye: dislocation of lens, retinal

tears and optic disc laceration.

3. Permanent privation of hear5ing of either ear: it should be permanent

deafness.

4. Privation of any member or joint: Member means any organ or limb of a

subject responsible for performance of distinct function. It includes eyes,
ears, nostrils, mouth, hands or feet. Joint may be small or big.

5. Destruction or permanent impairment power of any member or joint.

6. Permanent disfiguration of the head or face:

7. Fracture or dislocation of a bone or tooth.

8. Any hurt which :

 Endangers life ,

 Causes the victim to be in severe bodily pain for 20 days.

 Unable the victim to follow his ordinary pursuits for a period of 20 days.

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 INJURY REPORT

An injury report is a form of medico-legal report (MLR) giving the details of the
condition of a patient, solicited for legal purposes. Casualty medical officer or any other
medical officer may be called upon to examine the injured person
 Medico-legal injury cases should be examined without delay any time of the day
or night and are prepared immediately after the examination is done.
 The medical practitioner should enter all details of the examination of the
injured person in a Medico-legal Register in his own handwriting with a ball-
point- pen.
 The report should always be signed by the medical practitioner along with date,
full name, registration number, qualification, designation and current
employment.

An injury report comprises or three parts as given below

Injury Report

Preliminary Findings/ Opinion

Particulars Observations

1. Preliminary Particulars

i. Serial number, admission number.

ii. Name, age, sex, address, and father’s/ guardian’s name.
iii. Date, time, and place of examination.
iv. Name and number of the accompanying police constable and police
station to which he belongs.
v. Name of the person who accompanied the injured person with address and
relation.
vi. Brief statement of the injured, as to how he was injured.
vii. Two identification marks
viii. Size of the victim- stature, weight, and development.
ix. If the patient is serious, dying declaration should be recorded.

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2. Findings/Observations:- General physical examination: Consciousness,
orientation, pulse, temperature, blood pressure and reaction of pupils to light are to
be noted.

Following are the various entries in the report

i. Type of each injury: All injuries are observed and noted with site of body
parts & presence of any foreign material in wound should be noted e.g.-
abrasion, contusion, laceration, incised wound, etc.
ii. Size, shape and direction of each injury: size of all wound should be
measured and shape of the wound should be noted e.g.-circular, oval or
triangular with direction of wound i.e.- horizontal, vertical, or oblique.
iii. Location: Exact situation of wound with reference to some anatomical
landmark should be mentioned.
3. Opinion

i. Nature of each injury: it should be noted whether it is simple or grievous

ii. Weapon used to inflict the injury: weapon should be examined for marks
of blood stains, hair or pieces of cloth adherent to it, cloths should be
examined for the presence of cuts, tears or burns.
iii. Duration of injuries: opinion is based on the state of healing of the injuries.
iv. Cause of the patient’s condition: opinion on the cause of the patient’s
condition is based on the history and nature of injuries on the person.
v. Whether the weapon was dangerous or not?

Handing over the Report:

The initial report should be made and given immediately with investigation results
(blood examination, X- ray, and CT scans) which reflects the final conclusions drawn
from the examination findings available at the time of the initial consultation.

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