Traumatology

Dr. ROMANA MALIK

Forensic Medicine & Toxicology
MECHANICAL INJURY:
Injury where transfer of kinetic energy occurs

TRAUMATOLOGY:
Science which deals with all aspects of mechanical injury

FORENSIC TRAUMATOLOGY:
It deals with interpretation and certification of trauma in
the light of law
 Factors affecting Wound
Production Or Mechanism of Injury
1. Weapons:
a) Type of weapon
b) Mechanical force
i) Direct force
ii) Indirect force
c) Weight and velocity of weapon
d) Type of tissues
e) Resistance of the tissues
f) Motion of the body part
WOUND:
Disruption of the anatomical continuity of tissues of
the body

INJURY:
It is harm illegally cause to any person in body, mind,
reputation and property

HURT:
“In law it means causing of pain, harm, disease,
infirmity, injury, impairing, cause disabling,
dismembering any organ of the body or part thereof
without causing death.”

*All wounds are injuries,

all injuries are not wound
Types of body injuries:
1. Mechanical injuries
2. Firearm injuries
3. Road Traffic injuries
4. Thermal injuries

1. Mechanical Injuries: --------------> according to weapon used

i. Abrasion -------------------------> blunt force trauma
ii. Bruises ------------------------------> blunt force trauma
iii. Lacerations ---------------------------> blunt force trauma
iv. Incised wounds ---------------------> sharp force trauma
v. Stab wounds ------------------------> sharp force trauma
vi. Firearm injuries -------------------> firearm trauma

2. Other injuries: --------------------> irrespective of weapon used

i. Defence wounds
ii. Self-inflicting wounds
1. Abrasions:
A superficial injury involving only the superficial
layer of skin due to a mechanical force

Caused by:
Friction between skin and rough object.

Characteristics:
• Bleeds slightly
• Heels rapidly
• Leaves no scar

Classification of Abrasion:
1. Scratch
2. Graze
3. Imprint/pressure/contact
1. Scratch:
Linear injuries produced by pointed object running across the skin.
e.g Rough stone, pin, thorn, finger nail.

*Direction of injury is indicated by

sharp edge initially --------------> heaped up epithelium at the end

2. Graze: (brush, friction burn)

Injury is produced when broad surface of the skin slides
against a rough surface.

• It resembles a burn produced by friction,

therefore known as a friction burn.
• Commonly seen in traffic accidents, when the body is dragged
• Contaminated with grit

*Direction of injury is indicated by

serrated border initially -------------> heaped up epithelium at the end
3. IMPRINT:
PRESSURE,CONTACT , PATTERNED ABRASION

Injury produced by direct impact, pressure, contact

with some object which stamps its shape upon the
skin.

4. Ligature mark in hanging

5. Nail and thumb marks in manual strangulation
6. Teeth marks in biting
7. Whip mark in beating
8. Radiator or tyre marks in accidents
9. Muzzle mark in gunshot injuries
AGE OF ABRASION
• Bright red………………………….. Fresh abrasion
• Red Scab formation………………......12-24 hours
• Reddish brown scab …………….........2-3 days
• Peripheral growth of epithelium………….4-7days
• Complete healing (scab separation)……10days

Medicolegal aspects:
1. Site of impact
2. Identification of object
3. Cause of injury
4. Direction of injury
5. Time of injury
6. Any infection
7. Confusion with burns
2. BRUISES:
Also known as contusions
“It is an infilteration or extravasation of blood into the
tissues,due to rupture of small vessels as a result of blunt force”

*Bruise is visible through the skin

*Contusion is bleeding in the visceras e.g spleen,liver and not visible
externally
also known as Deep Bruise.

Classification of bruise:
1. Intra-Dermal Bruise
2. Subcutaneous Bruise (usual)
i) small pin-head
ii) Hematoma
3. Deep Bruise
Colour changes/ Age of Bruise:
• Red (Hemoglobin) Fresh bruise
• Blue (deoxygenated Hb) 1 day
• Bluish blackor brown (hemosiderin) 2-4 days
• Green (Hemotoidin) 5-7days
• Yellow (Bilirubin) 7-10 days
• Normal skin (phagocytes remove pigments) 14-15 days

Factors modifying appearance of a bruise:

1. Site of the injury
2. Vascularity of the part
3. Age
4. Sex
5. Color of skin
6. Natural disease
7. Gravitational shift of the blood
 Gravitational shift
The facial planes at the site of impact may prevent
blood from reaching the surface.
The bruise may not appear at the site of injury and
obeys law of gravity and therefore known as ectopic
bruise

e.g :
1. Head Bruise around the eye (spectacle
hematoma/black eye/Racoon’s eye)
2. Vertex of head Bruise behind the ear (Battles sign )
3. Fracture femur Head Bruise on outer aspect of lower thigh
4. Blow on the thigh Bruising around the knee
5. Blow to the calf muscles Bruise around the ankle
What is RACCON EYES?????
What is a Raccoon????
Medicolegal Aspects of Bruise:
1. Identification of object
2. Degree of violence
3. Cause of injury
4. Time of injury
5. Possibilty of infection

ARTIFICAL/FALSE BRUISE/PSEUDO BRUISES:

• To substantiate a false charge of an assault
• Artificial bruises are sometimes formed by the application of irritant
substances e.g.
i) marking nut juice
ii) calotropis
iii) root of plumbago
 TRUE BRUISE FALSE BRUISE

Colour changes are present No Colour changes are seen

Margins are much defined Margins are not much defined

Swelling is seen No swelling is seen

Extravasation of blood is present No extravasation is present

Blood coagulation is present No blood coagulation

On any part of body Only at accessible part

No itching Itching is present

Area is not corroded Signs of irritation or corrosion are seen

Chemical tests are negative Chemical tests are positive

Blood is present in true bruise Serum is present in false bruise

LACERATION:
“It is a wound with rupture of the skin or tears of the underlying tissues as a
result of the application of blunt force”

The offending object and amount of force determines the type & degree of
laceration

There is no relation between shape and size of wound and the weapon
producing it.

Lacerations are more commonly produced

• on the areas of the body where underlying structure is a rigid structure e.g
bone
So if blow over cheek bone………Laceration.
an identical blow on cheek ……... only bruise.
Characteristics of Laceration:
1. Edges/Margin….........................irregular,swollen,torn,inverted
2. Angles ………...………………….….....irregular
3. Deeper tissues ………..…….…..…..unevenly divided (tissue bridging)
4. Surrounding tissue ………….……..contused and swollen
5. Bleeding ………..………………….…..scanty (blood vessels crushed)
6. Leaves a Scar

CLASSIFICATION OF LACERATION:
Depending upon the manner of their production

7. Split laceration…………..………….. blunt perpendicular impact

8. Stretch laceration…………………… tangential impact

9. Avulsion…………………………………..horizontal impact

10. Tears………………………………………..irregularly directed impact

11. Internal laceration …………………. impact exceeding the tensile strength

& elasticity of internal organ
1. SPLIT LACERATION:
• “Lacerations produced due to crushing of skin between two hard objects i.e
underlying bone and object responsible for injury’’

• caused by: blunt perpendicular impact

• Results in linear split in the skin,which simulates an incised wound

• Common site: scalp,face,hands and lower legs

2. STRETCH LACERATION:
“Laceration produced due to overstretching of the skin till it splits and
produces a flap ”
• Caused by: Blunt tangential impact

• Flap produced indicates the Direction of the force

• Examples: i) Glancing kicks with a boot

ii) head strikes with motorcar wind screen
during accident
3. Avulsions: ( Grind Laceration)
“Laceration caused by grinding compression of
tissues,causing degloving of skin and crushing of underlying
muscles”
• Caused by: Horizontal impact

• Examples: crushing injuries by machinery

Vehicle wheel passing over a limb

4. TEARS:
“LACERATION CAUSED BY IMPACT AGAINST IRREGULAR OR
SHARP OBJECTS”
• Caused by: irregularly directed impact

• Examples: i) blows from broken bottles

• ii) falls on earthen-ware pots
INCISED WOUND:
“Injury caused by a weapon with a sharp cutting edge when it
is drawn across the skin”
• The long axis of these wounds is their length rather than depth. The weapons
include knives, razors, broken pieces of glasses.

• Caused by: Sharp edged weapon

Characteristics of Incised wound:

1. Edges…………………………………….smooth, clean cut, even , everted
2. Angles ………………………………… everted
3. Deeper tissues……………………..clean, evenly divided
4. Surrounding tissues…….……….free from bruising
5. Bleeding……………………………….freely and profusely
6. Measurements …………………..Length of wound is greater than depth
7. Clothes involved…………………..cut marks present on the clothes
8. Shape…………………………………...spindle shape or linear
Tailing :
Towards the end of the cut, the wound becomes increasingly shallow,
known as the tailing of the wound.
It indicates the direction.

Hesitation / Tentative Cuts:

“These are preliminary cuts made by a person intending to commit suicide by a cutting instrument
before gathering sufficient courage to make a final deep incision”

Common site: wrist and cut throat

Characteristics:
1. Small, multiple,parallel and superficial cuts
2. Seen at the commencement of the incised wound and
merge with the main incision

*TAILING:
Tailing may determine handedness of person
MEDICOLEGAL SIGNIFANCE OF INCISED WOUND:
1. HOMICIDAL INCISED WOUNDS: i) deep
ii) associated with defense injuries
iii) on any part of the body
common site:face,neck,genitals

2. SUICIDAL INCISED WOUNDS: i) multiple, superimposed,varying depth

ii) Self inflicted
iii)accessible parts of the body
common site: elbows,wrist,throat,groin

3. ACCIDENTAL INCISED WOUNDS: i) on any part of the body

ii) irregular,clean cut and everted
margins
commonly in traffic injuries,fall on broken
glass bottles
Difference between Incision & Split Laceration:
Character Incision Split Laceration

Margins Straight Ragged

Wound bed Clean out Bridging

Bleeding Profuse Scanty

Blood vessels Cut Crushed

Hair bulbs Cut Crushed

Trace evidence Mostly absent Mostly present

(Foreign body)
Infection Less More
STAB WOUNDS:
“Injury caused by pointed object when it is driven in through skin
and its depth is the greatest dimension”

weapons used; knife,dagger,needle,spear,arrow,scissors,ice pick

Types:
1. Penetrating stab wound:
i) when weapon enters a body cavity such as
thorax or abdomen
ii) only entry wound present
2. Perforating stab wound:
i) when a weapon after penetrating the
tissues,comes out from the other side making an exit wound
ii) both entry and exit wound is present
3. Punctured stab wound:
i) made by pins,needles
ii) M/L importance in INFANTICIDE
iii) fontanelle,nape of neck,axilla.
Characteristics:
a) Wound of Entry:
i) bigger than exit wound
ii)shape corresponds to the weapon used
Knife ( single edge) ‫ ……………… چاقو‬Wedge shaped
dagger( double edge) ‫ خنجر‬..................elliptical shaped
iii) size of wound
a) Smaller than breadth of weapon.
b) In drawing out,due to Rocking movement
than it becomes larger
iv) margins clear cut and inverted.
In rusty weapon ..………… edges everted
& bruised
b) Wound of EXIT:
i) SMALLER than entry wound
ii) Margins everted

c) Depth
is greater than its length and breadth
 MEDICOLEGAL ASPECTS OF STAB WOUND:

1. Nature & dimensions of the weapon used.

2. Position of victim and assailant from direction of wound.

3. Nature of injury and intention

i.e Homicide,
Accident
Suicide

4. Stab wound is converging wound whereas firearm

is diverging wound.
 DEFENCE WOUNDS:
“Injuries sustained by a person as a result of his spontaneous reaction
to protect himself when attacked”

Common site:
i) grasping surface of hands
ii) ulnar borders of forearms
iii) dorsum of hand
iv) lower limbs in sexual assault
v) Back

Characteristics:
• May be superficial or deep
• Corresponds to the weapon used
• Tells about victim’s awareness,consiousness &
ability to resist e.g not seen if hands are tied
SELF-INFLICTED WOUNDS:
“Injuries produced by a person on his body himself (self inflicted) or
caused by other acting in agreement with him ( friendly hand injury).”

Also known as FABRICATED, FACTITIOUS,FORGED or INVENTED INJURIES

Common sites: easily accessible parts of body e.g top of head,
forehead,front and outer side of thighs

Characteristics:
i)parallel,multiple & superficial
ii) non-involvement of clothes & vital organs
iii) hestation marks may be present

OBJECTS:
a) To support a false charge

b) To avert suspicion
CAUSE OF DEATH FROM WOUNDS:
1) PRIMARY OR IMMEDIATE CAUSES
i) excessive bleeding
ii) injury to vital organs
iii) neurogenic shock
iv) Embolism
v) Crush syndrome

2) SECONDARY OR INDIRECT CAUSES

i) infection
ii) thrombosis
iii) sepsis
iv) supervening of new disease
v) exacerbation of pre-existing disease
vi) neglect of patient
 FEATURES LACERATION INCISED WOUND STAB WOUND

Type of weapon Blunt weapon Sharp weapon Pointed weapon

Shape Irregular Linear/Spindle Depends on type of

weapon
Site Usually over bony Anywhere Usually on chest and
prominences abdomen
Surrounding Burised Normal Abraded/Bruised

Margins Irregular Clean cut and everted Entry wound inverted

Dimensions Variable Length > Depth Length < Depth

Hair & Blood Vessels Crushed Clean cut Variable

Hemorrhage Less Profuse Variable

Foreign body + _ +/-

Thank You