Slide 1

BLUNT FORCE TRAUMA

Berti Nelwan


Slide 2
Forensic Pathology
Forensic Pathology is the branch of medicine
which analyses victims of crime scenes
medically.
They are the last physician for the deceased
and their role is to discover and interpret the
evidence left during the autopsy.


Slide 3
Analysis of Wounds
Not every crime victim is murdered.
Physicians can contribute to proof of the
severity of a crime or that a crime
actually occurred in some cases for a
living victim.
Wounds provide evidence of the crime.


Slide 4
Wound Categories
Bruises (or contusions)
Abrasions (or grazes or scratches)
Lacerations
Incised wounds
Puncture (or stab) wounds
Gunshot wounds


Slide 5
Definition
Injuries resulting from an
impact with a dull, firm surface
or object.


Slide 6
The deaths resulting from blunt force trauma
occur in a variety of scenarios:
almost all transportation fatalities
jumping or falling from heights,
blast injuries,
Be struck by a firm object, such as a fist, crowbar,
bat, or ball.
Bite wounds and chop injuries may be considered
variants of blunt force trauma, sharp force
trauma, or a class of injuries unto themselves.


Slide 7
Blunt force trauma is routinely involved
in cases classified as accidents, as well as
in cases of suicide and homicide.
it is important to document evidence of
blunt force trauma in all autopsies
one should not immediately assume that
blunt force trauma is the cause of death


Slide 8
For example,
Individuals may die of infections, thromboemboli, or
organ failure that occurs as a delayed result of previous
blunt force trauma.
For purposes of death certification:
Proximate Cause of Death
the cause of death of an individual who dies of
pneumonia after being hospitalized for several days for
treatment of blunt force injuries following a motor
vehicle collision should be certified as "acute
bronchopneumonia complicating blunt force injuries
due to a motor vehicle accident."
the manner of death should then be certified as
"accident."


Slide 9
The severity of injuries inflicted as a result of
blunt force trauma is dependent on the
amount of kinetic energy transferred and the
tissue to which the energy is transferred.
The kinetic energy associated with a moving
object is equal to one half the mass of that
object multiplied by the velocity of the object
squared (W= 1/2 mv
2
).


Slide 10
Important: the characteristics of the
blunt object and the surface that is
impacted.
Impacts involving a large surface will result in a
greater dispersion of energy over a larger area and
less injury to the impacted tissues.
an impact on a small area of a curved surface, such as
the head, will cause greater damage than would be
caused were that same impact to occur on a flat
surface, such as the back, since there will be a more
concentrated point of impact on the head.


Slide 11
The composition, or plasticity, of the
tissues impacted also affects the
resultant injuries.
For example, a person who is kicked in the
chest may have only minimal injuries to the
elastic skin surface, whereas deeper, more
solid tissues such as ribs and internal organs
may experience fractures and lacerations.


Slide 12
The another factor affecting the severity
of blunt force injuries is the amount of
time the body and the impacting object
are in contact.
A longer period of contact allows kinetic
energy to be dissipated over a prolonged
period, resulting in less damage to the
tissues than an equally forceful impact with
dispersion of energy over a brief period.


Slide 13
This lecture focuses on the
cutaneous manifestations of blunt
force injury
Note:
The blunt force trauma may cause contusions and lacerations of the internal
organs and soft tissues, as well as fractures and dislocations of bony
structures.


Slide 14
The major types of cutaneous
blunt force injuries are as follows:
Contusion (bruise)
Abrasion
Laceration
Avulsion
Fracture


Slide 15
Bruises
A bruise is "a hemorrhage into tissues
produced by the escape of blood from blood
vessels".
Bruises may be found in the skin, muscles, and
internal organs.


Slide 16
Bruises
Bruises are typically produced by a blunt force
impact, such as a blow or a fall.
They may also be produced by squeezing or
pinching, where the force is applied gradually
and then maintained.


Slide 17
Important: Natural Bruises
Bruises may occur in a variety of natural diseases in
which there is an abnormality of the clotting
mechanism of the blood, e.g. scurvy (vitamin C
deficiency), leukemia, alcoholic liver disease.
This bruising is "spontaneous" because the injury
which produces it is so insignificant as to typically
pass unnoticed.
The presence of such natural disease will exaggerate
the bruising effects of any trauma.


Slide 18
Problems with Skin Bruises
Delayed appearance
Ageing (relative)
Site of Trauma
Shape of object
Degree of force
Post-mortem bruises
Post-mortem lividity


Slide 19
Classic Causes of Bruises
Finger pad bruises: battered babies, manual
strangulation
Different ages: repeated assaults
Shoulders and arms: forceful restraint
Wrists and ankles: dragging
Inner thighs: forceful intercourse
Chest: resuscitation
Bruising is uncommon in Suicides


Slide 20
Bruises
The extent of bruising is inversely proportional to the
sharpness of the impacting object.
Bruises may be associated with other blunt force
injuries such as abrasions and lacerations.
As a general rule bruising is not associated with
incised wounds or stab wounds where there is a free
flow of blood from the cut blood vessels rather than
leaking into the tissues.


Slide 21
Site of Trauma
In contrast with abrasions, the location of a
bruise does not necessarily reflect the precise
point of injury.
Leaking blood will follow the path of least
resistance and gravity.

For example, in the elderly, intense and
widespread bruising of the lower thigh
may follow a fracture of the hip; a
bruise of the temple may move down
to the cheek; a fractured jaw may result
in bruising appearing on the neck.


Slide 22
Delayed Appearance
Deep bruises may have delayed appearance at the
skin surface. Deep bruises may require as long as 12
or 24 hours to become apparent, and some may
never do so
The more superficial the source of bleeding, the
sooner the discoloration will be seen on the skin
surface.
In a living victim, a second examination in one or two
days may show bruising.
In the dead, a further examination one or two days
after the original autopsy may show bruises which
were not previously seen and reveal previously faint
bruises.


This may be particularly the case with
"fingerpad bruises" produced by hands.
Ultraviolet (UV) light may disclose
bruises which are not otherwise
identifiable at the time of examination.



Slide 23
Autopsy and Bruising
Bruising in Deep Tissue
1. Possibly life-threatening
2. Sometimes no external injury
3. Revealed in autopsy
Documenting Bruising
1. Photography
2. Notes


Slide 24
Degree of Force
The size of a bruise is an unreliable indicator
of the degree of force causing it.
However, a heavy impact is likely to produce a
large bruise and a light impact to produce a
small bruise.
If bruising is slight, it is reasonable to assume
that the degree of violence was slight.


Slide 25
Determining Degree of Force in Bruise
Patterns
Location:
Some areas of the body bruise more easily than
others. The face bruises more readily than the
hands.
Bruising occurs more readily in loose tissues and
where there is a large amount of subcutaneous fat
Bruising is less apparent where the skin is strongly
supported by fibrous tissue or if the muscle tone is
good.


Slide 26
Determining Degree of Force in Bruise
Patterns
Age
Infants and the elderly tend to bruise more easily than
young and middle aged adults.
Infants have loose and delicate skin, and the abundant
subcutaneous fat.
Elderly have degenerative changes in the tissues which
support the small blood vessels of the skin and
subcutaneous tissues.
Gender:
Women bruise more easily than men because they have
more subcutaneous fat and this is particularly true of
obese women.
Natural Disease
Skin color


Slide 27
Causitive Object
The shape of the bruise is most likely to reflect
the shape of the causative object when the
object is small and hard and death occurs
soon after injury


Slide 28
Causitive Object
A doughnut bruise is produced by an object
with a rounded contour (e.g. baseball).
Two parallel linear bruises result from a blow
with a rod or stick
Bruises can follow rounded contours if they
are caused by a flexible object like a lash

If the blow with the rod is struck
against the buttocks, - a particularly
pliable, curved, soft surface - the
tissues are compressed and flattened
under the impact; the resulting bruise
will follow the curved contour of the
buttocks.
A pliable weapon such as a strap or
electric flex may produce a similar
appearance as it wraps around the
body on impact.



Slide 29
Causitive Object
Bruises produced by fingerpads as a result of
gripping are usually larger than the fingerpads
themselves.
The pattern and location suggests the
mechanism of causation:
On the neck in throttling
On the upper arms in restraint.
Such bruises are referred to as patterned.

A bruise which bears the imprint of the
shape or contour of the impacting
object is said to be patterned.
A tracing of the pattern may be made
to match to the causative object, or
photographs of the injury and object
may be superimposed.
Patterned bruises of this type may be
associated with patterned (imprint)
abrasions.
ligatures around the neck in
strangulation
the headlight or bumper of a
vehicle in hit and run
the muzzle or sight of a gun in
contact gunshot wounds.



Slide 30
Aging of Bruises
Color changes a bruise goes
through can give a rough estimate
of time of injury
Colors result from breakdown of
hemoglobin from tissues
Dark blue/purple (1-18 hours)
Blue/brown (~1 to 2days)
Green (~ 2 to 3 days)
Yellow (~3 to 7 days)
This rate assumes person is
healthy, however.

Contusions

Bruise due to rupture of
small blood vessels (skin or
internal organs)

Colors result from
breakdown of hemoglobin
from tissues


Slide 31
red immediate
dusky purple / black soon after
green days 4 -5
Yellow days 7 - 10
resolution days 14 - 15
Camps:
violet immediate
blue day 3
green days 5 - 7
yellow days 8 - 10
resolution days 13 - 18
Glaister:


Slide 32
red dark / red black < 24 h
greenish tinge around day 7
yellow around day 14
resolution up to 30 days
red immediate
purple black soon after
green days 4 -5
yellow days 7 - 10
resolution days 14 - 15
Polson and Gee:
Smith and Fiddes:


Slide 33
Aging Bruises
While accurate estimation of the age of a single
bruise is not possible, a fresh bruise can be
distinguished easily from one which is several days
old.
Establishing that bruises are of different ages may be
of medical importance where there is an allegation
of repeated assaults:
Child abuse
Wife beating
Where pre-existing injuries need to be distinguished from
those produced by a recent assault like a chronic alcoholic
who was assaulted.


Slide 34
Post MortemBruises
Bruising is a phenomenon of living tissue-
since it usually requires circulating blood to
push the blood from the veins.
It isnt possible to tell bruises that occurred
causing death from those that occurred
minutes earlier. You can only say they
occurred at or about time of death.


Slide 35
Post MortemBruises
It requires considerable violence to produce a bruise
post mortem or after death.
These bruises are smaller relative to the degree of
force used.
Post mortem bruises are most readily produced in
areas of hypostasis (post mortem lividity, livor
mortis) or where tissues can be forcibly compressed
against bone.
A bruise can develop on the head after the body is
left lying on the back.


Slide 36
Post Mortem Lividity (hypostasis, livor
mortis)
The settling, after death, of blood within the blood
vessels under the influence of gravity.
This results in a purplish discoloration of parts of the
body that are lower while sparing areas of pressure
contact - contact pallor.
The pattern and distribution of lividity distinguishes
it from bruising.
A body found on its back has livor mortis on the
dorsal (back) side with pale areas where the bone
contacted the floor.

In doubtful cases, an incision of the skin
will cause blood to ooze from the cut
ends of vessels in instances of lividity.
In contrast, the blood within the tissues
in bruises will not ooze.
Washing the cut surface with running
water will remove the blood from livid
tissues but not the blood infiltrating the
tissues in bruises.
Confirmation of the distinction may be
made by microscopic examination.



Slide 37
Postmortemchanges on the chest caused by insect activity.


Slide 38
Patterns of Injury
Bruises to the knuckles of the hands, together
with bruises of the eyelids, bridge of the nose,
cheeks and lips, suggest a fist fight.
Bruising around the eyes (spectacle bruises)
may be produced by direct blows, but also
commonly result from a fracture of the base
of the skull, e.g. in vehicle collisions or
gunshot wounds to the head
They may also follow blunt impact to the
forehead producing jolting of the eyeballs in
their sockets with tearing of small orbital
blood vessels.


Slide 39
Patterns of Injury
Injuries in motor vehicle collisions almost
invariably include abrasions and lacerations as
well as bruises.
Patterns of injury may allow reconstruction of
incidents involving pedestrians or allow
distinction between driver and front seat
passenger.


Slide 40
Patternedabrasion on the head due to impact by a motor vehicle.


Slide 41
Two contusions on the skin of the chest


Slide 42
A contusion
on the arm.


Slide 43
Abrasions
A scraping injury to the superficial
layers of the skin (epidermis and
dermis) that results from friction
against a rough surface


Slide 44
Abrasions
Side impact produces a moving abrasion:
Indicates direction.
Trace material (e.g. grit).
Direct impact produces an imprint abrasion:
Pattern of causative object.
All abrasions reflect site of impact (in contrast with
bruises).
Assessment of age of abrasions is difficult.
Post-mortem abrasions - Brown, leathery


Slide 45
Abrasionon the elbow. Abrasionon the knee.


Slide 46
BRUSH-BURN ABRASION
One common type of blunt force injury is the so-
called brush-burn abrasion. Brush-burn abrasions
are broad, dried abrasions that often have a
yellow-orange or orange-red coloration.
These abrasions are caused by dragging or
scraping the surface of the skin against a rugged
surface; they are most often encountered when a
body slides on pavement. These abrasions are
sometimes called "road rash."


Slide 47
Brush-burntype abrasion on the left flank.


Slide 48
Laceration:
A bursting of the skin or other tissues
resulting from compression or stretching
associated with impact by a blunt object
or surface


Slide 49
Lacerations (Tears, Splits)
Splitting of the skin by the direct crushing
of blunt trauma.
Typically over bone, e.g. scalp, eyebrow,
cheekbone.


Slide 50
Lacerations
Distinguished from incised wounds by:
Adjacent abrasion/bruise
Ragged edge
Tissue bridges in depth
Forensic Importance
Not related to object shape
Trace evidence
Relatively little blood loss (except scalp)
Rarely suicidal


Slide 51
Two abraded lacerations on the forehead. A laceration near the vertex of the scalp.


Slide 52
Several chop injuries inflicted by a boat propeller.


Slide 53
Avulsion:
A more severe form of laceration in
which the soft tissues, musculature,
and/or bone are torn away from the
normal points of attachment


Slide 54
Avulsion of the right leg.


Slide 55
Fracture:
A break, rupture,
or separation of
tissue (most
often bone)
resulting from an
impact


Slide 56
Thank You