Professional Documents
Culture Documents
INJURIES
Definitions :
• Injury: Any harm, whatever illegally, caused to any person in body, mind,
reputation or property (Sec. 44 IPC).
Chemical injuries
a. Irritation: Due to application of weak acids,alkalis, plant or animal extracts.
b. Corrosion: Due to application of strong acids or alkalis.
Miscellaneous injuries
a. Electrical injury.
b. Radiation injury: Due to X-ray, UV radiation,radioactive substances.
c. Lightning injury.
d. Blast injury.
Circumstances of Abrasions
i. Usually, it is seen in accidents and assaults.
ii. Abrasions on the face or body of the assailant indicate a struggle.
iii. Person collapsing due to a heart attack may fall forward and receive abrasions on
the forehead,nose and cheek,but there will be no injuries on the upper limbs.
iv. Abrasions may be produced on the palmer surface of hands in a conscious person,
who while falling puts out his hands to save himself.
v. Alcoholics tend to fall backwards and strike the occiput on the ground.
vi. Hysterical women may produce abrasions over accessible areas, like the front of
forearm or over the face, to fabricate charge of assault.
Medico-legal Importance :
Abrasions give an idea about the site of impact and direction of force.
Nature of injury:Superficial Injury.
Patterned abrasions are helpful in connecting the wound with the causative weapon.
Age of injury can be determined, which helps to corroborate with alleged time of
assault.
In open wounds, dirt, dust, grease or sand is usually present which helps to connect
the injuries to the scene of crime.
Character and manner of injury may be known from its distribution.
Bruise / Contusion
Bruise is the extravasation of blood in the
subcutaneous/subepithelial tissues due to rupture of
blood vessels, usually capillaries, as a result of blunt
force injury or pressure.
‘Bruise’ is derived from old English word ‘brysan’,which means ‘to crush’.
Bruise’ implies that the lesion is observed through the overlying intact skin as
bluish purple discoloration and swelling of the involved area, while a ‘contusion’ is
a bruise within an organ or tissues, such as muscles,liver or mesentery.
Causes :
i. By application of blunt force viz. blow with fists,sticks, iron-bar, cane, whip or
chain.
ii. From compression, like pressing fingers.
iii. Medical intervention sometimes produces bruise—sternal and cardiac bruising,
bruising around needle puncture marks and pinching skin to test conscious level
(butterfly bruise).
Classification :
Bruise is classified into three types depending on its situation:
i. Intradermal bruise: Bruise lies in the immediate subepidermal layer. It is
made by impact with a patterned object, and hemorrhage is sharply defined.
ii. Subcutaneous bruise: It is situated in subcutaneous tissue, often in the fatty
layer, and the edges are blurred.Most common type of bruise caused by a blunt
object, and appears soon after injury as dark red swelling.
iii. Deep bruise: Bleeding deeper to the subcutaneous tissues. It may take hours
to 1–2 days to appear at the surface (delayed bruising). Therefore, one more
examination should be carried out 24–48 h after first examination. Infrared
photography may demonstrate such bruises, if suspected initially.
Factors Influencing the Bruise :
i. Type of tissue/site involved :
Soft, lax and vascular tissues, such as face,scrotum and eyelids develop large bruises
even with little force.
Bruising of scalp is better felt than seen.
Bruising is more marked on tissues overlying bone.
In boxers and athletes, bruising is much less,because of good muscle tone.
ii. Age :
Children and elderly bruise more easily because of softer tissue and delicate skin in
the former, and loss of subcutaneous supportive tissue and cardiovascular changes in
the latter.
iii. Sex:
Women tend to bruise more easily than men because tissues are more delicate and
subcutaneous fat is more.
Obese people bruise more easily than lean because tissues are more delicate.
iv. Tears:
Tearing of skin and subcutaneous tissue can occur from localized impact by or
against some hard, irregular object like car door handle, radiator mascot or from
blows with broken glass bottles.
v. Cut lacerations:
Sometimes, a heavy sharp edged weapon causes a deep and wide cut over the body
tissues.
oCharacteristics :
Margins: Ragged, irregular and uneven.
Site: Occurs most commonly over bony prominences.
Bruising and abrasion: Seen around the margin.
Edges: May give an indication of direction in which the blow or force was applied.
Depth of wound: Shows bridges of irregularly torn fibrous tissue, blood vessels
and nerves across the interior of the wound.
Soiling of wound: Mud, wood splinters, sand, glass fragments or paint material of
the vehicle involved,hair or fibers may get embedded in the wound, and are of great
medico-legal importance.
Hair bulbs: Crushed.
Hemorrhage: Less.
Shape: May correspond with the weapon or object which produced them.
Gaping: Seen due to pull of elastic and muscular tissues.
On healing: Produces permanent scar.
Dating of Laceration :
Duration Gross findings
Fresh Bleeding or fresh clot is attached; margins are red, swollen and tender
12–24 h Margins swollen, red and covered by dried blood clots and lymph
3–5 days Margins strongly adherent with each other and covered by dried crust
6–7 days Crust/scab falls off or can easily be taken off, soft reddish tender scar
Few weeks Scar is whitish, firm and painless
Complications
i. Lacerations may cause severe and fatal bleeding leading to shock and death.
ii. Infection.
iii. Pulmonary/systemic fat embolism may occur due to crushing of subcutaneous
tissue.
iv. If located where skin stretches or is wrinkled,e.g. over joints, repeated and
continued oozing of tissue fluids and blood may cause irritation, pain and
dysfunction.
• Medico-legal Importance :
The type of laceration may indicate the cause of injury and shape of blunt weapon.
Nature of injury: A laceration may be a simple injury.
Whether the laceration is accidental/homicidal/suicidal?
a. Accidental laceration: Commonly seen anywhere on exposed parts of body.
b. Homicidal laceration: Noticed on nonaccessible parts of the body, especially in
assault cases. It is usually seen on the head.
c. Suicidal lacerations are rarely seen, as they are painful to produce, and if present,
they are seen on exposed parts of body and on same side.
Foreign matter in the wound may give clues about the object causing it, e.g. paint
material of vehicle may be transferred to the lacerated wound.
Skin flap which overhangs the cut margin (avulsion cases) can indicate the
direction of force applied.
Incised Wound (Cut / Slash / Slice)
Incision is a clean cut wound through the tissues (usually the skin and
subcutaneous tissues including blood vessels),which is more long than
deep,and caused by a sharp-edged instrument.
It is produced by pressure and friction against the tissue by an object
having a sharp cutting edge or point, such as knife, box cutter, razor or
scalpel.
Characteristics :
Margins: Edges are clean cut, well-defined and usually everted.
Width/breadth: Width is greater than the edge of the weapon causing it due to
retraction of the divided tissues.
Length: Length is greater than its width and depth and has no relation to the
cutting edge of the weapon,for it may be drawn to any distance.
Shape: Usually spindle-shaped.
Depth and direction: Usually deeper at the commencement,except in case of
suicidal cut throat injuries, with hesitation cuts at the beginning.
Hemorrhage: As vessels are cut clean, hemorrhage is more.
Beveled cuts: If the blade of the weapon enters obliquely, tissues will be visible at
one margin and other margin will be undermined; if the blade is nearly horizontal, a
flap wound is caused.
Dating of Incised Wound :
Medico-legal importance :
Indicates the nature of weapon.
Give an idea about the direction of force.
Age of injury can be determined.
Position and character of wound may indicate manner of production, i.e. suicide,
accident, or homicide.
Stab Wound / Punctured Wound
Stab wounds are produced from penetration with long narrow
instruments having pointed(sometimes blunt) ends into the depths of
the body,which are deeper than its length and width.
Weapons used:
The most frequently used object is a knife, Less often, injuries are caused by pieces of glass
(broken-off bottle necks),scissors, dagger, screwdrivers, pens, ice picks or forks.
A stab wound is an open injury in which foreign material and organisms are likely to be
carried deep into the underlying tissues.
Classification
Clinically, stab wounds are of two types:
i. Penetrating wound:
o Weapon enters into the body cavity producing only one wound, i.e. wound of entry.
ii. Perforating wound (through and through punctured around):
o Weapon after entering into one side of the body will come out through the other side,
producing two wounds:
1. Wound of entry
2. Wound of exit
Characteristics :
o Margins:
• Edges of the wound are clean cut, usually no abrasion or bruising of the margins.
o Length:
• Length is slightly less than the width of the weapon.
o Breadth:
• It is more than thickness of the blade due to gaping.
o Depth:
• Depth is the greatest dimension of a stab wound.
• Depth corresponds to the length of the blade of the weapon entering the body,when
the whole length of the weapon enters the body, but has not produced any wound of
exit.
o Direction
o Shape:
• It is slit-shaped or gape depending on their location and their orientation, with regard to
the cleavage lines of Langer.