MEDICOLEGAL

ASPECTS OF
PHYSICAL INJURIES
Emil Josef B. Almazan MD PCOM MHcA
Physical injury - any adverse physical effect
of an insult to the human body

Causes:
1. Physical violence
2. Thermal
3. Electrical
4. Chemical
5. Radiation
6. Atmospheric Pressure
7. Infection
PHYSICAL VIOLENCE
- external trauma resulting to disruption in tissue integrity

Factors:
1. Kinetic energy
2. Time
3. Area involved
4. Elasticity of tissue

Vital Reaction:
1. Rubor
2. Calor
3. Dolor
4. Loss of Function
Wound Classification

A. Severity
- Mortal
- Non-Mortal

B. Instrument Used
- Blunt instrument
- Sharp instrument
- Tearing Force
- Atmospheric pressure
- Thermal
- Infection
C. Manner
- Hit
- Stab
- Explosion
- Abrasion

D. Depth
- shallow
- deep (penetrating, perforating)

E. Location
- coup
- contre-coup
- coup contre-coup
- locus minoris resistencia

F. Region/Organ Involved
G. Special Types of Wounds:
1.Defense wounds
2.Patterned wounds
3.Self-inflicted wounds

Motives for Self-Inflicted Wounds:

1.To create or magnify an injury
2.To escape certain obligations or punishment
3.To create a new identity
4.To gain attention or sympathy
5.Psychotic behavior

Methods:
1.Head banging
2.Exposure of body to heat
3.Penetrating sharp objects to body
4.Castration
5.Pulling of body hair
Legal Classification of Physical Injuries

1. Mutilation (Art. 262 RPC)

- reproductive organs
- non-reproductive organs
- must be intentional

Mayhem - deprivation of part of body in fighting

Vasectomy/Tubal Ligation - not considered as mutilation

2. Serious Physical Injuries

Art. 263 - wounding, beating, assaulting another

Art. 264 - administering an injurious substance
Serious Physical Injuries

Prision mayor: Insane, imbecile, importent,

blind
Prision correccional: lost use of senses, speech,
extremities, permanent incapacity
Prision correccional: deformed/disfigurement,
lost any other body part, incapacitated for more
than 90 days
Arresto mayor: illness/incapacity for more than
30 days
3. Less Serious Physical Injuries
- not described as Serious Physical Injuries
- incapacitate offended party for at least 10 days
- require medical attendance for 10-30 days (with proof)

Qualified or Aggravated by:

1. Manifest intent to offend or insult
2. Circumstances adding ignominy to offense
3. Victim is family, guardian or teacher
4. Victim is person of rank/authority

PD 169 - requirement for physicians to report serious and

less serious physical injury events to authorities
4. Slight Physical Injuries and Maltreatment
- Art. 266 RPC
a. Arresto menor - less than 10d incapacity
b. Arresto menor or fine not <P200.00 - no
incapacity
c. Arresto menor (min.) or fine not <P50.00 - ill-
treatment without causing injury
Art. 252 RPC - Physical Injuries in Tumultuous Affray:
1. There is tumultuous affray
2. Participants suffered from serious physical injuries
3. Person who inflicted injury unidentified
4. All those who appear to have participated in
injuring the offended party arrested for 5-15 d
Medical Classification of Wounds
1. Closed
2. Open
3. Stab
4. Punctured
5. Lacerated

Fatal Effects of Wounds:

1. May be fatal because of:
- hemorrhage
- injury to vital organs
- shock
2. May be indirectly fatal because of:
- secondary hemorrhage d/t sepsis
- infection
- scarring effect
- secondary shock
Closed Wounds
- intact continuity of skin/membrane
Superficial:
1. Petechiae - localized blood in SQ tissue
2. Contusion - effusion of blood to tissues due
to blunt trauma

Contusion:
<4d - red/purple
4-5d - greenish
7-10d - yellow
14-15 days - starts to fade from the periphery
4 weeks - complete disappearance
Musculoskeletal Injuries

1. Sprain - ligament or muscle

2. Dislocation - displacement of bones in a joint
3. Fracture - discontinuity of bone structure
a. Closed/simple
b. Open/compound
c. Comminuted
d. Greenstick
e. Linear
f. Spiral
g. Pathologic
4. Strain - over-stretching or muscle or ligament
5. Subluxation - incomplete/partial dislocation
Internal Hemorrhage - rupture of blood vessels

Cerebral Concussion
- suspension of brain functions as a result of head trauma

S/Sx:
1. Unconsciousness
2. Muscle relaxation/flaccidity
3. Closed eyelids and insensitive conjunctivae
4. Pale, cold and clammy skin
5. Slow respiration
6. Rapid and weak pulses
7. Low temperature
8. Sphincter relaxation
9. Depressed reflexes
Open Wounds
Abrasion - removal of supeficial layer of skin

Characteristics:
1. Develops at precise point of contact
2. Consists of parallel linear injuries along direction of
force
3. May exhibit pattern of wounding material
4. Heals in a short period of time and leaves no scar
5. Not usually important medically

Types:
1. Scratch
2. Graze
3. Impact/Imprint
4. Pressure/Friction
Incised Wound - produced by a sharp edge

Characteristics:
1. Straight
2. Clean-cut edges
3. Deep in the middle portion
4. Profusely bleeding
5. Gaping
6. Clothes may also show cut
7. Fast healing if uncomplicated
8. May be irregular (made by broken glass)

Changes:
1. After 12h - swollen edges, with blood and plasma
2. After 24h - proliferation of vascular and connective tissue
3. After 36-48 hours - capillary formation complete, with
apparance of granulation tissue
4. After 3-5 days - vessel thickening and fibrosis
Incised Wounds:
1. May be d/t a therapeutic procedure
2. From self-defense
3. Self-inflicted
4. Result of psychological/mental illness

Suicide wounds - accessible to the hand

Homicidal wounds - usually deep and multiple
Accidental - may be multiple, shallow
Stab Wounds - penetration of sharp-edged
instrument

- surface length may reflect width of instrument

- smaller if wound is shallow
- double-bladed: both tips of wound are sharp
- single-bladed: one tip is rounded and contused
- location of the wound may indicate relative
position of victim and perpetrator

Depth of Wound influenced by:

1. Instrument sharpness and size
2. Body area involved
3. Degree of applied force
Describing a Stab Wound:
1. Length
2. Wound tips
3. Wound edges
4. Linear direction
5. Location
6. Direction of penetration
7. Depth of penetration
8. Tissue/organ involved

Homicidal Stab Wounds:

- other injuries may be present
- located at any body part
- usually more than one stab wound
- there is a motive
- disturbance in the crime scene
Intent to Kill:
1. More than one stab wound
2. Stab wound located in different parts of the
body
3. Stab wounds are deep
4. Serrated wound edges - thrust and
withdrawal
5. Irregular/stellate wounds - changing direction
of the weapon
Punctured Wounds -sharp, pointed instrument
- entry is small but depth may be deep
- external injury may be small, but internal injury
may be great
- external wound may be sealed by clotted blood

Homicidal:
1. Usually multiple and located at different parts
of the body
2. Deep wounds
3. Presence of defense wounds
4. Signs of struggle
Lacerated Wound - tearing of skin due to blunt
instrument

Characteristics:
1. Shape and size of injury does not correspond to
instrument used
2. Outline is irregular, ill-defined
3. Due to blunt trauma
4. Where bone is superficially located
5. Bleeding is not extensive
6. Delayed healing with scar formation
Estimation of Skin Surface Area
(Rule of Nines)

Head and Neck 9%

Upper Extremity 9%
Anterior Chest and Abdomen 18%
Posterior Chest and Abdomen 18%
Anterior Lower Extremity 9%
Posterior Lower Extremity 9%
Genital Area 1%
Toxins
1. Snake Bites
- Neurotoxic
- Hematotoxic

2. Scorpion Stings
- single, punctured wound surrounded by
reddish area

3. Coelenterate Stings
- nematocyst venom
- urticarial rash with pallor, dilated pupils,
labored breathing
Secondary Causes of Death from Wounds
1. Natural consequence of wounds
2. Production of separate pathological condition
3. Definite pathological condition was present
4. Different pathological condition

Complications of Trauma/Injury:
1. Neurologic shock
2. Hemorrhage
3. Infection
4. Embolism

Wound Healing:
1. Primary Intention
2. Secondary Intention
3. Third Intention
END