LMMJ

MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES 1

Dr. Garcia
September 11, 2019

OUTLINE o For example if I will stab her slowly that

Physical Injuries means she will get more injury
a) Physics of Wound Production compared to when I will stab her rapidly
b) Appearance
c) Causes of Physical Injuries
d) Vital Reactions • Area of transfer
e) Classification of Wounds o the larger the area of contact, the lesser
1. As to severity the damage
2. As to the kind of instrument used
3. As to the manners of infliction • Other factors (elasticity, plasticity) of the tissue
4. As to the depth of the wound that is being injured
f) Types of Wound
1. Closed Wounds APPEARANCE
a. Superficial
1. Petechiae IMMEDIATE
2. Contusion • effect would be after the application of the
3. Hematoma
b. Deep stimulus
2. Open Wounds
a. Abrasion DELAYED
b. Incised
c. Lacerated • e.g. physical injuries brought about by infection -
d. Stab manifest only a few days or few hours after the
e. Punctured stimulus is applied
I. o By secondary infections such as tetanus

MEDICO-LEGAL ASPECTS OF PHYSICAL CAUSES OF PHYSICAL INJURIES

INJURIES • Victim could be dead or alive
• Physical violence or mauling – “binugbog”,
• Very important because they would have their legal “pinagtulungan”
implication. For example: Gunshot wound – the • Heat or cold – fire, thermal injuries, and frostbite
clinical setting it would fall under the service of • Electrical energy – Household sources,
trauma or surgery. They would have implications in Lightning
the administration of justice. • Chemical energy – Muriatic acid (most common)
• Radiation by radioactive substance
PHYSICAL INJURIES • Change in atmospheric pressure (Barometric
• Effects of some forms of stimulus on the body injuries) – diving
o Anything that could cause reaction, it
would be from outside or inside the body
• Immediate or delayed effects
o Immediate effects: e.g. if I would pop
your eyes it would produce redness
easily
o Delayed effects: effects from a previous
injury such as infection

PHYSICS OF WOUND PRODUCTION

• Kinetic energy (1/2MV2): movement of
instrument causing the injury, for example a
bullet. The faster the movement, the greater is
the damaged produced.
o 0.38 caliber bullet is heavier than M-16
bullet however the latter is faster and
would do more damage
• Time
o the shorter the period of time (time of
contact) needed for the transfer of
energy, the greater the likelihood of
producing damage
Frost bite

Scalding
VITAL REACTIONS: (MACRO OR MICRO)
• Occur in a live human person, this would play a
very important role when you do a diagnosis of
injuries that you could have observed especially
if doing autopsy to a victim that is already dead.
• If you see vital reaction in a dead person within
or around its injuries, it means that the injury is
inflicted while the person is still alive.
• There is usual inflammatory effect, when you
look at microscopic findings you would see
inflammatory process. If there is no inflammatory
process, it means that the injury was inflicted
when the person is already dead.
• Effects:
o Rubor
▪ redness or congestion of the
area due to an increase of blood
supply as part of the reparative
mechanism
o Calor
▪ sensation of heat or increase in
temperature
o Dolor
▪ pain on account of involvement
of the sensory nerve
o Tumor
▪ swelling
o Loss of Function
▪ on the account of trauma, the
tissue may not be able to
function normally
• Legal implication: Vital reaction differentiates
an ante-mortem from a post-mortem injury
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o EXCEPT:
▪ during agonal state in sudden
death (e.g. AMI)
• If you see an injury with vital reaction it means
that it happened when the victim is still alive, it
won’t be possibly reacting if the injuries were
inflicted after death
CLASSIFICATION OF WOUNDS
AS TO SEVERITY
• how severe the wound or injury
MORTAL WOUNDS
• Wound which is capable of producing death
immediately after infliction or shortly thereafter.
• Injury is in the vital organs, wound inflicted hit
the major vessels
NON-MORTAL WOUNDS
• Wound not capable of producing death .
• Wounds in the upper and lower extremities
without involving major arteries
AS TO THE KIND OF INSTRUMENT USED
• Wounds involving the following parts of the body
produce death within a short time:
o the heart and the large blood vessels
o the brain and upper part of the spinal
cord
o the lungs
o the stomach, liver, spleen and intestine
• Wound brought about by blunt instrument –
injury that does not penetrate (baseball bat)
(contusion, hematoma, lacerated wound)
• Wound brought about by sharp instrument:
o sharp-edged instrument – kitchen knife
(incised wound)
o sharp-pointed instrument – ice pick
(punctured wound)
o sharp-edged and pointed instrument –
bolo (stab wound)
• Wound by tearing force – lacerated wound
• Wound by change in atmospheric pressure –
Barotrauma
• Wound by heat or cold – Frostbite, burns, scald
• Wound by chemical explosion - Gunshot or
shrapnel wound – Wound by infection
AS TO THE MANNERS OF INFLICTION
• Hit – by means of bolo, blunt instrument, axe
• Thrust or stab – dagger, knife, saber, bayonet
• Projectile or shrapnel wounds – gun powder
explosion
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 • Sliding or rubbing or abrasion Contusion
• Effusion of blood into the surrounding
AS TO THE DEPTH OF THE WOUND tissues due to rupture of a blood vessel
• Superficial – when the wound involves only the • Results from blunt force or violence
layers of the skin. • Does not immediately develop after trauma
• Deep – when the wound involves the inner (minutes to hours)
structures of the body. It may be: • Manner of injury, (single blow/ numerous)
o Penetrating – wounding agent enters
and does not come out (solid organs) • MEDICO-LEGAL SIGNIFICANCE:
o Perforating – piercing or traversing o may infer shape of the object causing it
completely, causing communication o extent may suggest the degree of force
between entry and exit hollow organs applied
like stomach o distribution may indicate character and
manner of injury
TYPES OF WOUNDS
• AGE OF CONTUSION:
A.) CLOSED WOUNDS o Red to purple – recent
o Green – 4 to 5 days
• There is no breach of continuity of the skin or
o Yellow – 7 to days
mucous membrane
o Resumption to normal color –14 to 15
• Superficial – when the sound is just underneath days
the layers of the skin or mucous membrane
• Important in describing the contusion, as to
o Petechiae
when, where, what object, and how long has the
o Contusion
contusion occurred.
o Hematoma
• Contusions may appear anywhere in the body.
• Deep
They may not appear on the area where the
o Musculoskeletal Injuries
force was applied, in other words the location of
▪ Sprain
the contusion does not necessarily indicate that
▪ Dislocation
a force was applied on that certain area.
▪ Fracture
▪ Strain
▪ Subluxation
o Internal Hemorrhage
o Cerebral Concussion

SUPERFICIAL CLOSED WOUNDS

Petechiae (pinpoint hemorrhages)

• Circumscribed extravasation of blood into the
subcutaneous tissue or underneath mucous The common black eye
membranes
• Not always a product of trauma (ex: Liver
mortis) but may be present in:
o Asphyxial death/death by hanging
o Coronary occlusion
o Blood diseases – ITP, DENGUE

Yellow discoloration = hemolysis

Hematoma
• Extravasation or effusion of blood in a newly
formed cavity under the skin (Sac like structures
filled with blood)
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 • Usually develops where bony tissue is • The location of the abrasion may also give clue if
superficially located they appeared /were obtained before or after the
patient died.
CONFUSION HEMATOMA o E.g. Abrasions on bony surfaces or areas
Blood in the interstitial Blood in newly formed directly in contact with surfaces (if patient is lying
tissue cavity or against the wall) suggest that the abrasions
No elevation of the skin Always elevated were obtained after death. Also, if there were
Puncture and aspiration Puncture and aspiration abrasions seen on the neck that would suggest
yields NO blood yields blood and that the abrasions were most probably obtained
subsequent depression of before the patient died
the lesion
Forms of Abrasions
B.) OPEN WOUNDS 1. Linear
o Appears as single line (2 to 3 lines)
ABRASIONS o May be straight or curved
• Scratch, graze, impression mark, friction mark
2. Multi-linear
• Characterized by removal of superficial layer of the
o Several linear marks parallel to one another
skin
o Frequently seen on vehicular accidents
• Characteristics:
o Usually develops at the precise point of impact
of the force causing it, unlike contusions where it
does not necessarily appear wh ere the force
was applied
o Injury consists of parallel linear injuries which
are in line with the direction of the force causing
it
o May exhibit pattern of the wounding material
- Give important clues as to the manner of
affliction of these certain injuries
o Usually ignored! (if you know that you’re just
dealing with a simple non-medicolegal case) 3. Confluent
- But if you have an idea that you are mainly o Linear marks almost indistinguishable
looking into a foul play or assumptive that o If you are not able to identify the point of origin,
something has been using violence, you the direction, and end of the stimulus
might want to take note of these small
abrasions that you find in the physical
examination of patients
o Heals in a short time and leaves no scar
(disadvantage)
• Usually not documented d/t short-lived scars, lesser
proof in court if complaint is made by the victim.
• In looking for medico legal case, record every injury
there is.
4. Multiple
Importance of Noting Abrasions o Several abrasions of varying sizes and shapes
• Abrasions caused by fingernails may indicate may be found in different parts of the body
struggle or assault and/or usually located in the
face, neck, forearms and hands (on the offender)
• Abrasions resulting from friction on rough surfaces
are located on bony parts of the body and usually
associated with contusion and laceration (on the
dependent part)
• Nature of abrasion may infer degree of pressure,
nature of rubbing object and direction of movement

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• Different forms of abrasion may suggest the • Pressure or Friction abrasion
direction of force applied o Caused by pressure accompanied by
movement usually observed in hanging and
Types of Abrasions strangulation
• Scratch
o Caused by sharp pointed objects e.g. pin, Ante-mortem vs. Post-mortem Abrasion
fingernails, thorns Point of Ante-mortem Post-mortem
o Always parallel to direction of slide distinction abrasion abrasion
o Commencement (start) and termination are well- Color Reddish Yellowish and
defined bronze in translucent in
- Able to identify or still see the beginning and appearance to appearance
the end of the lines of a scratch slight exudation
• Graze of blood
o Usually caused by forcible contact with rough, Location Any area Generally over
hard objects resulting in irregular removal of (more bony
skin surface important) prominences
- This may be associated with irregular such as elbows,
application of stimulus with force knees, sacral
o Most common, esp. in children area, at the
o Rough surface floor back of the
head, and
• Impact or Imprint abrasions attributed to
o Tells the character or force that was used to rough handling
inflict the injury of the cadaver
o Pattern abrasions, stamping abrasions Vital Reaction With intravital No vital reaction
- Adapt the shape of the force that cause it reaction and
o According to Doc these abrasions are artistic may show
abrasions and may suggest the type of material remains of
that have caused the abrasion damaged
epithelium

• Ante mortem
o There is redness which implies an inflammatory
process (rubor).
o Occurs in any area – because the person is still
moving, so any are or body could have any
reaction.

INCISED WOUNDS
• Cut, slash, slice
• Produced by a short-edged cutting or short linear
edge
• May be impact cut (forcible contact) or sliced cut
(pressure plus movement)
• Caused by clean, sharp-edged cutting instrument
• Chopped/hacked
o If the injury was done using a heavy instrument
or
o If the injury is bigger than the usual incised
wound
o This term is usually used if there is deflection of
the skin already.
o Car marks (closely, these are patterned • Both incised wound and hacked wound are caused
abrasions) by sharp-edged instrument. But when there’s
deflection already of the structures or tissues (e.g.

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 incised wound of the head – if skin is able to be esophagus
deflected, then that is a hacked injury)
• May give clues as to the intention of the affliction
o May be suicidal, homicidal or accidental Superficial Usually present Absent but may
cut be present when
Changes that occur in an Incised Wound victim struggles
• After 12 hours:
o swollen edges; adherent with blood and with Position of May be sitting facing Usually victim is
leukocyte infiltration (inflammatory process) the body a mirror or standing lying
– this may be evident microscopically only
• After 24 hours: Wounding Firmly grasped or Usually absent
o proliferation of the vascular endothelium and weapon found lying beside
connective tissue cells victim
• After 36-48 hours:
o capillary network complete; fibroblasts Blood Blood found in front Blood found at
running at right angles to the vessels distribution part, hands generally the back of neck,
• After 3-5 days: smeared with blood hands clean
o vessels show thickening and obliteration
• These are delayed in wounds with dirty and irregular Motive History of mental Absence of such
edges depression, history (If you
emotional problems, have motive
Incised Wounds may be: etc. here, it becomes
• Suicidal MURDER)
o Located in peculiar parts of the body, like
the neck, flexor surfaces of the extremities
o Elbow, groin, knee, wrist, and accessible to
the hand in inflicting the injury. LACERATED WOUNDS
o The most common instrument used is the • Tear of the skin and underlying tissues due to
barber’s razor blade with improvised handle. forcible contact with a blunt instrument
• Homicidal • If force applied to a tissue is greater than its
o The incised wounds are deep, multiple, and cohesive force and elasticity, the tissue tears and a
involved both accessible and non-accessible laceration is produced.
parts of the body to the hands of the victim. • May be produced by:
o Clothings are always involved o hit with a piece of wood
• Accidental o iron bar
o Multiple incised wounds are commonly o fist blow
observed on the passengers and the driver o stone
of vehicular accident. o butt of firearm
o Stepping on the oyster shell, broken
glasses, sharp edges of metal sheets are
Characteristics of Lacerated Wounds
common causes of incised wound on the
sole of the feet. • Shape and size of injury DO NOT correspond to the
wounding instrument
Suicidal vs. Homicidal Cut-throat or Incised Wound • The tear on the skin is rugged with irregular and ill-
defined border
SUICIDAL HOMICIDAL
• Injury develops directly where the blunt force is
applied
Direction Oblique: below ear, Horizontal,
• Borders are contused and swollen
downwards, just BELOW Adam’s
• No extensive bleeding as blood vessels are not
ABOVE Adam’s apple
severed evenly
apple
• Delayed healing process and more tendency to
develop scar.
Severity Not so deep, may Usually deep
only involve trachea, and may involve
carotid, and cartilage and
sometimes bones

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 Lacerated vs. Incised Wounds • Limited external hemorrhage (threat of internal
INCISED WOUNDS LACERATED WOUNDS hemorrhage and tetanus infection)
• Appears benign outside
Edges are clean-cut, Edges are roughly cut, • Wound closes after the injury
regular and well-defined irregular and ill-defined • Small opening or entry point

There is NO swelling or There is swelling and

contusion around the contusion around the
wound wound
REFERENCES
Extremities of the wound Extremities of the wound • Old transes (2019, 2020)
are sharp or may be round are ill-defined and irregular • Recording
or contused
Hair bulbs are cut Hair bulbs are preserved
Faster healing Delayed healing
Scar is linear or spindle Scar is irregular
shaped

Caused by a sharp edged Caused by blunt

instrument instrument

• Incised – edges are clean

• Laceration – edges are irregular

STAB WOUND
• Produced by penetration of a sharp pointed and
sharp-edged instrument.
• If the sharp edge portion of the wounding
instrument is the first to come in contact with the
skin, the wound produced is an INCISED WOUND
• If the sharp-pointed portion comes in contact first,
then the wound is a STAB WOUND
• Bigger entry point

PUNCTURED WOUNDS
• A result of a thrust of a sharp pointed instrument
• Small external injury with certain degree of depth
• Commonly produced by ice pick, needle, nail, spear,
pointed stick, fang of animal (also, Tamaraw horns)

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