Blunt Force

PHILIPPINE COLLEGE OF SCIENCE AND TECHNOLOGY
Old Nalsian Road, Nalsian, Calasiao, Pangasinan, Philippines 2418

Tel. No. (075)522-8032/Fax No. (075)523-0894/Website: www.philcst.edu.ph
ISO 9001:2015 CERTIFIED, Member: Philippine Association of Colleges and Universities (PACU),
Philippine Association of Maritime Institutions (PAMI)
MODULE 3: MEDICO-LEGAL ASPECTS OF INJURIES AND WOUNDS

LESSON 1: BLUNT FORCE INJURIES
Learning Objectives:
At the end of the lesson, the student should be able to:
1. Define the different types of blunt force injuries.
Concept/Discussion:
In the forensic medical context, physical injury refers to the damage inflicted on “any part
of the body due to deliberate or accidental application of mechanical or other traumatic agent”.
A wound is a disruption of the continuity of tissues and lining epithelium (layer of the skin)
produced by external, mechanical force. The term injury is used synonymously with wound, but
the former can have a wider meaning, which encompasses not only damage produced by physical
force, but also damage produced by other means such as heat, cold, chemicals, electricity, and
radiation.
When an attending doctor conducts a clinical examination of a patient with injuries and wounds
and thinks that some kind of law enforcement investigation is essential so as to ascertain
responsibility regarding the case, the doctor should immediately register it as a medico-legal case.
It is also not up to the patient nor other concerned parties to decide whether the case should be
registered as medico-legal. Further, the doctor should focus on recording observations correctly
and not on acting as a detective.
Cases that should be labeled as medico-legal may include any of the following:
1. Roadside accidents, factory accidents or any other unnatural mishaps.
2. Suspected or evidence homicides or suicides (including attempted one)
3. Suspected or evident poisoning
4. Burn injuries due to any cause
5. Injury cases where foul play is suspected i.e. if a doctor thinks that the patient is an
accused or a victim in a criminal case
6. Injury cases where there is a likelihood of death in the near future.
7. Suspected or evident sexual offenses.
8. Suspected or evident criminal abortions
9. Unconscious, when the cause is not clear
10. Cases brought dead with improper history
11. Cases referred by courts
It is important for forensic physicians and forensic pathologists to appropriately assess and
document injuries to provide effective assistance in establishing the cause, which may later
become an issue in courts or other legal processes. Documentation should be provided

unambiguously and in detail so that it will be comprehensible not only to other doctors but
also to law enforcement officers, legal advisers, and the courts. The documentation may
include hand-drawn notes, photographs, and annotated proforma diagrams or body charts.
The following are potential relevant factors to be determined when the doctor notes the
history of the injured person:
 How was the injury sustained? Are weapons involved? And are they still available?
 What time was the injury sustained? The assault may have been reported days or weeks
after the incident, or there may be several injuries from different incidents. Specific times
should be documented.
 Has the injury been treated?
 Are there pre-existing illnesses?
 What are the patient’s regular physical activities?
 Does the patoent take regular medication?
 Is the victim right – or left-handed? How about the suspect? This may affect the
interpretation of injury causation.
 Is the patient under the influence of drugs or alcohol?  What is the clothing worn by the
patient?
The attending doctor should also assess potentially relevant information regarding the
injury by looking at specific characteristics, such as the type, location, pain, tenderness,
stiffness, causation, handedness, size, shape, color, orientation, age, time and transient
nature of injury. Injuries can be classified according to cause, namely blunt force injuries,
sharp force injuries, gunshot injuries, burns and head injuries. These and other medico-legal
terms discussed in this chapter are critical in documenting injuries.
In the medical sense, the abdomen of the human body is subdivided into smaller regions.
The two most common schemes divided it either into four quadrants or nine divisions. This is
an essential in documenting the location of the injuries and wounds.
The four Abdominopelvic Quadrants

The Right Upper Quadrant (RUQ) contains the following: the right portion of the liver, right
kidney, a small portion of the stomach, portion of the ascending and traverse colon, as well as
parts of the small intestine; while the Left Upper Quadrant (LUQ) is where the left portion of the
liver, the larger portion of the stomach, the pancreas, left kidney, spleen, portions of the
transverse and descending colon, and parts of the small intestine are located. For its part, the
Right Lower Quadrant (RLQ) is the location of the cecum, appendix, part of the small intestines,
the right reproductive organs, and the right ureter; while the Left Lower Quadrant (LLQ) serves as
the location of the most of the small intestines, some of the Large intestines, the left reproductive
organs and the left ureter.
The Nine Abdominopelvic Divisions

1. Right hypochondriac
2. Right lumbar
3. Right inguinal (Iliac)
4. Epigastric region
5. Umbilical region
6. Hypogastric region
7. Left hypochondriac region
8. Left Lumbar Region
9. Left inguinal (iliac) region
BLUNT FORCE INJURIES
Blunt force injuries are those resulting from forceful contact with a blunt object such as fists,
hammers, baseball bats, furniture, floors, walls roads, trees, or the interior surfaces of vehicles.
They are among the most common types of trauma encountered by forensic pathologists.
The injury can be caused by either a moving objects that strikes the body (such as blow from a
baseball bat) or a moving body that strikes an unyielding object (such as a fall that involves forces
associated with sudden deceleration). It can also occur when the physical force is applied more
slowly by the pressure of crushing, squeezing or pinching.
Three main types of blunt force injuries
A. ABRASIONS
Abrasions are also known as scrapes,
scratches or grazes. They refer to superficial
injuries involving only the outer layer of the
skin.; they do not penetrate the full thickness
of the epidermis. When a blunt object impacts
the surface of the skin, it results in the
disruption nd loss of superficial layers, of the
crushing or loss of skin or mucous membrane.
Abrasions may bleed only slightly, heal quickly
and oftentimes leaves no scar.
1. Brush Abrasions are broad patches,

the frictional element of which
gave rise to the term brush burns
(e.g. carpet burns). Brush burns are
commonly seen in their most florid
form as road rash following a
motor/vehicular accident in which
the victim slides along the road
surface.
2. A scratch is a linear abrasion produced by

drawing a sharp point over the surface of
the skin or mucus membrane. Common
examples of such sharp point include plant
thorns, barbed wire, human fingernails,
animal claws. The scratch marks may be
distinguished as coming from an adult or
child by looking at the spacing and
convergence of the scratches. Skin scraping
may be recovered from beneath the
fingernails used for scratching, and likewise be linked to the person who was
scratched through serology or DNA techniques.
Abrasions are sometimes considered superficial or trivial nd are, therefore,

easily overlooked by regular attending physicians. However, to the forensic
pathologists or the forensic physician, abrasions may provide valuable
information. The patterning is clearer that the observed in bruises because
abrasions frequently take a fairly detailed impression of the shape of the object
causing them.
Often, careful examination can indicate the exact site where the object struck
the skin, the shape of the causative object, and the direction the wounding object
was travelling to when it struck the skin. For example, a forensic pathologist
investigating a case of manual strangulation might find visible signs of attack on
the neck through small, crescent-shaped abrasions caused by the fingernails of
the victim or assailant.
Trace evidence from the object, such as dirt or glass, can also be found on the
contaminated graze, whereas skin fragments from the victim may be recovered
from wounding weapon. These may have important medico-legal significance
and should be carefully preserved for subsequent forensic analysis.
B. CONTUSIONS
A contusion, also as a bruise or ecchymosis
refers to discoloration resulting from hemorrhage
beneath the skin, tissue or mucosa, without any
associated breach in the surface. It is generally
produced when a blunt force has caused disruption of
blood vessels with escape of red blood cells into the
surrounding tissues, such as blow or fall, but cam also
result from crushing, squeezing or pinching. The blood
vessels most commonly ruptured are the capillaries and
small veins, rather than arteries.
Any tissue may bruise, but bruises confined to
deeper tissues, as in the skeletal muscle, are not visible
on the skin surface. Bruises of the deep tissues, even
when fatal, may not be evidenced by any injury to the skin surface. For example, jury
where there is a subdural hematoma may be encountered without recognizable
superficial bruising (also known as internal hemorrhage). A fatal strangulation with
extensive bruising of the muscles of the
neck may be accomplished without obvious bruising of
the skin. Blows to the abdomen b produce bruising and
ruptures in internal organ, but such blows may not
produce any abdominal wall bruising.
Contusions tend not to accurately reflect the
shape of the object that produced them and they change
shape in time. In other cases, the surface details of the
striking object or wounding weapon may be imprinted as
a patterned bruise on the skin and may be seen during
physical examination which can be documented by
photography.
The patterned injury or imprint bruises usually occurs following a heavy impact,
like from a shod foot or motor vehicle or from a muzzle or foresight of a gun in a contact
gunshot wound. With death occurring soon after inflicting injury, the diffusion of blood
is limited and thus obscuring the imprinted pattern.
There are cases where bruises give more general impression of the wounding
weapon or object such as belt used to hit a child. Finger-pad bruising can also be seen on
the neck in throttling, on the upper arms in restrains, on the thighs n rape, and on the
chest and face in cases of child abuse.
The size of the bruise is not a reliable indicator of the degree of force that caused
it. There are several factors that could influence bruise size such as anatomical site,
gender, age or the presence of natural disease. Females commonly bruise easily, and
patients with blood dyscrasia or blood disorder bruise easily. Blood thinning medications,
such as warfarin, may also accentuate hemorrhages.
Elderly individuals bruise more easily because of degenerative changes in the
blood vessels and the supportive tissues of the skin and subcutaneous fat. In the very old
and frail, a finding of senile purpura can be seen. This is characterized by sharply-defined
geographic areas of “spontaneous” bruising to the backs of the hands and forearms.
Meanwhile, there are individuals, such as children, who may have been victims of
significant violence and have significant internal injury, but show little to no external
evidence of injury.
Contusions may change color as they age before finally fading away. A fresh
bruise is typically dark red (the color of venous blood) and soon turns into dusky purple.
Thereafter, the color changes progressively from the periphery of the bruise towards the
center. It can be brown, green, yellow, and a pale straw color before finally disappearing.
These color changes reflect the breakdown of hemoglobin into colored products as part
of the inflammatory process. The time frame of the color change is extremely variable
depending upon the size, depth and location of the bruise and the general health of the
individual.
Most contusions normally disappear within one to our weeks (complete healing)
barring any medical complications. In general, contusions having green or yellow margins
are three or more days old and those with dark red or dusky purple color are fresh, having
been inflicted within a day or so. The accurate estimation of the age of a single bruise is
notoriously difficult but fresh bruises are easily distinguishable from bruises that are
several days old.
Establishing the bruises are of different ages, and therefore inflicted at different
times, is important in the assessment of allegations of repeated assaults, such as in child
abuse and spousal abuse.
The color of bruises does not change after death, but they may become more
evident against the now pale skin, or may alternatively be obscured by the post-mortem
skin color changes of lividity and decomposition. It may be difficult to distinguish a bruise
sustained at the time of death from one that occurred ante mortem (before death), and
such bruises are best described as having occurred approximately “at or about the time
of death”.
Contusions to the deep tissues can be present without any evident skin surface
injury, particularly if the force applied is by a smooth object over a wider area. Such deep
bruises may spread under the influence of gravity and body movement, following the path
of least resistance along natural or traumatic planes of cleavage of the tissues, making
them visible only after dissection nd otherwise not visible on the skin surface.
The shifting of deep bruises explains their delayed appearance at the skin surface
some days after infliction, often located at the sites distant from the points of impact. For
example, the delayed appearance of bruising around the yes follows a blow to the
forehead, bruising behind the knee follows a blow to the lateral thigh or a fractured neck
of femur, and bruising to the neck follows a fractured jaw.
A second examination of the alleged victim is an assault after an interval of a few
days may show visible bruising where previously there had been swelling or tenderness
of deep bruising. Such second examinations are recommended as best practice.
Skin and mucosal bruises may be accompanied by abrasions and lacerations, but
they are not usually associated with cuts and stabs, where there is a free flow of blood
from the cut vessels rather than infiltration of blood into the tissues.
Bruising is essentially a vital phenomenon, in which infiltration of blood into the
tissues occurs under the pressure of the circulating blood. This is why after death, the lack
of blood pressure means that a considerable force is required to produce a bruise on the
cadaver. Such post-mortem bruises are disproportionately small relative to the force
applied, which may be evident from associated fractures, and the resultant bruises are
usually only a few centimeters in diameter.
In assessing whether the contusion is ante-mortem or post-mortem, the findings
and circumstances as a whole should be considered as these can cause confusion.
However, finger-pad bruises to the insides of the upper arms may be produced by simply
lifting the cadaver, particularly in those elderly women who have abundant loose
upperarm fat, which is often congested due to post-mortem lividity. Any livid dependent
area of a corpse bruises more readily post-mortem as a result of the vascular congestion.
Post-mortem lividity, which is the gravitational pooling of blood within the blood
vessels after death, may be confused with bruising. However, the pattern and distribution
of lividity usually makes the distinction straightforward.
Various terms exist to

describe the gross appearance of a
contusion. These include
petechiae, ecchymosis, and
hematoma. Petechiae or petechial
hemorrhages are small punctuate
hemorrhages or very small
contusions. They are minute
reddish or purplish spots
containing blood that appears in
the skin and mucous membranes as a result of localized
hemorrhages. Sizes range from pinpoint to pinhead.
Ecchymoses are the so called “love bites” (hickeys or

chikinini). These are superficial contusions produced by the
negative pressure of mouth suction. They are usually located
at the side of the neck, on breast or inner thighs, especially I
victims of alleged sexual abuse or sexual assault.
If the extravasated blood collects as a
discreet tumor-like pool, the lesion is referred to as
hematoma, which is defined as a focal
spaceoccupying collection of blood that expands
and/or distorts the tissue configuration. In most
cases, however, it may continue to grow or show
no change. If the sac of blood does not appear,
then it may need to be surgically removed.
The following are the different types of hematoma identified:

1. Subdermal hematoma (under the skin)
2. Othematoma (between the skin and the layers of cartilage of the ear)
3. Perichondral hematoma (ear)
4. Perianal hematoma (anus)
5. Subungual hematoma (nails)
6. Head / brain
a. Cephalohematoma (between the periosteum and skull)
b. Epidural hematoma (between the skull and the dura matter)
c. Subdural hematoma (between the dura mater and arachnoid mater)
d. Subarachnoid hematoma (between the arachnoid mater and pia
mater)
e. Subgaleal hematoma (between the galea
aponeurosis and periosteum)
C. LACERATIONS
Laceration refers to the splitting of tissues and
the forceful tearing of the skin when an object
impacts the skin with a force that exceeds its
elastic capacity. Lacerations result from blunt
force or acceleration/deceleration injuries,
and are different from incised wounds
resulting from sharp objects.
Direct crushing, typically between an
underlying object on the one side and
underlying bone on the other, will result in split-like lacerations of the skin. Such skin splits occur
most commonly where the skin lies close to the underlying bones, such as on the scalp, eyebrows,
cheeks, elbows, knuckles, knees, and shins.
Lacerations have the following characteristic features:
 They are ragged wounds with irregular division of the tissue planes
 They tend to gape because of the pull of elastic and muscular tissues
 Their margins are often bruised and abraded; these are important diagnostic features that
must be looked for with a hand-lens if necessary.
 Blood vessels, nerves, and delicate tissue bridges may be exposed in the depth of the
wound soiled by, for instance, grit, dirt or particles of glass
 Occasionally, the margins are shelved or flaps of skin are produced by a shearing blow,
the direction of which can then be deduced.
 Laceration of skin overlying bone may split the skin so cleanly as to simulate an incision;
this is particularly so on the scalp, face or shin, but close examination of the wound
together with the history of how the injury came to be sustained should clarify the
situation.
Lacerations do not generally reflect the shape and size of the object that produced them. They
may be smaller that the impact area or may extend beyond the impact area. However, like
contusions and abrasions, lacerations may have forensic value in death certification nd in court
room testimony, such as when the degree of violence and suffering are discussed.
Learning Sources:
• Sabino-Diangson, Grace D. (2015), Legal Medicine, ChapterHouse Publishing

Incorporated, Quezon City.
• Lagonera, Manuel G. (2010), Legal Medicine, Wiseman’s Book Trading, Quezon City
• https://in.pinterest.com/pin/643944446691829341/
• https://www.quora.com/What-is-the-main-characteristic-of-myxedema
• https://www.nejm.org/doi/full/10.1056/NEJMicm1106238
• https://biologydictionary.net/anthropometry/

Blunt Force

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Blunt Force

Uploaded by

Copyright:

Available Formats

PHILIPPINE COLLEGE OF SCIENCE AND TECHNOLOGY

Old Nalsian Road, Nalsian, Calasiao, Pangasinan, Philippines 2418

MODULE 3: MEDICO-LEGAL ASPECTS OF INJURIES AND WOUNDS

become an issue in courts or other legal processes. Documentation should be provided

The four Abdominopelvic Quadrants

The Nine Abdominopelvic Divisions

BLUNT FORCE INJURIES

Three main types of blunt force injuries

1. Brush Abrasions are broad patches,

2. A scratch is a linear abrasion produced by

Abrasions are sometimes considered superficial or trivial nd are, therefore,

Various terms exist to

Ecchymoses are the so called “love bites” (hickeys or

The following are the different types of hematoma identified:

• Sabino-Diangson, Grace D. (2015), Legal Medicine, ChapterHouse Publishing

You might also like