INJURY CONTUSION

BY
Dr. AWDHESH KUMAR
ASSOCIATE PROFESSOR
DEPARTMENT OF FORENSIC MEDICINE
SARASWATI MEDICAL COLLEGE UNNAO
CONTUSION (Bruise, Haematoma)

Definition
A contusion is a haemorrhage into the tissues
as a result of rupture of small blood vessels,
especially capillaries by a blunt impact.
 CAUSES

- These injuries can be produced by blunt force

- e.g. fist, stone, stick, cane, shoes, etc.
 CLINICAL FINDINGS
-Examination of a Bruise about the colour, site,
size, shape, etc. of a bruise.
- A bruise usually shows no external bleeding,
- heals completely in 15 days
- no permanent scars.
- contusions of the viscera such as brain, heart,
liver, lungs, etc. could be fatal.
 CLASSIFICATION
Bruises Basically bruises are of three types -
1.SUPERFICIAL BRUISES
- Swelling due to infiltration of blood into the
subcutaneous tissues.
2.DEEP /DELAYED /MIGRATORY /ECTOPIC
BRUISES
- swelling may take more time to appear
externally.
- They may also be found in a different location
than actual site of injury, e.g. black eye .
3.PATTERNED BRUISES
- take up the shape of the causative weapon
used.
- e.g. ‘Tram-line’ or ‘Railway-line’ bruise this
comprised of two parallel linear bruises with
an unbruised area inbetween resulting from
a rod.
MECHANISM OF CONTUSION:
When a rod in used to hit, skin with blood
vessels underneath yields to the pressure at
the edges and ruptures bleeding at the edges
of the impacting object resulting in parallel
bruises.
 FACTORS AFFECTING BRUISING
• Type of tissue/site involved
• Age
• Sex
• Color of skin
• Natural diseases
• Gravity shifting of blood, etc.
AGE OF THE BRUISE (TIME SINCE INJURY)
COLOUR CHANGE TIME SINCE INJURY
• Bright red
(Swoolen tenden)- Freshly produced
• Bluish - Few hours to 3 days
• Bluish black/brown - 4th day
• Greenish- 4th to 5th days
• Yellowish - 7th to 12th days
• Normal - 2 weeks.
 DIFFERENTIAL DIAGNOSIS
1. ARTIFICIAL BRUISES (FABRICATED WOUNDS)
-These are skin lesions produced by the application of
certain irritant substances such as plumbago rosea-
roots/twigs of the plant and marking nut juice over
skin, which resembles a bruise apparently .
2. POSTMORTEM BRUISING
- Bruises cannot be produced after 2 minutes of
death.
- However, small bruises can be developed by great
violence even up to 3 hours of death.
3. POSTMORTEM LIVIDITY
DIFFERENCES BETWEEN BRUISE AND POSTMORTM
LIVIDITY
Characteristics Bruise PM Lividity
1 Swelling +ve –ve

2 Vital reaction +ve –ve

3 Incision of the lesion Blood is found Blood is

Extravasated into found intact
the within the
subcutaneous blood vessels
tissue
 Differences between artificial (Fabricated wound) and
true bruise
Characteristics Artificial bruise True bruise
1 Cause Irritant chemical Trauma (blunt)
2 Site Accessible parts Accessible parts
3 Colour Dark brown Typical changes
4 Shape Irregular Regular
5 Margin Regular + vesicles Nil
6 Inflammation +ve –ve
7 Itching +ve –ve
8 Vesicles under nails +ve –ve
9 Ecchymosis –ve +ve
10 Content Acrid serum Blood
11 Chemical test +ve –ve
 MEDICOLEGAL IMPORTANCE
• Bruise is of Lesser Importance than an
Abrasion Reasons for this are:
-Size of a bruise may not correspond to the size
of the weapon used
-Bruise may appear late after injury
-Bruise may appear in far away regions of the
body from the actual site of injury.
• It can help in assessing certain facts such as:
-Causative weapon
-Time since injury
-Degree of violence
• Characteristics and manner of injury,
• e.g.
-bruising of inner aspects of thighs or genitalia
is suggestive of rape or such other sexual
offences,
-bruising of shoulder blade are suggestive of
struggle.
 LACERATION (Tears)

Definition
A laceration is a disruption of the continuity of
tissue, produced by stretching or crushing
type of blunt forces.
 CAUSES

• Tearing up of tissues by blunt force,

• e.g.
- splitting of the skin by the overstretching on
fractured bones underneath,
- crushing of skin between two hard objects,
etc.
 CLINICAL FINDINGS
• Margins – irregular with pieces of tissues
attached in between, called tissue tags or
bridges
• Bruising – seen around the margin
• Deeper tissues – unevenly divided with tissue
tags
• Hair bulbs – crushed
• Depth of the wound – varies with force, and
contains abundant foreign matter such as
dust particles, paint material of the vehicle
involved, etc
• Laceration of viscera – heavy bleeding may be
seen, which may ultimately turn fatal
• Skin laceration – usually one of the margins
overhangs the other, which could help in
assessing the direction of force
• On healing – it produces permanent scar.
 CLASSIFICATION OF LACERATION
three types:
1. SPLIT LACERATION (INCISED-LIKE
LACERATION)
• Occurs when the skin is crushed between
two hard objects, e.g. incised-like laceration
of the scalp and forehead.
2. STRETCH LACERATION
Occurs due to the over-stretching of the skin,
beyond its elasticity, e.g. in fracture of
femur/other long bones , tyre passes over
the anterior abdominal wall.
3. AVULSION (AVULSED LACERATION)
skin (only) separates by tearing from the
underlying tissues e.g. common in road traffic
accidents.
 MEDICOLEGAL IMPORTANCE
1. motive of injury:
• Accidental—commonly seen anywhere on
exposed parts of the body
• Homicidal—especially noticed on non-
accessible parts of the body especially in
assault cases
• Suicidal—are very rarely seen as they are
painful to produce.
2. WEAPON USED
Foreign matter in the wound could give clues
about the, etc. e.g. paint material of
causative vehicle may be transferred onto
the lacerated wound.
3. DIRECTION OF FORCE
The skin flap, which overhangs the cut margin
(avulsion cases).
STAB WOUND
 DIFF. IN INCISED, LACERATION AND STAB INJURY
CHARACTERSTIC INCISED WOUND laceration STAB
1 MANNER OF SHARP WEAPON BLUNT POINTED
PRODUCTION

2 SITE ANYWHERE OVER BONY CHEST, ABDOMEN

PROMINENCE
3 MARGIN SMOOTH, CLEAN IRREGULAR, CLEAN CUT OR
CUT ,EVERTED UNDERMINED LACERATED
4 ABRASION AND ABSENT PRESENT ABSENT
BRUISE
5 Shape LINEAR IRREGULAR LINEAR OR IRREGULAR
6 DIMENSION LONGER IRREGULAR DEPTH GREATER
7 BLEEDING PROFUSE VARIABLE VARIABLE
8 HAIR BULB CLEAN CUT CRUSHED CLEAN CUT
9 BONE CUT FRACTURED PUCTURED