Bases of forensic medical Bases of forensic medical traumatologytraumatology

PLANPLAN

• 1. General questions of1. General questions of forensic medical forensic medical traumatologytraumatology

• 2. Abrasions. 2. Abrasions. • 3. Bruises (contusion).3. Bruises (contusion).• 4. Lacerations. 4. Lacerations. • 5. Damage of skull and bones5. Damage of skull and bones

FORENSIC TRAUMATOLOGYFORENSIC TRAUMATOLOGYAn Injury or a Wound An Injury or a Wound

means a solution or disruption of the anatomical means a solution or disruption of the anatomical continuity of any of the body tissuescontinuity of any of the body tissues

Factors Responsible For a Mechanical Injury:Factors Responsible For a Mechanical Injury:

1) force; 1) force;

2) area over which it acts;2) area over which it acts;

3) specific effect of the force;3) specific effect of the force;

4) time taken over which the kinetic energy is 4) time taken over which the kinetic energy is transferred.transferred.

CLASSIFICATION OF WOUNDSCLASSIFICATION OF WOUNDSA. Classification of Injuries according to causative factors:A. Classification of Injuries according to causative factors:I. I. Mechanical or Physical injuriesMechanical or Physical injuries

Injuries produced by application of blunt force:Injuries produced by application of blunt force:1. Abrasion1. Abrasion2. Bruise or contusion2. Bruise or contusion3. Laceration3. Laceration4. Fracture or dislocation of a bone, tooth or joint4. Fracture or dislocation of a bone, tooth or jointInjuries produced by application of sharp weapon:Injuries produced by application of sharp weapon:5. Incised wound5. Incised wound6. Punctured (stab) wound6. Punctured (stab) wound7. Incised- stab wound7. Incised- stab wound8. Chopped wound8. Chopped wound9. Sawn wound9. Sawn woundInjuries produced by application of teeth:Injuries produced by application of teeth:10. Bite marks.10. Bite marks.Injuries caused by a high velocity projectile:Injuries caused by a high velocity projectile:11. Firearm wound11. Firearm wound

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CLASSIFICATION OF WOUNDS (2)CLASSIFICATION OF WOUNDS (2)

II. II. Thermal injuriesThermal injuries 1. Due to application of heat:1. Due to application of heat:

a) General effects of exposure to heat, hot atmosphere - a) General effects of exposure to heat, hot atmosphere - Hyperpyrexia (heat stroke or sun stroke)Hyperpyrexia (heat stroke or sun stroke)

b) Effects of local application of heat: b) Effects of local application of heat: • Burn (due to application of dry heat);Burn (due to application of dry heat);• Scald (due to application of moist heat).Scald (due to application of moist heat).2. Due to application of cold:2. Due to application of cold: a) General effect of exposure to cold – Hypothermia;a) General effect of exposure to cold – Hypothermia; b) Local effects of exposure to cold:b) Local effects of exposure to cold:• Frost bite (due to dry cold);Frost bite (due to dry cold);• Trench foot (due to moist cold).Trench foot (due to moist cold).III III Chemical injuriesChemical injuries:: Corrosive poisons. Corrosive poisons.

CLASSIFICATION OF WOUNDS (3)CLASSIFICATION OF WOUNDS (3)

IV. IV. Miscellaneous injuries Miscellaneous injuries

1. Electrical injury;1. Electrical injury;

2. Radiation injuries;2. Radiation injuries;

3. Lightning injuries (a combination of electrical 3. Lightning injuries (a combination of electrical injury, mechanical injury and thermal injury);injury, mechanical injury and thermal injury);

4. Blast injuries (a combination of mechanical 4. Blast injuries (a combination of mechanical and thermal injuries).and thermal injuries).

CLASSIFICATION OF WOUNDS (4)CLASSIFICATION OF WOUNDS (4)

B. Medico-legal classification of injuries:B. Medico-legal classification of injuries:I. Self-inflicted or SuicidalI. Self-inflicted or SuicidalII. Injuries inflicted by others or Homicidal II. Injuries inflicted by others or Homicidal III. Accidental injuriesIII. Accidental injuriesIV. Defence woundsIV. Defence woundsV. Fabricated woundsV. Fabricated wounds

C. Classification in relation to moment of Death:C. Classification in relation to moment of Death:• Ante-mortem wounds Ante-mortem wounds • Post-mortem woundsPost-mortem wounds

Various Contact Surfaces of Blunt ObjectsVarious Contact Surfaces of Blunt Objects

Injuring Action of a Flat Surface: Unlimited, Injuring Action of a Flat Surface: Unlimited, Limited, and Mixed.Limited, and Mixed.

ABRASIONSABRASIONS

An An abrasionabrasion is is a destruction of the epidermis only. a destruction of the epidermis only.

The exposed raw surface is covered by exudation The exposed raw surface is covered by exudation of lymph and blood, which produces a protective of lymph and blood, which produces a protective covering known as a covering known as a scab or crust.scab or crust.

They are They are simple injuriessimple injuries, bleed slightly, and heal , bleed slightly, and heal rapidly without scar formation. rapidly without scar formation.

Mechanism of the Abrasion FormationMechanism of the Abrasion Formation

Destruction of the Epidermis Destruction of the Epidermis in Abrasionin Abrasion

Types:Types:

1) Scratches:1) Scratches: 2) Grazes2) Grazes (sliding, scraping or grinding abrasions): (sliding, scraping or grinding abrasions): ““drag marks”drag marks”

(3) Pressure Abrasions (crushing or friction (3) Pressure Abrasions (crushing or friction abrasions):abrasions):

Ligature MarkLigature Mark

MANUAL STRANGULATIONMANUAL STRANGULATION crescentic abrasionscrescentic abrasions

4) Impact 4) Impact Abrasions Abrasions (contact or (contact or

imprint imprint abrasions):abrasions):

Age of Abrasions:Age of Abrasions:

• Fresh:Fresh: Bright red. Bright red. • 12 to 24 hours:12 to 24 hours: Lymph and blood dries up leaving a Lymph and blood dries up leaving a

bright scab. bright scab. • 3 to 4 days:3 to 4 days: Reddish-brown scab. Reddish-brown scab. • 4 to 5 days:4 to 5 days: Epithelium grows and covers defect Epithelium grows and covers defect

under the scab. under the scab. • After 7 days:After 7 days: Scab dries, shrinks and falls off. Scab dries, shrinks and falls off.

On post-mortem drying, abrasions become On post-mortem drying, abrasions become dark-brown or even black dark-brown or even black

Medico-legal Importance:Medico-legal Importance: 1) Idea about the site of impact and direction of the force. 1) Idea about the site of impact and direction of the force.

2) Patterned abrasions are helpful in connecting the 2) Patterned abrasions are helpful in connecting the wounds with the object which produced them. wounds with the object which produced them.

3) The age of the injury can be determined. 3) The age of the injury can be determined.

4) Dirt, dust, grease or particles of stone or sand are usually 4) Dirt, dust, grease or particles of stone or sand are usually present, which may connect the injuries to the Scene of present, which may connect the injuries to the Scene of crime. crime.

5) Character and manner of injury may be known from its 5) Character and manner of injury may be known from its distribution. distribution.

CONTUSIONS (BRUISES)CONTUSIONS (BRUISES)

A A contusion contusion

(or bruise) (or bruise)

is an effusion of is an effusion of blood into the blood into the tissues, due to tissues, due to the rupture of the rupture of blood vessels, blood vessels, due to blunt due to blunt violence. violence.

Spectacle haematoma; black eye) Spectacle haematoma; black eye)

HaematomaHaematoma

Patterned BruisesPatterned Bruises

Deep Tissue and Organ Contusions:Deep Tissue and Organ Contusions:

Contusions of Heart and KidneyContusions of Heart and Kidney

The Age of Bruise:The Age of Bruise: • At first: At first: PurplePurple• Few hours to 2 days: Few hours to 2 days: Blue-purpleBlue-purple• 3 - 4 days: 3 - 4 days: Brown (haemosiderin) - greenish Brown (haemosiderin) - greenish

(biliverdine)(biliverdine)• 5 to 6 days: 5 to 6 days: Yellow (bilirubin)Yellow (bilirubin)• 7 to 8 days: 7 to 8 days: Three-coloured:Three-coloured: on periphery - on periphery -

brown-yellow, in media part - greenish -brown, brown-yellow, in media part - greenish -brown, in the center - blue-purplein the center - blue-purple

• 2 weeks: 2 weeks: NormalNormal

A love bite (Hickey) may vanish in 2 or 3 days.A love bite (Hickey) may vanish in 2 or 3 days.

Ante-mortem and Post-mortem BruisingAnte-mortem and Post-mortem Bruising: :

In In ante-mortemante-mortem bruising there is :bruising there is :• swelling, swelling, • damage to epithelium, damage to epithelium, • extravasation, extravasation, • coagulation, coagulation, • infiltration of the tissue with blood and color infiltration of the tissue with blood and color

changes. changes.

These signs are absent in These signs are absent in post-mortempost-mortem bruises. bruises.

ComplicationsComplications

• A contusion may contain 20 to 30 ml of blood A contusion may contain 20 to 30 ml of blood or even more. Multiple contusions can cause or even more. Multiple contusions can cause death from shock and internal haemorrhage.death from shock and internal haemorrhage.

• Gangrene and death of tissue can result.Gangrene and death of tissue can result.• Pooled blood can serve as a site for strong Pooled blood can serve as a site for strong

bacterial growth, especially for Clostridia group.bacterial growth, especially for Clostridia group.• Rarely in severe sudden compression of the Rarely in severe sudden compression of the

subcutaneous tissue, pulmonary fat embolism subcutaneous tissue, pulmonary fat embolism may occur.may occur.

Medico-legal Importance:Medico-legal Importance:

I) The degree of violence may be determined from I) The degree of violence may be determined from their size. their size.

2) Patterned bruises may connect the victim and the 2) Patterned bruises may connect the victim and the object or weapon. object or weapon.

3) The age of the injury can be determined. 3) The age of the injury can be determined.

4) Character and manner of injury may be known 4) Character and manner of injury may be known from its distribution. from its distribution.

Homicidal bruisesHomicidal bruises

LACERATIONSLACERATIONS

Lacerations Lacerations are are tears of skin, tears of skin, mucous mucous membrane, membrane, muscle or muscle or internal organs internal organs produced by produced by application of application of blunt force to blunt force to broad area of the broad area of the body. body.

They are also called They are also called tears or ruptures.tears or ruptures.

Types: Types: 1) Split Lacerations: Splitting occurs by crushing of the skin between two

hard objects. Scalp lacerations occur due to the tissues being crushed between skull and some hard object, such as the ground or a blunt instrument.

2) Stretch Lacerations: Overstretching of the skin if it is fixed will cause laceration. There is a local pressure with pull, which increases until tearing occurs and produces a flap. This is seen in cases of run-over by a motor vehicle, and the flap may indicate the direction of the vehicle's movement.

3) Avulsion is a laceration produced by sufficient force (shearing force) applied at an acute angle to detach (tear off) a portion of the traumatized surface of an organ from its attachment. The shearing and grinding force produced by a weight, such as a lorry wheel passing over a limb, may cause separation of the skin from the underlying tissues (avulsion) over a relatively large area. This is called "flaying". The underlying muscles are crushed, and the bones may be fractured. The separated skin may show extensive abrasions from the rotating frictional effect of the tyre.

4) Tears: Tearing of the skin and tissues can occur from impact by or against irregular or semi-sharp objects, such as the door handle of a car. This is another form of overstretching.

Characters:Characters:

1.1. Margins are Margins are irregularirregular 2.2. Ends are Ends are bluntblunt 3.3. BruisingBruising is seen around the wound. is seen around the wound. 4.4. Deeper tissues are unevenly divided with tags of tissue at the Deeper tissues are unevenly divided with tags of tissue at the

bottom of the wound bridging across the margin. bottom of the wound bridging across the margin. Tissue Tissue bridgesbridges consist of nerves, blood vessels and elastic and consist of nerves, blood vessels and elastic and connective tissue fibres. connective tissue fibres.

5.5. Hair bulbs are crushed. Hair bulbs are crushed.

Lacerations on the Lacerations on the cut: cut: (1) wound canal: (1) wound canal: (2, 4) central zone; (2, 4) central zone; (3) peripheral zone; (3) peripheral zone; (5) margins.(5) margins.

Wound Healing (Age of wound)Wound Healing (Age of wound)

• The phase of traumatic inflammation (from 1 to The phase of traumatic inflammation (from 1 to 3 days after wounding)3 days after wounding)

• The destructive phase (from 4 to 6 days)The destructive phase (from 4 to 6 days)• The proliferative phase (from 4 to14 days)The proliferative phase (from 4 to14 days)• The phase formation of scar (from 7 to14 days)The phase formation of scar (from 7 to14 days)

Ante-mortem Lacerations showAnte-mortem Lacerations show

• bruising of marginsbruising of margins• vital reactionvital reaction• eversion and gaping of the margins.eversion and gaping of the margins.

ComplicationsComplications

• Laceration of an internal organ may cause severe Laceration of an internal organ may cause severe or even fatal bleeding. Multiple lacerations, or even fatal bleeding. Multiple lacerations, involving only the skin and subcutaneous tissue, involving only the skin and subcutaneous tissue, each causing some haemorrhage, may combine each causing some haemorrhage, may combine to cause shock and death.to cause shock and death.

• Pulmonary or systemic fat embolism may occur Pulmonary or systemic fat embolism may occur due to crushing of subcutaneous tissue.due to crushing of subcutaneous tissue.

• Infection.Infection.

Difference between Ante-mortem and Post-mortem WoundsDifference between Ante-mortem and Post-mortem Wounds

CharacteristicsCharacteristics Ante-mortem woundAnte-mortem wound Post-mortem woundPost-mortem wound

MarginsMargins The edges are swollen, everted, The edges are swollen, everted, retracted, and gaping. retracted, and gaping.

The edges do not gape but are The edges do not gape but are close to each other. close to each other.

HaemorrhageHaemorrhage Abundant and usually arterial. Abundant and usually arterial. Slight or larger than slight, Slight or larger than slight, venous.venous.

SpurtingSpurting Signs of spurting of arterial blood on Signs of spurting of arterial blood on the body, clothing or in its vicinitythe body, clothing or in its vicinity

No spurting of blood.No spurting of blood.

ExtravasationsExtravasations . Staining of the edges of the wound . Staining of the edges of the wound and extravasations in the neighbouring and extravasations in the neighbouring subcutaneous and interstitial tissues subcutaneous and interstitial tissues which can not be removed by washing.which can not be removed by washing.

The edges and cellular tissues are The edges and cellular tissues are not deeply stained.not deeply stained.

CoagulationCoagulation Firmly coagulated blood in wounds Firmly coagulated blood in wounds and tissuesand tissues

No clotting or soft clots.No clotting or soft clots.

Vital reactionVital reaction Signs of vital reaction, i.e., in­Signs of vital reaction, i.e., in­flammation and repair. flammation and repair.

No signs of vital reaction.No signs of vital reaction.

Enzyme Enzyme histochemistryhistochemistry

Increased activity of Increased activity of adenosinetriphospate, aminopeptidase, adenosinetriphospate, aminopeptidase, acid and alkaline phosphatase.acid and alkaline phosphatase.

Diminished or no enzyme Diminished or no enzyme activity.activity.

Causes of Death due to WoundsCauses of Death due to Wounds

• Immediate or direct.Immediate or direct.• Remote or indirect.Remote or indirect.

Immediate CausesImmediate Causes• Haemorrhage.Haemorrhage.• Mechanical Injury to a Vital Organ.Mechanical Injury to a Vital Organ.• Shock.Shock. Types:Types: • • HaemorrhagicHaemorrhagic shock: This occurs when the blood loss is shock: This occurs when the blood loss is

sufficient to impair peripheral perfusion that produces a sufficient to impair peripheral perfusion that produces a sufficient degree of systemic anoxia. Loss of 10 to 40 % of the sufficient degree of systemic anoxia. Loss of 10 to 40 % of the total blood volume produces shock.total blood volume produces shock.

• • TraumaticTraumatic or wound shock. or wound shock. • • BurnBurn shock: It results from loss of plasma, absorption of shock: It results from loss of plasma, absorption of

necrotic tissue, and bacterial sepsis following extensive burnsnecrotic tissue, and bacterial sepsis following extensive burns • • SurgicalSurgical shock. shock. • • Cardiac Cardiac or cardiogenic shock.or cardiogenic shock. • • SepticSeptic shock. shock. • • EndotoxicEndotoxic shock. shock.• Reflex Vagal Inhibition.Reflex Vagal Inhibition.

Remote CausesRemote Causes

• Infection.Infection.• Gangrene or Necrosis.Gangrene or Necrosis.• Crush Syndrome.Crush Syndrome.• Neglect of Injured Person.Neglect of Injured Person.• Surgical Operation.Surgical Operation.• Natural Disease.Natural Disease.• Fibrous scar tissue formed due to healing may contract and Fibrous scar tissue formed due to healing may contract and

produce complications, e.g., fibrous scar in a hollow muscular produce complications, e.g., fibrous scar in a hollow muscular organ may produce stricture and obstruction.organ may produce stricture and obstruction.

• Thrombosis and Thromboembolism.Thrombosis and Thromboembolism.• Embolism (Air, Fat, Tissue).Embolism (Air, Fat, Tissue).

Medico-legal Importance:Medico-legal Importance: 1) The type of laceration may indicate the cause 1) The type of laceration may indicate the cause

of the injury and the shape of the blunt weapon. of the injury and the shape of the blunt weapon.

2) Foreign bodies found in the wound may 2) Foreign bodies found in the wound may indicate the circumstances in which the crime indicate the circumstances in which the crime has been committed. has been committed.

3) The age of the injury can be determined.3) The age of the injury can be determined.

Types of skull fractures Types of skull fractures ● ● fissuredfissured

● ● stellate or radiatingstellate or radiating

● ● depressed (including terrace-like) depressed (including terrace-like)

● ● elevatedelevated

● ● perforating (buttonhole) fractureperforating (buttonhole) fracture

● ● gutteredguttered

● ● crushed or comminuted.crushed or comminuted.

Conclusion.Conclusion.

• Thus, knowledge of characteristics, stages of Thus, knowledge of characteristics, stages of progress of damage by blunt objects help the progress of damage by blunt objects help the doctor in his professional activities, as often was doctor in his professional activities, as often was he who first described it in the medical records.he who first described it in the medical records.

LIST OF LITERATURELIST OF LITERATUREMain literatureMain literature1. Babanin A.A., Belovitsky O.V., Skrebkova O.Yu. Forensic 1. Babanin A.A., Belovitsky O.V., Skrebkova O.Yu. Forensic

medicine. Textbook // Simferopol, 2007. – 464 p.medicine. Textbook // Simferopol, 2007. – 464 p.2.Simpson’s forensic medicine. 10-th ed, 1991.2.Simpson’s forensic medicine. 10-th ed, 1991.Additional literatureAdditional literature1.Forensic pathology: 2-nd ed. / Vincent J.Di Maio, Dominick Di 1.Forensic pathology: 2-nd ed. / Vincent J.Di Maio, Dominick Di

Maio. – CRC Press. - 2001.Maio. – CRC Press. - 2001.2. Color atlas of Forensic pathology / by Jay Dix. – 2000.2. Color atlas of Forensic pathology / by Jay Dix. – 2000.3. Forensic evidence: science and the criminal law / Terrence F. 3. Forensic evidence: science and the criminal law / Terrence F.

Kiely – CRC Press. - 2001.Kiely – CRC Press. - 2001.4. Forensic science: an illustrated dictionary / by John C. Brenner. – 4. Forensic science: an illustrated dictionary / by John C. Brenner. –

CRC Press. - 2000.CRC Press. - 2000.5. Guide to forensic pathology / Jay Dix, Roben Calaluce; with 5. Guide to forensic pathology / Jay Dix, Roben Calaluce; with

contributions by Mary Fran Ernst. – 1999.contributions by Mary Fran Ernst. – 1999.6. Molecular forensics / edited by Ralph Rapley, David Whitehouse. 6. Molecular forensics / edited by Ralph Rapley, David Whitehouse.

– Wiley. – 2007.1. Babanin A. A., Belovitsky O.V., Skrebkova – Wiley. – 2007.1. Babanin A. A., Belovitsky O.V., Skrebkova O.Yu. Forensic Medicine. Textbook.- Simferopol, 2007.- 464 p.O.Yu. Forensic Medicine. Textbook.- Simferopol, 2007.- 464 p.