Chapter 10 MEDICO-LEGAL ASPECT

OF PHYSICAL INJURIES

LESSON 1: PHYSICAL INJURIES: DEFINITIONS

Medical Aspect:
- Medically, injury is defined as, any discontinuity or breach in the anatomy of the body.

Legal Aspect:
- Legally, injury is defined as any harm caused illegally to a person i.e. to his body, mind, reputation or
property.

LESSON 2: CLASSIFICATION OF WOUNDS

I. As to severity of injury
1. Non-mortal wound
- wounds which is not capable of producing death immediately after infliction or shortly
thereafter

2. Mortal Wound
- wound which is caused immediately after infliction or shortly thereafter that is capable of
causing death.
 Part of the body where the wounds inflicted are considered mortal:
 Heart and big blood vessels
 Brain and upper portion of the spinal cord
 Liver, stomach, spleen and intestine lungs
 Grievous Injury - All fractures of bones are classified as grievous injuries. Injuries to soft
tissues and organs that incapacitates a person from doing his normal duties for more
than TEN days

II. As to the Kind of Instrument Used

1. Blunt instrument - contusion, lacerated wound
2. Sharp instrument
a. Sharp-edged Instrument - incised wound
b. sharp-pointed instrument - punctured wound
c. Sharp-edged and sharp pointed instrument - Stab wound
3. Wound brought about by change of atmospheric pressure - Barotrauma
4. Wound brought about by heat and cold

III. As Regard to the Depth of Wound

1. Superficial
- When the wound involves only the layers of the skin
2. Deep
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 - when the wound involves the inner structure beyond the layers of the skin
a. Penetrating
- one in which the wounding agent enters the body but did not come out or the mere
piercing of a solid organ or tissue of the body
b. Perforating
- when the wounding agent produces communication between the inner and the outer
portion of the hollow organs.

IV. As regard to the Relation of the Site of the Application of Force and the Location of Injury
1. Coup Injury
- Physical injury which is located at the site of the application of force
2. Counter- Coup Injury
- physical injury found opposite at the site of application of force.
3. Coup Contre-Coup Injury
- physical injury located at the site and also opposite the site of application of force.
4. “Locus Minoris Resistencia”
- physical injury located not at the site nor opposite the site of the application of force but in
some areas offering the least resistance to the force applied.
5. Extensive Injury
- physical injury involving a greater area of the body beyond the site of the application of force.

V. Special Types of Wounds

1. Defense Wound
- Wound which is the result of a person’s instinctive reaction of self-protection.
2. Patterned Wound
- Wound in the nature and shape of an object or instrument and which infers the object or
instrument causing it.
3. Self-Inflicted Wounds/ Fabricated Wounds
- Wound produced on oneself.
- Motive of Producing Self-Inflicted wounds;
o To escape certain obligation or punishment
o To create new identity or destroy the existing one Finger-prints may be destroyed by acid
by cutting or burning
o To gain attention or sympathy Psychotic behavior

LESSON 3: TYPES OF WOUNDS

I. CLOSED WOUND
There is no breach of continuity of the skin mucous membrane
1. Superficial
- when wound is just underneath the layers of the skin or mucous membrane.
Types:
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 o Petechiae
o Hematoma
o Contusion
2. Deep
- Musculo-Skeletal Injuries
Types:
o Sprain
o Dislocation Fracture
o Strain – to injury by too much tension, use or effort
o Subluxation- partial dislocation of bone

II. OPEN-WOUND
- There is a breach of continuity of the skin or mucous membrane
Types:
o Abrasion
o Incised Wound
o Stab Wound
o Punctured
o Lacerated

CONTUSION
- Haemorrhage or bleeding is the escape of blood from any part
of the vascular system.
- Bruising is haemorrhage into the surrounding tissues. Bruising
may be seen in skin, muscle or any internal organ.

Types of contusion
1. Superficial
- It may occur immediately after the impact, due to
accumulation of fluid blood subcutaneously
2. Deep
- This signifies bleeding deeper to the subcutaneous tissues. It may takes hours or one or two days
to appear at the surface.
3. Patterned
- Due to compression of body part, some imprint of the object may be reproduced.

Characteristics of contusion
- Subcutaneous injury involving rupture of capillaries, epithelium being intact.
- Caused by hard & blunt objects.
- Site of bruise may be the site of impact or away from the site of impact due to gravity (ectopic bruise)
- Size of injury may vary from pin point hemorrhage to large haematoma.
- Contusion may not be visible in dark individuals

Characteristics of contusion
- Deep contusion may become visible externally after 1-3 day
- It may be associated with some other injuries like abrasion, laceration Contused Lacerated Wound.
- It heals within 1-2 weeks without apparent scarring.

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Factors influencing the degree and extent of contusion
1. General Condition of the victim – some healthy person are easily bruise
2. Part of the body affected
- body with excessive fat- contusion easily develops
- Parts with abundant fibrous tissue and good muscle tone – bruising less
3. Amount of force applied – the greater the force applied the more effusion of blood will develop.
4. Disease – contusion may develop with or without the application of force.
Example: Hemophilia, Anemia, whooping cough, even vicarious menstruation
5. Sex – women, specially obese, easily develop contusion
6. Application of heat or cold
- if immediately after injury cold compress is applied the production of contusion will be minimized.
- After it has already develop, application of warm compress will hasten its disappearance.
7. Age – children and old age persons rend to bruise easily
- Children- have loose and tender skin
- Old people – less flesh and blood vessels are fragile

Contusion Post-Mortem Lividity

- Ante-Mortem phenomenon - Post-Mortem phenomenon
- Is due to rupture of capillaries, - Is due to stagnation of blood in
hence extravasation of, blood. toneless dilated capillaries.
- May be present anywhere on the - Present only on dependent body
body. parts.
- Features of inflammation are seen - Features of inflammation is absent
- Colour changes as per stage of -
healing are seen
- To know; nature of injury, type of - To know; time since death, position of
weapon dead body, whether dead body was
shifted?

HEMATOMA (BUKOL)
 Accumulation of blood in a newly- formed cavity beneath the skin
 May be indicative of the amount of force applied

ABRASION
(Syn: grazes, scratches)

Definition: "a portion of the body surface from which the skin or mucous membrane has been removed by
rubbing" (from the Latin ab- from ,and radere- to scrape).

Characteristics of abrasion
 Superficial injuries
 Caused usually due to friction with rough, blunt, hard objects.( except scratches )
 Site of abrasion is the site of impact.
 They bleed slightly, sometimes there may be only lymph exudation.
 They heal rapidly within 1 to 2 weeks without scarring.

Forms of abrasion
1. LINEAR:
 Abrasion which appears as a single line

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  It may be straight or curved

2. MULTI-LINEAR:
 abrasion which develops when the skin is
rubbed on a hard rough object producing
several linear marks parallel

3. CONFLUENT:
 Abrasion where the linear marks on the skin are almost indistinguishable on
the account of the severity of friction and roughness

Types of abrasion

1. SCRATCHES: Caused by scratching with a sharp tip, e.g. pins, needles, knife, thorn, nail etc.
2. GRAZES : This injury results when the body is dragged on the rough surface, eg. during vehicular accidents.
3. Imprint Abrasion : It results from pressure of object on the body with no or little friction, sometimes it may
reproduce its print on the body.

4. Friction or pressure abrasion

 Caused by pressure accompanied by movement usually observed in hanging and strangulation
 Spiral strand of the rope as seen in the sin in hanging.

MEDICO-LEGAL ASPECT OF ABRASION

 These injuries are mostly accidental, sometimes homicidal & rarely suicidal.
 FORENSICALLY VERY IMPORTANT.
o Often the most informative of all injures:
 Always reflect site of impact
 Often indicate causative object/surface
 Often indicate direction of impact.
 These injuries are mostly accidental, sometimes homicidal & rarely suicidal.

LACERATION
From Latin lacerare - to tear.

Definition:
 It is defined as the injury caused by Heavy, Hard & Blunt objects, involving damage to some deeper
layers & deeper body parts. e.g. dermis, muscles, bones & internal viscera.

Characteristics of lacerated wounds

 It is caused by heavy, hard & blunt objects
 Deep injury.
 Site of injury is the site of impact.
 Shape of injury is irregular.
 Margins of injury are usually abraded or contused, showing irregular tags of tissues.
 Hair & hair bulbs are crushed.
 Nerves are crushed hence paralysis may result.
 Blood vessels are crushed hence bleeding is relatively less.
 Foreign body in the form of earth, hairs, cloth etc is usually present.
 Healing is by scarring

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TYPES OF LACERATED WOUNDS

1. Split laceration
 It results due to perpendicular force impact.
 The body part get crushed between heavy object & underlying bone.
2. Stretch laceration
 Caused by a heavy blunt impact on a fixed, localized area of skin causing the skin to overstretch
 E.g. glancing kick with shoe.
3. Torn lacerations
 Caused by a projecting surface of an object being dragged over the skin.
 e.g. road traffic accidents , machinery accidents
4. Perforated lacerations
 Caused by objects capable of penetrating the skin
 e.g. missiles of firearms, shrapnel from explosions
5. Blast lacerations
 Caused by local blast effect of expanding gases
 e.g. blast injuries
6. Crush lacerations
 Occurs as a result of crush injury where the injury
is caused by protruding bone fragment
7. De-gloved lacerations
 Caused by grinding force over the body resulting
peeling off of the skin from underlying tissues.
 E.g. road traffic accident

MEDICO-LEGAL ASPECT

 Lacerations are usually homicidal or accidental.

 Suicidal are very rare because of extreme force required & extensive pain.
 These are usually grievous injuries.

FORENSIC IMPORTANCE
 Shape and size not usually related to causal object
 Rarely self-inflicted
INCISED WOUND
 Impact cut – when there is a forcible contact of the cutting instrument with the body surface.
 Slice cut – when cutting injury is due to the pressure accompanied with movement of the instrument.
 Chopped or Hacked wound – when the wounding instrument is a heavy cutting instrument like saber.
Injury is severe.

CHARACTERISTICS OF INCISED WOUNDS

 They are caused by sharp edged weapons.
 Shape of injury is linear usually elliptical or spindle shaped.
 Margins are slightly everted, clear-cut, smooth & clean  Surrounding skin is clear.

CHARACTERISTICS OF INCISED WOUNDS

 Blood vessels are cut hence bleeding is profuse.
 Hair , hair bulb, muscles, bones are cut
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  Nerves are cut hence paralysis may result.
 Usually no foreign body is present.
 Healing is usually by scarring

Medico-legal aspect of incised wound

 Incised wounds are usually homicidal or suicidal & rarely accidental in nature.
 In homicidal incised wound, defense incisions are present on dorsum of hand, ulnar aspect, forearm or on
palm.
 Post mortem incised wounds may be caused by criminal to hide crime & identity.

PENETRATING INJURIES
 Penetrative injuries are injuries that pass through the
skin to enter the body cavities/deep tissues.
 Therefore death can be caused by either damage to
internal organs or hemorrhage by damage to major
vessels.

Types of penetrative injuries

 Stabs – caused by flat, thin bladed sharp cutting weapons. E.g. dagger, pen knives, table knives
 Punctures – caused by weapons where only the tip is pointed and rest of the weapon blunted
E.g. needles (knitting, sewing), pointed cycle spokes
 Perforations – caused by long blunt ended weapons. e.g. screw drivers, probes

Injury with one end cut & the other end torn making a 'Fish Tail' [arrow]
 The knife used would have been one with a single cutting edge

 The knife used would have been one with a double

cutting edge.

 The knife used would have been one with a hilt guard.

TYPES OF STAB WOUNDS

 Penetrating Wound – The weapon enters the body cavity, such as thorax or abdomen.
 Perforating Wound – When the weapon after penetrating the tissues, comes out from other side
making an exit wound.

EFFECTS OF STAB WOUNDS

 Victim may not initially be aware of injury. There may be little or no external blood loss.
 Internal blood loss may be profuse and rapidly fatal or slow enough to allow time for medical treatment.
 Main effect is bleeding. The time taken to incapacitate the victim and what actions are still possible is very
difficult to estimate.

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Characteristics of stab wounds
 Caused by sharp, more or less pointed, long objects.
 Depth is the greatest dimension.
 Wound of entry & wound of exit may be present.
 Shape of wound of entry depends upon nature of blade.
 Margins are inverted at wound of entry & everted at wound of exit.
 Direction of assault can be known by combining wound of entry & exit.
 It is a deep injury.  Healing is usually by scarring.

MEDICO-LEGAL ASPECT OF STAB WOUND

 The shape of the stab wound may indicate the class and type of the weapon which may have caused the
injury.
 The depth of the wound will indicate the force of penetration.
 Direction and dimensions indicate the relative positions of the assailant and the victim.
 The age of the injury can be determined.
 Position, number and direction of stab wound may indicate manner of production, i.e., suicide, accident,
or homicide.
 If a broken fragment of weapon is found, it will identify the weapon or will connect an accused person with
the crime.

PUNCTURED WOUNDS

Wound characteristics
 Result of a pointed or sharp and usually slender object forced inward
 Depth is greater than length
 Presents danger to vital organs
 Puncture wound is the result of a thrust of a sharp pointed instrument.
 Opening on the skin is very small
 External hemorrhage is limited although internally it may be severe
 Sealing of the external opening will be favorable for the growth and
multiplication of microorganism.

CHOPPING/HACK WOUNDS
 These represent injuries caused by relatively heavy sharp- edged
implements, such as machetes, meat cleavers, swords, hatchets and axes, etc…

Wound Characteristics
 Can have characteristics of both incised and lacerated wounds
 Extensive damage
o Avulsion (skin removal)
o Eviscerations (organ removal)
o Possible broken bone
GUNSHOT WOUND

 Gunshot wounds are typically categorized by examining characteristics of wound and looking for the
presence of gunshot residues.
 Presence of gunshot residues is used to determine approximate muzzle to garment / target distance.

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FACTORS INFLUENCING FIREARM INJURY
 Type of firearm weapon
 Type of cartridge
 Muzzle velocity
 Range of firing
 Angle of firing
 Ricocheting of bullet
 Part of body struck.

RANGE OF FIRING
 Contact firing- Muzzle end is in contact with body part.
 Close range- Firing up to 2yards(3feets)
 Long range- Firing beyond 2 yards.

A gunshot wound can be penetrating, perforating, or grazing.

 A penetrating gunshot wound is one in which the bullet remains in the body;
o A penetrating gunshot wound only has an entrance wound. These injuries are often the most
lethal; as they indicate that the entirety of the bullet's kinetic energy was transferred to the body.
 A perforating gunshot wound is one that passes through the body completely;
o There are both an entrance wound and an exit wound.
o Often, a bullet that has passed through a body can become deformed and tumble
 Grazing wound is one in which the bullet grazes the body as it passes, causing a generally milder injury
than the other forms of gunshot wound.

When looking at gunshot residues, it is important to remember that it is not possible to accurately determine
distances without conducting tests using the suspected firearm and similar ammunition

 If a bullet enters at an angle, there may be an elliptical abrasion around the hole.

 The victim’s face and entire head just exploded and left massive shotgun
wound where the head once was with his jaw hanging and lose brain
filling the hollows.

Effect of Hair on the Deposition of Gunshot Residue

 The skin area has a dense gunshot residue deposit.
When the same ammunition and firearm are used at
the same distance to fire into a hair- covered scalp,
there is no visible gunshot residue present.
 The hair was partially cut for examination purposes.

 Show gunshots with and without intervening hair

that clearly display the difference in the presence or absence of
gunshot residue deposits.
 Also note the reduction in the amount of bullet
wipe; the hair not only filters out powder particles, but it also
absorbs a considerable amount of the carbonaceous bullet-
wipe material.
MEDICO-LEGAL ASPECT OF GUNSHOT INJURY
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  The direction of the firing
o It is better to try to assess the direction of the firing from the dispersion of the pellets incases of
shotgun injuries and from abraded/contused and grease collars, in case of bullet injuries by rifled
weapons.
 Distance of firing
o In case of bullet injury (rifled gun), the distance of firing can be assessed from:
 Effects of fire, smoke, burnt and unburnt gunpowder, when firing is from a short or near
distance.

Evidences that gunshot wound is homicidal.

 Site of wound of entrance has no point of election.
 Fire is made when the victim is at some distance.
 Signs of struggle or disturbance.
 Wounding firearm not usually found at the crime scene.
 Testimony of the witness.

Evidences that the gunshot wound is accidental.

 Usually one shot.
 No special area of the body involved.
 Consideration on the testimony of the assailant and determination as to whether it is possible as to
knowing the relative position of the victim.
 Testimony of the victim.

BURN
 The depth of a burn is dependent on the temperature of the burning agent and the length of time.
 Tissue damage may occur at temperatures of 48 degrees Celsius.
 Irreversible damage to the dermis occurs at 70 degrees Celsius.
 Burn injuries are described as:
o Superficial (first-degree burns)
o Superficial or deep partial thickness (second-degree burns)
o Full thickness (third-degree burn)

Burn Classification
 Superficial (first degree burn)
o Involve only the epidermal layer of the skin.
o Sunburns are commonly first-degree burns.
 Superficial or deep partial thickness (second-degree burn)
o Destruction of the epidermis and varying depths of the dermis.
o Usually painful because nerve endings have been injured & exposed.
o Ability to heal because epithelial cells is not destroyed.
 Full thickness (third-degree burn)
o Destruction of the epidermis and the entire dermis, subcutaneous layer, muscle and bone.
o Nerve ending are destroyed-painless wound.
o Escher may be formed due to surface dehydration.
o Black networks of coagulate capillaries may be seen.
o Need skin grafting because the destroyed tissue is unable to epithelialize.
o Deep partial-thickness burn may convert to a full-thickness burn because of infection, trauma or
blood supply.

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Factors determining severity of burns
 Size of burn
 Depth of burn
 Age of victim
 Body part involved
 Mechanism of injury
 History of cardiac, pulmonary, renal or hepatic disease
 Injuries sustained at time of burn

BURN INJURIES
Severity of burns depends directly on:
 Intensity of fire
 Duration of exposure

 Chemical fires may reach temperatures of several thousand degrees

 House fires seldom exceed 1200 F (649 C), at this temperature it is unlikely adult body
will burn completely
 Even though external body is charred and unrecognizable, internal organs are usually
intact and liquid blood for DNA, toxicology, and carbon monoxide testing is present.

 Teeth will usually be in excellent condition for identification purposes

 When body is exposed to heat, muscles contract and draw arms and legs
into bent position This position has been compared to the stance of a
pugilist – boxer.

 This burned position is referred to as “pugilistic attitude”

 Contracted muscles of upper & lower extremities

• Heat Fracture - fractures of the skull due to intra-cranially generated steam and
fracture of extremities due to thermal contraction of tendons. ##

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