Mechanical injuries

1.

ZAPOROZHIAL STATE MEDICAL UNIVERSITY
THE DEPARTMENT OF PATHOLOGICAL ANATOMY and FORENSIC
MEDICINE

2.

MECHANICAL INJURIES
Forensic-medical examination of mechanical injuries
( the injuries from blunt hard objects and sharp objects) is
an important section of forensic-medical traumatology.
Such injuries are the most widespread.
They can inflict in situations of private life, work, sport,
traffic accident etc.
Action of blunt and sharp objects can inflict death of
an injured person.

3.

MECHANICAL INJURIES
Mechanical injuries are injuries
produced by physical violence.
A wound or injury is a loss of
the natural continuity of any of
the tissues of the living body.
Classification :
I. Mechanical injuries:
1) Abrasions.
2) Contusions.
3) Lacerations.
4) Incised wounds. 5) Stab wounds.
6)Chop wounds.
7) Fractures. 8) Dismemberment.
Legally, injuries are classified into:
1. Simple, 2. Moderate, 3. Grievous

4.

MECHANICAL INJURIES
Dismemberment ( railway trauma )

5.

MECHANICAL INJURIES
The mechanical injuries appear as a result of action
on the body of blunt and sharp objects: hammers, knives,
scissors,

6.

MECHANICAL INJURIES
Axe, rolling-pin, knives, screw-driver, scissors, iron

7.

ABRASIONS
An abrasion is a destruction of the skin,
which usually involves the superficial layers
of the epidermis only.
They are caused by a lateral rubbing action
by a blow, a fall on a rough surface, by being
dragged in a vehicular accident, fingernails,
thorns or teeth bite.

8.

ABRASIONS
Some pressure and movement by agent on
the surface of the skin is essential.
If sufficient friction is applied, partial or
complete removal of the epidermis may
occur, and the superficial layer of dermis is
damaged.

9.

ABRASIONS
The rougher surface and the more rapid the
movement of the skin over it, the deeper is
the injury.
The exposed raw surface is covered by
exudation of lymph and blood, which
produces a protective covering known as
a scab or crust.

10.

ABRASIONS
Abrasions vary in size, depending on the
extent of the body surface exposed
to the abrading force.

11.

ABRASIONS
They are simple injuries, bleed slightly, heal
rapidly without scar formation.
Large abrasions can cause severe pain and
bleeding.
The size, situation, pattern and number of
abrasions should be noted.

12.

AGE OF ABRASIONS
The exact age cannot be determined.
Fresh: Bright red.
12 to 24 hours: Lymph and blood dries up leaving a
bright scab.
2 to 3 days: Reddish-brown scab.
4 to 7 days: Epithelium grows and covers defect
under the scab.
After 7 days: Scab dries, shrinks and falls off.

13.

ABRASIONS
Medico-legal Importance:
1) They give an idea about the site of impact and direction
of the force.
2) They may be the only external sign of a serious internal
injury.
3) Patterned abrasions are helpful in connecting the
wounds with the object which produced them.
4) The age of the injury can be determined.
5) In open wounds, dirt, dust, grease or particles of stone
or sand are usually present, which may connect the injuries
to the scene of crime.

14.

ABRASIONS
Medico-legal Importance:
6) Character and manner of injury
may be known from its
distribution:
a) In throttling, crescent-like
abrasions due to fingernails are
found on the
neck,
b) In smothering, abrasions
may be seen around the mouth
and nose,

15.

ABRASIONS
Medico-legal Importance:
c) In sexual assault, abrasions
may be found on the breasts,
genitals, inside of the thighs and
around the anus,
d) Abrasions on the face or
body of the assailant indicate a
struggle,
e) Abrasions on the victim
may show whether the fingernails
of the assailant were long,
irregular or even broken.

16.

CONTUSIONS (BRUISES)
A contusion is an effusion of blood into the
tissues, due to the rupture of blood vessels,
(venules and arterioles) due to blunt violence.
The bruise is usually situated in the
subcutaneous tissues, often in the fat layer.
In contusion, there is a painful swelling and
crushing or tearing of the subcutaneous tissues,
usually without destruction of the skin.

17.

CONTUSIONS (BRUISES)
A contusion is usually a superficial injury, but
also occurs in deeper structures and viscera.
They are caused by blunt force, such as fist,
stone, stick, whip, boot, etc.

18.

CONTUSIONS (BRUISES)
Bruises may be seen in association with
abrasions or lacerations.
When a large blood vessel is injured, a tumourlike mass called haematoma is formed.
A fresh bruise is usually tender and slightly
raised above the surface of the skin,
and even a deep-seated bruise shows some
swelling when compared with the opposite limb or
part of the body.

19.

CONTUSIONS (BRUISES)
A bruise has lighter colour in the centre
because extravasated blood is pushed outward
by the impact.

20.

CONTUSIONS (BRUISES)
Size:
Bruises vary in size: from pinhead
to large collections of blood
in the tissues.
The size of a bruise is slightly
larger than the surface
of the agent which caused it,
as blood continues to escape
into the area.

21.

CONTUSIONS (BRUISES)
Size:
As a general rule, the greater the force of violence
used, the more extensive will be the bruises,
but size and shape are modified by the following
factors:
- Condition and Type
of Tissue
- Age
- Sex
- Color of Skin
- Natural Disease

22.

THE AGE OF BRUISE
A bruise heals by destruction and removal of the
extravasated blood.
The haemoglobin is broken down into methaemoglobin,
verdochaemochromogen , biliverdin and bilirubin by the
action of enzymes.
The color change starts at the periphery and extends to
the centre.
Great care should be exercised in giving opinion as to the
age of contusions depending on color changes.
The doctor can only state that the appearance (color) of a
contusion is consistent with its having been caused so
many days back.

23.

THE AGE OF BRUISE
At first: Red.
Few hours to 2 days : Blue.
3th day : Bluish-black to brown .
4 to 6 days : Greenish .
7 to 12 days : Yellow .
2 weeks – 1 month : Normal.

24.

CONTUSIONS (BRUISES)
Medico-legal Importance:
1)The degree of violence may be determined from
their size.
2) Patterned bruises may connect the victim and the
object or weapon, e.g., whips, chains, canes,
ligature, vehicle, etc.
3) The age of the injury can be determined.
4) In the case of fall, sand, dust, gravel or mud may
be found on the body.

25.

CONTUSIONS (BRUISES)
Medico-legal Importance:
5) Character and manner of injury may be known
from its distribution.
a) When the arms are grasped, there may be 3
or 4 bruises on one side and one larger bruise on
the opposite side, from the fingers and thumb
respectively, indicating the position of the assailant
in front of or behind the victim,
b) Bruising of the arms in a victim may indicate
restraint,

26.

CONTUSIONS (BRUISES)
Medico-legal Importance:
c) Bruising of the shoulder-blades indicate firm
pressure on the body against the ground or other
resisting surface,
d) In manual strangulation, the position and
number of bruises and nail marks may give an
indication of the method of attack or the position of
the assailant,
e) Bruising of thigh especially inner aspect,
and of genitalia indicates rape.

27.

LACERATIONS
Lacerations are tears
or splits of skin,
mucous membrane,
muscle or internal
organs produced by
application of blunt
force to broad area
of the body, which
crushed or stretched
tissues beyond the
limits of their
elasticity.

28.

LACERATIONS
They are caused by
blows from blunt
objects, by falls on
hard surfaces, by
machinery, traffic
accidents, etc..
If the blunt force
produces extensive
bruising and
laceration of deeper
tissues it is called
crushing injury.

29.

TYPES OF THE LACERATIONS
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.
Incised-like or Incised-looking
Wounds: Lacerations
produced without excessive
skin crushing, may have
relatively sharp margins.

30.

TYPES OF THE LACERATIONS
Blunt force on areas where
the skin is close to bone,
and the subcutaneous tissues
are scanty, may produce
a wound which by linear
splitting of the tissues,
may look like incised wound.
The sites are the scalp,
eyebrows, cheek bones, lower
jaw, iliac crest, perineum
and shin.
A wound produced by a fall
on the knee or elbow with the
limb flexed, and by a broken
glass, or sharp stone also
looks like incised wound.

31.

TYPES OF THE LACERATIONS
2) Stretch Lacerations:
Overstretching of the skin if it is fixed, will cause
laceration.
There is localized pressure with pull which
increases until tearing occurs and produces the
“flap”.
This is seen in the running over by a motor vehicle,
and the flap may indicate the direction of the
vehicle.
They can occur from kicking, and also when
sudden deformity of a bone occurs after
fracture, making it compound.

32.

TYPES OF THE LACERATIONS
3) Avulsion :
An avulsion is a laceration
produced by sufficient force
delivered at an acute angle to
detach (tear off) a portion of a
traumatized surface from its
attachments.
The shearing and grinding force by
a weight, such as lorry wheel
passing over a limb, may
produce separation of the skin from
the underlying tissues (avulsion)
over a relatively large area. This
is called "flaying".

33.

TYPES OF THE LACERATIONS
4) Tears:
Tearing of the skin and tissues can occur from
impact by or against irregular objects, such as
door handle of car. This is another form of
overstretching.
5) Cut Lacerations:
Cut lacerations may be produced by a heavy sharpedged instrument.
The object causing a lacerated wound crushes and
stretches a broad area of skin, which then splits
in the centre.

34.

CHARACTERS OF THE LACERATIONS
1)Margins are irregular, ragged and uneven and
their ends are pointed or blunt, but show minute
tears in the margins.
2) Bruising is seen either in the skin or the
subcutaneous tissues around the wound.
3) Deeper tissues are unevenly divided with tags of
tissue at the bottom of the wound bridging
across the margin. Tissue bridges consist of
nerves, blood vessels and elastic and connective
tissue fibres.
4) Hair bulbs are crushed.

35.

CHARACTERS OF THE LACERATIONS
5) Hair and epidermal tags may be driven deeply
into the wound.
6) Haemorrhage is less because the arteries are
crushed and torn across irregularly, and thus
retract and the blood clots readily.
7) Foreign matter may be found in the wound.
8) Depth varies according to the thickness of the
soft parts at the site of the injury and degree of
force applied.
9) The shape and size may not correspond with the
weapon or object which produced it.

36.

LACERATIONS
Complications:
1) Laceration of an internal organ may cause
severe or even fatal bleeding. Multiple
lacerations, involving only the skin and
subcutaneous tissue, each causing some
haemorrhage, may combine to cause shock and
death.
2) Pulmonary or systemic fat embolism may occur
due to crushing of subcutaneous tissue.
3) Infection.
.

37.

LACERATIONS
Medico-legal Importance:
1) The type of laceration may indicate the cause of
the injury and the shape of the blunt weapon.
2) Foreign bodies found in the wound may
indicate the circumstances in which the crime
has been committed.
3) The age of the injury can be determined.

38.

LACERATIONS
Circumstances of Injuries:
Suicidal lacerations are very rare, as they are
painful.
Accidental lacerations are usually situated on the
exposed parts of the body and mostly on the
same side.
In the case of fall on the head, the abraded scalp
surface will be circular and completely surrounds
the laceration.
Homicidal wounds are usually seen on the head.

39.

INCISED WOUNDS
An incised wound is a clean cut through the tissues, which
is longer than it is deep.
It is produced by the pressure and friction against the
tissue by an object having a sharp-cutting edge, such as
knife, razor, scalpel, sword, etc.

40.

CHARACTERS OF THE INCISED WOUNDS
Margins:
The margins are clean cut, well-defined and usually
everted.
The edges may be inverted if a thin layer of muscle
fibers is adherent to the skin as in the scrotum.
The edges are free from contusions and
abrasions.
1)
2) Width:
The width is greater than the edge of the weapon
causing it, due to retraction of the divided
tissues.
3) Length:
The length is greater than its width and depth.

41.

CHARACTERS OF THE INCISED WOUNDS
4) Shape:
It is usually spindle-shaped due to greater
retraction of the edges in the centre.
5) Haemorrhage:
As the vessels are cut cleanly, the haemorrhage is
more. Spurting of blood occurs if an artery is cut.

42.

CHARACTERS OF THE INCISED WOUNDS
6) Direction:
Incised wounds are deeper at their beginning
because more pressure is exerted on the knife at
this point.
This is known as the head of the wound.
Towards the end of the cut, the wound becomes
increasingly shallow, till finally as the knife
leaves the tissues the skin alone is cut.
This is known as the tailing of the wound, and
indicates the direction in which the cut was
made.

43.

AGE OF INCISED WOUNDS
In an uncomplicated wound healing occurs as
follows:
Fresh: Haematoma formation.
12 hours: The edges are red, swollen and adherent
with blood and lymph; leucocytic infiltration.
24 hours: A continuous layer of endothelial cells
covers the surface; overlying this a crust or scab
of dried clot is seen; vascular buds begin to form.
36 hours: The capillary network is complete;
mitotic activity in the basal cells.
.

44.

AGE OF INCISED WOUNDS
48 to 72 hours: Epidermal cells invade the space
where connective tissue finally develops;
the wound is filled with fibroblasts and capillary
buds grow in from the cut surfaces.
Three to five days: Definite fibrils running parallel
to the vessels are seen; vessels show thickening
and obliteration.
One to two weeks: Scar tissue is formed.

45.

INCISED WOUNDS
Medico-legal Importance:
1) They indicate the nature of weapon (sharp-edged).
2) They give an idea about the site of impact and direction of the force.
3) The age of the injury can be determined.
4) Position and character of wounds may indicate mode of production,
i.e., suicide, accident or homicide.

46.

INCISED WOUNDS
Circumstances of Injuries
Suicide:
1) They are multiple and
parallel or nearly so, in any
one area.
2) They are uniform in depth
and direction.
3) They are relatively trivial.
4) The fatal wounds are
present on several limited,
easily reached areas of the
body, such as front of the
neck, wrists, groin, and
occasionally on the back of
legs or on chest.

47.

INCISED WOUNDS
Circumstances of Injuries
Homicidal wounds of the chest are usually present
over a wider area and are more horizontal.
They may be directed from below upwards, which
is rarely seen in suicidal wounds.
Incised wounds situated on the back, or in such a
position as cannot be easily reached by a suicide
are homicidal.

48.

INCISED WOUNDS
Circumstances of Injuries
Accidental incised wounds may be caused by
falling upon a sharp-cutting weapon held in the
hand, or upon a sharp-pointed object, or by a
sharp piece of broken glass.
They may be situated anywhere on the body but are
commonly seen about the hands.

49.

STAB-INCISED WOUNDS
This is wounds, which appear from action of object with the
sharp end and sharp edge. This object can be with the
one-sided blade or two-sided blade. For example, scalpel,
kitchen knife, dagger, etc.

50.

CHOP WOUNDS
They are deep gaping wounds caused by a blow with the
sharp-cutting edge of a fairly heavy weapon, like an axe, a
sabre.
The dimensions of the wound correspond to crosssections of penetrating blade.

51.

CHOP WOUNDS
The margins are sharp and may show slight abrasion
and bruising with marked destruction of underlying organs.
If the edge is blunt, the margins are ragged and braised.
Undermining occurs in the direction towards which the chop
is made.
When the whole blade strikes the body at the same time,
the depth may be same throughout the wound.

52.

CHOP WOUNDS
Usually the lower end (heel) of the axe strikes the surface
first, which produces a deeper wound than the upper (toe)
end wound.
The deeper end indicates the position of the assailant.
Most of these injuries are homicidal and usually inflicted
on the head, face, neck, shoulders and extremities.
Accidental injuries are caused by power fans, band saws
or ship propellers, which may lacerate the soft tissues
extensively or amputate parts of the body.
Suicidal injuries are rare.

53.

CHOP WOUNDS

54.

STAB OR PUNCTURE WOUNDS
A stab wound is produced from
penetration by long narrow
instruments with blunt or
pointed ends into the depths
of the body, such as knife,
dagger, nail, needle, spear,
arrow, screwdriver, etc. that is
deeper than its length and
width on skin.
This can occur by driving the
object into the body, or from
the body's pressing or falling
against the object.

55.

STAB OR PUNCTURE WOUNDS
They are called penetrating wounds, when they
enter a cavity of body. When the weapon enters
the body on one side, and comes out on the
other side, perforating wounds or through-andthrough puncture wounds are produced.
The wound of entry is larger with inverted edges,
and the wound of exit is smaller with everted
edges, due to tapering of blade.

56.

CHARACTERS OF THE STAB WOUNDS
1) Margins:
The edges of the wound are clean-cut.
There is usually no abrasion or bruising of the margins, but
in full penetration of the blade, bruising may be produced
by the hilt or hilt-guard striking the skin.
The margins may be abraded, and ragged if the cutting
edge is blunt.
The opening may enlarge by backward, forward or a lateral
movement of the weapon.
The wound will gape, if a muscle is cut across.

57.

CHARACTERS OF THE STAB WOUNDS
2) Length:
The length of the wound is slightly less than the width of
the weapon up to which it has been driven in, because of
stretching of the skin.
For measuring the length of the stab wound, the edges of
the wound should be brought together.
If the instrument is thrust in, and is then completely
withdrawn with the cutting edge dragging against one
end, the wound would be extended superficially,
producing a tail.

58.

CHARACTERS OF THE STAB WOUNDS
3) Depth:
The depth (length of track) is greater than the width and
length of the external injury.
The depth of a stab wound is usually equal to, or less than
the length of the blade, that is used in producing it.
4) Shape:
The shape of the wound usually corresponds to the weapon
used, but the shape of the wounds made by the same
weapon may differ on different parts of the body.

59.

CHARACTERS OF THE STAB WOUNDS
5) Direction:
When the knife penetrates at an angle, the wound
will have a beveled margin on one side with
undermining (undercutting) on the other, so that
subcutaneous tissue is visible, indicating the
direction from which the knife entered.
In solid organs like the liver, the track made by the
weapon is better seen.
The principal direction should be noted first and
other next, e.g., backwards and to the right.

60.

MEDICO-LEGAL IMPORTANCE OF THE STAB
WOUNDS
1)The shape of the wound may indicate the type of
the weapon which may have caused the injury.
2)If a broken fragment of weapon is found, it will
identify the weapon or will connect an accused
person with the crime.
3)The depth of the wound will indicate the force of
penetration.

61.

MEDICO-LEGAL IMPORTANCE OF THE STAB
WOUNDS
4) Direction and dimensions of the wound indicate
the relative positions of the assailant and the
victim.
5) The age of the injury can be determined.
6) Position, number and direction of wounds may
indicate manner of production, i.e., suicide,
accident, or homicide.

62.

MEDICO-LEGAL QUESTIONS ON TRAUMA
1)Can post-mortem injuries be distinguished from
ante-mortem injuries?
2) Can the time of infliction of the wound be
determined?
3) Which of the several injuries caused death?
4) How long did the victim live, and could he have
carried out voluntary acts after receiving a fatal
injury?
5) What is the relationship of trauma and natural
disease?