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MEDICO LEGAL ASPECT OF INJURY

(LEGAL MEDICINE)





Submitted to:

Atty. Salex Alibogha
Professor
CPU College of Law





Submitted by:
Charma Rose Babayo
JD 3
rd
year




2013

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INTRODUCTION:

MEDICO LEGAL ASPECT OF INJURY

Definition of Injury
Medico-legally: injury is defined as breach or dissolution of natural continuity of any of
the tissue of a living body by actual physical violence.
Legally: trauma or injury may be defined as any harm whatsoever in nature caused
illegally to the body, mind, reputation or property

Definition of Wound
Medico-legally: include any lesion, external or internal, caused by violence, with or
without breach of continuity of skin.

Classification:
Etiological classification
- Mechanical
- Thermal
Depending upon severity of injury
- Simple injury
- Grievous injury
Depending upon the moment of death
- Ante mortem injury

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- Post mortem injury
Medico legal classification

TOPICS:

MECHANICAL INJURIES
-are those, which are caused by the physical violence to the body, depending on the
manner and how they are caused.

Examples: Blunt force injury
Sharp force injury
Fire-arm injury

Classification of Mechanical Injuries
Blunt Force Injuries/Trauma:
- There are many different forms of wound types that vary anywhere from bullets
and stabbing to blunt force and burns. No matter the type, each leaves a different
pattern and tells about the victims manner of death. A forensic pathologists job is
to investigate what the wound tells about how and what caused it. Though blunt
force wounds dont always leave the same evidence of diffusion as a gunshot or
knife, pathologists may still be able to complete conclusive determinations about
the trauma. Not only would they assess the wound, but also examine the force and
magnitude of infliction, which would lead to a conclusion of the cause of injury or

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death. Blunt force trauma is-as its name would suggest- a severe traumatic
episode caused to the body or head with the sudden introduction of a blunt
instrument used with great force. This could be caused by an attacker striking out
at a victim with: hands, a large piece of wood, baseball bat or other such item that
could cause severe damage to a body or skull if impacted quickly. Experimental
studies have shown, by analyzing forces generated by punching and kicking a
punch-ball that men can punch up to a force of 500-750 N and kick between
750-1200 N, while women can only punch up to 350-550 N, and kick 500-750 N.
Now though most cases you may see involve blunt force being caused by a
persons hands, feet, head, or even a bat, or other foreign object; it can also be
seen being caused from a car accident, such as from the dashboard, steering
wheel, or even the rear of the driver and passenger seats from victims not wearing
their seatbelts. Blunt force could even happen without the result of many visible
indicators. Individuals who die from this do so because of internal injuries
received from the force, resulting in nothing more than exterior bruising that may
not seem alarming.
1. Abrasions
2. Contusions
3. Lacerations
Sharp Force Injuries/Trauma:
1. Incised wounds
2. Stab wounds
3. Chop wounds

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Fractures
Fire arm injuries

1. ABRASIONS
-Injuries involving superficial layers of the skin and are caused by impact of an object,
fall on rough surface and pressure of finger nails, teeth, muzzle of a gun or by rope.

Abrasion

Tangential Compression
(friction/sliding/scrape) (crushing/pressure)

Linear Brush Patterned Non-Patterned
(scratch) (graze)

Impact Contact

Age of abrasion
Recent abrasion appears bright red scab 12-24 hrs.
Reddish brown scab 2-4 days.
Healing process starts 4-7 days.
Epithelium grows and dried scab falls 8-10 days.
Absence of infection.

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Antemortem Abrasions
Are with reddish brown colour injuries and has margins are blurred due to vital
reactions.

Postmortem Abrasions
If it is yellowish in colour, has translucent area, margins are sharply defined and there
is absence of vital reactions.

Artifacts in Abrasion
by ants, insects, animals and marine animals.

Medico-Legal Aspects in determining Abrasion
The expert need to indentify the following:
Site of impact and possibility of internal injury.
Identification of object causing the injury.
Cause of injury.
Direction of injury.
Time of injury.

2. CONTUSION/BRUISE

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- Contusion is an infiltration or extravasion of blood into the tissue due to rupture
of vessels by the application of blunt force. It is subcutaneous without
discontinuity of skin.
Examples: by a stick, stone or fist.
Features of contusion
Varies in sizes-Haematoma.
Superficial contusions are slightly raised over the skin.
May not be present at site of the impact.
Superficial contusions appear soon with red colour.
Deeper contusion appears late, can be detected by infra red photography.
Contusions over bony prominences are less visible externally.

Factors modifying the appearance of contusion
Site of injury
Vascularity of the part
Age
Sex
Colour of the skin
Nature of disease
Shifting of blood due to gravity


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Colour changes in the contusion
Colour changes in the contusion are due to disintegration and haemolysis of red blood
cells.
Haemosiderin-Iron pigments,dark brown colour to blue colour. 2-4 days.
Haematoidin-Iron free pigment. Green in colour. 5-7 days.
Bilirubin-Yellow colour.7-10 days.
Normal colour of skin 15-20 days.
Pigments are removed by phagocytes.

Age of the contusion
Colour changes
Histologically
Healing process depends on:
o Size and situation of contusion
o Age and physique of the person
o Presence and absence of disease
Antemortem contusion

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There is a sharp, well defined margins, swelling of the tissues, discoloration of the
skin, extravasation of blood into the true skin and subcutaneous tissue and doubtful
cases-Microscopic examination.


Postmortem contusion
It san be produced with in 1-2 hrs after death and if the body is decomposed it is
difficult to differentiate between antemortem and postmortem contusions.
Self inflicted contusion
It is rare and can be inflicted by irritant substances like Marking nut,root of plumbago
zeyloxica or rosea. It can also be differentiated by chemical analysis.
Homicidal contusion
Shape and size of contusion,indicates the weapon used.
Accidental contusion
Their position,arrangement,circumstances and surroundings.

Medico-Legal Aspects in determining Contusion
The expert need to indentify the following:
Identification of the object
Degree of violence

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Cause of injury
Time of injury

3. LACERATION WOUNDS/INJURIES
- These are the wounds caused by the blunt force resulting torn of the skin and the
underlying tissue, with a minimal bleeding.
Features of the lacerated wounds
Edges are ragged, irregular and contused
Margins are abraded due to impact of blunt force
Deep tissues are crushed
Hair bulbs are crushed
Less bleeding due to crushing of underneath vessels
Presence of foreign materials
Shape-Irregular
Size-May or may not correspond to the weapon
Margins-Irregular
Floor-Tags of tissue seen across the floor
Damage to the tissue-Gross and extensive
Haemorrhage-Less because of crushing of vessels
Foreign substances at the site of injury-dust, mud, gravels etc.
Healing-Process delayed due to gross damage and infection
Scars-Due to damage to skin and tissue

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Types of lacerated wounds
Split laceration:
Found in pats overlying bones-scalp, face, hands and lower limbs
Due to perpendicular impact by blunt force
Due to crushing of skin between two hard objects
It simulates the incised wound
Stretch laceration:
Due to over stretching of skin and produces flap
Due to blunt tangential impact-when head strikes on the wind screen of the vehicle
Due to sudden deformity of bones after fractures
Avulsion wound:
Degloving of skin over the impacted area due to compression and grinding of
underlying tissue
Commonly seen in road traffic accidents and by machinery in heavy industries
Tears laceration:
Due to friction with irregular or pointed end of a weapon or an object on the surface
of the body
Deeper at the string point than at the terminal
Cut laceration:
This type of lacerated wound is produce by not so sharp edge of heavy weapon

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Seen in chop wounds
Margins are not clear cut
Abrasions or contusions are seen on the margins

Medico-Legal importance of laceration
Homicidal-occurs in any part of the body .produced by blows with hard and blunt
weapon.
Suicidal-Very rare.
Accidental-Road traffic accidents, accidental fall from height.
Foreign bodies-Mud, gravel, oil etc.


4. INCISED WOUNDS
- Its produced by sharp cutting instruments-knife,razor,blade,swords,chopper,axe etc.
Features:
Edges are regular,clear cut, retracted and averted.
Except in neck and scrotum-edges are inverted.
Spindle shaped wound, maximum widening in the central part.
Length is greater than the breadth.
Breadth is greater than the thickness of the cutting blade.

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Gaping is greater if underlying muscles are divided across or cut obliquely.
Hemorrhage is excessive due to the cleat division of blood vessels.
Half severed artery bleeds more as they can neither retract nor contract.
Edges of wound may be irregular when skin is loose and if cutting edge is blunt.
By nature of the incised wound, weapon used can be identified.
Light sharp cutting weapons-razor blades, knife an produce incised wounds by
striking, drawing or by sawing.
Drawing cuts-Deeper at start, gradually become shallow and at the end only skin is
cut with scratch Tailing of the wound
The position of the accused and victim can be identified in homicidal cases, and
suicidal cases which hand has been used.
Sawing cuts-Multiple at the beginning and only one deep cut wound called
Tentative or Hesitation cuts
Bevelling cuts-When weapon is used oblique or tangential way over the body.



Heavy sharp cutting weapons-like swords,axes,choppers etc-wounds are greater and
severe. Usually homicidal in nature.
Injuries caused by these weapons show signs of bruising over the edges and extensive
damage to deeper structures and organs.

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Incised wounds made by curved weapons like sickle, tangi etc will cause single
wound when hit over the convex portion of body.
Weapons applied over the flat surface, it will make two wounds with intact of skin
between these two wounds and they will be in the same line.

Medico-Legal importance of incised wounds
Homicidal-Any part of the body, commonly on the neck, head and trunk, also be
found on the inner side of forearm or hand of victim while defending or protecting.
Defence Wounds.
Suicidal-Found in the accessible parts by light weapons on the throat (cut throat
wounds). Tail end of the wound indicates which hand has been used.
Accidental-Any part of the body hands, fingers during the handling of knife, razor
blades etc.
Weapon in relation to wounds
Incised wound means use of sharp cutting weapons.
Bevelled cuts and chop wounds suggest use of heavy or moderately heavy sharp
cutting weapons.
Manner of use of weapon
Deep chop wounds and bevelling suggests striking by the weapon.
Tailing and hesitation cuts indicate drawing of the weapon.

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Multiple superimposed or overlapping injuries are indicated by saw like movement of
the weapon.

Direction of application of force
From the tailing and bevelling, the direction of application of force can be known.
The relative position of the victim and the assailant can also be known, by the direction
of application of force.
Age of the wound or time since injury
In case of dead bodies-histological examination of tissue from the margin of the wound,
gives the clue that the survival of time after injury.
Time since injury can be studied by the healing process.
- When fresh- Bleeding is still present or fresh soft clot is adhered, margins are red,
swollen and tender.
- By 12 hrs- Blood clot and lymph dry up, margins are red and swollen. Histologically
there is infiltration of leucocytes.
- By 24 hrs- Proliferation of connective tissue cells and vascular endothelium for neo-
vascularisation.
- By 36 hrs- Fibroblastic infiltration and capillary network formation starts.
- By 48hrs- Capillary network is completed. Fibroblasts run across the new vessels.
- By 3-5days- Vessels are obliterated and thickened, wound heals and scar formation starts
and advances.

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- By 6
th
day- Scar formation is completed. Scab over the wound falls off. After weeks and
months, soft, tender, reddish scar becomes tenderless, whitish and firm.

5. DEFENCE WOUNDS
Defense wounds result from the immediate and instinctive reaction of the victim to save
himself, either by raising the arm to prevent the attack or by grasping the weapon.
o If the weapon is blunt, bruises and abrasions produced on the forearms or backs of
the hand.
o If the weapon is sharp the injuries will depend upon the type of attack, whether
stabbing or slashing.
o If the weapon is single edged and grasped-single wound. Double edged-double
wound.

6. FABRICATED & SELF-INFLICTED WOUNDS
They are the wounds inflicted by a person on his own body.
Fabricated wounds-produced by a person on his own body or others body with
consent. (fictitious, forged or invented)
To charge an enemy with assault or attempted murder.
To aggravate a simple injury.
By the assailant to pretend self defence.
In thefts\robbery where servants of the house are involved, to get absolved from
the crime.

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By woman to bring a charge of rape against an enemy.


7. STAB WOUND\PUNCTURED WOUND
These are the deep wounds produced by the pointed end of a weapon or an object,
entering the body.
These injuries generally caused by sharp pointed piercing stabbing weapons-
knives, dagger, bayonet, arrow, pick-axe, broken glass pieces.
A stab wound caused by a sharp pointed and cutting instrument has clean cut
edges, have sharp angles at the two extremities.
The wound is wedge shaped if it is produced by instrument with only one cutting
edge.
A sharp pointed and cylindrical or conical instrument produces a wound having a
circular or slit like opening.
When the edges of the weapon are sharp, the wound produced is an Incised
penetrating wound.
When the weapon edge is blunt, it produces a Lacerated penetrating wound.
Features of punctured wound
Length of the external wound should correspond with the breadth of the blade of
the weapon.
Entry wound length is little shorter than breadth of the blade or body of the
weapon.

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Exit wound also similar to entry wound.
Breadth of the entry or exit wound should correspond with the thickness of the
part of the blade of the weapon. But it depends on the elasticity of the skin,
direction of underlying muscle fibers and their intactness.
If the fibres are not cut, due to rigor mortis reduces the breadth-fibres are cut
increases the breadth.
Depth is the greatest dimension of a stab wound produced by the length of the
weapon introduced and its length and breadth by the breadth and thickness of the
weapon respectively.
Sometimes wound may be greater than the length of weapon in the yielding parts.
Edges are retracted, clean or lacerated and bruised according to the weapon used.
Knives, daggers, bayonets and other sharp cutting weapons cause surface injuries
will be an Incised Wound.
Pick-axe or horn of animals which have blunt edges-margins irregular, bruised
and lacerated.

8. CONCEALED PUNCTURED WOUND
These are punctured wounds produced by needles, nails or pins.
Concealed parts of the body-nostrils, frontanella, and fornix of the upper eyelids,
axilla, vagina, rectum and nape of the neck.
Complications
Marked internal haemorrhage.

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Infection to the wound due to foreign materials.
Air embolism.
Pneumothorax.
Asphyxia due to inhalation of blood.

Medico-Legal I mportance
Shape of wound indicates the type of weapon.
The depth of the wound indicates the force of the penetration.
Direction and dimensions of the wound indicate the positions of assailant and victim.
Age of the injury can be determined.
Position, number and direction of wounds can give clue for manner of production-
Suicidal, Accidental, Homicidal.

9. FRACTURE
- Fracture of a bone is defined as disintegration or breakage of bone due to blunt force
either directly or indirectly.
Direct fracture.
Indirect fracture.
Direct Fracture
Focal fractures
Small force applied to a small area. Injury to overlying soft tissue is minimal.

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Eg-forearm and leg, where two bones lie adjacent to each other. While defending blows
during an attack. Tapping Fracture.



Crush fractures
It results from application of a large force over a large area and is typically fragmented.
Injury to the surrounding soft tissue is usually extensive.
If two bones lie adjacent to each other, both are involved.
Eg- fracture of tibia and fibula in RTA.
Penetrating fracture
It results from applications of a large force over a small area.
Eg- Bullet injury to a bone. Both tissue damage and the comminuted type of fracture.

I ndirect Fractures
Traction Fractures
It results when a bone is pulled apart by traction.
Eg- Transverse patellar fracture due to violent contraction, of this type of fracture due
to sudden contraction of quadriceps.


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Angular fraction
It occurs due to bending of bone. The concave surface of the bend is compressed,
while the convex surface is put under traction resulting in breakage.

Rotational fracture
Fracture in spiral, when it is twisted.
Vertical compression fracture
In this type fracture can be seen in long bones with oblique fracture when hard shaft
of the bone is driven into the cellous portion.
In RTA there has been a collision and knee has impacted violently against the
dashboard.
Angular-Compression fracture
Here the fracture line is curved, with an oblique component due to compression and a
transverse component due to angulation.

Repair and healing of the fracture
Healing of the fracture depends on the age and nutritional status of a person.
Usually cancellous bone unites faster than cortical bone.
Haemorrhage phase.
Proliferation phase.

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Callus phase.
Consolidation phase.
Remodeling phase.

In the Haemorrhagic phase, bleeding will be at the site of fracture.
In the Proliferation phase, a collar is formed around the fractured ends by proliferation
of cells from periosteum and endosteum.
In the Callus phase, cellular elements give rise to osteoblasts and chondroblasts which
produce a matrix of collagen and polysaccharide, impregnated with calcium.
In the Consolidation phase the callus is transformed into mature bone by 4-6weeks in
children and in adults by 12-14weeks.
In the final, the Remodeling phase, matured bone will take place.

Medico-Legal I mportance
Fracture of a bone constitutes grievous injury according to law.
The type of fracture can give the clue of causative force, whether direct, indirect,
rotational or angular etc.
The site of fracture may help to indicate the cause of death.
Eg- fracture of hyoid bone suggestive of throttling.

CAUSE OF DEATH DUE TO INJURIES

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Primary/Immediate causes
- Neurogenic shock
- Injury to vital organs
- Hemorrhage

Secondary/Remote causes
- Infection
- Thromboembolism
- Acceleration of pre existing disease
- Professional medical negligence














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REFERRENCE:

http://www.scribd.com/doc/90786762/Medico-Legal-Aspect-of-Injury

http://jama.jamanetwork.com/article.aspx?articleid=326172

http://www.google.com.ph/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&
cad=rja&ved=0CEcQFjAC&url=http%3A%2F%2Fnky.wdfiles.com%2Floca
l--files%2Fforensic-
medicine%2FINJURY.ppt&ei=Di95UsK0I83arAfx7oGoBQ&usg=AFQjCNF4
Amp2doJen2QbXLJZVwDBuGLOpA&sig2=J7wuUoMs23-64NVY_6fpIw

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