BLUNT FORCE TRAUMA~ Berti Nelwan

by: Dr.EzyanATP
Forensic Pathology
Forensic Pathology is the
branch of medicine which
analyses victims of crime
scenes medically.
They are the last physician for
the deceased and their role is
to discover and interpret the
evidence left during the
autopsy.

Analysis of Wounds
Not every crime victim is
murdered.
Physicians can contribute to
proof of the severity of a crime
or that a crime actually
occurred in some cases for a
living victim.
Wounds provide evidence
of the crime.

Wound Categories
Bruises (or contusions)
Abrasions (or grazes or
scratches)
Lacerations
Incised wounds
Puncture (or stab) wounds
Gunshot wounds

Definition
Blunt force trauma is routinely
The composition, or plasticity,
Injuries resulting from an impact with
involved in cases classified as
of the tissues impacted also
a dull, firm surface or object.
accidents, as well as in cases of
affects the resultant injuries.
The deaths resulting from blunt
suicide and homicide.
For example, a person who is
force trauma occur in a variety of
it is important to document
kicked in the chest may have
scenarios:
evidence of blunt force trauma in
only minimal injuries to the
almost all transportation
all autopsies
elastic skin surface, whereas
fatalities
deeper, more solid tissues such
one should not immediately
as ribs and internal organs may
jumping or falling from heights,
assume that blunt force trauma is
experience fractures and
the cause of death
blast injuries,
lacerations.
Be struck by a firm object, such The severity of injuries inflicted as
The another factor affecting the
a result of blunt force trauma is
as a fist, crowbar, bat, or ball.
severity of blunt force injuries is
dependent on the amount of
Bite wounds and chop injuries
the amount of time the body
kinetic energy transferred and
may be considered variants of
and the impacting object are in
the tissue to which the energy
blunt force trauma, sharp force
2
contact.
is transferred. (Ek= 1/2 mv ).
trauma, or a class of injuries
A longer period of contact
Important: the characteristics of
unto themselves.
allows kinetic energy to be
the blunt object and the
dissipated over a prolonged
surface that is impacted.

period, resulting in less damage

to the tissues than an equally
forceful impact with dispersion
of energy over a brief period.

Impacts involving a large surface

will result in a greater dispersion
of energy over a larger area and
less injury to the impacted tissues.
on a small area of a curved
surface, such as the head, will
cause greater damage than would
be caused were that same impact
to occur on a flat surface, such
as the back, since there will be a
more concentrated point of impact
on the head.

The major types of cutaneous blunt force injuries are as follows:

Contusion (bruise)
Abrasion
Laceration
Avulsion
Fracture

Bruise
Important: Natural Bruises

A bruise is "a hemorrhage into

tissues produced by the escape of

blood from blood vessels".
Bruises may be found in the skin,
muscles, and internal organs.
Bruises are typically produced by a
blunt force impact, such as a blow
or a fall.
They may also be produced by
squeezing or pinching, where the
force is applied gradually and then

Bruises may occur in a variety of

natural diseases in which there is
an abnormality of the clotting
mechanism of the blood, e.g.
scurvy (vitamin C deficiency),
leukemia, alcoholic liver disease.
This bruising is "spontaneous"
because the injury which produces
it is so insignificant as to typically
pass unnoticed.
The presence of such natural

Problems with Skin Bruises

Delayed appearance
Ageing (relative)
Site of Trauma
Shape of object
Degree of force
Post-mortem bruises
Post-mortem lividity

maintained.
Contusions are
discolorations of the skin caused
by bleeding into the tissues from
ruptured blood vessels.

Classic Causes of Bruises

Finger pad bruises: battered

babies, manual strangulation
Different ages: repeated
assaults
Shoulders and arms: forceful
restraint
Wrists and ankles: dragging
Inner thighs: forceful
intercourse
Chest: resuscitation
Bruising is uncommon in
Suicides

Delayed Appearance

Deep bruises may have

delayed appearance at the skin
surface. Deep bruises may require
as long as 12 or 24 hours to
become apparent, and some may
never do so
The more superficial the
source of bleeding, the sooner the
discoloration will be seen on the
skin surface.
In a living victim, a second
examination in one or two days
may show bruising.
In the dead, a further

disease will exaggerate the

bruising effects of any trauma.

Bruises

The extent of bruising is inversely

proportional to the sharpness of
the impacting object.
Bruises may be associated with
other blunt force injuries such as
abrasions and lacerations.
As a general rule bruising is not
associated with incised wounds or
stab wounds where there is a free
flow of blood from the cut blood
vessels rather than leaking into
the tissues.

Autopsy and Bruising

Bruising in Deep Tissue
1. Possibly life-threatening
2. Sometimes no external injury
3. Revealed in autopsy
Documenting Bruising
1. Photography
2. Notes

Site of Trauma

In contrast with abrasions, the

location of a bruise does not
necessarily reflect the precise
point of injury.
Leaking blood will follow the
path of least resistance and
gravity.

Degree of Force

The size of a bruise is an

unreliable indicator of the
degree of force causing it.
However, a heavy impact is
likely to produce a large bruise
and a light impact to produce
a small bruise.
If bruising is slight, it is
reasonable to assume that the
degree of violence was slight.

examination one or two days after

the original autopsy may show
bruises which were not previously
seen and reveal previously faint
bruises.

Determining Degree of Force in Bruise Patterns

Location:
Age
Some areas of the body bruise Infants and the elderly tend to
more easily than others. The
bruise more easily than young
face bruises more readily than
and middle aged adults.
the hands.
Infants have loose and delicate
Bruising occurs more readily in
skin, and the abundant
loose tissues and where there
subcutaneous fat.
is a large amount of
Elderly have degenerative
subcutaneous fat
changes in the tissues which
Bruising is less apparent
support the small blood vessels of
where the skin is strongly
the skin and subcutaneous
supported by fibrous tissue or
tissues.
if the muscle tone is good.
Gender:
Women bruise more easily than
men because they have more
subcutaneous fat and this is
particularly true of obese
women.
Natural Disease
Skin color

Causitive Object

Aging of Bruises

The shape of the bruise is most

likely to reflect the shape of the
causative object when the object is
small and hard and death occurs
soon after injury
A doughnut bruise is produced by
an object with a rounded contour
(e.g. baseball).
Two parallel linear bruises result
from a blow with a rod or stick
Bruises can follow rounded
contours if they are caused by a
flexible object like a lash
Bruises produced by
fingerpads as a result of gripping
are usually larger than the
fingerpads themselves.
The pattern and location
suggests the mechanism of
causation:
On the neck in throttling
On the upper arms in restraint.
Such bruises are referred to as
patterned.

Color changes a bruise goes

through can give a rough
estimate of time of injury
Colors result from breakdown of
hemoglobin from tissues
o Dark blue/purple (1-18 hours)
o Blue/brown (~1 to 2days)
o Green (~ 2 to 3 days)
Yellow (~3 to 7 days)

This rate assumes person is healthy,

however.
While accurate estimation of the
age of a single bruise is not
possible, a fresh bruise can be
distinguished easily from one
which is several days old.
Establishing that bruises are of
different ages may be of medical
importance where there is an
allegation of repeated assaults:
Child abuse
Wife beating
Where pre-existing injuries need
to be distinguished from those
produced by a recent assault like
a chronic alcoholic who was
assaulted.

Camps:

Polson and Gee:

red

immedia
te

red dark / red

black

< 24 h

dusky purple /
black

soon
after

greenish tinge

around day
7

green

days 4 -5

yellow

Yellow

days 7 10

around day
14

resolution

up to 30
days

days 14 15

resolution
Glaister:
violet

immediate

blue

day 3

green

days 5 - 7

yellow

days 8 - 10

resoluti
on

days 13 - 18

Smith and Fiddes:

red

immediate

purple black

soon after

green

days 4 -5

yellow

days 7 - 10

resolution

days 14 - 15

Post Mortem Bruises

It requires considerable violence

to produce a bruise post mortem
or after death.
These bruises are smaller relative
to the degree of force used.

The settling, after death, of

blood within the blood vessels
under the influence of gravity.
This results in a purplish
discoloration of parts of the

The pattern and distribution of

lividity distinguishes it from
bruising.
A body found on its back has
livor mortis on the dorsal (back)

body that are lower while

sparing areas of pressure
contact - contact pallor.

Post mortem bruises are most

readily produced in areas of
hypostasis (post mortem lividity,
livor mortis) or where tissues can
be forcibly compressed against
bone.

Patterns of Injury

Bruises to the knuckles of the

hands, together with bruises of

the eyelids, bridge of the nose,
cheeks and lips, suggest a fist
fight.

Bruising around the eyes

(spectacle bruises) may be
produced by direct blows, but also
commonly result from a fracture
of the base of the skull, e.g. in
vehicle collisions or gunshot
wounds to the head
They may also follow blunt impact
to the forehead producing jolting
of the eyeballs in their sockets
with tearing of small orbital blood
vessels.

Injuries in motor vehicle collisions

almost invariably include
abrasions and lacerations as well
as bruises.

Patterns of injury may allow

reconstruction of incidents
involving pedestrians or allow
distinction between driver and

front seat passenger.

side with pale areas where the

bone contacted the floor

BLUNT HEAD TRAUMA

Blunt trauma to the scalp and face
can produce contusions, lacerations,
and abrasions.
Battles sign a bluish
discoloration of the skin behind the
ear that occurs from blood leaking
under the scalp after a skull fracture.
Spectacle hemorrhage
(raccoons eyes) a discoloration
of the tissues around the eyes
usually due to a fracture of the skull.

are three major types of hemorrhages which occur in the skull.

1) Epidural hemorrhage
bleeding directly under the skull on
top of the dura mater. It is
associated with a skull fracture and a

Subdural hemorrhage bleeding

under duramater on top of the brain.
It may or may not be associated
with trauma and is caused by torn

Subarachnoid hemorrhage
caused by blunt trauma or ruptured
blood vessels. It is located directly on
the surface of the brain.

torn artery. This type of hemorrhage

accumulates rapidly and death may
occur quickly.

veins which forces the blood to

accumulate more slowly than the
epidural bleed.

Pathologists also look for the

presence of coup and
contrecoup injuries to the brain
to help differentiate between a
fall and a blow to the head by a
second party.
Coup injury caused when a
moving object (such as a
hammer) strikes a stationary
head. The injuries to the brain
will be directly beneath the point
where the weapon strikes the
head.
Contrecoup injury caused
when a moving head (as in a fall)
strikes a stationary object like
the floor. The injuries to the brain
will be opposite the point of
impact.

Abrasions
Definition

A scraping injury to the

superficial layers of the
skin (epidermis and
dermis) that results from
friction against a rough
surface
An abrasion is denuded
skin caused by friction. A
wound may be either deep
or superficial depending on
the force and the
coarseness of the surface
which caused the abrasion.

Side impact produces a moving

abrasion:
Indicates direction.
Trace material (e.g. grit).
Direct impact produces an
imprint abrasion:
Pattern of causative object.

All abrasions reflect site of

impact (in contrast with
bruises).
Assessment of age of
abrasions is difficult.
Post-mortem abrasions Brown, leathery

BRUSH-BURN ABRASION
One common type of blunt force
injury is the so-called brush-burn
abrasion. Brush-burn abrasions are
broad, dried abrasions that often
have a yellow-orange or orange-red
coloration.
These abrasions are caused by
dragging or scraping the surface of
the skin against a rugged surface;
they are most often encountered
when a body slides on pavement.
These abrasions are sometimes
called "road rash."

Laceration:
A bursting of the skin or
other tissues resulting
from compression or
stretching associated with
impact by a blunt object or
surface
Splitting of the skin by
the direct crushing of
blunt trauma.
Typically over bone,
e.g. scalp, eyebrow,
cheekbone.
Distinguished from
incised wounds by:
Adjacent
abrasion/bruise
Ragged edge
Tissue bridges in depth
Forensic Importance
Not related to object
shape
Trace evidence
Relatively little blood
loss (except scalp)
Rarely suicidal
Avulsion:

Fracture:

A more severe form

of laceration in
which the soft
tissues,
musculature, and/or
bone are torn away
from the normal
points of
attachment

A break, rupture, or
separation of tissue (most
often bone) resulting from
an impact