• Iden<fy
the
type
of
Injury
?
• How
the
injury
has
been
caused
(weapon)
?
• When
was
it
caused
(Age)
?
• Reconstruc<on
of
the
event
• Circumstances
of
the
event;
assault/accident/ self
inflicted
• Nature
of
the
injury
?
Non-‐grievous/Grievous/ Fatal
in
the
ordinary
course
of
nature/ necessarily
fatal
Blunt
weapons/force:
Abrasions
Contusions
Lacera<ons
Puncture/perforated
wounds
Sharp
weapons:
Cut
injuries
or
incised
wounds
Stab
injuries
• Most
superficial
of
all
injuries
on
skin
&
mucosa
• Confined
to
epidermis,
hence
should
be
no
bleeding
• But
corrugated
nature
of
papillae
results
in
bleeding
• Caused
by
blunt
surface/pointed
objects
• Surface
discoloured/moistened
with
exudate
• Abrasions
heal
without
a
permanent
scar
1. Linear
abrasions/scratch
abrasions
2. Graze
abrasions/Brush
abrasions
3.
Imprint
abrasions/crush
abrasions/pa]erned
• Caused
by
<p
of
a
knife/pin/finger
nail
• When
drawn
across
the
skin,
takes
epidermis
with
it
leaving
a
groove
• Heaping
of
epidermis
at
one
end
• Thus
direc<on
of
movement
can
be
worked
out
(using
a
magnifying
glass)
• Caused
by
tangen<al
movement
of
a
broad
rough
object/surface
• Tags
of
epidermis
carried
in
the
direc<on
of
movement
• There
will
be
mul<ple
parallel
grooves
with
exudate
• Ex.
Pedestrian
sliding
on
the
road
surface/ striking
skin
with
a
brick
at
an
angle
• Causa<ve
weapon/object
strikes
perpendicularly
on
the
skin
• Leaves
an
imprint
of
the
striking
surface,
hence
able
to
iden<fy
the
weapon/object
• Ex.
Assault
with
bicycle
chain,
serrated
knife
edge,
falling
on
a
wire
mesh,
muzzle
imprint
of
a
fire
arm,
tyre
mark
in
run
over
• May
be
associated
with
underlying
contusion
• Immediately
a^er
injury
–
serous
exudate,
tender,
redness
• 24
hours
–
brownish
scab
with
surrounding
redness
• 2-‐3
days
–
scab
darker
and
redness
fades
• 4-‐6
days
–
scab
contracts
leaving
white
margin
around
the
scab
• 7-‐10
days
–
scab
falls
leaving
a
de-‐pigmented
area
• Situated
sub-‐epidermally,
visible
through
overlying
corium
• Ex.
Tyre
imprint
in
run-‐over
accident,
assault
with
a
cycle
chain
• Tyre
tread
consists
of
grooves/ridges
• Skin
pushed
into
grooves
and
ridges
(of
the
tyre)
compress
skin
and
blood
pushed
out
• Small
vessels
break
along
ridge-‐groove
(of
the
tyre)
junc<on
• Bleeding
occurs
through
damaged
blood
vessels
along
the
ridge-‐groove
junc<on
• Thus
an
imprint
of
the
tyre
tread
pa]ern
is
stamped
on
the
skin
in
run
over
accidents
• Nature
of
<ssue,
be]er
seen
in
fa]y
<ssue
and
less
prominent
in
fibrous
<ssue,
muscular
<ssues
• Amount
of
force
used,
higher
the
force
larger
the
bruise
• Easily
caused
when
there
is
underlying
bone,
ex
scalp,
over
the
<bia
• Fragility
of
vessels,
old
age
fragile
vessels
rupture
with
minimum
of
force
(contd.)
• Bleeding
diathesis
leads
to
easy
bruising
• With
passage
of
<me
bruises
become
more
prominent;
haemolysis
stains
<ssues,
movement
of
blood
from
deep
to
superficial
layers
• Blood
in
a
bruise
in
certain
sites
gravitates;
scalp
to
orbit,
upper
arm
to
elbow,
thigh
to
knee
• Extravasated
blood
(red
cells)
undergoes
degrada<on
with
the
passage
of
<me
• Haemoglobin
breaks
down
into
haemosiderin,
biliverdin
and
bilirubin
• Colour
change
from
RED
to
PURPLE
to
BLUISH
BROWN
to
GREEN
to
YELLOW
• However,
colour
change
may
not
happen
in
this
order
• Da<ng
bruises
from
the
above
colour
changes
not
very
reliable
• Many
variable
factors
affect
the
process
• These
include
size
of
the
bruise,
age
of
the
person,
coagula<on
defects
• Only
reliable
conclusion
is
that
when
a
bruise
is
yellow
it
is
more
than
18
hours
old
• Discoid
bruises,
1cm
diameter,
in
groups
corresponding
to
finger
<ps
in
manual
strangula<on,
grip
marks
as
in
child
abuse
• Assault
with
a
cylindrical
or
rectangular
club
produce
“tram
line”
or
“rail
way
track”
shaped
bruises
Weapon
sinks
and
pulls
blood
vessels
which
break
at
the
margin.
Once
the
pressure
from
rod
is
released
blood
rushes
up
leading
to
bleeding
along
the
two
margins
• “Black
eye”
is
accumula<on
of
blood
around
the
eye
in
the
eye
socket.
Caused
by
either
direct
blow
to
eye,
gravita<on
of
blood
from
scalp
injury
or
fractured
roof
of
orbit
• “Love
bites”
is
also
a
form
of
bruise
made
up
of
<ny
petechiae
due
to
suc<on
on
the
skin.
There
may
be
an
associated
imprint
abrasion
from
teeth
• Only
the
term
“
contusion”
can
be
used
for
organs
• Contusions
are
seen
in
almost
all
the
organs
when
there
is
extravasa<on,
infiltra<on
and
coagula<on
in
the
viscera;
brain,
heart,
lungs,
liver,
spleen,
bowel,
mesentery
and
even
in
muscles
• Caused
by
blunt
trauma,
involving
the
full
thickness
of
skin,
subcutaneous
<ssues,
muscle
or
organ
• Skin
edges
irregular,
margins
may
be
bruised,
ends
torn,
blood
vessels
and
nerves
crossing
the
base
crushed
intact,
o^en
contaminated
• Lacera<on
on
scalp
mimics
an
incised
wound
as
the
scalp
splits
due
to
blunt
trauma
against
underlying
skull
• Split
lacera<on:
Force
in
the
form
of
crushing
force,
ex.
struck
by
a
club
on
the
head
where
there
is
underlying
bone,
mimics
a
cut
• Torn
lacera<on:
Tearing
force
causing
torn
lacera<on
ex.
when
a
projec<ng
object
tears
through
skin
• Stretch
lacera<on:
Excessive
force
pulling
the
skin
(Contd.)
• De-‐gloving
lacera<on:
Grinding
type
of
force
as
in
run
–over
accident
• Crush
lacera<on:
Due
to
crushing
type
of
force
the
fractured
bone
fragments
pierce
through
skin
from
within
ex.
heavy
object
falling
on
head
Lacera0ons
are
produced
by
non-‐blunt
trauma
in
special
situa0ons
ex.
Due
to
blast
effect
of
bomb
explosion
and
missiles
from
firearm
and
explosive
devices
• Fracture
is
a
breach
in
the
con<nuity
of
bone
Classifica0on
of
fractures
A. Simple
fractures
–
overlying
skin
intact
B. Compound
fractures
–
overlying
skin
breached
(Contd.)
Classifica0on
of
fractures
• Green
s0ck
fracture
–
incomplete
fracture
• Transverse
fracture
–
break
across
the
bone
• Spiral
fracture
–
break
spirals
around
the
bone
• Oblique
fracture
–
diagonal
fracture
across
the
bone
(Contd.)
• Segmental
fracture
–
fracture
at
two
levels
with
a
floa0ng
segment
• Comminuted
fracture
–
bone
fragmented
into
several
pieces
Classifica0on
of
fractures
• Pathological
fractures
–
fracture
of
bones
which
have
been
weakened
by
disease
ex.
Osteoporosis
• Caused
by
sharp
weapons;
knife,
sword,
axe,
glass,
by
slashing
ac<on
• Length
of
wound
is
greater
than
the
depth
• Edges
are
sharply
cut
(Contd.)
• Margins
clean
and
free
of
damage
• Ends
sharply
cut
• Structures
which
cross
the
wound;
blood
vessels,
nerves
sharply
cut
• Bleeds
profusely
as
the
blood
vessels
are
cleanly
cut
• When
slashed
across
the
body,
entry
end
may
be
deeper
than
the
exit
end
where
the
wound
becomes
shallow
and
ends
as
a
linear
abrasion
(tapering,
tailing)
Classified
as
:
Stab
wounds:
to
be
described
Puncture
wounds:
caused
by
blunt
pointed
weapons
with
rounded
sha^.
Wound
edges
irregular,
margins
with
bruises/abrasions
ex.
Pencil,
pointed
metal
rod
Perfora<ng
wounds:
caused
by
long
blunt
ended
weapons.
Wound
edges
irregular,
margins
with
bruises/abrasions
ex.
screw
driver
• Stab
wound
is
inflicted
by
a
flat,
thin
bladed,
sharp
(cujng),
pointed
weapon
ex.
Kris
knife,
dagger,
table
knife
• Depth
of
the
wound
is
greater
than
the
length
• Edges
are
sharply
cut
&
margins
free
of
abrasions
• Ends
are
sharply
cut
(contd.)
• Structures
crossing
the
base
cleanly
cut;
blood
vessels,
nerves
• There
is
profuse
bleeding
from
cut
vessels
• Under
cujng
of
<ssues
seen
when
stabbed
at
an
angle
• Danger
of
piercing
internal
organs/infec<on/
hemorrhage
into
body
cavi<es
f
(contd.)
• Shape
of
the
stab
could
be
linear
or
ellip<cal
• With
a
thin
bladed
knife
stab
wound
is
linear
• If
the
stab
wound
is
placed
across
Langer’s
lines
or
across
muscles
it
would
be
ellip<cal
• Therefore
when
measuring
the
length,
need
to
approximate
the
edges
(contd.)
• Use
of
knives
with
double
cujng
edges,
both
ends
of
the
wound
will
be
sharply
cut
• Knives
with
one
edge
sharp
and
the
other
blunt
and
thick,
the
blunt
end
will
produce
“fish
tail
“
appearance
• If
one
edge
of
knife
is
serrated
as
in
“Rambo”
knife,
stab
wound
shows
serrated
abrasions
along
one
edge
(contd.)
• Usually
the
length
of
the
stab
is
approximately
equal
to
the
width
of
the
blade
• In
par<al
entry,
the
length
of
the
wound
will
correspond
to
the
width
of
the
blade
at
the
point
of
penetra<on
• Elas<city
of
skin
and
contrac<on
of
cut
muscles
make
the
length
smaller
than
the
width
of
the
blade
(contd.)
• Rocking
of
the
knife
in
the
wound,
stabbing/
pulling
out
knife
at
an
angle
or
movement
of
the
vic<m
will
make
length
greater
than
the
width
of
the
blade
• Stab
wound
may
be
V
or
L
shaped
when
re-‐ stabbing
is
done
a^er
par<al
withdrawal
• If
stab
is
caused
with
applica<on
of
greater
amount
of
force,
a
hilt
mark
would
be
present
(contd.)
• Presence
of
hilt
mark
indicates
total
penetra<on
of
the
blade
• On
the
abdominal
wall,
with
forceful
stabbing
deep
organs
may
be
damaged
even
with
a
shorter
blade
due
to
the
collapsible
nature
of
the
wall
• When
lungs
pierced
by
a
stab,
lung
collapses
and
stab
may
appear
deeper
than
actual
penetra<on
• Double
edged,
thin
tapering
blade
with
a
sharp
point
will
penetrate
with
less
force
• Thin
skin
facilitate
penetra<on
as
opposed
to
thick
skin
ex.
palmar
skin
• Presence
of
underlying
bone
or
car<lage
will
require
use
of
more
force
• Thick
garments
will
also
act
as
a
barrier
ex.
denim
cloth
• Hemorrhage
–
a)
leading
to
acute
circulatory
failure
(hypovolaemic
shock)
b)
accumula<on
of
blood
in
closed
spaces
ex.
EDH,
SDH,
haemothorax,
haemoperitonium,
haemopericardium
causing
pressure
effects
• Direct
damage
to
organs;
heart,
brain,
lung
etc.
(Contd.)
• Complica<ons
of
injuries;
infec<on,
tetanus,
air
embolism,
fat
embolism,
pulmonary
embolism
• Surgical/anaesthe<c
misadventures
(contd.)
• Aggrava<on
of
pre-‐exis<ng
disease;
ischemic
heart
disease,
hypertension,
diabetes
• Remote
complica<ons;
epilepsy
following
head
injuries,
peritoneal
adhesions
due
to
laparotomy
Postmortem
injuries
are
caused
a^er
the
death
of
a
person,
should
be
able
to
dis<nguish
them
from
ante-‐mortem
injuries
Postmortem
injuries
are
caused
by:
• Animals
such
ants,
cockroaches,
rats,
dogs,
fish,
crocodiles
• During
resuscita<on,
transporta<on
of
a
body,
autopsy
examina<on,
embalming,
burning,
floa<ng
in
water,
exhuma<on