Mechanical Injuries
Mechanical Injuries
INJURIES
GUIDED BY- Dr.NARENDRA VATSA
Chemical injuries
a. Irritation: Due to application of weak acids,alkalis, plant or animal extracts.
b. Corrosion: Due to application of strong acids or alkalis.
Miscellaneous injuries
a. Electrical injury.
b. Radiation injury: Due to X-ray, UV radiation,radioactive substances.
c. Lightning injury.
d. Blast injury.
Based on Severity of Injury (Legally)
i. Simple
ii. Grievous.
Based on Nature of Injuries (Medico-legally)
i. Suicidal
ii. Homicidal
iii. Accidental
iv. Defense wounds
v. Fabricated or self-inflicted wounds.
Based on Time of Infliction
i. Antemortem—recent or old
ii. Postmortem.
Abrasion
Abrasion is the removal of
superficial epithelial layer of
the skin, usually the epidermis
and papillary dermis, by
friction against rough surface.
Types :
Scratch/linear abrasion:
It is caused by a sharp or pointed object passing across the skin, such as
fingernails, thorn or pin.
Fingernail abrasions are seen in throttling, sexual assaults and child abuse.
Graze abrasion (sliding/scrape/grinding abrasion):
Grazes (gravel rash) are caused by horizontal or tangential friction between
the skin and the hard rough surface.
Most common type of abrasion, and commonly seen in road traffic accidents.
When the friction force is great, grazed area appears like burn injury. Such
graze abrasions are called as brush burn.
Pressure abrasion (crushing/friction abrasion):
It is caused by direct impact or linear pressure of a rough object over the skin.
The slight movement directed inwards results in crushing the superficial layers of the
cuticle and bruising underneath.
Imprint abrasion (impact/contact/patterned abrasion):
It is caused when the force is applied perpendicular to the skin,the cuticle gets
crushed at the point of impact and bears the imprint of the object causing it.
Commonly seen over bony prominences, where a thin layer of skin covers the bone.
When a person is knocked down by car, pattern of the radiator grill, headlamp rim or
tyre-tread mark may be seen on the skin.
UV light may be used to visualize the pattern injuries not apparent with visible light.
OTHER TYPES OF ABRASION :
CONTUSED ABRASION :
The crushing will cause damage of capillaries in the dermis with extravasation
of blood(contusion) surrounding the abrasion.
POSTMORTEM ABRASION.
FABRICATED ABRASION.
NAPPY ABRASIONS.
It produces minimum bleeding, heals rapidly and leaves no permanent scarring
on healing.
Circumstances of Abrasions
i. Usually, it is seen in accidents and assaults.
ii. Person collapsing due to a heart attack may fall forward and receive abrasions
on the forehead,nose and cheek,but there will be no injuries on the upper limbs.
iii. Abrasions may be produced on the palmer surface of hands in a conscious
person, who while falling puts out his hands to save himself.
iv. Hysterical women may produce abrasions over accessible areas, like the front
of forearm or over the face, to fabricate charge of assault.
Medico-legal Importance :
Abrasions give an idea about the site of impact and direction of force.
Nature of injury:Superficial Injury.
Patterned abrasions are helpful in connecting the wound with the causative
weapon.
Age of injury can be determined, which helps to corroborate with alleged time
of assault.
In open wounds, dirt, dust, grease or sand is usually present which helps to
connect the injuries to the scene of crime.
Bruise /
Contusion
Bruiseis the extravasation of blood in the
subcutaneous/subepithelial tissues due to
rupture of blood vessels, usually capillaries,
as a result of blunt force injury or pressure.
Classification :
Bruise is classified into three types depending on its situation:
i. Intradermal bruise: Bruise lies in the immediate subepidermal
layer.Margins are quite distinct and hemorrhage is sharply defined.
ii. Subcutaneous bruise: It is situated in subcutaneous tissue, often in the
fatty layer, and the edges are blurred.Most common type of bruise caused by a
blunt object, and appears soon after injury as dark red swelling.
iii. Deep bruise: Bleeding deeper to the subcutaneous tissues. It may take
hours to 1–2 days to appear at the surface (delayed bruising). Therefore, one
more examination should be carried out 24–48 h after first examination. Infrared
photography may demonstrate such bruises, if suspected initially.
Patterned Bruise :
The imprint or design of the offending weapon or object is imprinted over the
skin.
SHIFTING BRUISE:
Appear at different site from the actual site of application of mechanichal
force.
This sort of feature is frequently associated with deepseated contusions.
This phenomenon is due to hemolysis of blood.
TRAM LINE CONTUSION:
Characterized by two parallel tram-track like lines of hemorrhages.
Six penny bruises:
Resulted from fingertip pressure.
SUBCUTANEOUS
BRUISE
PATTERNED CONTUSION
Factors Influencing the Bruise :
i. Type of tissue/site involved :
Soft, lax and vascular tissues, such as face,scrotum and eyelids develop large
bruises even with little force.
Bruising of scalp is better felt than seen.
Bruising is more marked on tissues overlying bone.
In boxers and athletes, bruising is much less,because of good muscle tone.
ii. Age :
Children and elderly bruise more easily because of softer tissue and delicate
skin in the former, and loss of subcutaneous supportive tissue and
cardiovascular changes in the latter.
iii. Sex:
Women tend to bruise more easily than men because tissues are more delicate
and subcutaneous fat is more.
Obese people bruise more easily than lean because tissues are more delicate.
iv. Color of skin:
Bruising is more clearly seen and recognized in fair skinned persons than those
with dark skin, in whom they may be better felt than seen.
Classification
Clinically, stab wounds are of two types:
i. Penetrating wound:
o Weapon enters into the body cavity producing only one wound, i.e. wound of entry.
ii. Perforating wound (through and through punctured around):
o Weapon after entering into one side of the body will come out through the other side,
producing two wounds:
1. Wound of entry
2. Wound of exit
Characteristics :
o Margins:
o Edges of the wound are clean cut, usually no abrasion or bruising of the
margins.
Length:
o Length is slightly less than the width of the weapon.
Breadth:
o It is more than thickness of the blade due to gaping.
Depth:
o Depth is the greatest dimension of a stab wound.
o Depth corresponds to the length of the blade of the weapon entering the
body,when the whole length of the weapon enters the body, but has not
produced any wound of exit.
Direction
Shape:
o It is slit-shaped or gape depending on their location and their orientation, with
regard to the cleavage lines of Langer.