INJURIES

Assoc. Prof. Beatrice Ioan MD, PhD, MA

Generalities
Definition- damage to the tissues of the body caused by a mechanical force Damaging agents: - Mechanical - Physical - Chemical - Biological - Psychical, psychological

Classification
I. Intact skin - Traumatic eritema - Bruise (contusion) - Hematoma
II. Injured skin - Abrasion (scratch, graze) - Wounds

Traumatic eritema
produced by a light slap or a continuous pressure against the tissues transient irritation of the nervous endingsdilatation of the vessels pain, redness of the skin/ red points on the skin, tumefaction all signs and simptoms dissapear in a few hours

Bruise/contusion
- Blunt injury to the tissue- strike or compression Blunt objects: rock, stick, club, hammer, fist, leg - Damage of the small and middle blood vessels beneath the skin- the blood leaks into the surrounding tissues - Most frequent under the skin - Possible deep bruising- any organ, tissue

Bruise/contusion
- Usually it does not reproduce the pattern of the causative object- the blood leaks in a diffuse manner Bruise changes with time and position - The bruise may become visible at a later moment from the trauma - repeated examinations - The bruise may appear at a different site than the injury site

Bruise/contusion Timing colour changes

Chemical changes of hemoglobin
the first hours- red (HbO2)

few hours- bluish (reduced Hb)

3-5 days- green-yellow (biliverdin)

7-8 days- yellow- brownish (hemosiderin)

7-20 days- normal skin colour (depend on the size and depth of the bruise).

Bruise/contusion
The speed of the changes is very variable7-10 days Recognition of bruises of different colours in the same person- inflicted at different times- repeated aggressions- child/adult abuse Differentiated from postmortem lividities

Bruise/contusion - Size
space outside the vessels for free blood to accumulate; gravity of the bleeding, depending on: * the intensity of the traumatism; * the size and the density of the vascular network in the damaged region; presence of the bone directly under the skin;

depth of blood accumulation;

fragility of blood vessels;

coagulability of the blood

Bruise/contusion
Particular types of causation- mark bruises - Tram-line/railway-line - Bilateral ovalar bruises on the throat- manual strangulation - Envelope imprint

Tram-line/railway-line - two parallel lines of bruising with a pale undamaged area between- rod-like weapon, either cylindrical or square-sectioned

Hematoma
Definition- an important collection of blood- the rupture of a big vessel- blunt injury Localization: tissues, organs, natural cavities Superficial hematoma- the covering skin is bruised; May determine compresion of the muscles, nerves, vessels- surgical treatment to evacuate the blood; hematomas in the natural cavities or inside the organs have, frequently, a severe evolutioneven death

Abrasion
- The most superficial type of injury which destroys the integrity of the skin Mechanism: - Friction of a sharp or irregular object against the surface of the skin, determining the abrasion of the superficial layers. - Less often- vertical impact- crushed injury Two possibilities: - An object strikes the skin (a bite from a tooth) - The body hits a stationary object (fall)

Abrasion
- Usualy confined to epidermis- no bleeding - Some abrasions enter the dermis- slight bleeding (dermal papillae) Shape: - Linear - Broader- brush abrasion E.g., dragging across a rough road in traffic accidents- multiple parallel linear abrasions When the skin is protected by clothingfriction burn- reddened, excoriated area

Abrasion
Evolution the first 12- 24 hours- crust (yellow or redishbrownish); 3-4 days- the crust begins to detach; 7-8 days- a white track on the skin - dissapears without any traces

Fingernail abrasions - strangulation by hand- curved /on the neck; - linear abrasions- the finger are dragged down the skin (sexual attacks, child abuse)

Marker- abrasion
- usually when the impact is vertical to the surface of the skin (crushing abrasion);

Draging
- linear, thin, parallel abrasions - direction of the force causing the abrasion- close examination- the torn epidermis will be pulled towards the distal (final) end of the abrasion

Laceration
- Blunt injury- crushes the tissues

- Penetrates the full thickness of the skin

Laceration- characteristics
irregular edges;

blood infiltration in the edges;

bruises and abrasions in the surrounding tissues;

persistance of tissue strands across the interior of the wound;

the hair is not destroyed / may be crushed; content- crushed tissues, clots of blood, small pieces from the clothes, dirt; main complication- infection

Laceration- particular types

Crack wound
the skin is compressed between the bone and the blunt object- e.g. scalp; the margins are regular, sharp; must be differentiated from the cut wounds - the crack wound presents tissue strands across the margins - injuries in the surrounding tissues

Bite wound - preserve the shape of the teeth - samples of saliva- identification of the aggressor

Pricking wound
Mechanism Lateral compression of the tissues by a thin object with acute point- needle, screw driver (pricking object) Characteristics

Entry wound on the skin/mucosal surface

a red point if the weapons diameter is small (sharp needle) or a small wound with sharp edges if the weapons diameter is bigger

Pricking wound
Channel in the depth of the tissues Exit wound rare the damaged part of the body is small/thin the weapon is long enough

Pricking wound
Complications severe, even lethal bleeding when blood accumulates inside a natural cavity (e.g. pericardium)

death- when the heart or fontanel (infanticide) are damaged

Cut wounds
- Sharply cut injuries - Produced by objects with at least one cutting edgepressure and movement of a sharp edged object against the tissues

Classification cuts (slashes)- larger than deeper, usually linear;

partial detachment of the tissues- the cut is oblique; complete section of a part of tissue, an organ (nose) or a part of a limb

Cut wounds - characteristics

regular edges; surrounding tissues- intact; no tissue strands in the interior of the wound; the hair is divided; the cut is deeper at the entry, becomes progressively shallower as the wound approaches the distal end linear abrasion - mouse tail content- blood (liquid or clots); main complication- bleeding

Cut wounds
Defence wounds passive defence- cuts on the dorsal part of the hands and forearms; active defence- cuts on the palms (the victim tryes to catch the knife).

Stab wound
Mechanism: pricking and cutting the tissues, by an object with acute point and sharp edge/edges Characteristics Entry wound on the skin; characteristics of a cut wound; according to its aspect, is possible to determine if the knife has one or more cutting edges edges * buttonhole- two cutting edges * triangle- one cutting edge

Stab wound
Channel In the depth of the tissues its direction shows the weapons direction inside the tissues; Exit wound characteristics of a cut wound According to the aspect of the entry wound and channel is possible to estimate the dimensions of the knife in the cavities with a bony wall

Split wound
Mechanism: heavy objects with a sharp edge- axe, hoe, heavy sword
Appearance - combination between cut wound on the surface of the skin and laceration in depth Frequent - Bone fractures - Damages in the vital organs - danger for life

Description of injuries
Location Dimensions Shape Direction Aspect - bruise colour - abrasion crust - wound - margins - surrounding tissues - ends - content - stage of healing

Wounds - forensic relevance

The damaging weapon marker injury Producing mechanism - injuries located on the prominent parts of the body fall - bruises and abrasions on the neck strangulation by hand/ligature Date of the trauma - bruise - colour - abrasions - aspect of the crust - wounds stage of the healing aspect of the scar