MECHANICAL

INJURIES
GUIDED BY- Dr.NARENDRA VATSA

PRESENTED BY – KAMAL PATHAK

Definitions :
 Injury: Any harm, whatever illegally, caused to any person in body, mind,
reputation or property (Sec. 44 IPC).
 Legally injury will include “any lesion, external or internal caused by
violence,with or without breach of continuity of skin”.
 Here the word illegal is included in definition. The implications of this
inclusion are that not all injuries caused are illegal.
 Wound:Clinically, it means any injury where there is breach of natural
continuity of skin or mucous membrane.
 Classification of Wounds / Injuries
 Based on Causative Factors:
 Mechanical or physical injuries (produced by physical violence)
i. Abrasion
ii. Bruise or contusion
iii. Lacerated wound
iv. Incised wound
v. Stab wound
vi. Firearm wound
vii. Fracture/dislocation of bone, tooth or joint.
 Thermal injuries
 Due to application of heat
a. General effects (may not cause any visible injury),e.g. heat cramps and heat
stroke.
b. Effects of local application, e.g. burns and scalds.
 Due to application of cold
a. General effects, e.g. hypothermia.
b. Local effects, e.g. frost bite and trench foot.

 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.

v. Gravity shifting of blood (ectopic/migratory bruise):

 It is responsible for the appearance of bruises at a site other than the site of
injury, e.g.black eyes.
 Dating/Age of Bruise :
 Methods used to date a bruise are:
i. Histology (only in postmortem situation)
ii. Color changes (visual examination)
iii. Calorimetry
iv. Spectrophotometry.
 Bruises heal by destruction and removal of extravasated blood.
 Color change starts at the periphery and extends inwards to the center.
 The time required for bruising to clear is extremely variable and is only a
general guideline in interpreting the age of the bruise.
 Healthier the individual, the more rapid will be the healing.
 A bruise takes a much longer duration to heal in the old than in the young.In
old age, it may remain for 4–5 weeks.
 Bruises of soft loose tissues,like those surrounding the eye resolve faster.
 Environmental lighting may slightly alter the color of the bruise.
 Drugs, such as steroids may change the rate of bruise dispersion, and
interventions, such as ice packs or heat treatment may add to variability.
 Bruises of the same age may show different color progression, so that
variation in color does not necessarily mean that there have been multiple
episodes of injury.
Complications :
i. Multiple contusions can cause death from shock and internal hemorrhage.
ii. Gangrene and death of tissue can result.
iii. Bacterial infections, especially by Clostridia can occur.
iv. Pulmonary fat embolism may occur.
 Medico-legal Importance :
 It is advisable that a medical officer should reexamine the patient after 24 h,
as by this time the bruises are clearly visible.
 Degree of violence may be determined from their size.
 Nature of injury.
 Contusions can be produced postmortem, if a severe blow is given to the body
within few hours after death.
 Sometimes, the autopsy surgeon needs to differentiate bruise from PM
staining.
 Bruises may be fabricated by applying juices of marking nut or calotropis to
incriminate others, or in defense of a crime.
Lacerated Wound
 Laceration is the tearing or splitting of skin, mucous
membranes, muscles or internal organs caused by either a
shearing or a crushing force, and produced by application
of a blunt force to a broad area of the body.
 If the blunt force produces extensive bruising and
laceration of deeper tissue, it is called crush injury.
o Types:
i. Split lacerations:
 Occur when soft tissues are sandwiched between a hard unyielding deeper
structure and the agent applying the force.
 Scalp lacerations occur due to the tissues being crushed between the skull and
some hard object.
ii. Stretch lacerations:
 Result from a heavy forceful frictional impact of blunt forces exercising
localized ‘pressure with pull’.
 Overstretching of the skin and subcutaneous tissues may cause lacerations
with flapping of the skin, which may indicate the direction of application of
force.
iii. Avulsion or grinding compression:
 Produced by shearing force delivered at an oblique or tangential angle to
detach (tear off) a portion of traumatized skin surface or viscus (tissue/organ)
from their attachment.
iv. Tears:
 Tearing of skin and subcutaneous tissue can occur from localized impact by or
against some hard, irregular object like car door handle, radiator mascot or
from blows with broken glass bottles.
v. Cut lacerations:
 Sometimes, a heavy sharp edged weapon causes a deep and wide cut over the
body tissues.
o Characteristics :
 Margins: Ragged, irregular and uneven.
 Site: Occurs most commonly over bony prominences.
 Bruising and abrasion: Seen around the margin.
 Edges: May give an indication of direction in which the blow or force was
applied.
 Depth of wound: Shows bridges of irregularly torn fibrous tissue, blood
vessels and nerves across the interior of the wound.
 Soiling of wound: Mud, wood splinters, sand, glass fragments or paint
material of the vehicle involved,hair or fibers may get embedded in the
wound, and are of great medico-legal importance.
 Hair bulbs: Crushed.
 Hemorrhage: Less.
 Shape: May correspond with the weapon or object which produced them.
 Gaping: Seen due to pull of elastic and muscular tissues.
 On healing: Produces permanent scar.
 Dating of Laceration :
Duration Gross findings
Fresh Bleeding or fresh clot is attached; margins are red, swollen and tender
12–24 h Margins swollen, red and covered by dried blood clots and lymph
3–5 days Margins strongly adherent with each other and covered by dried crust
6–7 days Crust/scab falls off or can easily be taken off, soft reddish tender scar
Few weeks Scar is whitish, firm and painless
Complications
i. Lacerations may cause severe and fatal bleeding leading to shock and death.
ii. Infection.
iii. Pulmonary/systemic fat embolism may occur due to crushing of subcutaneous
tissue.
iv. If located where skin stretches or is wrinkled,e.g. over joints, repeated and
continued oozing of tissue fluids and blood may cause irritation, pain and
dysfunction.
 Medico-legal Importance :
 The type of laceration may indicate the cause of injury and shape of blunt weapon.
 Nature of injury: A laceration may be a simple injury.
 Whether the laceration is accidental/homicidal/suicidal?
a. Accidental laceration: Commonly seen anywhere on exposed parts of body.
b. Homicidal laceration: Noticed on nonaccessible parts of the body, especially in assault cases.
It is usually seen on the head.
c. Suicidal lacerations are rarely seen, as they are painful to produce, and if present, they are
seen on exposed parts of body and on same side.
 Foreign matter in the wound may give clues about the object causing it, e.g. paint material
of vehicle may be transferred to the lacerated wound.
 Skin flap which overhangs the cut margin (avulsion cases) can indicate the direction of force
applied.
Incised Wound (Cut / Slash /
Slice)

 Incision is a clean cut wound through the tissues (usually

the skin and subcutaneous tissues including blood
vessels),which is more long than deep,and caused by a
sharp-edged instrument.
 It is produced by pressure and friction against the tissue
by an object having a sharp cutting edge or point, such
as knife, box cutter, razor or scalpel.
 Characteristics :
 Margins: Edges are clean cut, well-defined and usually everted.
 Width/breadth: Width is greater than the edge of the weapon causing it due to
retraction of the divided tissues.
 Length: Length is greater than its width and depth and has no relation to the
cutting edge of the weapon,for it may be drawn to any distance.
 Shape: Usually spindle-shaped.
 Depth and direction: Usually deeper at the commencement,except in case of
suicidal cut throat injuries, with hesitation cuts at the beginning.
 Hemorrhage: As vessels are cut clean, hemorrhage is more.
 Beveled cuts: If the blade of the weapon enters obliquely, tissues will be
visible at one margin and other margin will be undermined; if the blade is
nearly horizontal, a flap wound is caused.
 Dating of Incised Wound :
 Medico-legal importance :
 Indicates the nature of weapon.
 Give an idea about the direction of force.
 Age of injury can be determined.
 Position and character of wound may indicate manner of
production, i.e. suicide, accident, or homicide.
Stab Wound / Punctured Wound

 Stab wounds are produced from penetration with

long narrow instruments having
pointed(sometimes blunt) ends into the depths of
the body,which are deeper than its length and
width.
 Weapons used:
 The most frequently used object is a knife, Less often, injuries are caused by pieces of glass
(broken-off bottle necks),scissors, dagger, screwdrivers, pens, ice picks or forks.
 A stab wound is an open injury in which foreign material and organisms are likely to be
carried deep into the underlying tissues.

 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.

Complications / Cause of Death

i. Hemorrhage leading to hypovolemic shock due to injuries of major vessels
(most frequent cause).
ii. Cardiac tamponade (less common).
iii. Aspiration of blood and air embolism—when the stab is located on the neck
(injury to jugular vein).
iv. Infections, because of foreign matter embedded in the wound.
v. Asphyxia.
vi. Pneumothorax.
Medico-legal Importance :
 Shape of the wound may indicate the type of weapon,which may have caused
the injury.
 Depth of the wound will indicate the force of penetration.
 Direction and dimensions of the wound indicate the relative positions of the
assailant and the victim.
 If a broken fragment of weapon is found, it will identify the weapon or will
connect an accused person with the crime.
 Position, number and direction of wounds may indicate manner of production,
i.e. suicide, accident or homicide.
Suicide
 Location: Accessible areas (precordial region—
most common site).
 Direction: Descending, backwards and to the
right.
 Depth: Variable, mostly superficial and one
enters the heart/pericardium.
 Extensive traces of blood on the hands of
the victim.
 Tentative/hesitation wounds: Concomitant,
shallow stabs with similar direction.
 Combination with trial cuts (mostly on the
arms/wrists).
 Absence of defense injuries.
Homicide
 Most deaths from stab wounds are homicidal,
especially if found in an inaccessible area, such
as back.
 Stabs are most often located on the thorax
and the neck.
 Stab wound of the chest may have any
direction, but the most common direction is
at an angle from left-to-right and from above
downwards.
 The absence of weapon at the scene of
incident
suggests homicide
 The number of stabs shows a correlation
with gender of the perpetrator. In homicide
committed by female perpetrators, the victims
have fewer stab wounds than in homicides
committed by male perpetrators.
Firearm Wounds

 Gunshot wounds are either penetrating or perforating.

 Characteristics of firearm wounds depend upon:
 Nature of the firearm, whether shotgun or rifle.
 Shape and composition of the missiles.
 Range (distance) of firing.
 Part of the body struck (head or trunk).
 Direction of firing.
 Characteristics of Shotgun Wounds :
 At close range, the shotgun is the most formidable and destructive of small arms.

o Contact or Near Contact Shot :

 Contact wound can be hard (muzzle held tightly against the skin), loose,angled or
incomplete.
 Contact shotgun wounds of the head are the most mutilating firearms wounds.
 Extensive destruction of bone and soft tissue structures occurs with bursting rupture of the
head and evisceration of the brain.
 Contact wound of the trunk appear circular in shape,and have diameter usually equal to that
of the bore of the weapon as shot enters as a mass.
 The gases cause laceration of deeper tissues and even fragmentation of bone.
 Usually, shotgun projectiles do not exit out of the body.
o Close Range (Between contact and 3 ft) :
 Close range shotgun wounds of the head are almost as mutilating as contact wounds, because
the pellets are still traveling in a single mass.
 Depending on the angle of firing, the wound is circular or elliptical. There are no separate
pellet holes.
 Singeing of hair, scorching, blackening and tattooing(less with smokeless powder) of skin is
seen.Blackening and tattooing can be demonstrated by infrared photography.
 No burning is seen beyond 1 ft (30 cm).
 Wound track and adjacent tissues appear cherry-red due to absorption of CO.
o Mid/Near Range (Upto 7 ft) :
 No burning and soot soiling is there, but tattooing can be seen upto 3–4 ft (90–125 cm).
 As distance increases, the main entrance wound progressively becomes smaller and individual
pellet wounds increases in number.

o Long Range (Beyond 7 ft):

 Beyond 7 ft, great variation occurs in the size of the pellet pattern depending on the
ammunition used, the choke of the gun and the range.
 Characteristics of Rifled Firearms Wounds:
 Handguns are most commonly used form of firearm both in homicides and
suicides.
 The presence and extent of tearing of the skin depends on the caliber of the
weapon, the amount of gas produced by the combustion of the propellant, the
firmness with which the gun is held against the body and the elasticity of the
skin.
o Contact Shot:
 Whole of the discharge containing flame, gases, powder smoke and metallic particles will be
blown under pressure into the track taken by the bullet through the body.
 In case of contact shot over forehead or mastoid region(head)entry wound will be large and
irregular,stellate or cruciform shaped.
 There is little or no evidence of burning, singeing,blackening and tattooing.
 Muscles around the track taken by bullet will be cherry-red due to presence of
CO.
 Burning, blackening and powder grains deposits will be found in the depths of
the wound.
 Hair nearby may get burnt or clubbed by fire/heat.
o Close Shot (Flame Range):
 Entry wound is small and circular in shape having .
 Evidence of burning, singeing, blackening and tattooing of the skin in and
around the entry wound.
 The blood and injured soft tissues in the track will be cherry-red due to CO.
o Near Shot (Medium-Range or Intermediate Range):
 Entry wound will be circular in shape, approximately the same size as the
bullet.
 Entry wound looks like a distant shot when the range is beyond 6 inches (15
cm). Beyond 15 cm, the burning effects of gases and singeing of hair is absent.
 Zone of blackening will be present when the range is within 6–8 inches (15–20
cm), and zone of tattooing will be present around it.
o Distant Shot:
 Entry wound is usually circular in shape, smaller than the bullet.
 Distant gunshot wounds of the head may have a stellate or irregular
appearance simulating a contact wound.
 There will be no evidence of any burning, singeing,blackening and tattooing.
 Postmortem Examination:
 Scene of crime:
o Before any object is removed, the following photographs must be taken with
identifying labels and rulers:
 Bullet holes in the walls, floor, ceiling or in the furniture.
 Body of the victim before and after undressing.
 After removing the clothes, entrance and exit bullet holes along with bullets,
pellets or wads found in the body.
 All the clothing is removed, the condition and the extent of blood staining is
noted.
 Location, number, size of the bullet hole, the extent of soot and powder
distribution,and the density of tattooing around the bullet hole is noted.
 Note whether the fibers of the clothing are turned inwards or outwards.
 Clothing may be forced into the tissues in shotgun wounds.
o Bullet wounds:
 Multiple wounds should be numbered.
 Description of Bullet Wounds
 Alteration by medical care personnel.
 Track taken by the bullet through the body.
 FRACTURES
 Breach in the continuity of bone due to
application of mechanical force or other
traumatic agent is called as fracture. The force
applied to bone may be direct or may be indirect.
Classification
 Fracture are classified by various means such as
A. Based on etiology
1. Traumatic fracture – fracture resulting from application of mechanical force
2. Pathological fracture – due to some pathology or disease, the bone is weak and sustains
fracture.
B. Based on displacements
1. Un-displaced
2. Displaced
C. With relation to skin and external environment
1. Simple fracture – the overlying skin and tissues are intact
2. Compound fracture or open fracture – here the overlying skin and tissues are torn and
communicating with the exterior
D. Based on pattern of fracture
1. Transverse fracture 2. Spiral fracture
3. Oblique fracture
4. Segmental fracture 5. Comminuted fracture
E. Direct fracture
1. Focal fracture 2. Crush fracture
3. Penetrating fracture
o Medicolegal Importance
1. Fracture of bone constitute grievous hurt.
2. Fracture accompanied with vessel injury may endanger life.
3. Fracture associated with injury to nerve may cause deformity or loss of
function.
4. Multiple fracture with hemorrhage may cause death of a person.
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