INJURIES from

BLUNT & SHARP

FORCES
Objectives

 Main objective
 To recognize the forensic importance of injuries

 Specific objectives
1. To define “injury”
2. To describe the different causes of injuries
3. To describe the different types of injuries that result from blunt
and sharp forces
4. To describe the mechanisms by which injury are incurred
5. To explain how injuries are described
6. To explain the forensic importance of these injuries
Injury
 Tissue damage from
mechanical force
 a ‘breach’ in the
skin

 Damage or harm
caused to the structure
or function of the body
caused by outside
agent or force, which
may be physical or
chemical

www.forensicmed.co.uk,
http://en.wikipedia.org/wiki/Injury
Mechanisms
of injury
 accidental
 act of self-
harm/self-
infliction
 an action by a
third party/non-
accidental
Causes of Injuries

 Kinetic injuries: application of physical or mechanical force

1. Blunt force trauma: abrasions, contusions, lacerations
 a moving object striking the body
 the moving body striking a fixed object or surface
2. Sharp force trauma: incised wounds, stab wounds
 applied force is concentrated over a small area, requires
little force to cut tissues
  Non-kinetic injuries: application
of ‘non-motion’ trauma
 Thermal: heat or cold
 Chemical
 with tissue releasing energy

 Electrical: high or low voltage

Causes of  flow of current may cause
Injuries localized burn if resistance is
high

 Electromagnetic energy
 Radiation
 Atmospheric pressure
 high or low, in air or water
Description of Wounds

 Nature of the wound (bruise, abrasion, laceration,

etc.)
 Wound dimensions (length, width, depth, & from
fixed anatomical points)
 Draw diagram – annotated
 Photograph with or without scale
 Associated features (bruising, abrasions, etc.)
 Foreign material
 Deeper structures – examination under anesthesia?
 Investigations – radiography, blood samples, etcl.)

http://www.forensicmed.co.uk/wounds/wound-documentation/
 BRUISE (CONTUSION)
BLUNT FORCE
ABRASION
INJURIES
LACERATION
 Blunt force injuries

 Injuries not caused

by instruments,
objects or
implement with
cutting edges
 Nature of force
applied: direct
blows (impacts),
traction, torsion,
oblique or shearing
forces
BLUNT FORCE
INJURIES:
OUTCOMES
 No injury
 Tenderness
 Pain
 Reddening
(erythema)
 Swelling or edema
 Bruising (contusion)
 Abrasions (grazes)
 Lacerations
 Fractures
Bruising (contusion)

 Hematoma, ecchymosis
 Blunt trauma → rupture of a blood
vessels → leakage of blood from the
site of rupture into the surrounding
tissues → discoloration of the
overlying skin
 External bruising
 Internal bruising
Bruising (contusion)
 The greater the force, the more blood
vessels are damaged, the greater the
leakage of blood and the bigger the
bruise
 Site, shape, size, severity of bruising
vary
 Site of bruising does not necessarily
reflect site of trauma
 bleeding into tissues may continue
for some time after impact under
circulatory pressure
 extravasated blood tracks along
natural/traumatic planes of least
resistance, influenced by gravity and
body movement
Bruising (contusion)

 Degradation of
hemoglobin results in the
color change of a bruise
 Change in color vary as
the bruise ages
 Variability in color
dependent on:
 Depth of the bruise
 Location
 Vascularity of underlying
tissue
 Age, complexion
Bruising (contusion)

 Visual aging of bruises

NOT accurate
 Yellow-hued bruise >18
hours
 Red, blue, purple present
from 1 hour to complete
healing
 Red color can be present
at any time
 Bruises of same age on
same person can vary in
color
Maguire S. et al. Can you age bruises accurately in children? A
systematic review. Arch Dis Child 2005:90:187-189
Bruising (contusion)

 Do not accurately reflect

the object causing them
but there are some patterns
that indicate the type of
weapon used
 ‘tramline’ or ‘railway
line’ bruise – blow from a
linear object
 row of oval or round
bruises – knuckles
(punch), fingertip
pressure (gripping)
Bruising (contusion)

 Often associated with skin

abrasion or laceration
 Less often associated with
incised or stab wounds which
allow outward escape of blood
from cut vessels
 Bruising after death occurs
 generally small
 lie on the dependent parts of
the body
 may be found in areas of post-
mortem dissection
Abrasions

 Graze, scratch
 Superficial injury involving the
outer layers of the skin without
penetration of the full thickness
of the skin or the mucus
membrane
 Due to impact against some
hard, blunt & rough object or
wound
Abrasions
 Size, shape & type of
abrasion depend on:
 nature of the surface of
the object which
contacts the skin
 shape of the object
 angle at which contact
is made
 Scratches or linear
abrasions
 Grazes/sliding or
tangential or brush
abrasions
 Pressure abrasions or
crushing abrasions or
imprint abrasions
 Patterned abrasions or
impact abrasions
 Tangential abrasion Brush abrasion
Linear abrasion

Abrasions: types
 Crush abrasions Patterned abrasions

Abrasions: types
Abrasions: Forensic
Setting

Surface will show the

direction of force applied
on the torn epidermis
 Strands are drawn
towards the end of the
injury and are ‘heaped
up’
 Edges of the wound
may also be ragged &
directed towards the
end of the wound

www.forensicmed.co.uk, Haroon A, Mechanical injuries.

https://www.documentingreality.com/forum/f10/patterned-abrasions-106455/
Lacerations

 Tear or split in the skin

 Blunt force compressing or
overstretching the skin → split
through the full thickness of the
skin → bleed
 Characteristics
 Ragged edge
 Bridging fibers: nerves, small fibrous
bands of the fascial planes,
occasionally, medium-seized
elastic blood vessels at the base of
the laceration
 Associated bruising, abrasion
 Provides little specific information
about the casual object
 Lacerations

 Commonly where the skin can

be compressed between the
applied force and underlying
bone (over the scalp, face,
elbows, knees, shins)
 Rare in areas over the soft,
fleshy areas of the body (unless
severe force is applied)
 When force applied to the skin
is more tangential: laceration
may be horizontal → a large
area of separation of skin from
Haroon A, Mechanical injuries. the underlying skin
https://www.documentingreality.com/forum/f10
/patterned-abrasions-106455/
Lacerations: Forensic
importance

 Size and shape not usually

related to causal object
 Rarely self-inflicted

Haroon A, Mechanical injuries.

https://www.documentingreality.com/forum/f10/patterned-abrasions-106455/
 Lacerations

Split laceration Stretch laceration Avulsion

Cut laceration Tear

 SHARP
INCISED WOUND
FORCE STAB WOUND
INJURIES
Sharp force
injuries
 Sometimes
indistinguishable from
blunt force injuries
 Have cleanly divided,
distinct wound edges,
which may span
irregular surfaces, and
penetrate different
types of tissue with the
same contact.
 NO bridging fibers
Incised wounds

 Caused by objects with a sharp or cutting edge

 Distinguished from a stab wound by being longer than
it is deep
 Edges of the wound will give some indication as to the
sharpness of the weapon causing it
 Sharp-edged implement → no bruising or abrasion of
the wound margin
 No bridging fibers are present: cutting edge divides
everything in its passage into the skin
Incised wounds

 Rarely life
threatening
 Except incisions
made over the wrist
or neck where
major arteries lie in
the superficial
tissues
Sharp force injuries

SLASH WOUND/SLICE STAB WOUND

 Incised wound caused by  Caused by a motion down
an object sweeping or through (rather than across)
moving across the skin the skin surface
surface
 Deeper than its length on
the skin surface
Stab wounds

 Depth of the injury and

its direction –
information needed in
considering different
accounts of causation
of stab wounds
 Any weapon with a
point or tip can cause a
stab wound
 edge of the blade
need not be sharp
(e.g. ballpoint pen,
screwdriver, car
keys)
 Stab wounds: factors that determine how
much force is needed for penetration to
occur:

 Sharpness of the tip of the weapon: the sharper

the tip, the easier it is to penetrate the skin
 Geometry of the knife, including the radius of the
blunt edge at the tip
 Sharpness of the ‘cutting edge’ of the implement
 Nature of the force applied: stabbing incidents
are usually dynamic, involving complex relative
movements between victim and assailant
 Clothing may offer significant resistance to
penetration
 Associated bone injury: suggests a greater force
has been used to inflict the wound
Stab wounds: nature
of entrance wound
on the skin surface

 Assists in determining
the size and the cross-
sectional shape of the
weapon used
 PUNCH
KICKING, STAMPING
PATTERNS OF BITE INJURIES
INJURY DEFENSE INJURIES
SELF-INFLICTED INJURIES
Punch
Blow delivered by a
clenched fist & can
be directed anywhere
→ bruises, abrasions,
lacerations, fractures
Kicking, stamping

 Caused by a foot which is either

swung or moved downwards with
some force → delivery of blunt force
trauma to the body → abrasions,
contusions, lacerations
Kicking, stamping
 Stamping injuries have a more
compressive component: high
levels of force are used
→ more of bruises, lacerations, fewer
abrasions
→ intradermal bruise may reflect the
pattern of the sole of the shoe of the
assailant
→ skeletal fractures are common: most
common in the facial skeleton and
ribs
→ intra-abdominal injuries: rupture of
the internal organs, particularly the
liver and the spleen
Bite mark
 A mark caused by teeth
alone or by teeth in
combination with other
mouth parts
 Human or animal
 Damage – due to a
mixture of cutting + tearing
when teeth clamp down
on skin & other tissue
Bite mark

 Appearance vary:
little to no visible
injury→ reddening,
swelling, bruising,
abrasions/cuts and
substantial skin and
tissue loss
 Pattern of individual
teeth marks at the site
of injury
Bite injuries
 May be found on almost any
surface
 Specific sites are associated
with specific forms of assault
 sexual assaults: neck, breasts,
shoulders
 child abuse: arms, buttocks
 adolescent self-inflicted bites:
medial aspect of the arm

 May be inflicted by animals

 analysis by an odontologist will be
most helpful

 Source for DNA collection

Defense injuries

 Normal reflex to protect oneself

 Raise hands to protect head and
face → bruise, incised or stab
wound
 Attempt to grab or deflect the
weapon
 May be absent: rendered
unconscious, incapacity through
drugs or alcohol, restraint by
another person(s)
Self-inflicted Injuries
 NO specific features of injuries that
identify them as self-inflicted
 Preferred injuries: Incised or stabbed
wounds with sharp or pointed
object, gunshot wounds
 sharp force injuries: most commonly
found at the ‘elective sites’ of the
body
 incised wounds – front of the wrists,
neck
 stab wounds – precordium, abdomen

 Blunt force injuries are rarely self-

inflicted
Self-inflicted Injuries

 Persons who only want to ‘self-harm’

or mutilate themselves
 site can be anywhere on the body
that can be reached by the
individual
 except in cases of severe mental
disease: eyes, lips, nipples,
genitalia tend to be spared
 Other features of self-inflicted injuries
 multiple, predominantly parallel
wounds
 suicidal acts: superficial injuries
(‘hesitation’ or ‘tentative’ injuries)
Child physical abuse

RED FLAGS
 No explanation, vague
explanation for a significant
injury
 Discrepancy between history
given and the injuries
sustained
 Story changes or varies
 History of how the injury was
sustained is incompatible
with the child’s development
 Parent/caretaker denies the
injury
 Another child is blamed for a
significant injury
 Unreasonable delay in
seeking care
 Inappropriate affect of the
caregiver: defensive,
belligerent, hostile
Child physical abuse

Belt marks Loop mark bruises

Facial bruises
Fingerprint marks Pinch mark
Child physical abuse

Cigarette burns Tramline bruise

Bruise

Laceration Rib fractures

Intimate partner violence

Lacerations

Contusion
Contusion
Sexual assault Infliction of blunt force
(penetrative) → abrasion, laceration,
or contusion
injuries
Anatomy of the female genitalia

FOSSA NAVICULARIS
POSTERIOR
FOURCHETTE
Anatomy of the Female Genitalia

labia
minora

hymen vaginal
opening
Injuries
heal!
 No evident
injury at the
time of
examination but
medical
evaluation
cannot
exclude….
 Determining length of
survival after receiving an
injury
 difficult: each person is
unique → variability in
survival and post-injury
activity is expected
Survival Injuries that result in
bleeding or hemorrhage →
compensated shock
As blood loss continues →
uncompensated shock →
death
 Mutilation
Legal 
 Serious physical injury
classification
 Less serious physical injury
of physical
 Slight physical injury and
injuries maltreatment
Issues

 No medical definitions for these legal terms

 Subjective take on “medical attendance”

Take home messages

 Blunt force trauma results in abrasions, bruises, and

lacerations.
 Sharp force trauma results in incised wounds, slashes
or slices, stab wounds.
 Injuries are inflicted accidentally, by the self or by
the action of another person.
 Certain actions can, at times, lead to identifiable
patterns of injury (punch, kick, stamp, bite, self-
infliction, defensive action).
 Injuries heal.
 Survival depends on the condition of the injured
person and the post-injury activity. Uncontrolled
bleeding from the injury/injuries can be fatal.