INJURIES_2012_2013

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INJURIES

Assoc. Prof. Beatrice Ioan

MD, PhD, MA

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Generalities

Definition- damage to the tissues of the bodycaused by a mechanical force

Damaging agents:- Mechanical

- Physical

- Chemical

- Biological

- Psychical, psychological

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Classification

I. Intact skin

- Traumatic eritema

- Bruise (contusion)- Hematoma

II. Injured skin- Abrasion (scratch, graze)

- Wounds

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Traumatic eritema

• produced by a light slap or a continuouspressure against the tissues

• transient irritation of the nervous endings-dilatation of the vessels

• pain, redness of the skin/ red points on the skin,

tumefaction

• all signs and simptoms dissapear in a few hours

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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 vesselsbeneath the skin- the blood leaks into thesurrounding tissues

- Most frequent under the skin

- Possible deep bruising- any organ, tissue

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Bruise/contusion

- Usually it does not reproduce the pattern of thecausative object- the blood leaks in a diffusemanner

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 thanthe injury site

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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 anddepth of the bruise).

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Bruise/contusion

The speed of the changes is very variable- 7-10 days

Recognition of bruises of different colours in the same person- inflicted at differenttimes- repeated aggressions- child/adult

abuse

Differentiated from postmortem lividities

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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 inthe damaged region;

• presence of the bone directly under the skin;

• depth of blood accumulation;

• fragility of blood vessels;

• coagulability of the blood

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Bruise/contusion

Particular types of causation- mark bruises

- “Tram-line”/”railway-line

- Bilateral ovalar bruises on the throat- manual

strangulation

- Envelope imprint

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“Tram-line”/”railway-line” - two parallel lines of bruising

with a pale undamaged area between- rod-like weapon,

either cylindrical or square-sectioned

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Hematoma

Definition- an important collection of blood- therupture 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 evolution-

even death

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Abrasion

- The most superficial type of injury whichdestroys 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)

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Abrasion

- Usualy confined to epidermis- no bleeding

- Some abrasions enter the dermis- slightbleeding (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 clothing-“friction burn”- reddened, excoriated area

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Abrasion

Evolution

• the first 12- 24 hours- crust (yellow or redish-

brownish);

• 3-4 days- the crust begins to detach;

• 7-8 days- a white track on the skin - dissapears

without any traces

Fi il b i

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Fingernail abrasions

- strangulation by hand- curved /on the neck;

- linear abrasions- the finger are dragged down the skin (sexual

attacks, child abuse)

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

abrasion);

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Draging

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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

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Laceration

- Blunt injury- crushes the tissues

- Penetrates the full thickness of the

skin

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Laceration- characteristics

• irregular edges;

• blood infiltration in the edges;

• bruises and abrasions in the surrounding tissues;

• persistance of tissue strands across the interior of thewound;

• the hair is not destroyed / may be crushed;

• content- crushed tissues, clots of blood, small piecesfrom the clothes, dirt;

• main complication- infection

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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 strandsacross the margins

- injuries in the surrounding tissues

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Bite wound

- preserve the shape of the teeth

- samples of saliva- identification of the aggressor

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Pricking wound

Mechanism

Lateral compression of the tissues by a thin object withacute point- needle, screw driver (pricking object)

CharacteristicsEntry wound

• on the skin/mucosal surface

• a red point if the weapon’s diameter is small (sharpneedle) or a small wound with sharp edges if theweapon’s diameter is bigger

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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

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Pricking wound

Complications

• severe, even lethal bleeding when bloodaccumulates inside a natural cavity (e.g.

pericardium)

• death- when the heart or fontanel

(infanticide) are damaged

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Cut wounds

- Sharply cut injuries

- Produced by objects with at least one cutting edge-pressure and movement of a sharp edged object againstthe 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 apart of a limb

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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 progressivelyshallower as the wound approaches the distal end →

linear abrasion - mouse tail

• content- blood (liquid or clots);

• main complication- bleeding

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Cut wounds

Defence wounds

• passive defence- cuts on the dorsal part of the hands and forearms;

• active defence- cuts on the palms (thevictim tryes to catch the knife).

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Stab wound

Mechanism: pricking and cutting the tissues, by an objectwith 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 theknife has one or more cutting edges edges

* buttonhole- two cutting edges

* triangle- one cutting edge

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Stab wound

Channel

• In the depth of the tissues

• its direction shows the weapon’s direction

inside the tissues;

Exit wound

• characteristics of a cut wound

According to the aspect of the entry wound andchannel is possible to estimate thedimensions of the knife in the cavities with abony wall

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Split wound

Mechanism: heavy objects with a sharp

edge- axe, hoe, heavy sword

Appearance - combination between cut wound on thesurface of the skin and laceration in depth

Frequent

- Bone fractures- Damages in the vital organs

- danger for life

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Description of injuries• Location

• Dimensions

• Shape

• Direction

• Aspect

- bruise – colour

- abrasion – crust

- wound - margins

- surrounding tissues

- ends

- content

- stage of healing

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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 – strangulationby hand/ligature

• Date of the trauma

- bruise - colour - abrasions - aspect of the crust

- wounds – stage of the healing – aspect of the scar

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