INJURIES A ssoc. Prof. Beatrice Ioan MD, PhD, MA
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INJURIES
Assoc. Prof. Beatrice Ioan
MD, PhD, MA
7/28/2019 INJURIES_2012_2013
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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