LEGAL MEDICINE AND MEDICAL JURISPRUDENCE

Medico-legal Aspect of Physical Injuries I

Lecturer: Dr. Garcia | August 9, 2017
Transcribed by: Garcia|GarfinlLopez|MercadolNovenolSalalila
OUTLINE
1. Physical Injuries
a. Appearance In actual cases, an ice pick, which has a smaller
b. Causes of Physical Injuries surface area, will cause more/greater damage
c. Classifications of Wounds
i. As to severity or injury than a knife or a blunt instrument
ii. As to the kind of Instrument such as the hammer, which has larger surface
Used
iii. As to the manners of infliction
area.
iv. As to the Depth of the Wound
o Other factors
d. Types of Wounds
i. Closed Wound Elasticity
a) Superficial Plasticity
Petechiae
Contusion
Hematoma APPEARANCE
b) Deep o Immediate
II. Open Wounds After the application of stimulus
a) Abrasion o Delayed
b) Incised
c) Lacerated
E.g. physical injuries brought about by
d) Stab infection
e) Punctured Others include contusions

PHYSICAL INJURIES CAUSES OF PHYSICAL INJURIES

Effects of the application of stimulus on the body
(These will have so many forms, may manifest on
different times)
Immediate or delayed effects
Physics of Wound Production
o Kinetic energy (MV2)
0.38 caliber bullet is heavier than M16 bullet,
however the latter is faster and do more
damage
o Time (When the stimulus was applied)
The shorter the period of time needed for
transfer of energy, the greater the likelihood
of producing damage
The injuries will vary, depending on the time,
the stimulus was applied.
A fixed (stationary) car hit by a moving car will
have a greater damage/impact than a moving
car hit by another moving car. How does time
comes in play? The moving car will
require/take more time to contact with the
surface of the other moving car, on the other
hand, the fixed car that was hit by a moving
car will only require short time and will have
the greater damage.
o Area of transfer
The larger the area of contact the lesser the
damage
There would be so much surface area to
receive the impact, so that the energy wont be
concentrated on one area alone, so there
would be lesser impact on that surface.
Physical violence or mauling
Heat or cold (Thermal Injuries)
Electrical energy
Chemical energy
Radiation by radioactive substance
Change in atmospheric pressure (Barometric Injuries)
*Thermal Injuries - Frost bites
* Electrical Injuries - Usually on extremities d/t lesser
resistance to conducted electricity
Vital Reactions (Macro or Micro)
Cardinal Signs of Inflammation
Rubor redness or congestion of the area due to an
increase of blood supply as part of the reparative
mechanism
Calor sensation of heat or increase in temperature
Tumor - swelling
Dolor pain on account of involvement of the sensory
nerve
Loss of function on the account of trauma, the tissue
may not be able to function normally
Vital reactions differentiate an ante-mortem from a post-
mortem injury except during agonal state in sudden
death e.g. AMI
Physicians are required to record all the injuries and may
be asked if, for example redness observed in one area of
the body occurred before or after the patient died.
If the injury was obtained after death, it will not illicit
vital reactions.
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 LMMJ MEDICOLEGAL ASPECTS OF INJURIES I

CLASSIFICATION OF WOUNDS a.) Superficial when the sound is just underneath the
As to Severity layers of the skin or mucous membrane
Mortal wounds: wound which is capable of Petechiae
producing death immediately after infliction or Contusion
shortly thereafter; fatal injuries or wounds Hematoma
b.) Deep
Non-mortal wounds: wound not capable of - Musculoskeletal Injuries
producing death o Sprain
o Dislocation
As to the Kind of Instrument Used o Fracture
Wounds involving the following parts of the body o Strain
produced death within a short time: o Subluxation
Heart and large blood vessels - Internal Hemorrhage
Brain and upper part of spinal cord - Cerebral Concussion
Lungs
Stomach, liver, spleen and intestines SUPERFICIAL CLOSED WOUNDS
*Injuries to these organs are fatal and may cause death PETECHIAE (Pinpoint Hemorrhages)
Wounds brought about by blunt instrument Circumscribed extravasation of blood into the
contusion, hematoma, lacerated wound subcutaneous tissue or underneath mucus
Wound brought about by sharp instrument: membranes
o Sharp edged instrument incised wound Not always a product of trauma but may be present in:
o Sharp pointed instrument punctured o Asphyxial death or death by hanging
wound o Coronary occlusion (E.g. AMI)
o Sharp edged and pointed instrument stab o Blood diseases
wound
Wound by tearing force - lacerated wound CONTUSION
Wound by change in atmospheric pressure Effusion of blood into the surrounding tissues due to
Barotrauma rupture of a blood vessel
Wound by heat or cold - Frost bite, burns, scald Results from blunt force or violence
Wound by chemical explosion - Gunshot or Does not immediately develop after trauma (minutes
shrapnel wound to hours)
Wound by infection Medico- legal significance:
o May infer shape of object causing it
As to the Manners of Infliction - give clues to where and what object was
Hit by means of bolo, blunt instrument, axe used.
Thrust or stab - dagger, knife, saber, bayonet o Extent may suggest the degree of force applied
Projectile or shrapnel wounds - gun powder explosion (E.g. if contusions are confluent
Sliding or rubbing or abrasion bigger force)
o Distribution may indicate character and manner
As to the Depth of the Wound of injury
Superficial when the wound involves only the layers o Hemorrhage in between the interstitium
of the skin
Deep when the wound involves the inner structures Age of contusion:
of the body. o Red to purple recent
It may be o Green 4 to 5 days
o Yellow 7 to days
a) Penetrating wounding agent enters and does
o Resumption to normal color 14 to 15 days
not come out; usually solid organs
* Important in describing the contusion, as to when,
b) Perforating piercing or traversing completely,
where, what object, and how long has the contusion
causing communication between entry and exit;
occured.
usually hollow organs
Contusions may appear anywhere in the body. They may
TYPES OF WOUNDS
not appear on the area where the force was applied, in
Closed Wounds
other words the location of the contusion does not
There is no breach of continuity of the skin or mucous
necessarily indicate that a force was applied on that certain
membrane
area.
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 LMMJ MEDICOLEGAL ASPECTS OF INJURIES I

HEMATOMA FORMS OF ABRASIONS

Extravasation or effusion of blood in a newly formed 1. Linear
cavity or space under the skin o Appears as single line (2 to 3 lines)
Usually develops where bony tissue is superficially o May be straight or curved
located 2. Multi-linear
Contusion Hematoma o Several linear marks parallel to one
another
Blood in the interstitial Blood in uniform cavity
o Frequently seen on vehicular accidents
tissue
3. Confluent
No elevation of the Always elevated
o Linear marks almost indistinguishable
skin
Puncture and Puncture and aspiration 4. Multiple
aspiration yields no yields blood and
o Several abrasions of varying sizes and shapes may
blood subsequent depression be found in different parts of the body

* Different forms of abrasion may suggest the direction of

force applied
Open Wounds
TYPES OF ABRASIONS
Abrasion (scratch, graze, impression mark, friction mark)
Scratch
Characterized by removal of superficial layer of the
o Caused by sharp pointed objects e.g. pin,
skin fingernails, thorns
Characteristics: o Always parallel to direction of slide
o Usually develops at the precise point of o Commencement (Start) and termination are well-
impact of the force causing it, unlike contusions defined
where it does not necessarily appear where the Graze
force was applied o Usually caused by forcible contact with rough,
o Injury consists of parallel linear injuries which are hard objects resulting in irregular removal of skin
in line with the direction of the force causing it surface (Most common, esp. in children)
o May exhibit pattern of the wounding material Impact or Imprint abrasions
(May give clues as to what object caused it) o Pattern abrasions, stamping abrasions
o Usually ignored! o According to Doc these abrasions are artistic
o Heals in a short time and leaves no scar abrasions and may suggest the type of material
(Disadvantage)
that have caused the abrasion
*Usually not documented d/t short-lived scars, lesser proof
Pressure or friction abrasion
in court if complaint is made by the victim.
o Caused by pressure accompanied by movement
IMPORTANCE OF NOTING ABRASIONS usually observed in hanging and strangulation
Abrasions caused by fingernails may indicate struggle
or assault and/or usually located in the face, neck,
forearms and hands Ante-mortem vs. Post-mortem Abrasions
Abrasions resulting from friction on rough surfaces are
located on bony parts of the body and usually
Point of Ante-mortem Post-mortem
associated with contusion and laceration distinction abrasion abrasion
Nature of abrasion may infer degree of pressure,
Color Reddish bronze Yellowish and
nature of rubbing object and direction of movement
in appearance translucent in
The location of the abrasion may also give clue if they
to slight appearance
appeared /were obtained before or after the patient
exudation of
died
blood
E.g. Abrasions on bony surfaces or areas directly in
Location Any area Generally over
contact with surfaces (if patient is lying or against
(more bony
the wall) suggest that the abrasions were obtained
important) prominences
after death. Also, if there were abrasions seen on
such as elbows
the neck that would suggest that the abrasions
and attributed to
were most probably obtained before the patient
died rough handling
of the cadaver
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 LMMJ MEDICOLEGAL ASPECTS OF INJURIES I

Vital With intravital No vital reaction Distinctions between Suicidal and Homicidal Cut- throat or
reaction reaction and Incised wound
may show
remains of Suicidal Homicidal
damaged Direction Oblique: below Horizontal:
epithelium Ear downwards below
Incised Wounds just above adams adams apple
Cut, slash, slice apple
Produced by a short-edged cutting or short linear Severity Not so deep, Usually deep
edge may only involve and may
May be impact cut (forcible contact) or sliced cut trachea, carotid involve
(pressure plus movement) and sometimes cartilage and
Chopped/hacked using a heavy instrument esophagus bones
May be suicidal, homicidal or accidental Superficial cut Usually present Absent but
may be
Changes that occur in an incised wound present when
After 12 hours swollen edges, adherent with blood victim
and with leukocyte infiltration struggles
After 24 hours proliferation of the vascular Position of the May be sitting, Usually victim
endothelium and connective tissue cells body facing a mirror is lying
After 36 to 48 hours capillary network complete, or standing
fibroblast running at right angle to the vessels; Wounding Firmly grasped, Usually absent
evident under microscopic examination weapon or found lying
After 3 to 5 days vessels show thickening and beside victim
obliteration Blood Blood found in Blood found
These are delayed in wounds with dirty and irregular distribution front part, at the back of
edges. hands neck, hands
generally clean
Incised Wounds may be: smeared with
Suicidal located in peculiar parts of the body, like blood
the neck, flexor surfaces of the extremities Motive History of Absence of
(elbow, groin, knee), wrist and accessible to the hand mental such history
in inflicting the injury. The most common instrument depression or
used is the barbers razor blade with improvised problems
handle.
Lacerated Wounds
Homicidal the incised wounds are deep, multiple
Tear of the skin and underlying tissues due to forcible
and involve both accessible and non-accessible parts
contact with a blunt instrument
of the body to the hands of the victim. Clothings are
If force applied to a tissue is greater than its cohesive
always involved. force and elasticity, the tissue tears and laceration is
Accidental multiple incised wounds are commonly produced
observed on the passengers and driver of vehicular May be produced by:
accident. Stepping on the oyster shell, broken glasses, o Hit with a piece of wood
sharp edges of metal sheets are common causes of o Iron bar
incised wound on the sole of the foot. o Fist blow
o Stone
o Butt of firearm

Characteristics of Lacerated Wounds

Shape and size of injury DO NOT correspond to the
wounding instrument
The tear on the skin is rugged with irregular and ill-
defined borders as compared to incised wound which
has clean and well defined border

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 LMMJ MEDICOLEGAL ASPECTS OF INJURIES I

Injury develops directly where the blunt force is Not all are sutured d/t possible internal bleeding
applied Some are followed through and probed to check for
Borders are contused and swollen organ damage
No extensive bleeding as blood vessels are not severed
evenly As to the Depth of the Wound
Delayed healing process and more tendency to Superficial when the wound involves only the layers
develop scar of the skin
Deep when the wound involves the inner structures
Lacerated vs Incised Wounds of the body.
Incised wounds Lacerated wounds It may be
Edges are clean cut, Edges are roughly cut, a) Penetrating wounding agent enters and does
regular and well- irregular and ill-defined not come out; usually solid organs
defined b) Perforating piercing or traversing completely,
There is NO swelling or There is swelling and causing communication between entry and exit;
contusion around the contusion around the usually hollow organs
wound wound
Extremities of the Extremities of the wound As to the relation of the site of the application of force and
wound are sharp or are ill-defined or the location of injury
may be round or irregular Coup injury physical injury which is found at the site
contused of the application force DIRECT. (e.g. stationary head +
Hair bulbs are cut Hair bulbs are preserved moving object)
Faster healing Delayed healing Countre Coup injury physical injury opposite the site
Scar is linear or spindle Scar is irregular and also opposite site of application of force (e.g.
shaped moving head + fixed object)
Caused by a sharp Caused by blunt Coup Countre-Coup injury physical injury which is
edged instrument instrument found at the site and aligned opposite the site of
application of force; accessory injury;
injury not necessarily brought about where the force
was applied (initial force); E.g. Falling downstairs

Stab Wounds
Produced by penetration of a sharp pointed and sharp
edged instrument
If the sharp edge portion of the wounding instrument is
the first to come in contact with the skin, the wound
produced is an incised wound (TAKE NOTE)
If the sharp pointed portion comes in contact first,
then the wound is a stab wound
Locus Minoris Resistencia - physical injury located
not at the site nor opposite the site of the application
of force but in some areas offering the least resistance
to the force applied
Mostly found on the infra -orbital space

Punctured Wounds
A result of a thrust of a sharp pointed instrument
Small external injury with certain degree of depth
Commonly produced by icepick, needle, nail, spear,
pointed stick, fang of animal (also, Tamaraw horns)
Limited external hemorrhage
Appears benign outside

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 LMMJ MEDICOLEGAL ASPECTS OF INJURIES I

This boy has spectacle hemorrhages. The black eyes may

occur from a direct blow to the eyes, side of the head, or
from blood seeping down around the eyes after fractures of
the skull. If there are no injuries around the eyes, then the
hemorrhages probably came from fractures of the skull.

Extensive injury - physical injury involving a greater

area beyond the site of the application of force with
manifest marks of extensions from the location of the
place where the force is applied
o E.g. Injuries from vehicular accidents

Special Types of Wounds

Defense wounds
Patterned Wounds
Self-inflicted Wounds

- to be continued -
References: PPT + Lecture + Old Trans 2018