blunt force trauma

1. MECHANICAL INJURIES(BLUNT FORCE) DR. ANIL KUMAR MITTAL DR.MONISHA PRADHAN DR.ANAND PAWAR

2. INJURY Definition Under section 44 of the Indian Penal code, Denotes any harm whatever illegally caused to any person, in body mind, reputation or property.

3. CLASSIFICATION

4. A.DEPENDING UPON CAUSATIVE FACTOR. I.Mechanicalor Physical injuries. (a)Those caused by blunt force. . 1) Abrasion 2) Lacerations 3) Contusions ( Bruises)

5. A.DEPENDING UPON CAUSATIVE FACTOR. I.Mechanical or Physical injuries. (b) Those caused by sharp force. (1) Incisions (2) Stab (3)Punctures incised punctures or lacerated punctures

6. I . Mechanical or Physical injuries. (c) Caused by Fire Arms. Rifled Firearms Smooth Bore Firearms. country made Firearms. A.DEPENDING UPON CAUSATIVE FACTOR.

7. A.DEPENDING UPON CAUSATIVE FACTOR. I . Thermal injuries. Due to heat: Generalized effects of heat. i.e. A)Heat Hyperpyrexia. ( heat stroke) B)Heat Exhaustion ( Heat collapse) C)Heat Cramps ( Miners cramps

8. A.DEPENDING UPON CAUSATIVE FACTOR . I . Thermal injuries. Due to heat: Localized effects of heat. i.e. A)Burns ( Due to application of dry heat) B)Scalds ( Due to application of moist heat)

9. A.DEPENDING UPON CAUSATIVE FACTOR. I . Thermal injuries. (b) Due to Cold Generalized effects of cold i.e. Hypothermia Localized effects of cold. i.e. Frost Bite (due to dry cold) Trench TrenchFoot ( Due to wet cold)

10. A.DEPENDING UPON CAUSATIVE FACTOR. CAUSED BY CHEMICAL AGENTS. Corrosions ( Due to strong Acids or Alkalies) Irritation ( Due to weak acids, alkalies, vegetables or animal extracts

11. A. DEPENDING UPON CAUSATIVE FACTOR. MISCELLANEOUS A)Lighting B)Electricity C)Radiation ( X-ray, U-V rays, radioactive) D)Blast Injuries

12. Simple Grievous Dangerous B) DEPENDING UPON GRAVITY

13. C) DEPENDING UPON TIME OF INFLECTION Antemortem Postmortem Perimortem

14. D.DEPENDING UPON THE MANNER OF INFLICTION Suicidal Accidental Homicidal Defence Wounds Self- Inflicted Fabricated / Fictitious Injuries

15. ABRASIONS DEFINITION : Abrasions are the injuries involving superficial layers of the skin the epidermis or mucus membrane, due to impact against some hard, blunt, & rough object/ weapon.

16. ABRASION- 1. Scratches or Linear Abrasions Nails, Thorn, Needle 2. Grazes ( Sliding/ Tangential Brush Abrasions) 3. Pressure Abrasions / Crushing Abrasions / Imprint AbrasionsEg : Hanging, Manual Strangulation, RTA- Radiator grill, Tyre tread mark . 4.Patterned Abrasions Eg: RTA- Rubber Tread, Cycle Chain, Necklace 5. Atypical Abrasions

37. AGE (FATE) OF AN ABRASIONS Usually heals with out any formation of scar FRESH: Reddish- Due to oozing serum & little blood. Dermis : Congested & painful. 12-24 Hours :- Exudation dries up to form reddish scab. Comprising of – Dried blood, lymph & injured epithelial cells. 2-3 Days :- SCAB – Reddish Brown. 4-5 Days :- SCAB – Dark Brown 5-7 Days:- SCAB- Brownish Black & Starts falling from the margin. 7-10 Days:- SCAB– Shrinks & falls off leaving depigmented area underneath.

38. MEDICOLEGAL IMPORTANCE:- Only external visible signs of a severe or even fatal internal injury. 1.Point of impact of the blunt force. 2.Pattern- Nature of force. 3.Site & Distributions over the body. 4. Direction of application 5. Presence of material like mud, grit, coal- dust, cement etc. denotes site. 6. Various stages of healing. 7. AM / PM 8. Fabricated

41. Contusion/bruise Are characterized by infiltration of extravassated blood in the subcutaneous and/ or sub epithelial tissues resulting from the rupture of small blood vessels due to application of blunt force.

42. Factors affecting bruise formation AMOUNT OF FORCE:- Greater the force of violence, the more extensive will be the bruises. CHILDERN- Bruise more rapidly than adult. OLD PERSON – Easily owing to loss of flesh & CVS changes CHRONIC ALCOHOLICS – Easily bruises – Cutaneous vasodilatation. BOXERS & ATHLETES – Less bruising due to good muscle tone. WOMEN – Bruises more easily- Delicacy of skin. Greater amount of subcutaneous fat. STRONG HEALTHY PERSON –Stand considerable force without bruising.

43. OBESE FLABBY- bruise easily from lesser amount of violence. DISEASE EXAGGERATED BRUISING – Scurvy, vitamin- k & Prothrombin deficiency, Haemophilia, Leukemia & Atherosclerosis VASCULARITY OF THE AREA: Amount of blood extravasations vascularity – varies from area to area. So more over face, genitalia, scrotum RESILIENCY OF THE AREA Such as abdominal wall, buttocks.

44. Migratory/ectopic bruises These deep bruises may not only take a long time to become visible but may not appear against the actual point of impact. Blood escaping from the damaged blood vessels tracks along the fascial OR muscular planes & following the path of least resistance, may make its appearance hours or even days after the impact, at a place where the tissue layers become superficial.

45. Another Factor : Haemolysis – When freed the haemoglobin is able to stain the tissues. Well known P.M phenomenon of bruising becoming more prominent after Death : Examples :- 1.Black eye – Spectacle haematoma. 2.Fracture pelvis – Bruise thigh . 3.Kick on muscle calf- Bruise over ankle

65. Age/fate of bruises FRESH – Reddish FEW HOURS – Bluish SECOND DAY – Bluish Purple THIRD DAY – Bluish Black FOURTH & FIFTH DAY – Brownish due to presence of haemosiderin an iron-containing pigment FIFTH /SEVENTH DAY – Greenish due to presence of haemotoidin SEVENTH/ TENTH DAY- Yellow due to presence of bilirubin TWO WEEK – Normal skin colour Will depends upon its site, Size & Constitution Of the victim including personal idiosyncrasies towards the process of healing.

66. Bruise may not appear in: Site of injury is on yielding part such as anterior abdominal wall. Offending weapon is yielding in nature & flat surface – Sand bag. Case of blow over sole of Foot, Palm – Subcutaneous thick. Body surface covered with thick Rug or Blanket

67. Patterned bruise Tram – Line or Railway Line Bruise Two parallel linear haemorrhages frequently resulting from rod, stick, with an intervening almost unbruised area when rod or object forcibly dent. The skin and the underneath tissues in the area where it makes its impact, the tissues on each side of this impact gets stretched. This stretching of the sides results in rupture of vessels leading to formation of line of bruising on either side Strangulation – Pattern of Necklace Cycle chain.

68. Intradermal bruises Bruises usually situated in subcutaneous tissue, in the fatty layer. Sub epidermal layer – Impacting object may be more distinct. Impacts from whip or Rubber soles of shoes. This is due to – Thin layer of skin or superficial situation & partly due to translucency. Ex: Production of tyre marks

71. mli 1. Evidence of application of blunt force. Accidental Homicidal Suicidal – Unusual ARTIFICIAL BRUISES 2. Though in itself a trivial injury, Lies in the site & the organs involved. Contusion of vital organs heart and brain. Caused marked derangement of functions & even death

72. 3. Volume of blood- Circulating Diminished – Due to Extravasation 4. Patterned Bruising Nature of agent used. 5. Healing – Determination of age. 6. Bruising- Scalp- It is better. 7. Bruising over the particular part of the body-Indicate some peculiar offence Ex : On the Neck Inner Side of Thigh – FemalesIndicate Sexual Assault small bruises The so called “six Penny Bruises” 8.Character & manner of injury may be known from its distribution.

73. complications 1. Contusion contain 20- 30 ml of blood or even more. Multiple contusion can cause death from shock & internal haemorrhages. 2. Gangrene & death of tissue. 3.Good site for Bacterial growth.

74. LACERATED WOUND A Laceration is a rupture or tear or split in the skin, mucus membrane, muscle or any internal organ, involving depth more than the covering epithelium of the skin or that of an organ & are produced by application of blunt force. Laceration may be produced by any one or more of the following means. Passive agent like ground Vehicles Blunt weapons.

75. types CONTUSED LACERTION OR BRUISED TEAR : If the impact produces bleeding into the surrounding tissues termed as ABRADED LACERATION OR SCRAPED TEAR :Margins of the laceration are denude of the epithelium Many factors influences the formation & appearances of laceration such as the Configuration of the object delivering the force Type of the tissue Areas of the body involved Velocity of the offending weapon

76. INCISED LOOKING LACERATION WOUND When skin is closely applied to the bone & the subcutaneous tissue is scanty, blunt force may produce a wound which by linear splitting of the tissue resembles an incised wound. The sites for production of such wound are Scalp Face Eyebrow Iliac crest shin

83.  AVULSED LACERATIONS Grinding compression by heavy weight such as a wheel of a heavy vehicle, SPLIT LACERATIONSplit laceration occur when the soft tissues are ‘sandwiched’ between a hard underlying deeper structure & the agent applying the force. Example blunt Injury to the scalp.

87. Features of lacerations MARGINS- ragged, irregualar, uneven EDGES- indication of direction DEPTH- present bridges of irregular torn fobrous tissue, blood vessels, & nerves. DO NOT BLEED MUCH

95. Self Inflicted/Fabricated wounds Self inflicted are caused by a person on his own body. Fabricated/Fictitious/Forged-caused by the person or accomplice -To charge their enemy -Simple to Grievous for gain -To pretend self defense to escape charge of assault -Prisoners, military recruits, rape charges

96. ANTEMORTEM / POSTMORTEM LACERTIONS Eversion or gaping of the margins is usually seen in when it has been inflicted during the life

97. Injury Sec 44 IPC Hurt Sec 319 IPC Simple & GrievousSec 320 IPC Assault Sec 351 IPC Battery Homicide; Lawful, Unlawful Culpable Homicide sec 299IPC Murder Sec300 IPC Punishment for Murder Sec 302 IPC Attempt to murder 307 IPC Sec321,322,323,324, 325,326,327,328 304A IPC Rash and negligent act Medico Legal Aspects of Injuries

98. Injury(S 44 IPC); any Harm whatever illegally caused to any person in body, mind, reputation or property. Injury is an act contrary to law The term Illegal is applicable to everything which is an offence or, prohibited by law. It furnishes ground for legal action

99. HURT Hurt (S 319 IPC) Who ever causes bodily pain, disease or infirmity to any person is said to cause hurt Act neither intended nor likely to cause death is hurt, even though death is caused. (Kicking, causing death in presence of splenomegaly) Many hurts can also be classed under assault. Hurt can also be caused by acts that are not assaults (lacing tea with poison)

100. Assault(S.351 IPC): Whoever makes any gesture, or any preparation intending or knowing it to be likely that such gesture or preparation will cause any person present to apprehend that he who makes that gesture or preparation is about to use criminal force to that person, is said to commit an assault.

101. •Battery: It is the assault brought to execution. It is the actual injury to a person •Simple Hurt: Which is neither extensive nor serious and heals without leaving a permanent scar.

102. Aggravated forms of Hurt By dangerous weapons To extort property or to constrain to do illegal act By means of poison to commit offence To extort confession To deter public servant from his duty

103. Grievous Hurt, 320 IPC 1. Emasculation; Loss of Masculine Power. 2. Permanent Privation of sight of either eye; (Like corneal scarring, retinal detachment) 3. Permanent Privation of hearing of either ear. (Permanent loss of hearing. TM rupture) 4. Privation of any member or any joint; (Member is any organ or tissue capable of independent function) 5. Destruction or permanent impairing of power of any member or joint

104. 6. Permanent disfiguration of Head or Face 7. Fracture Dislocation of Bone or tooth 8. Any Hurt which endangers life or which causes the sufferer to be during the space of 20 days in severe bodily pain, or unable to follow his ordinary pursuits. Any dangerous hurt is grievous. An act neither intended nor likely to cause death is hurt even though death is caused.

105. Homicide, Culpable Homicide Causing death by Human Agency Lawful; Excusable and Justifiable CH (s 299 IPC): Who ever causes death by doing an act with the intention of causing death, or with the intention of causing such bodily injury as is likely to cause death, or with the knowledge that he is likely by such an act to cause death, commits CH

106. Explanation 1: A person who causes death of another labouring under disorder, disease, infirmity which accelerates his death, is deemed to have caused his death.

107. •Expl 2; Where death is caused by bodily injury the person who causes such bodily injury shall be deemed to have caused the death although death would have been prevented by skillful treatment. •Expl 3; Causing the death of a child in the mothers womb is not homicide. It may amount to homicide to cause the death of a living child if any part of the child has been brought forth, though the child may not have breathed or completely born.

108. Unlawful Homicide •Culpable Homicide not amounting to Murder (S. 299 IPC) •Murder (S. 300 IPC) •Rash and Negligent Homicide(304 A) •Dowry Death (304 B) •Suicide (305, 306)

109. Culpable Homicide is Murder.. •CH is murder if the act by which the death is caused with the intention of causing death, •or it is done with the intention of causing such bodily injury as the offender knows to be likely to cause death of the person •or it is done with the intension of causing bodily injury inflicted is sufficient in the ordinary course of nature to cause death. •That the person committing the act knows that it is so imminently dangerous that it must in all probabilities cause death, or such bodily injury as is likely to cause death, commits CH amounting to Murder

110. CH is not Murder.. •Exception1: The offender while deprived of self control by grave sudden provocation, causes the death of another person who gave the provocation, more any other by mistake /accident provided the provocation is not voluntarily sought. Ex•2. If the offender exercising good faith in right of private defense exceeds the powers given to him and causes the death of the person without premeditation. Ex 3: If the offender being public servant in advancing of public justice exceeds the powers given to him and causes death without ill will towards the person whose death is caused. Ex 4: If committed without premeditation in fight, in heat of passion without taking undue advantage and acting in a cruel manner Ex 5: If person whose death is caused being above the age of 18 years suffers death or takes the risk of death with his own consent

111. Punishment for Murder •Sec 302 IPC: Punishment for Murder. Whoever commits murder shall be punished with death, imprisonment for life or shall also be liable to fine. •304A IPC: Rash and Negligent Act. Whoever causes death of any person by doing rash and negligent act not amounting to homicide will be punished with imprisonment of either description for a term which may extend to 2 yrs or fine or both. (No intention/knowledge to cause death) S 304 B IPC (1), (2) •Dowry Death: (1) Death of a woman caused by burns or bodily injury or occurs otherwise than normal circumstances within seven years of her marriage and it is shown that before her death she was subjected to cruelty or harassment by her husband or relative of her husband in connection with demand for Dowry, shall be deemed to have caused the death. •(2) Whoever commits Dowry death shall be punished with imprisonment of not less than 7 yrs, may extend to life imprisonment.

112. Sec 321-328 IPC 321- Voluntarily causing hurt 322- Voluntarily causing greivous hurt 323- Punishment for voluntarily causing Hurt (1 year +/- Rs 1000/-) 324- Voluntarily causing hurt by dangerous weapons or means (shooting, stabbing cutting or any weapon of offence or means i.e. fire, heated substance, poison, corrosive or explosive) 325- Punishment for voluntarily causing GH (7 years +/- fine) 326- Punishment for voluntarily causing GH by dangerous weapon or means (10 year +/- fine) 327- Voluntarily causing hurt to extort property or constrain to an illegal act (10 years) 328- Causing hurt by means of poison with intent to commit an offence (10 years)

113. The following points are to be discussed: Type of injuries – Simple or grievous Antemortem or Postmortem Age of injuries Manner of injuries – accidental, suicidal or homicidal Type of weapon

114. Injury report : Name , Age, Sex, Address. Date Place of examination Name of the police , number, name of the police station Brief history Examination proper

115. Examination proper: Number Site Size Type – Simple or Grievous opinion

116. Accidental, suicidal and homicidal TRAIT ACCIDENTAL SUICIDAL HOMICIDAL 1. Site Any where Vital areas Any where 2. Weapon Not present Present Not Present 3. Severity Variable Mostly super- Mostly severe ficial. 1 or 2 wounds severe 4. Hesitation absent Present Present cuts

117. Accidental, suicidal and homicidal TRAIT ACCIDENTAL SUICIDAL HOMICIDAL 5. Defense absent Absent May or may wounds not present 6. Cloths damaged and Not damaged May be stained damaged 7. Secondary may be present Absent May be injuries connected with fight 8. Crime Variable usually closed Disturbed scene room. Not disturbed

118. Accidental, suicidal and homicidal TRAIT ACCIDENTAL SUICIDAL HOMICIDAL 9. Motive Absent Present Present

119. Antemortem and postmortem injuries FINDINGS ANTEMORTEM POSTMORTEM 1. Edge swollen everted absent retracted gaping 2. Hemorrhage profuse slight, venous 3. Spurting arterial flow over no spurting clothing 4. Extravasations staining of the edge can be of blood can not be removed 5. Coagulation firm difficult to wash soft easily removed

120. Antemortem and postmortem injuries FINDINGS ANTEMORTEM POSTMORTEM 5. Coagulation firm difficult to wash soft easily removed 6. Vital reaction present absent 7. Enzymes reaction can be no such reaction seen

122. Immediate : : destruction of vital organs. Causes of death due to injury:

124. Severe trauma

125. BurnsPrimary OR Neurogenic shock Secondary OR hematogenic shock Hypovolemic OR Oligaemic shock Causes of death due to injury:

126. Early causes : Thromboembolism: 1. External embolism: - Foreign Body (bullet from firearm) - Foreign Material like air, solid particle 2. Internal embolism: - Fat Embolism - Bone Marrow Embolism - Amniotic Fluid Embolsm Causes of death due to injury:

127. Early causes : Thromboembolism: 3. Pulmonary Air embolism: - Thrombi formed in the walls of pelvic leg veins. - Most Common sites of thrombosis are deep femoral vein, posterior tibial vein and popliteal vein. Causes of death due to injury:

128. Early causes : Thromboembolism: 3. Pulmonary Air embolism: -Dating of Pulmonary embolus: First day: Purplish strands of fibrin four days: Thicker strands and sheets of fibrin Twenty Fifth day: Fibrin begins to be absorbed. Causes of death due to injury:

130. Internal bleeding due to ruptures of vessels and bleeding into body cavities – like pericardium, peritoneum, pleura and cranium. Causes of death due to injury:

131. Late causes: Infection : Purulent infection form gram positive cocci, gram negative bacilli, anaerobes like Clostridium Perfringens. tetanus and Anthrax are more dangerous. Medicolegal issue: failure to give or delay in giving antibiotics which have both civil and criminal consequences. Causes of death due to injury:

133. aspiration of gastric contents

134. Infection

135. Toxins

136. Systemic shock

137. Irritant gases - Lung epithelium suffer diffuse alveolar damage. Causes of death due to injury:

138. Late causes: Respirator lung : Similar to ARDS. Develop when a patient dies after an appreciable period of mechanical ventilation Usually after many days or weeks. Causes of death due to injury:

139. Late causes: Renal failure: Consequent to extensive muscle damage Burns Poison such as Mercuric salts, Carbon Tetrachloride. In burn and muscle damage, tubules may be blocked with brown casts of myoglobin. Causes of death due to injury:

140. Late causes: Disseminated Intravascular Coagulation: Follows whole range of traumatic, infective and other acute events. Abnormal activation of coagulation process. Brain and placenta are particularly potent. Causes of death due to injury:

141. Late causes: Subendocardial Haemorrhage: Specially studied by Sheehan in 1930. Found in abortion, acute haemorrhage associated with pregnancy, and severe trauma. Well marked haemorrhages under endocardium of left ventricle. Flame shaped, confluent, non petecheal. Causes of death due to injury:

145. Whether the infection occurred in coincidence with the original trauma (primary infection)

151. Radiological examination including magnetic resonance imaging Endoscopic examination Diphanoscopicexamination The application of operation microscopes to forensic practice

152. Vitality and time course of wounds The term ‘‘wound’’ describes the morphologic-functional disruption of the continuity of a tissue structure. A wound can be inflicted during life—when the cardiovascular and respiratory system is still intact—or after death, i.e. after cardiac and respiratory arrest. Traumatization during life triggers vital reactions that do not occur in postmortem wounds.

153. Three types of vital reactions in wound healing can be distinguished: 1. Reactions of the scavenger type, which are almost exclusively mediated by blood cells. 2. Reactions by complex signal transduction pathways, which involves cascade-like release of chemokines, cytokines and adhesion molecules and may influence type 1 and type 3 reactions. 3. Reactions of the scarring type, which involve the final repair of the damaged tissue and are carried out primarily by cells residing at the wound edges, i.e. partly concerning mesenchymal cells and partly tissue-specific cells dependent on the involved organ system.

154. The three different types of reaction follow roughly parallel temporal courses that include cascade-like interactions among themselves. Whereas demonstration of a vital reaction suffices to differentiate an intravital wound from a postmortem wound, the vital reactions themselves follow strictly temporal courses. The regular time-dependent occurrence of each phenomenon allows—in limits—a reliable temporal classification of wound healing.

155. Taphonomy is the study of processes that affect any organism from the time of death to the time of discovery (1). Taphonomicfactors include both natural phenomena (environmental, floral, and faunal) and human interference. After death, taphonomic processes can alter the appearance of bone to such a degree that forensic investigators may not be able to recognize evidence of criminal activity, e.g., surface remains in fields with tall crops can be inadvertently run over by farm equipment, resulting in crushing and sharp force trauma that may mask preexisting intentionally inflicted wounds. Documenting and experimenting with taphonomic variables assists forensic investigators to interpret accurately the damage inflicted to bone, in particular, to distinguish antemortem trauma from postmortem damage, and to identify taphonomic changes that have the potential to mask evidence of foul play