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Saturday, August 27, 2011


ML Classification of Injury:


Fracturew and dislocation

a)Incised wound
b) Chop wound
c)Stab wound


a) Firearm wound
DUE TO COLD-frost bite ,immersion foot
DUE TO HEAT-burns,scald
3.Chemical corrosive acid ,corrosive alkali
4.physical- electricity .lightning,Xray.





  • Surface injury to the skin and sub-cutaneous which leads to an effusion of blood into tissues
  • usually caused by blunt trauma.
  • Appears 1-2 hours after injury.
  • may take the shape of weapon eg railway tract appearance.
  • Children, old, obese women bruise easily.
  • Mongolian spot shouldn’t be confused with bruise.
  • Contusion may be also in the internal organs
  • Gravity shifting of bruise may occur in late occuring bruises

Color changes in a bruise:
  • 1st day- red
  • 2nd day- 3rd day -bluish
  • 4th day- brown day(haemosiderin)
  • 5th-6th day- green(haematoidin)
  • 7th-12th day- yellow(bilirubin)
  • 13th-15th day ,2 weeks – normal
  • Subconjunctival Hage donot undrego colour change

ML aspect of contusion:
  • Patterned bruise-Identification of weapon,ligature,vehicle
  • Degree of violence from size
  • Time since injury
  • Purpose of injury
  • Homicidal, suicidal, accidental .position of assylant while arms are grasped

Difference between antemortem and postmortem bruise:

Antemortem contusion

  • Swelling present
  • Color changes present
  • Epithelium abraded
  • Clotted blood in tissue present

Postmortem contusion

  • Not present
  • Not present
  • Not present
  • Not present

Difference b/n artificial and true bruise
Artificial bruise

  • By juice of marking nut,calotropis or plumbago
  • At exposed accessible site
  • Dark brown colour
  • Shape irregular
  • Margins well defined and regular
  • Itching present
  • Positive chemical test

True bruise

  • Trauma
  • Anywhere
  • Typical colour changes
  • Usually rounded
  • Not well defined,diffuse,no vesicles
  • Absent
  • negative

Patterned intradermal bruise on the forehead due to a
fall onto ribbed ceramic tiles.

Bruising of the upper arm. The pattern of these bruises
is typical of forceful gripping. Small abrasions from fingernails are
also seen.

Typical ‘railway-line’ bruises caused by a wooden rod.
Note that the centre of the parallel contusions is unmarked.

Recent bruising of the abdominal wall and scrotum due
to kicking.


  • destruction of only superficial layer of epidermis,thickness of skin is 1.6mm.
  • Bleed very slightly
  • Heal very rapidly
  • Leave no scar

Types of abrasions:
  • Scratch or linear abrasion-has length but no significant by pin, thorn, nail etc. very sharp objects
  • Graze(sliding,grinding abrasion)-longitudional parallel lines. by rough surface in contact with a broader surface of skin, eg. RTA
  • Patterned abrasion (pressure and impact abrasions)- thumb mark in strangulation, ligature mark in hanging, wheel mark of tyre,teethbite mark.

Age of abrasion by color change: exact age cant be determined
  • Red color- fresh
  • Red scab- 12-24 hours-by dryind of blood and lymph
  • Reddish brown scab- 2 to 4 days
  • Healing from periphery- 4 to 7 days,dark brown
  • Complete healing- 10 to 14 days
  • Seperation of scab- 10 to 14 days

ML importance:
  • Identification of object
  • Direction of injury
  • Time since injury
  • Possibility of internal injury
  • Somtime erosion by ants look like abrasion.d/d-ants produce abrasion that are brown,irregular margin,commonly at mucocutaneous junction about eyelids,nostril,mouth,axilla,by hand lens show multiple cresent shaped,sand like bite marks

Antemortem abrasion

  • has Moist surface
  • Bleeding present
  • On drying scab formation,scab slightly raised
  • Blurred margin
  • Inflammation present
  • Intravital reaction and congestion seen

Postmortem abrasion

  • Dry surface
  • No bleeding
  • No scab
  • Sharply defined margin
  • Inflammation absent
  • Not seen

Abrasions from scraping against a rough surface
during a fall.

Extensive abrasions caused by stumbling, drunk and
naked, against furniture. The dark leathery appearance is due to
post-mortem drying of the damaged areas of skin

Incised wound:(cut,slash,slice)
  • Clean cut through tissues ,usually skin and subcut. By sharp edged or cutting weapon, eg. knife, sword, glass.
  • Edges are smooth, clean cut and everted.
  • Broader than the edge of weapon
  • Length is greater than depth and breadth.
  • Bleed profusely
  • Superficial towards the end of wound k/a tailing
  • Edges may be inverted in case of underlying muscle attached to skin, eg. scrotum.

ML importance:to find homicidal,accidental or suicidal

  • Homicidal, anywhere in the body, deep
  • Suicidal- multiple, superficially, usually in the left hand
  • Accidental- anywhere
  • Edges of the wound indicate: antemortem or postmortem, sharp or blunt weapon.

Difference between incised wound

  • Bleed freely and profusely
  • Arterial spouting present
  • Blood is clotted
  • Edges gape
  • Inflammation present
  • Serum serotonin and histamine increased


  • Very slight or no hemorrhage
  • Not present
  • Not clotted
  • Edges closely
  • Not present
  • Not raised

Difference between suicidal and homicidal cut-throat wounds

  • Left side of neck,passing across the throat,usually in rt handed
  • Level above thyroid cartilage
  • Multiple no ,superficial,rarely single
  • Edges usually ragged,due to overlapping
  • Hesitation cuts present
  • Defence wound absent
  • Weapon usually present
  • Clothes not torn or damaged
  • Circumstancial evidence, quite place

Homicidal wounds

  • Usually on both sides
  • On or below thyroid cartilage
  • Multiple .cross each other at a deep level
  • Sharp and clean cut,bevelling may be seen

Incised wound to the flank; it is clearly longer than it
is deep

A complex stab wound where all three injuries are
caused by a single action. The first entry is in the right breast; there
is an exit wound in the middle and a re-entry wound over the centre
of the chest.

Stab or punctured wound:

  • Type of incised wound whose depth is greatest in dimension.
  • Eg. Knife wound, dagger

Types of stab wound:
  • Penetrating wound- has only wound of entry
  • Perforating wound- has both entry and exit wound

Features of stab wound:
  • Aperture is usually smaller than the weapon due to elasticity of the skin
  • Depth is greater than breadth and length.
  • Very little external hemorrhage but profuse internal hemorrhage

  • Shape- Wedge shaped with knife, elliptical with dagger, rounded with needle, slit-like opening with screw driver,
  • Margins of entry wound are clean and inverted,
  • Margins of exit wound are small and everted
  • Direction determined by line joining entry and exit wounds or X-ray after radio-opaque dyes.

ML(medical legal ) importance:
  • Nature of weapon
  • Direction of wound
  • to find Suicidal, homicidal or accidental

Lacerated wound:
  • Wound in which skin and underlying tissue is turned due to blunt force application

  • Split laceration
  • Stretch laceration
  • Avulsion
  • Tears (caused by irregular sharp object)

1.Split laceration (incised looking wound)
  • Usually found overlying the bones
  • caused by blunt perpendicular impact
  • Skin splits between 2 hard objects and simulate an incised wound

2.Stretch laceration:
  • Overstretching of skin produces a flap
  • Caused by blunt tangential impact
  • Also by sudden deformity of bone after a fracture

3. Avulsion:
  • Caused by horizontal crushing impact
  • Commonly truck, bus wheel, muscles are crushed
  • Also known as degloving of skin

Multiple lacerations from a blunt steel bar. These were
initially mistaken by the police for axe wounds. The abraded or
crushed margins can be easily seen.

Laceration of an arm of a pedestrian struck by a car.
The impact has been oblique, causing a flap of skin to tear away
to the right.

Nature of injuries- simple, grievous, dangerous
1.Simple injury:
  • Neither serious nor extensive
  • Heals rapidly w/o leaving permanent deformity or disfigurement

2. Grievous injury:
  • Emasculation
  • Permanent loss of sight of either eye
  • Permanent loss of hearing of either ear
  • Destruction of joint or any member of body eg. Limb
  • Permanent disfigurement of head or face
  • Fracture or disfigurement of bone or tooth
  • Any hurt to be in hospital for 20 days

3. Dangerous injury:
  • Compound fracture of skull
  • Injury to vital organ eg. spleen, liver
  • A wound of large artery eg. radial femoral


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