Mechanical & regional injuries

LECTURE OONN MMEECCHHAANNIICCAALL AANNDD
RREEGGIIOONNAALL IINNJJUURRIIEESS
DDRR .. SSOONNOO MMAALL RRAATTNNAANNII
AASSSSIISSTTAANNTT PPRROOFFEESSSSOORR
DDEEPPAARRTTMMEENNTT OOFF FFOORREENNSSIICC MMEEDDIICCIINNEE
JJIINNNNAAHH SSIINNDDHH MMEEDDIICCAALL UUNNIIVVEERRSSIITTYY KKAARRAACCHHII..

MMEECCHHAANNIICCAALL IINNJJUURRIIEESS
• DEFINITION OF INJURY
According to Pakistan Penal Code an injury is defined
as any harm what so ever illegally caused to any
person in body, mind, reputation or property. The
medical profession is concerned with bodily harm
which is covered by the term Hurt.
• HURT:
Whoever causes pain, harm, disease infirmity or injury
to any person or impairs, disable or dismembers any
organ of the body or part thereof of any person without
causing his death, is said to cause hurt.

Injuries caused by physical violence to the
body are known as MECHANICAL INJURIES.
Mechanical Injuries are classified in to:
• ABRASIONS.
• BRUISES OR CONTUSIONS
• WOUNDS: -Theses are of 4 varieties.
Incised Wounds.
Stab or puncture wounds
Penetrating,
Perforating.
Lacerated Wounds.
Fire Arm Wounds.

AABBRRAASSIIOONNSS
• Abrasions are injuries involving loss of
the superficial epithelial layer of the
skin and are produced by a blow or a
fall on rough surface, by scratching
with finger nails, thorns or by teeth bite
or by friction and pressure of strings or
ropes tied around the neck or other
parts of the body. Abrasions vary in
size and shape and bleed very little.

• Depending up on the manner in
which they are caused, abrasions
are classified in to:
• Scratches.
• Grazes.
• Imprint, pressure or Contact
Abrasions.

TTYYPPEESS::
a) SCRATCHES: ARE PRODUCED WHEN
OBJECTS LIKE FINGER NAILS,
PIN, THORN, ETC IS DRAWN
ON THE SKIN.
CHARACTERISTICS: A CLEAN AREA
AT THE COMMENCEMENT &
HEAPING UP OF SURFACE
LAYERS OF SKIN AT THE
TERMINATION.

b) GRAZE: Graze is an injury which is
produced when a broad surface of the
skin slides or scraps against a rough
surface. It is commonly result of a traffic
accident, more particularly when the
body has been dragged. The direction of
injury is indicated by serrated border
initially and heaped up epithelium at the
end. This type of abrasions helps a lot in
reconstruction of the events in a
vehicular accident. Abrasions caused by
fall on the ground are generally found
over bony prominences such as elbows,
front of knees etc.

ARE CAUSED BY CONTACT WITH
ROUGH SURFACES LIKE GROUND,
ROAD RESULTING IN USUALLY
IRREGULAR, REMOVAL OF SKIN
SURFACE ALSO CALLED AS BRUSH
BURNS IF ACCOMPANIED BY
BRUISE.
EXAMPLE SEEN IN:
o ROAD TRAFFIC ACCIDENTS (R.T.A).
o DRAGGING OF BODY ON A GROUND.
o GLANCING KICK WITH A BOOT.

EEXXAAMMPPLLEE::
• LIGATURE MARKS IN CASES OF
HANGING, STRANGULATION.
• BLOWS WITH LASH.
• FRICTION BETWEEN SKIN & EDGES OF
GARMENTS.
d) IMPRINT ABRASION: (STAMPED ABRASION)
CAUSED BY IMPACT OF
OFFENDING OBJECT WITH
SKIN.
REGISTERING THE
IMPRESSION OF THE OBJECT.

EXAMPLE:
- TYRE MARK.
- IMPRINT OF RADIATOR GRILL.
- TEETH MARKS.
- LIGATURE PATTERN.
- MUZZLE IMPRINT.
MEDICO-LEGAL SIGNIFICANCE:
IDENTIFICATION OF OFFENDING
OBJECT.

• Abrasions should be differentiated from
post mortem injuries due to ants and
insects which commonly attack the moist
and exposed parts of the body.
• Water animals such as fishes, which
usually attack projecting parts of body
such as nose, lips, ears, fingers etc here
the edges appear nibbled.
• In cases of bed sores, which are seen in
disabled persons especially over back.
• In abrasions due to ants, insects, fishes
etc the signs of vital reaction are absent.
•

DEFERENTIAL DIAGNOSIS.
1) POST MORTEM INSECT BITE (ANT BITE)
• NO VITAL REACTION.
• ON EMPOSED PARTS/WET AREAS.
• USUALLY NOT PARALLEL.
• EDGES NIBBLED.
2) EXCORIATION BY EXCRETA.
• INFANTS & DEBILITATED PERSON.
• CONFINED TO PERI-ANAL REGION
BUTTOCKS.

3) PRESSURE SORES.
• H / O CONFINEMENT.
• ON PRESSURE POINTS.
DATING AN ABRASION (AGE)
OBSERVATION TIME
BRIGHT RED FRESH
RED SCAB
DRIED BLOOD/SERUM
12-24 HOURS.
REDDISH BROWN SCAB 2-3 DAYS.
HEALING FROM PERIPHERY 4-7 DAYS.
COMPLETE HEALING 10-14 DAYS.

MMEEDDIICCOO LLEEGGAALL IIMMPPOORRTTAANNCCEE
OOFF AABBRRAASSIIOONNSS
They provide valuable information
depending up their.
• Site.
• Nature of object used.
• Purpose of injury.
• Direction of injury.
• Time of injury.

• SITE:
In cases of fall on rough surface the
abrasions are mostly found over the bony
prominences such as elbows, front of
knees, hands etc.
• NATURE OF OBJECT USED:
e.g. ligature mark in cases of hanging
strangulation, nail marks over the neck in
throttling, teeth bite in defense or
struggle.

• PURPOSE OF INJURY:
Site of an abrasion helps to determine purpose of
injury e.g. around the neck in throttling, over nose
and mouth in smothering, on the inner aspects of
thighs and genitilia in rape, around the anus in
sodomy, and over bony prominences in cases of
fall.
• DIRECTION OF INJURY:
Serrated border initially and heaped up epithelium
at the end.
• TIME OF INJURY:
This can be determined from the process of
healing.

BBRRUUSSIIEE ((CCOONNTTUUSSIIOONN))
DEFINITION: AREAS OF DISCOLORATION
FORMED DUE TO COLLECTION OF BLOOD
IN SUB-EPIDERMAL LAYERS OF SKIN OR
COVERING OF AN ORGAN AS A
RESULT OF RUPTURE OF CAPILLARIES
OR VENULES WITH0UT BREACH IN THE
INTEGRITY OF COVERING TISSUE (SKIN
OR CAPSULE), AS A RESULT OF
APPLICATION OF BLUNT OBJECT.

DDIIAAGGNNOOSSTTIICC FFEEAATTUURREESS::
= ROUNDED IN SHAPE. SHAPE MAY
CORRESPOND THE SHAPE OF
CAUSATIVE OBJECT.
= REDDENED AREA WHEN FRESH.
= PAIN WITH TENDERNESS.
= SWELLING.
= EPIDERMIS MAY / MAY NOT SHOW
DAMAGE.
= SIZE VARIES FROM PINHEAD TO AN
EXTENSIVE HAEMATOMA.

TTEERRMMIINNOOLLOOGGYY UUSSEEDD FFOORR EEXXTTRRAA
VVAASSCCUULLAARR CCOOLLLLEECCTTIIOONN OOFF BBLLOOOODD..
RRAATTIIOONNAALLEE IISS SSIIZZEE..
a) PETECHIAL HAEMORRHAGE:
SIZE OF PINHEAD.
b) ECCHYMOSIS:
MORE THAN PIN HEAD, SMALLER THAN
BRUISE.
c) BRUISE:
LARGER THAN 5 mm IN DIAMETER.
d) HAEMATOMA:
REMARKABLE COLLECTION OF BLOOD.

CCAAUUSSEESS::
1. SPONTANEOUS (DUE TO DISEASE):
DISEASE OF BLOOD, PURPURA,
SCURVY, LEUKAEMIA.
2. TRAUMATIC:
BLOWS WITH CLUB, LATHI, FIST,
KICKS, STONE & BRICKS.
FIRM GRIPING (IN WEAK
DEBILITATED PERSONS)

TTYYPPEE OOFF BBRRUUIISSEE:: DDEEPPEENNDDIINNGG UUPPOONN
DDEEPPTTHH OOFF TTHHEE TTIISSSSUUEE
IINNVVOOLLVVEEDD
1. SUPERFICIAL:
INTRADERMAL BRUISE:
1. DEEP:
DELAYED BRUISE
VISCERAL BRUISE
OR CONTUSION.
BELOW THE EPIDERMAL
LAYERS. VISIBLE, EASILY
PALPABLE.
INVOLVING VASCULATURE
OF MUSCLES, ORGANS &
DEEP ADIPOSE TISSUE.
DEEP BRUISE MAY BECOME EVIDENT AFTER
THE LAPSE OF SOME TIME (2-3 DAYS).

MMEECCHHAANNIISSMM::
SUDDEN PRESSURE DUE TO
MECHANICAL IMPACT CAUSES
CAPILLARIES & VEINS TO RUPTURE
RESULTING IN ACCUMULATION OF
BLOOD BENEATH THE SKIN. SKIN
POSSESSING ELASTICITY &
PLASTICITY OFFER GREATER
RESISTANCE, SO DO NOT BREAK.

FFAACCTTOORRSS MMOODDIIFFYYIINNGG TTHHEE
AAPPPPEEAARRAANNCCEE OOFF BBRRUUIISSEE..
1) CONDITION & TYPE OF TISSUE:
BRUISE OCCUR MORE READILY,
EASILY & EXTENSIVELY IN LAX TISSUE
(EYE LIDS) AND WHERE EXCESSIVE.
S/C FAT IS PRESENT. (FACE, BREAST)
CONVERSELY WHERE SKIN IS STRONGLY
SUPPORTED BY FIBROUS TISSUE
(SCALP, PALMS OR SOLE) OR WHERE
MUSCLE TONE IS STRONG (BOXERS,
ATHLETES) BRUISE IS NOT FORMED OR
LESS MARKED.

22)) EECCTTOOPPIICC BBRRUUIISSEE::
A BRUISE MAY NOT BE PRESENT
NECESSARILY AT THE SITE OF
IMPACT.
THE EXTRAVASATED BLOOD MAY
MOVE ALONG TISSUE PLANES UNDER
GRAVITY INFLUENCE AND GETS
COLLECTED AT A DISTANT PLACE
(GRAVITY SHIFTING).

EEXXAAMMPPLLEE::
- BLOW ON FOREHEAD OR FALL ON
VERTEX: BLACK EYE.
- FACTURE HEAD OF FEMUR
LATERAL ASPECT
OF LOWER THIGH.
- BLOW ON OUTER PART OF THIGH
BRUISE AROUND
KNEE.

33)) AAGGEE::
CHILDREN (DUE TO LOOSENING OF
SKIN) & OLD (DUE TO LOSS OF FLESH &
CHANGES IN BLOOD VESSELS) BRUISE
EASILY.
4) SEX: FEMALES (OBESE) BRUISE
EASILY.
5) VASCULARITY OF PART: BRUISING IS
DIRECTLY PROPORTIONAL TO
VASCULARITY OF AFFECTED PART.
6) COMPLEXION: VISIBILITY BETTER AND
CLEAR IN FAIR SKINNED PEOPLE.

77)) PPRREESSEENNCCEE OOFF DDIISSEEAASSEE..
• COAGULATION FACTOR DEFICIENCY.
• DISEASE OF BLOOD VESSELS.
• DIMINISHED PLATELETS.
BRUISE
EASILY
8) SITE TO INJURY: BRUISING IS MORE MARKED
IN TISSUE OVERLYING BONES WITHOUT
INTERVENTION OF FIBROUS TISSUE OVER
SKIN.

MMEEDDIICCOO--LLEEGGAALL SSIIGGNNIIFFIICCAANNCCEE
• INDICATES OFFENDING OBJECT (BLUNT).
• GIVES IDEA ABOUT DEGREE OF VIOLENCE.
• TIME OF INJURY.
• MOTIVE/PURPOSE OF INJURY.
• IN THROTTLING, PRESSURE OF PADS OF
FINGER (SIX PENNY BRUISE) – HOMICIDE.
• BRUISE ON BACK OF FINGERS, HAND &
FOREARMS. ( DEFENSIVE ACT).
• MULTIPLE SMALL BRUISE ON ARMS JUST
BELOW SHOULDERS.
(FORCE FULL GRASPING DURING STRUGGLE)

• NUMEROUS BRUISE OF DIFFERENT AGE
LOCATED AT JOINTS & OTHER AREAS IN.
• ADULTS: ALCOHOLICS, DRUG
DEPENDENT.
• IN CHILDREN: BATTERED BABY
SYNDROME.
• TRAM TRACK BRUISE: RESULTS FROM
BLOW WITH ROD, STICK OR WHIP & ANY
FLEXIBLE OBJECT. (TORTURE). CENTRAL
DEPRESSED PALE AREA WITH MARGINS
SHOWING BLOOD & SWELLING.

• SUCTION PETECHIE: BRUISING ON THE CHEEKS
& BREAST. (SEXUAL INTERCOURSE),(LOVE
BITES)
• BRUISE ON THE MEDIAL ASPECT OF THIGH,
VULVA & AROUND ANUS INDICATE FORCEFUL
SEXUAL INTERCOURSE.
• BRUISING OF CERVIX SHOWS DILATATION
CERVIX.
• BRUISING OF BUTTOCKS INDICATE TORTURE
• HOMICIDAL BRUISE: STILL COMMON IN OUR
SOCIETY.
• MULTIPLE & MASSIVE CONTUSIONS MAY LEAD
TO REDUCTION OF EFFECTIVE CIRCULATING
BLOOD VOLUME LEADING TO SHOCK THAT MAY
PROVE FATAL.

• DUE TO SUDDEN COMPRESSION OF
SUBCUTANEOUS TISSUES, FAT MAY BE
DISPLACED AND ENTERS INTO INJURED
VESSELS LEAD INTO FAT EMBOLISM.
• ACCIDENTAL: COMMON OCCURRENCE.
• SUICIDAL: NOT COMMON SUICIDAL
FALL DO OCCUR.
• SELF INFLICTED: ARTIFICIAL BRUISED
AREA PRODUCED BY
RUBBING MARKING NUT
JUICE OVER SKIN.

DDAATTIINNGG AA BBRRUUIISSEE ((AAGGEE OOFF BBRRUUIISSEE))
DONE BY:
- MACROSCOPIC EXAMINATION
(COLOR CHANGES).
- MICROSCOPIC EXAMINATION (BLOOD
PIGMENTS).
MECHANISM:
BLOOD, DUE TO DISINTEGRATION OF RBC
BY HAEMOLYSIS, RELEASES
HAEMOGLOBIN THAT BREAKS DOWN
INTO HAEMOSIDRIN, HAEMOTOIDIN &
BILIRUBIN BY THE ACTION OF
HISTIOCYTES & TISSUE ENZYMES.

MMAACCRROOSSCCOOPPIICC CCHHAANNGGEESS::
CHANGES ARE SEEN FROM PERIPHERY TO CENTER.
CHANGES OBSERVED TIME REQUIRED
RED 1ST DAY.
VOILET 2ND DAY.
BLUISH-BLACK 3RD DAY.
BROWN OR LIVID RED 4TH DAY.
GREENISH& THEN
5TH -6TH DAY.
GREEN
YELLOWISH & THEN
YELLOW
7TH-12TH DAY.
NORMAL 13TH -15TH DAY

MMIICCRROOSSCCOOPPIICC CCHHAANNGGEESS::
HEMOSIDIRIN WITHIN MACROPHAGES:
NOT LESS THAN 24-48
HOURS.
HEMOTOIDIN WITHIN
MACROPHAGES: NOT LESS THAN 3
DAYS.
BILIRUBIN EXTRA CELLULAR: NOT
LESS THAN 7 DAYS.

IINNCCIISSEEDD WWOOUUNNDDSS::
• 1. SYNONYMS: CUT, SLASH, SLICE.
• 2. DEFINITION: WOUNDS CAUSED BY
IMPACT OF SHARP EDGE
OBJECT, EDGE MAY BE
LINEAR OR POINTED.
• 3. CAUSATIVE WEAPONS:
• - INSTRUMENTS: KNIVES, RAZOR,
BLADES DAGGERS,
SWORDS, AXE.
• - FRAGMENTS OF: CHINA GLASS,

APPEARANCE & SEVERITY DEPENDS UPON:
- SHAPE OF WEAPON.
- SHARPNESS OF EDGE.
- MANNER OF INFLICTION.
- TISSUE INVOLVED.
DIAGNOSTIC FEATURES:
a) SHAPE: USUALLY SPINDLE SHAPED &
GAPING.
b) MARGINS: CLEAN & REGULARLY CUT IF THE
SKIN IS FIRM OR TAUT, IRREGULAR
MARGINS ARE SEEN IF SKIN IS LOOSE OR LAX.
EXAMPLE: SCROTUM, NECK (OLD PERSON).

c) EDGES: SHARP, EVENLY DIVIDED,
EVERTED, SMOOTH.
RETRACTION OF SKIN &
UNDERLYING MUSCULATURE
CAUSES EVERSION OF MARGINS
& GAPING OF WOUND.
d) ANGLES: SHARP , ACUTE.
e) BASE: INTERVENING DEEPER TISSUES
ARE CLEANLY & EVENLY
DIVIDED.
f) DIMENSIONS: LENGTH IS GREATER THAN
DEPTH. WIDTH OF WOUND IS
GREATER THAN THE EDGE OF
WEAPON CAUSING IT.

g) BLEEDING: BLEED FREELY &
PROFUSELY (VESSELS ARE CUT).
h) TAILING: GRADUAL DECREASE IN DEPTH
OF WOUND IS SEEN TOWARDS
TERMINAL END. SO A
SUPERFICIAL WOUND INVOLVING ONLY SKIN
IS SEEN. THIS IS CALLED “ TAILING OF THE
WOUND”. TAILING INDICATES DIRECTION OF
FORCE.
i) CLOTHES: CUTS ON CLOTHES MAY
CORRESPOND WITH THE WOUND BUT IF THE
CLOTHES ARE LOOSE, FOLDED OR DRAWN
UP DURING STRUGGLE, CUTS IN CLOTHES
MAY NOT COINCIDE WITH THE WOUNDS.

CLASSIFICATION OOFF IINNCCIISSEEDD WWOOUUNNDD
((BBAASSEEDD OONN TTHHEE MMOOTTIIVVEESS // IINNTTEENNTTIIOONN //
MMAANNNNEERR))..
1. THERAPEUTIC (INFLICTED IN GOOD
FAITH):CAUSED BY SURGEON AS A
PART OF TREATMENT. THEY ARE
FOUND AT CERTAIN ELECTIVE,
DEFINITE ANATOMICAL SITES.
2. ACCIDENTAL:
a) FROM FALLING UPON A SHARP OBJECT.
b) IMPACT BY A SHATTERED OBJECT LIKE
GLASS, OCCUR ON ANY PART OF BODY.

3. HOMICIDAL TO PUNISH:
CAUSED WITH 3 MOTIVES.
TO MAIM OR DISFIGURE OR TO KILL:
• FOUND ON FACE (CROSS SLASH).
• FOUND ON NECK REGION.
• ADDITIONALLY DEFENSE WOUND ON HAND &
ARMS ARE FOUND, IF VICTIM WAS
CONSCIOUS.
HOMICIDAL WOUNDS VARY CONSIDERABLY IN:
- DIRECTION.
- DEPTH.
- LOCATION.

4. SUICIDAL: FOUND ON CERTAIN ELECTIVE
SITES.
= SIDES + FRONT OF NECK.
= FRONT OF WRIST (RADIAL ARTERY).
= FRONT OF THIGH (FEMORAL).
= FRONT OF CHEST (HEART).
FEATURES: MULTIPLE, SUPER IMPOSED,
PARALLEL OF VARYING DEPTHS FOUND
ON OPPOSITE SIDE OF THE WORKING
HAND OF THE DECEASED, SHOW
HESITATION OR TENTATIVE CUTS.

CHARACTERISTICS OF HESITATION OR
TENTATIVE CUTS.
PRELIMINARY CUTS, SMALL,
SUPERFICIAL,MULTIPLE FOUND AT THE
COMMENCEMENT OF DEEP WOUND &
MERGING IN DEEP CUT.

DIFFERENTIATION B/W SUICIDAL & HOMICIDAL CCUUTT TTHHRROOAATT..
11..CCIIRRCCUUMMSSTTAANNTTIIAALL EEVVIIDDEENNCCEE ((EEXXTTRRAA CCOORRPPOORRAALL EEVVIIDDEENNCCEE))..
INDICATOR SUICIDAL CUT
THROAT
HOMICIDAL CUT THROAT.
PLACE SOLITARY,
SEGREGATED
LONELY.
NOT NECESSARY.
SCENE. UNDISTURBED. DISTURBED.
SELECTION OF
WEAPON
LIGHT, SHARP EDGE. HEAVY WITH SHARP EDGE.
PRESENCE OF
WEAPON AT THE
SCENE.
PRESENT. USUALLY ABSENT MAY BE
PRESENT.
CLOTHES. ORDERLY. BLOOD
STAINED ON
ANTERIOR PORTIONS
OF CLOTHES.
DERANGED SUGGESTING
SCUFFLE. BLOOD STAINS ON
BACK OF NECK AND GROUND.
FARWELL LETTERS. MOSTLY PRESENT. ABSENT. IF PRESENT,
COMPARE HAND WRITING.
PERSONALITY
TRAIT.
DEPRESSED. NORMAL.

IIII.. CCOORRPPOORRAALL EEVVIIDDEENNCCEE::
CADAVERIC SPASM. HANDS CLENCHED HOLING
INSTRUMENT.
HANDS MAY BE CLENCHED,
CONTAINS BELONGING OF
THE ASSAILANT.
DEFENCE WOUNDS. ABSENT. PRESENT.
DISTRIBUTION OF
INJURIES.
CONFINED TO CERTAIN
ELECTIVE SITE (NECK).
ADDITIONAL INJURIES OVER
THE BODY.
WOUND COMPLEX.
SITE. LEFT SIDE OF NECK IN RIGHT-HANDED
PERSON OR VIE VERSA.
BOTH SIDE & MID LINE.
LEVEL. HIGHER LEVEL ABOVE THE
THYROID CARTILAGE.
LOWER LEVEL BELOW THE
THYROID CARTILAGE.
TENTATIVE CUTS. PRESENT AT THE
COMMENCEMENT.
NIL.
DIRECTION OF WOUND OBLIQUELY DOWN WARDS &
MEDIALLY.
TRANSVERSE, UPWARDS &
LATERALLY.
DEPTH OF WOUND GRADUAL DEEPENING,
SHALLOWING WITH TAILING.
B0LD DEEP CUT WITHOUT
TAILING.
NECK STRUCTURES. SUPERFICIAL STRUCTURES
ARE CUT AT HIGHER LEVEL
THAN DEEPER ONE.
SUPERFICIAL
STRUCTURES ARE CUT
AT LOWER LEVEL THAN
THE DEEP ONE.

DDEEFFEENNSSEE WWOOUUNNDDSS..
WOUNDS CAUSED AS A RESULT OF IMMEDIATE &
INSTINCTIVE REACTION OF VICTIM TO SAVE HIM FROM
THE ATTACKING WEAPON, EITHER BY RAISING THE
ARM OR BY GRASPING THE WEAPON.
SITES:
WEAPON TYPE LOCATION
BLUNT BRUISE DORSUM OF HANDS,
MEDICO LEGAL IMPORTANCE:
1. INDICATIVE HOMICIDE.
2. VICTIM WAS ALIVE & CONSCIOUS.
FORE ARMS
SHARP
EDGES.
INCISED WOUNDS PALM OF HANDS
ULNER BORDER OF
FOREARM.

FFAABBRRIICCAATTEEDD ((FFIICCTTIITTIIOOUUSS.. FFOORRGGEEDD
SSEELLFF--IINNFFLLIICCTTEEDD IINNJJUURRIIEESS..
DEFINITION: THE WOUNDS INFLICTED ON THE BODY, BY
THE PERSON HIMSELF OR BY ANOTHER PERSON TO
MISGUIDE THE INVESTIGATORS, WITH SOME MALAFIDE
INTENTIONS OR ULTERIOR MOTIVES.
MOTIVES:
1. TO BRING A CHARGE AGAINST A PERSON OR TO
IMPLICATE AN INNOCENT PERSON IN A FALSE CASE.
2. TO ACCUSE POLICE OF MALTREATMENT DURING
CUSTODY.
3. POLICE/WATCHMAN/GUARDS CLAIM EFFICIENCY
DURING CATCHING/ENCOUNTERS WITH CRIMINALS.
4. MURDERER MISGUIDING THE INVESTIGATORS, THAT
KILLING WAS IN SELF-DEFENSE.

WEAPONS USED:
1. SHARP EDGE LIGHT CUTTING
WEAPON_____ COMMONLY USED.
2. FIRE ARMS (SHOT GUN)______ RARELY
USED
3. CHEMICALS _______ MARKING NUT JUICE
VERY RARELY USED.
4. BLUNT WEAPONS_______ VERY RARELY
USES
o INJURIES SUSTAINED DUE TO FALL ARE
CLAIMED TO BE CAUSED BY BLOWS.
o TOOTH SHED DUE TO DISEASE IS CLAIMED
TO CAUSED BY BLUNT TRAUMA.

ELECTIVE SITES:
1. ACCESSIBLE/NON VITAL AREAS. TOP OF
HEAD/FORE HEAD OUTER SIDE OF LEFT
ARM. FRONT OF LEFT FOREARM. FRONT
OF CHEST/ABDOMEN. FRONT & OUTER
PART OF THIGH.
1. HISTORY.
EXAGGERATION WITH REFERENCE TO:
o WEAPON.
o NUMBER OF ATTACKERS.
o METHOD OF INFLICTION.
o NUMBER OF BLOWS.

EXAMINATION OF CLOTHES:
o CLOTHES ARE SPARED USUALLY.
o IF CLOTHES ARE INVOLVED THEY ARE DAMAGED, THEY
ARE CUT IN A WAY INCOMPATIBLE, WITH THE NUMBER,
LENGTH DIRECTION & NATURE OF WOUND.
THE WOUND:
o SUPERFICIAL, MULTIPLE, MADE HALF HEARTEDLY.
o SEEN ON ACCESSIBLE, NON-VITAL LESS FUNCTIONING
AREAS.
o CAUSED BY LIGHT, CUTTING INSTRUMENTS.
o FIREARMS ARE ALSO USED IN OUR AREAS.
o SHOT GUNS ARE USED.
o CARTRIDGE DISCHARGING SMALL PALLETS IS USED.
o SEEN SUPERFICIALLY BELOW THE SKIN OR ON
MUSCULAR AREA.
o WOUND MAY BE INCISED & PELLETS ARE KEPT
MANUALLY.
o AFTER X-RAY (CERTIFICATE) THEY ARE REMOVED.

STAB WOUND:
DEFINITION: WOUND CAUSED BY A SHARP POINTED
WEAPON DRIVEN IN THE BODY, THE DEPTH OF WOUND
BEING THE GREATEST DIMENSION.
SUBSTITUTING WORDS:
PENETRATING WOUND: WHEN THE WEAPON AFTER
PASSING THROUGH TISSUES OPEN IN TO SOME PART
OF THE BODY i.e. WOUND OF ENTRY BUT NO WOUND OF
EXIT.
PERFORATING WOUND: WHEN THE WEAPON PASSES
THROUGH & THROUGH THE BODY MAKING TWO
WOUNDS i.e. WOUND OF ENTRANCE, WOUND OF EXIT,
CAUSATIVE WEAPON.
- FLAT, POINTED OBJECTS_____ KNIFE, DAGGER,
.
- SHARP, ROUNDED OBJECTS____NEEDLES, ICE PICKS.
- ELONGATED, BLUNT ENDED ____ SCISSOR, FENCE.

DIAGNOSTIC FEATURES: HAVING ALL THE
FEATURES OF INCISED WOUND, BUT DEPTH IS
MORE THAN OTHER DIMENSIONS.
HOW TO ASCERTAIN DEPTH OF WOUND:
IN CASE OF PENETRATING WOUNDS:
IN LIVING:
NEVER INSERT ANY INSTRUMENTS/PROBE IN THE
SUSPECTED STAB WOUND BECAUSE, CLOT
ALREADY FORMED BY BODY RESPONSE CAN BE
DISLODGED, CAUSING FRESH BLEEDING WITH
FATAL RESULT. SHIFT THE INJURED TO
OPERATION THEATRE, UNDER ANESTHESIA &
ASEPTIC CONDITIONS EXPLORATION OF WOUND
IS DONE, DEPTH IS OBSERVED.

IN CASE THE PERSON IS DEAD: AUTOPSY IS DONE
& DEPTH IS GAUGED IN CASES OF PERFORATING
WOUNDS: THE WOUND OF EXIT IS THE GUIDING
PRINCIPLE.
CHARACTERISTICS OF WOUND OF ENTRY &
WOUND OF EXIT CAUSED BY PERFORATING
WEAPON WOUND OF ENTRY.
- GENERALLY BIGGER THAN THE WOUND OF EXIT.
- PIECES OF CLOTH/FIBERS DIRECTED TOWARDS
WOUND.
- MARGINS ARE CLEAN CUT & INVERTED.
- ABRASION/BRUISING OF EDGES/MARGINS DUE
TO EFFECT OF HILT OF WEAPON MAY BE SEEN.
- SHAPE OF WOUND MAY CORRESPONDS THE
SHAPE OF WEAPON.

EXAMPLE:
WEAPON SHAPE OF WOUND
SINGLE SHARP
EDGED WEAPON.
WEDGE SHAPE
DOUBLE SHARP EDGED WEAPON ELLIPTICAL SHAPE
ROUNDED POINTED CIRCULAR
POINTED SQUARE CRUCIATE
DOUBLE EDGED BLUNT CIRCULAR WITH BRUISING
INSTRUMENT TWISTED BEFORE
WITH DRAWL.
TRIANGULAR OR CRUCIATE.
WOUND OF EXIT:
SMALLER WITH EVERTED MARGINS.
CLOTH FIBERS ARE DIRECTED OUT WARDS.

LLAACCEERRAATTEEDD WWOOUUNNDDSS
• Lacerated wounds are the wounds in
which the tissues are torn as a result of
application of blunt force to the body; the
force may be produced by some moving
weapon or object or by a fall. Localized
portions of tissues are displaced by the
impact of blunt force. This displacement
sets up traction forces and tearing or
rupture of the tissues.

The cchhaarraacctteerriissttiicc ffeeaattuurreess ooff
llaacceerraatteedd wwoouunnddss aarree::
• The edges are irregular, ragged and frequently bruised.
• The margins are commonly abraded and abraded area
corresponds to the surface of impact.
• Deeper tissues are unevenly divided.
• Hair bulbs if present are crushed.
• Blood vessels are crushed unevenly so external hemorrhage is
less.
• Foreign material usually found in the wound.
• No relation ship between wound and weapon causing it is
seen.
• Usually accompanied by internal injuries.
• Fat embolism is the chief complication.

• Depending upon the manner in which they
are produced, they are classified in to.
• SPLIT LACERATIONS: (Blunt
perpendicular impact).
• STRETCH LACERATIONS ( Tangential
impact )
• AVULSION ( Horizontal crushing impact )
• TEARS ( Irregularly directed impact )

- MARGINS : FREQUENTLY ABRADED.
- EDGES : IRREGULAR, JAGGED,
INVERTED, SWOLLEN, BRUISED.
- ANGLES : TORN, IRREGULAR.
- DEPTH (BASE) : UNEVEN, NON UNIFORM DEPTH,
STRAND OF TISSUE FOUND,
BRIDGING/ CROSSING
OVER AT THE VARYING DEPTHS.
- HAIRS BULBS: CRUSHED.
- B. VESSELS : CRUSHED.
- SKIN : FLAPPING.
- EXTERNOUS : COMMONLY FOUND.
- MATERIAL :

MECHANISM OF CAUSATION OR TYPES:
ON THE BASIS OF MECHANISM OF CAUSATION
LACERATION ARE DIVIDED INTO 4 TYPES.
a) SPLIT / SLIT LACERATION.
SPLITTING OF SKIN AND UNDERLYING TISSUES
OCCUR, WHEN THERE IS COMPRESSION/
CRUSHING OF THE AFFECTED TISSUE BETWEEN
TWO HARD OBJECTS THAT IS BONE & BLUNT
INSTRUMENT OR GROUND. IMPACT IS
PERPENDICULAR.
EXAMPLE: COMMONLY SEEN OVER SCALP,
CHEEK (ZYGOMATIC ARCHES) CHIN,
EYE BROW ETC.

RESEMBLANCE: APPARENTLY OR ON
CURSORY EXAMINATION THEY ARE
CONFUSED WITH INCISED
WOUNDS.
SOLUTION: CAREFUL EXAMINATION WITH
HAND LENS, SHOWS, DENUDATION
OF HAIRS NOT CUTTING,
IRREGULAR EDGES WITH
BRUISING.
b) OVER STRETCHING OF SKIN:
THERE IS LOCALIZED PRESSURE WITH
PULL, WHICH INCREASES UNTIL TEARING
OCCURS PRODUCING A FLAP INDICATING
DIRECTION OF THE OFFENDING OBJECT,
IMPACT IS TANGENTIAL.

EXAMPLES:-LACERATION OF SCALP WHEN
HEAD STRIKES WITH WINDSCREEN.
- GLANCING KICKS WITH A BOOT.
- DEFORMITY OF BONE OCCURRING
AFTER FRACTURE CAUSING
OVERLYING TISSUES AND SKIN TO TEAR.
c) AVULSION/GRINDING COMPRESSION OF SKIN
LOCALIZED PRESSURE DUE TO HEAVY
WEIGHT CAUSES TEARING OF SKIN, CRUSHING
OF MUSCLES & SEPARATION OF SKIN FROM THE
UNDERLYING TISSUES, FORMING A SPACE.
THERE WILL BE EXTRAVASATION OF BLOOD,
FAT, FOREIGN BODIES IN THE POTENTIAL
SPACE. IMPACT IS HORIZONTAL.

EXAMPLE: RUN OVER BY A LORRY WHEEL.
COMPLICATION: CRUSH SYNDROME LEADS
TO FAT EMBOLI RESULTING IN DEATH.
CRUSH RELEASE OF FAT ENTRY IN THE BLOOD.
CIRCULATION FAT EMBOLI DEATH.
d) TEARING OF THE SKIN: CAUSED BY IMPACT BY
OR AGAINST IRREGULAR OR SHARP
PROJECTING OBJECT. THIS IS ANOTHER FORM
OF OVER STRETCHING.
EXAMPLE: MOTOR CAR / DOOR / HANDLES.

e) CUT LACERATION: WHEN A HEAVY AND
SHARP EDGED WEAPON IS USED SKIN IS CUT
WITH BRUISING AT EDGES, HAIRS ARE FORCED
INTO WOUND.
EXAMPLE: HATCHET OR CHOPPER WOUND.
MEDICOLEGAL ASPECTS:
I) IDENTIFICATION OF OBJECT:
a) BLUNT ROUND END (POCKER HEAD)
GIVES A STELLATE SHAPE
WOUND
b) HAMMERHEAD GIVES A CRESENTRIC
SHAPED WOUND.
c) LINEAR ROUND OBJECT SUCH AS IRON
BAR GIVES A LINEAR, Y – SHAPED END
WOUND (SWALLOW’S TAIL).
d) LINEAR WITH EDGE (SQUARE JACK
HANDLE) GIVES A GROOVED TEAR.

II) DIFFERENTIATION B/W FALL & BLOW
WITH STICKS.
a) SHALVING OR MERGENCE: ONE MARGIN
OVER RIDING THE OTHER.
b) FOREIGN BODIES/MATERIAL: INDICATE
THE FALL.
III) INDICATION OF DIRECTION OF FORCE
THE MORE UNDERMINED EDGE IS THE
SIDE TOWARDS WHICH THE FORCE OF
STRIKING OBJECT IS DIRECTED. THE SIDE
SHOWING ADJACENT CONTUSION IS THE
SIDE FROM WHICH FORCE IS DIRECTED.
IV) INDICATES PLACE OF INCIDENCE:
THE FOREIGN BODIES FOUND IN THE DEPTH
OF WOUND INDICATES PLACE OF INCIDENCE.

V) MANNER OF INJURY:
ACCIDENTAL: COMMON, ESPECIALLY IN
THE URBAN AREA. INVOLVES THE
EXPOSED PARTS OF THE BODY.
HOMICIDAL: COMMON IN RURAL AREA
WHERE PRIMITIVE INSTRUMENTS ARE
USED FOR ASSAULT.
SUICIDAL: VERY RARE.

VI) COMPICATIONS:
a) LACERATION MAY BE A SOURCE OF
SEVERE, EVEN FATAL INTERNAL OR
EXTERNAL BLEEDING.
b) BECOMES A PORTAL OF ENTRY FOR
THE BACTERIA.
c) PULMONARY OR SYSTEMIC FAT
EMBOLISM.

MM..LL.. IIMMPPOORRTTAANNCCEE
• Mostly seen in vehicular accidents or
building collapse.
• Homicidal, when hit with some hard, blunt,
heavy weapon of Assault.
• Suicidal when jumping on rough ground
from a height to commit suicide.
•

REGIONAL INJURIES
HEAD INJURIES

HHEEAADD IINNJJUURRYY
• Head injury is the leading cause of
death in road traffic accidents. It may
be caused by other accidents such as
fall from height or may be due to
homicidal attack with blunt weapons.
Fire arm injuries of head are another
common cause of death, mostly
homicidal.

For an easy understanding the head
injuries are studied under three heads
• Scalp Injuries
• Skull Injuries
• Brain Injuries

aa)) SSCCAALLPP IINNJJUURRYY
• Majority of injuries in Pakistan are
accidental or homicidal.
ANATOMY-
• S- skin
• C- connective tissue
• A - aponeurosis
• L - loose connective tissue
• P- periosteum

Majority of injuries in Pakistan are accidental or
homicidal. Very rarely , scalp injuries are suicidal
in nature mostly seen in lunatics.
Accidental scalp injuries mostly seen in vehicular
accidents , fall from height or an object falling on
the head. Most of the homicidal injuries are
caused by hitting by a blunt weapon like lathi or
sharp weapon like axe, hatchet, chopper,sword ,
gandasa , etc.

Scalp injuries may be contusion , incised or
lacerated wound. In scalp lacerated wound may
look like incised wound. It is essential that edges
of wounds should be carefully noted as in
incised wound the margins would be clean cut
and hair bulb clear cut while in lacerated wound ,
the edges would be irregular and hair bulb
crushed. Scalp injuries sometimes go unnoticed
being hidden under the hair. Since scalp is
dense tissue , less signs of bleeding , swelling
and other signs of inflammation are observed.

Injuries of the scalp which have a special medicolegal
significance are .
• Contusion
BLACK EYE : this is a condition due to the bleeding in the
soft tissue around the eye owing to blunt trauma of the
forehead rupturing the blood vessels and the blood
tracks along the facial attachment around the lower
margin of the orbits.
SPECTACLE HEMATOMA : This is a condition in which
blood is collected in the soft tissue around the eyes , due
to the fracture of the base of the skull.
BATTLE’S SIGN : A Bluish discoloration of the skin behind
the ear that occurs from the blood leaking under the
scalp after a skull fracture

BB.. SSKKUULLLL FFRRAACCTTUURREESS
Following are the types of fractures of skull
• Depressed Fracture : It is due to direct impact of
weapon on the skull where bone is depressed to the
extent of the force used. Since , the depression may
resemble the weapon , the fracture is also called as
Signature fracture or fracture ala signature.
• Comminuted Fracture : It is a case of depressed
fracture where bone on fracture site gets broken into
multiple pieces. The fragmented parts may get driven
into underlying brain tissue. If there is no displacement
of comminuted fragments , the area looks like spider’s
web of mosaic.

• Pond or Indented Fracture : it may be seen in
small infants and children where skull is elastic.
It may be produced by obstetric forceps during
childbirth or hit by a blunt object. There may be
indentation or simple buckling of skull.
• Gutter Fracture : It is due to Flanking or grazing
by the bullet which produces a furrow in outer
table of the skull.
• Linear or fissured fractures: They are linear
cracks without any displacement of fragments of
skull bones. The line of linear crack is very thin.
They are usually caused by a blunt impact with
broad resisting force like fall on the ground or in
road traffic accidents.

• Diastatic Fracture: Separation of sutures or diastatic
fracture is called when fracture line involves separation
of sutures. They are commonly seen in children. There
are caused due to broad impact of blunt force like fall
from height , road traffic accidents , train accidents , etc.
• Contre-coup Fractures: there Fractures occur when
head is not supported and is moving. In this fracture is
seen on diagonally opposite side of the skull. It may be
depressed fissured or crushed. Such fractures are
common in road traffic accidents.
• Basilar Fracture : Basilar fractures are fractures of base
of the skull ranging from linear to complex one. Basilar
fractures are produced by heavy blunt force like fall ,
road accidents , etc.

Fractures ooff BBaassee ooff tthhee SSkkuullll
FFoolllloowwiinngg aarree ttyyppeess ooff ffrraaccttuurreess ooff bbaassee ooff sskkuullll::
•FFrraaccttuurree ooff tthhee aanntteerriioorr ccrraanniiaall ffoossssaa :: iiss dduuee ttoo ddiirreecctt iimmppaacctt
oorr aass aa rreessuulltt ooff ccoonnttrraaccoouupp iinnjjuurriieess,, rreessuullttiinngg iinn bbllaacckk eeyyeess oorr
eessccaappee ooff CCSSFF aanndd bblloooodd ffrroomm tthhee nnoossee
•FFrraaccttuurree ooff tthhee mmiiddddllee ccrraanniiaall ffoossssaa :: iiss dduuee ttoo ddiirreecctt iimmppaacctt
bbeehhiinndd tthhee eeaarrss oorr ccrruusshh iinnjjuurriieess ooff tthhee hheeaadd rreessuullttiinngg iinn eessccaappee ooff
CCSSFF aanndd bblloooodd ffrroomm tthhee eeaarr wwhheerree ppeettrroouuss ppaarrtt ooff tthhee tteemmppoorraall
bboonnee iiss ffrraaccttuurreedd
•FFrraaccttuurree ooff tthhee ppoosstteerriioorr ccrraanniiaall ffoossssaa :: iiss dduuee ttoo tthhee iimmppaacctt oonn
tthhee bbaacckk ooff tthhee hheeaadd ,, rreessuullttiinngg iinn eessccaappee ooff CCSSFF aanndd bblloooodd iinnttoo
ttiissssuueess ooff tthhee bbaacckk ooff tthhee nneecckk..

• Fracture around foramen magnum (Ring
Fracture) : This is a type of fissured fracture which
encircles the base of skull around the foremen
magnum running 3 – 5 cm outside foramen
magnum at the back and sides of the skull. Such
fractures are seen in following cases :
(A) Fall from height where a person falls on feet or
buttock and impact passes upward through spinal
column.
(B) Fall from height where head strikes the ground
first.
(C) Fall of heavy load on head.
(D) Violent twisting of head.

• Hinge Fracture ( Transverse Fracture) : It is a
fracture of the base of the skull where the
fracture line runs from side to side across the
floor of the middle cranial fossa , passing
through the pituitary fossa in the midline
following the course of least structural
resistance.

IINNTTRRAACCRRAANNIIAALL
HHAAEEMMOORRRRHHAAGGEESS
•EEXXTTRRAADDUURRAALL
•SSUUBBDDUURRAALL
•SSUUBBAARRAACCHHNNOOIIDD
•IINNTTRRCCEERREEBBRRAALL
•IINNTTRRAAVVEENNTTRRIICCUULLAARR
•PPOONNTTIINNEE
•CCOONNTTRREECCOOUUPP

EXTRA DDUURRAALL HHAAEEMMOORRRRHHAAGGEE
• It may occur as a result of violence with or
without cranial fracture. It is generally due to
rupture of middle meningeal artery or posterior
meningeal artery, diploic veins or dural venous
sinuses.
• In infants and old people, the dura is tightly
adherent to the skull, so extra dural
haemorrhage is less common in these ages,
peak is seen in second and third decades.

EXTRA DDUURRAALL HHAAEEMMOORRRRHHAAGGEE
((CCoonntt))
• As bleeding commences, it strips off the
duramater from the under surface of skull
with progressive accumulation of blood. It
is usually unilateral. There is often free
interval between infliction of injury and
symptoms of extra dural haemorrhage,
this symptom free period is known as
LUCID INTERVAL which may vary from 2
hours- 7 days,but in most cases
symptoms are apparent in 4 hours.

SSUUBB DDUURRAALL HHAAEEMMOORRRRHHAAGGEE
• It is also due to trauma, causing rupture of dural venous
sinuses and cortical veins. Subdural haemorrhage is
seen in old people, chronic alcoholics, blood diseases.
• It is generally diffuse over both cerebral hemispheres
and tends to gravitate to the base of the brain.
• Increasing drowsiness and severe headache follows in
3-10 days after trauma. There may be weakness of one
or other side of the body. Unilateral dilatation of pupil is
frequently seen. Lucid interval is longer than that seen in
extra dural haemorrhage.

SSUUBB AARRAACCHHNNOOIIDD HHAAEEMMOORRRRHHAAGGEE
• Between arachnoid and piamater due to,
violence causing tearing of arachnoid
membrane or laceration of the cortex, in
asphyxia such as strangulation, traumatic
asphyxia, diseases such as rupture of athero
sclerosed arteries, purpura, leukemia. It can
occur at all ages. The diagnostic features are
sudden onset of severe headache and stiff neck,
followed by transient unconsciousness and
finding of bloody cerebrospinal fluid under
increased pressure.

IINNTTRRAA CCEERREEBBRRAALL HHAAEEMMOORRRRHHAAGGEE
• It may be on the surface or in the substance of the brain.
This is usually due to disease e.g. encephalitis,
thrombosis, embolism or high blood pressure etc
occurring as a result of sudden emotion, excitement or
quarrel and rarely due to trauma with or without fracture
of the skull.
• The effect varies with site. In rapidly fatal cases there is
sudden onset of coma. In others consciousness may be
lost for varying period of time. In acute stages the eyes
are usually deviated to the side of the lesion and
paralysis of the opposite side of the body. The neck is
not as stiff as in sub arachnoid haemorrhage.

INTRACEREBRAL HHAAEEMMOORRRRHHAAGGEE((CCoonntt))
• A chronic stage of forgetfulness, lack of
coordination, tremors and dysarthria,
known as PUNCH DRUNKENNESS,
SLUG HAPPY or GOFFY is found among
old boxers and is believed to be due to
tiny haemorrhages in the brain during
fights few years back.

IINNTTRRAAVVEENNTTRRIICCUULLAARR HHAAEEMMOORRRRHHAAGGEE
• It is also due to trauma.
Haemorrhage in ventricles can be
demonstrated by lumbar puncture
where the cerebrospinal fluid is
tinged with blood.

PPOONNTTIINNEE HHAAEEMMOORRRRHHAAGGEE
• The haemorrhage in pons is
characterized by constriction of pupil
of the affected side followed by
constriction of pupil of the opposite
side, the pupils are thus
asymmetrically pinpoint . More over
the body temperature rises markedly
due to damage to heat regulating
centre in the pons.

CCOONNTTRREE CCOOUUPP HHAAEEMMOORRRRHHAAGGEE
• In cases where head is supported and fixed the
injury occurs just below the site of impact and
small haemorrhage may also occur, this is coup
haemorrhage.
• In contre coup haemorrhage, when head is free
to move, the skull on contact with a blunt object
stops, but the brain continues to move due to
inertia, so due to these linear and rotational
strain the meninges are torn leading to extensive
haemorrhage.

DDAATTIINNGG OOFF HHAAEEMMOORRHHHHAAGGEE
• Rough idea can be had from the colour
and consistency of the clot, and the colour
of cerebrospinal fluid.
• In fresh haemorrhage the clot is red and
soft.
• In 6-7 days, the clot starts breaking down.
• In 12-15 days, a small clot leaves as a
residue ,a yellowish stained slit or a small
pale brown clot.

DDAATTIINNGG OOFF HHAAEEMMOORRRRHHAAGGEE((CCoonntt))
• The fate of big clot is liquefaction, leading to
slow removal of pigment while clear fluid is
drawn in by osmosis.
• Eventually there is a cyst of several centimeters
in diameter with gliosis forming a kind of capsule
on it, the capsule becomes evident to naked eye
by about 8 days. The capsule looks like
duramater in about2-3 months and within a year
becomes thick and fibrous, and the brain is
dented by the cyst.

DDAATTIINNGG OOFF
HHAAEEMMOORRRRHHAAGGEE((CCoonntt))
• In the examination of CSF, if the supernatant of the
centrifuged fluid show no tinge of pink, only few hours
have passed.
• After that time the erythrocytes began to haemolyse and
following sequence of events is observed.
• After 6 hours, the supernatant fluid is pink, indicating free
haemoglobin, no intact RBCs are found microscopically
in the sediment after 3-6 days and Xanthochromia,
imparted by break down of haemoglobin, commences at
12-24 hours, reaches maximum in few days and fades
away in 2-3 weeks.

IINNJJUURRIIEESS TTOO TTHHEE BBRRAAIINN
• CEREBRAL CONCUSSION
• CEREBRAL IRRITATION
• CONTUSIONS AND LACERATIONS
• COMPRESSION OF THE BRAIN
• HAEMORRHAGES

MMEECCHHAANNIISSMM OOFF BBRRAAIINN IINNJJUURRIIEESS
• Before studying brain injuries it is
necessary to understand the various
mechanisms involved, which include-
• ACCELERATING INJURY
• DECELERATING INJURY
• SHEAR STRAIN/ ROTATIONAL INJURY
• COUP & CONTRE COUP INJURY

AACCCCEELLEERRAATTIINNGG IINNJJUURRYY
• WHEN A MOVING OBJECT HITS THE
HEAD WHICH IS STATIC, THE SKULL
PICKS UP THE MOMEMTUM FIRST AND
HITS THE BRAIN WHICH IS STILL AT
REST,YET TO PICK UP MOMENTUM.
THIS IS CALLED ACCELERATING
INJURY.
• Example is hitting the head with a hockey
stick.

DDEECCCCEELLEERRAATTIINNGG IINNJJUURRYY
• WHEN A NON MOVING OBJECT SUDDENLY
ARRESTS THE HEAD IN MOTION, THE SKULL
LOOSES ITS MOMENTUM MUCH PRIOR TO
BRAIN, WHICH HITS THE INNER SURFACE
OF THE SKULL BEFORE BECOMING STATIC.
THIS IS CALLED DECCELERATING INJURY.
• Example- when a motor cyclist stricks head
against a electric pole on the road.

SSHHEEAARR SSTTRRAAIINN// RROOTTAATTIIOONNAALL
IINNJJUURRYY
• SHEAR STRAIN IS A STRAIN PRODUCED TO
CAUSE ADJOINING PARTS OF THE BODY TO
SLIDE RELATIVE TO EACH OTHER IN A
DIRECTION PARALLEL TO THEIR PLACES OF
CONTACT.(LINEAR STRAIN)
• WHEN HEAD STOPS AFTER COMING IN
CONTACT WITH AN OBJECT, THE BRAIN
CONTINUES TO MOVE DUE TO INERTIA
CAUSING ROTATIONAL INJURY.
(ROTATIONAL STRAIN)

CCOOUUPP && CCOONNTTRREE CCOOUUPP
IINNJJUURRIIEESS
• COUP INJURY- WHEN HEAD IS SUPPORTED
AND FIXED THE INJURY TO THE BRAIN
OCCURS JUST BELOW THE SITE OF
IMPACT.
• Example- Impact on forehead causes injury in
frontal lobes.
• CONTRE COUP INJURY- WHEN HEAD IS
FREE TO MOVE, THE INJURY OCCURS ON
THE OPPOSITE SIDE OF THE IMPACT.
• Example – Impact on forehead causes injury in
occipital area.

TTHHEEOORRIIEESS RREEGGAARRDDIINNGG
CCOONNTTRREE CCOOUUPP IINNJJUURRIIEESS
• DIRECT IMPACT THEORY.
• LINEAR AND ROTATIONAL STRAIN
THEORY.
• LATEST IS VACCUM THEORY.

TTHHEEOORRIIEESS AABBOOUUTT CCOONNTTRREE
CCOOUUPP LLEESSIIOONNSS
• STRUCK HOOP THEORY- Due to
elasticity of skull, the flattening of the skull
result at the point of impact resulting in
compression of the skull so that skull
assumes an ovoid shape shortly and thus
damage is caused to the opposite side of
the impact of brain.
• RUSSELL’S THEORY- Sudden
displacement of the brain towards impact
side due to brain reacting as a jelly mass

and a potential space is developed on
opposite side injuring the vessels and
resulting in subdural and cortical damage.
GAGGIO’S PRESSURE GRADIENT
THEORY- At the moment of impact, there is
positive pressure on the side of impact and
negative pressure on the opposite side; this
bursts the vessels on the opposite side.
HOLBOURN SHEAR STRAIN THEORY-
(ROTATIONAL FORCE THEORY): Contre
coup lesions are chiefly due to local
distortion that causes shear strain due to
pulling apart of constituent particles of brain.

WHEN MOVING HEAD is suddenly
decelerated by hitting a firm surface,
contre coup injury results, the sudden
arrest of head results in brain that is still
in motion striking the stationary skull.
RAWLING’S THEORY OF BONY
IRREGULARITIES- Irregular bony
prominences particularly orbital and
cribriform plate, lesser wings of sphenoid
contuse or lacerate base of frontal lobes
and tips of temporal lobes, some times
with fracture of orbital plate.

• Fall on side of head producing contusion
on opposite side of brain due to formation
of cavity or vacuum on opposite side of
impact, the vacuum exerts a suction effect
that damages the brain.
• MORITZ’S RADIATING WAVE THEORY-Energy
of impact in a hollow organ
propagates by radiating waves along the
meridional lines that damages as they
leave the site of impact and converge as
they approach the opposite side.

CCEERREEBBRRAALL CCOONNCCUUSSSSIIOONN
((CCOOMMMMOOTTIIOO CCEERREEBBRRII))
• The term cerebral concussion is
generally used to indicate a purely
functional disorder that is reversible
and of relatively minor nature.
• It is popularly known as STUNNING.
• Concussion is believed to be due to
minor neuronal injury, with damage to
any part of neuronal body, axons and
synapses.

CCeerreebbrraall ccoonnccuussssiioonn ((CCoonntt))
• CLINICAL FEATURES:
• In mild injury the essential feature is transient but
immediate unconsciousness or impaired consciousness
following trauma to the head.
• In severe injury the victim falls down and become
unconscious, but there is no paralysis. The face is pale
and the pupils are constricted and react to light. Skin is
cold and clammy and body temperature is subnormal.
Sphincters are relaxed and there is incontinence of urine
and faeces. Result may be death from SYNCOPE. Some
times after apparent recovery death may occur from
INFAMMATION or COMPRESSION.

CCEERREEBBRRAALL CCOONNCCUUSSSSIIOONN ((CCoonntt))
• RECOVERY- In cases of recovery without
inflammation or irritation following
functional disturbances may be seen.
• (a) RETROGRADE AMNESIA.
COMPLETE LOSS OF RECENT PAST
MEMORY, i.e. PRE AND POST INJURY
EVENTS, USUAL DURATION IS 15-30
DAYS.

CCeerreebbrraall ccoonnccuussssiioonn ((ccoonntt))
• (b) POST TRAUMATIC AUTOMATISM: THE
PATIENT MAY SPEAK AND ACT IN A
PURPOSIVE MANNER, BUT DOES NOT
KNOW WHAT HE WAS DOING AND RETAINS
NO KNOWLEDGE OF HIS ACTIONS.
• (c) POST CONCUSSION SYNDROME: AFTER
RECOVERY OF CONSCIOUSNESS THERE
MAY REMAIN SYMPTOMS OF HEADACHE,
MENTAL IRRITABILITY, LOSS OF HEARING,
SIGHT AND INSOMNIA.

CCEERREEBBRRAALL IIRRRRIITTAATTIIOONN
• INCLUDE PECULIAR SET OF SMPTOMS
THAT MAY FOLLOW CEREBRAL
CONCUSSION. HERE THE PATIENT LIES
CURLED UP IN BED WITH HIS HEAD
BENEATH THE PILLOWS, HE DISLIKES ALL
FORMS OF INTERFERENCE AND EXPOSURE
TO LIGHT. HE IS NOT UNCONSCIOUS BUT
PAYS NO ATTENTION TO HIS
SURROUNDINGS. HE IS LIABLE TO BECOME
AGGRESSIVE IF DISTURBED. THE
SYMPTOMS GRADUALLY DISAPPEAR WITH
COMPLETE RECOVERY OR FOLLOWED BY
POST CONCUSSION SYNDROME.

CCEERREEBBRRAALL CCOONNTTUUSSIIOONNSS &&
LLAACCEERRAATTIIOONNSS
• In this case due to head injury there is
disruption of soft tissues of the brain
especially the cortical region with damage
to blood vessels with extravasation of the
blood in to the substance of affected area,
the area gets bruised and swollen and
constitute a contusion.

NAMES OF CONTUSIONS IINN DDIIFFFFEERREENNTT
PPAARRTTSS OOFF BBRRAAIINN’’,,
• Contusions found in deeper structures of brain
along the line of impact are called
INTERMEDIATARY CONTUSIONS.
• Contusions caused by fractures of the skull are
called FRACTURE CONTUSIONS.
• Contusions in frontal lobes due to gliding of brain due to
severe impact are known as GLIDING CONTUSIONS.
• Contusions in the cerebellar tonsils and medulla
produced by momentary shift of brain towards foramen
magnum are called HERNIATION CONTUSIONS

CCLLIINNIICCAALL FFEEAATTUURREESS
• Loss of unconsciousness predominantly.
• COMPLICATIONS-
• Cerebral contusions may lead to,
-Bleeding from torn plial blood vessels.
-Edema of brain tissue.
-Increased intracranial pressure.
-Death when not properly treated.
-Healing by gliosis may cause pressure
symptoms.
• COUP & CONTRE COUP INJURIES ARE ALSO
CONTUSIONS & LACERATIONS OF THE
BRAIN.

CCEERREEBBRRAALL CCOOMMPPRREESSSSIIOONN
• IT IS A CLINICAL CONDITION CAUSED BY
INCREASED INTRACRANIAL PRESSURE WHICH
DISTURBS THE BRAIN FUNCTION.
• CAUSES
• FORMATION OF PRESSURE OVER AND AROUND
THE BRAIN STEM AS A RESULT OF DEPRESSED
FRACTURE OF SKULL, FOREIGN BODY, EDEMA OR
HAEMORRHAGES.
• Diagnosis of cerebral compression is very important
as surgical treatment of the cause can relieve
compression, which is a live saving measure.

IINNJJUURRIIEESS TTOO TTHHEE SSPPIINNEE
CONCUSSION OF SPINE
THIS CONDITION CAN OCCUR WITHOUT ANY
EVIDENCE OF EXTERNAL INJURY TO THE
SPINAL COLUMN, FROM A FORCIBLE BLOW
ON THE BACK OR A FALL FROM HEIGHT OR
A BULLET INJURY BUT IS COMMONLY SEEN
IN RAILWAY ACCIDENTS AND MOTOR CAR
COLLISIONS, HENCE ALSO KNOWN AS
RAILWAY SPINE.

SSIIGGNNSS AANNDD SSYYMMPPTTOOMMSS
• MAY APPEAR IMMEDIATELY OR MAY BE
DELAYED FOR HOURS OR DAYS. THERE
MAY BE PARALYSIS OF UPPER AND
LOWER LIMBS OR LOWER LIMBS ALONE
WITH INVOLVEMENT OF BLADDER AND
RECTUM. THE PERSON MAY PRESENT WITH
HEADACHE, GIDDINESS, RESTLESSNESS,
NEURASTHENIA, LOSS OF SEXUAL POWER
AND WEAKNESS IN THE LIMBS. THE
PARALYSIS IS TEMPORARY AND
RECOVERY OCCURS WITHIN 48 HOURS.

IINNJJUURRIIEESS TTOO TTHHEE UUPPPPEERR
CCEERRVVIICCAALL SSPPIINNEE
• VERTICAL IMPACT TO THE HEAD WITH
STRAIGHTENED NECK MAY LEAD TO
COMPRESSION FRACTURE OF ATLAS KNOWN AS
JEFFERSON’S FRACTURE, ANOTHER COMMON
FRACTURE SEEN IS IN SECOND CERVICAL
VERTERBA, AXIS IS KNOWN AS HANGMAN’S
FRACTURE IN WHICH THERE IS ANTERIOR
DISLOCATION OF C2 WITH FRACTURE OF
ODONTOID PROCESS OR IT’S ANTERIOR
DISLOCATION CRUSHINING THE MEDULLA AND
PONS WHERE VITAL CARDIAC AND RESPIRATORY
CENTERS ARE SITUATED,THIS IS SPECIALLY SEEN
IN JUDICIAL HANGING.

IINNJJUURRIIEESS TTOO MMIIDDDDLLEE AANNDD
LLOOWWEERR CCEERRVVIICCAALL SSPPIINNEE
• MOST COMMON INJURIES ARE HYPER
FLEXION AND HYPER EXTENSION INJURIES
KNOWN AS WHIPLASH INJURIES, WHICH
ARE MOST COMMONLY SEEN IN MOTOR
CAR ACCIDENTS WHERE DUE TO SUDDEN
STOPPAGE OF A VEHICLE IN SPEED
CAUSES HYPERFLEXION AND THEN HYPER
EXTENSION OF NECK, PULLING THE
NERVES AT THE ROOT OF NECK LEADING
TO PARALYSIS OF LIMBS WITH FRACTURES
OF C3 AND C4.

TTHHOORRAACCIICC AANNDD LLUUMMBBAARR SSPPIINNEE
• T1 TO T10 ARE MORE RESISTANT TO
INJURIES BECAUSE OF ADDITIONAL
STABILITY OF THORACIC RIB CAGE, SO
DISLOCATOIN AND ROTATIONAL INJURIES
ARE LESS COMMON AS COMPARED TO
LOWER THORACIC AND LUMBAR SPINE
BECAUSE OF INCREASED FLEXIBILITY AS
SEEN IN SEAT BELT SYNDROME .
LUMBOSACCRAL SPINE IS MORE PRONE TO
FRACTURES AND COMPRESSION INJURIES.

IINNJJUURRIIEESS TTOO SSPPIINNAALL CCOORRDD
• SPINAL CORD INJURY MAY RESULT IN
QUADRIPLEGIA OR PARAPLEGIA.
QUADRIPLEGIA(PARALYSIS OF ALL FOUR
LIMBS) IS SEEN WHEN INJURY IS ABOVE
THE LEVEL OF EMERGENCE OF ROOTS
SERVING THE BRACHIAL PLEXUS(4TH
CERVICAL) AND PARAPLEGIA (PARALYSIS
OF LOWER LIMBS) ISSEEN DUE TO INJURY
BELOW THE LEVEL OF EMERGENCE OF
BRACHIAL PLEXUS(1ST AND 2ND THORACIC
VERTEBRAE).

PPEENNEETTRRAATTIINNGG IINNJJUURRIIEESS OOFF
TTHHEE SSPPIINNAALL CCOORRDD
• PENETRATING INJURIES ARE USUALLY
CAUSED BY MISSILES SUCH AS BULLETS.
• ANOTHER TYPE OF PENETRATING INJURY
IS PITHING IN WHICH A NEEDLE IS PUT IN
NAPE OF NECK BETWEEN 2ND AND 3RD
CERVICAL VERTEBRAE AND ROTATED TO
SEPARATE SPINAL CORD FROM MEDULLA,
THIS IS ONE OF THE COMMON METHOD OF
INFANTICIDE.

IINNJJUURRIIEESS TTOO TTHHEE NNEECCKK
((II))SSUUIICCIIDDAALL CCUUTT TTHHRROOAATT
((iiii))HHOOMMIICCIIDDAALL CCUUTT TTHHRROOAATT
S.NO SUICIDAL CUT
THROAT
HOMICIDAL CUT
THROAT
1 LEFT SIDE OF THE NECK IN A
RIGHT HANDED PERSON
COMMONLY ABOVE THYROID
CARTILAGE
USUALLY IN THE CENTRE OR
BOTH SIDES OF THE NECK
COMMONLY BELOW THE THYROID
CARTILAGE
2 HESITATION OR TENTATIVE
CUTS SEEN AT THE
COMMENCEMENT OF THE
WOUND
NO HESITATION CUTS SEEN
3 SLOPED DOWN FROM LEFT TO
RIGHT IN A RIGHT HANDED
PERSON
SLOPED UP,ANY SIDE
4 GRADUAL DEEPENING AND
SHALLOWING WITH TAIL OF THE
WOUND ON THE RIGHT SIDE IN
A RIGHT HANDED PERSON
BOLDLY CUTTING ACROSS. NO
TAILING IS SEEN

CCUUTT TTHHRROOAATT ((CCOONNTT))
S.NO SUICIDAL CUT
THROAT
HOMICIDAL CUT
THROAT
5 CURVED ACROSS THE NECK MOSTLY HORIZONTAL
6 MAIN WOUND MAY CONTAIN
MANY CUTS
MAIN WOUND SINGLE AND DEEPLY
CUT
7 OFTEN ACCOMPANIED BY
WOUNDS ACROSS WRISTS OR
VITAL PARTS IN AN ATTEMPT
TO COMMIT SUICIDE
NO ACCOMPANYING WOUNDS ON
WRISTS, BUT THERE MAY BE SEVERE
INJURIES OVER OTHER PARTS OF
THE BODY, SO AS TO OVER COME
THE VICTIM

CCUUTT TTHHRROOAATT ((CCOONNTT))
S.NO SUICIDAL CUT THROAT HOMICIDAL CUT THROAT
8 NO CUTS ON HANDS FREQUENTLY DEFENCE WOUNDS
OVER PALMER ASPECTS OF HANDS IN
AN ATTEMPT TO CATH HOLD OF
WEAPON OF ASSAULT
9 AS HEAD IS THROWN BACK
CAROTID ARTERY IS
USUALLY SAVED
CAROTID ARTERY AND JUGULAR
VEINS LIKELY TO BE CUT
10 WEAPON FOUND NEAR THE
BODY OR FIRMLY GRASPED
IN THE HAND DUE TO
CADAVERIC SPASM
WEAPON NOT FOUND ON THE SCENE
OF CRIME AND NO CADAVERIC SPASM
SEEN
11 SELECTS A QUITE ROOM
USUALLY BED ROOM OR
BATH ROOM BOLTED FROM
INSIDE USUALLY IN FRONT
OF A MIRROR WHICH SHOWS
ARTERIAL SPOUTING,MORE
OVER FAREWEL LETTER MAY
BE PRESENT
DISTURBANCE OF SURROUNDING
FURNITURE IS SEEN AT THE SCENE OF
CRIME.NO FAREWEL LETTER SEEN
12 MOSTLY ADULT MALES ANY BODY

IINNJJUURRIIEESS TTOO TTHHEE FFAACCEE
• LOSS OF SIGHT
• LOSS OF HEARING
• DISLOCATION OF A TOOTH
• CUTTING OF NOSE
• CUTTING OF EAR LOBES
• CUTTING OF LIPS
• CUTTING OF TONGUE
• DISFIGURATION OF THE FACE (VITRIOLAGE)
• FRACTURE OF ZYGOMATIC BONE
• FRACTURE/ DISLOCATION OF MANDIBLE

INJURIES TTOO TTHHEE FFAACCEE ((ccoonntt))
• A COMMON INJURY TO THE FACE
SEEN IN ROAD TRAFFIC ACCIDENTS
TO THE DRIVER IS BIRD FEET INJURY
WHICH IS DUE TO BREAKING OF WIND
SCREEN CAUSING PIECES OF
BROKEN GLASS TO CAUSE
LACERATED WOUNDS OF THE FACE
AND IT APPEAR AS IF SOME BIRD HAS
INJURED THE FACE WITH CLAWS.
(WIND SCREEN INJURIES)

IINNJJUURRIIEESS TTOO TTHHEE CCHHEESSTT
• TRAUMATIC ASPHYXIA
• Traumatic Asphyxia or crush Asphyxia, is a form of Asphyxia
resulting from trauma to the chest, or pressure on the chest and
back, which prevents respiratory movements. This may occur
accidentally through.
• The chest being pressed violently in crowds at big fairs.
• Being trampled in stamped crowds.
• Chest trauma from run over car accident.
• Steering wheel injury.
• Building collapse.
• AUTOPSY FINDING
• In addition to signs of asphyxia, there are 4 characteristic
features.
• Deep cyanosis of the face.
• Numerous Petechial hemorrhages.
• Demarcating line between discolored upper part and normal
colour below the line.
• Blood shot eyes.

TTrraauummaattiicc AAsspphhyyxxiiaa ((ccoonntt))
• The mechanism is as follows. Compression of
the chest displaces blood from superior vena
cava and subclavian veins in to smaller veins
and capillaries of the head and neck which are
considerably engorged and pressure in them
rises so rapidly as to burst their walls. Therefore
the face and neck of the victim are deeply
cyanosed, almost black, eyes are bloody red
(blood shot), and numerous petichae are found
over the scalp, face, neck and shoulders. The
level of compression is indicated by a well
defined demarcating line between dis coloured
upon portion of the body and lower normally
colour part.

CCHHEESSTT IINNJJUURRIIEESS ((ccoonntt))
• RIBS.
MOST COMMON ARE FRACTURES OF THE RIBS.
THE RIBS WHICH ARE MOST COMMONLY
FRACTURED ARE 4TH ,5TH ,6TH, 7TH AND 8TH RIBS, AS
THEY ARE MOST PROMINENT AND FIXED AT BOTH
ENDS.THE MOST COMMON SITE OF FRACTURE IS
AT THE MOST CONVEX PARTS OF THE RIBS NEAR
THEIR ANGLES.BILATERAL FRACTURES OF RIBS
ARE SEEN IN RUN OVER VEHICULAR
ACCIDENTS.THE BROKEN ENDS OF RIBS MAY
RUTURE THE PLEURA OR LUNGS LEADING TO
PNEUMOTHORAX OR HAEMOTHORAX.

• STERNUM
FRACTURE OF STERNUM IS RARE EXPECT
IN CASES OF STEERING WHEEL INJURY TO
THE DRIVER OF A CAR WHEN HIS CHEST
STRIKES THE STEERING WHEEL IN CAR
COLLISION. THE MOST COMMON
FRACTURE IS A TRANSVERSE FRACTURE
EITHER BETWEEN THE MANIBRIUM AND
BODY OF STERNUM OR SLIGHTLY
BELOW.BACKWARD DISPLACEMENT OF
LOWER SEGMENT OF FRACTURE CAN
CAUSE DAMAGE TO VISCERA BEHIND IT.

• LUNGS
WOUNDS OF THE LUNGS ARE MORE COMMON
BECAUSE OF FRACTURE OF THE RIBS CAUSING
LACERATIONS OR PENETRATING INJURIES DUE
TO SHARP POINTED WEAPONS OR FIRE
ARMS.MOVE OVER HIGH EXPLOSIVE BLAST CAN
ALSO CAUSE EXTENSIVE INJURIES TO THE LUNGS
CAUSING CONGESTION, HAEMORRHAGE AND
SUBPLEURAL BULLAE IN THE LUNGS.BECAUSE
OF GLIDING IN CAR ACCIDENTS CONTRE COUP
INJURIES MAY BE SEEN IN THE LUNGS.THE
INJURIES CAN CAUSE PLEURISY, AIR EMBOLISM,
PNEUMOTHORAX, HAEMOTHORAX, EMPHYSEMA.

• SIGNS OF LUNG INJURIES.
• DURING LIFE INJURY TO THE LUNG
CAN BE DIAGNOSED BY
• SEEING SPUTUM WHICH CONTAIN
TRACES OF BLOOD AND IN MORE
SERIOUS CASES FRANK
HAEMOPTYSIS.
• TRAUMATIC EMPHYSEMA
• DYSPNOEA

CCHHEESSTT IINNJJUURRIIEESS((ccoonntt))
• HEART.
THE INJURIES TO THE HEART CAN BE,
• NON PENETRATING
• PENETRATING
NON PENETRATING INJURIES ARE DUE TO BLUNT
TRAUMA CAUSING BRUISING OF THE HEART WITH
SUDDEN DEATH DUE TO VENTRCULAR
FIBRILLATION OR VALVULAR RUPTURE. ANOTHER
COMMON CONDITION IS CARDIAC TEMPONADE IN
WHICH A DISEASED HEART MAY RUPTURE DUE TO
TRAUMA CAUSING ACCUMULATION OF BLOOD IN
THE PERICARDIAL SAC WHICH CAN INTERFERE
WITH NORMAL CONTRACTION AND RELAXATION
OF THE HEART(250-300 ML), LEADING TO CARDIAC
ASYSTOLE AND DEATH.

HHEEAARRTT IINNJJUURRIIEESS ((ccoonntt))
• PENETRATING INJURIES ARE MOST COMMONLY
DUE TO,
• SHARP EDGED POINTED WEAPONS.
• BULLETS.
STAB WOUNDS OF AURICLES ARE MORE
DANGEROUS BECAUSE OF THEIR THIN WALLS
THEY BLEED MORE PROFUSELY,AS COMPARED
TO VENTRICLES WERE WALLS ARE THICK, IN THE
SAME WAY STAB IN RIGHT VENTRICLE IS MORE
DANGEROUS THAN STAB OF LEFT VENTRICLE
WHERE THE WALL IS MORE THICK AS COMPARED
TO THE RIGHT SIDE
• SOME TIMES HEART MAY BE INVOLVED WHEN
INJURY IS OVER TRIGGER AREAS SUCH AS
CAROTID SINUS ,SOLAR PLEXUS OR TESTES
WHERE AS A RESULT OF TRAUMA VAGUS NERVE
IS STIMULATED WHICH ARRESTS THE
HEART(VASOVAGAL SHOCK)

CAUSES OOFF DDEEAATTHH IINN HHEEAARRTT
IINNJJUURRIIEESS
• HAEMORRHAGE
• SHOCK
• CARDIAC TEMPONADE
• CORONARY ARTERY LESION CAUSING ISCHAEMIA
OF THE HEART.
BIG VESSELS- AORTA & PULMONARY VESSELS.
THESE ARE USUALLY INJURED BY PENETRATING
WEAPONS OR BULLETS,RUPTURE OF AORTA MAY
OCCUR FROM TRAUMA OR DISEASE, SUCH AS
RUPTURE OF AORTIC ANEURYSM.
FIRE ARM INJURIES WITH BULLETS WHICH IMPART
VIBRATION WAVES DUE TO SPINNING MOVEMENT
CAN CAUSE RUPTURE OF HEART, LUNGS AND BIG
BLOOD VESSELS.

AABBDDOOMMIINNAALL IINNJJUURRIIEESS
• DEATH MAY OCCUR WITH A BLOW
WITHOUT DAMAGE TO ABDOMINAL
VISCERA DUE TO REFLEX INHIBITION
OF THE HEART THROUGH VAGAL
NERVE STIMULATION.
• COMMON INJURIES ARE STABS, GUN
SHOT INJURIES AND BLOWS.

AABBDDOOMMIINNAALL IINNJJUURRIIEESS ((ccoonntt))
• LIVER.
OWING TO IT’S SIZE, IT’S FIXED POSITION AND
FRIABLE CONSISTENCY, IT IS COMMONLY
INVOLVED IN STABS IN ABDOMEN,KICKS,
BLOWS,ROAD TRAFFIC ACCIDENTS AND SOME
TIMES BY FRACTURED RIBS AFTER PIERCING THE
DIAPHRAGM.
COMPLICATIONS OF INJURY TO LIVER ARE,
• SHOCK
• MASSIVE INTERNAL HAEMORRHAGE
• INFECTION, SUCH AS PERITONITIS

AABBDDOOMMIINNAALL IINNJJUURRIIEESS((ccoonntt))
• SPLEEN.
• IT IS ONE OF THE COMMONEST
ORGAN TO RUPTURE DUE TO
INJURIES IF ENLARGED IN DISEASES
SUCH AS MALARIA.
• DEATH MAY OCCUR DUE TO,
• SHOCK
• EXCESSIVE INTERNAL HAEMORRHAGE

AABBDDOOMMIINNAALL IINNJJUURRIIEESS ((ccoonntt))
• STOMACH AND INTESTINES. MAY BE
RUPTURED IN BLAST INJURIES OR WHEN
ALREADY DISEASED SUCH AS PEPTIC
ULCER OR ULCERS IN INTESTINES IN
TYPHOID AND AMOEBIASIS. OTHER
COMMON CAUSES ARE STAB AND GUN
SHOT INJURIES.
• KIDNEYS- BECAUSE OF THEIR
ANATOMICAL LOCATION ARE USUALLY
NOT RUPTURED, EXCEPT IN STABS AND
GUN SHOT INJURIES

INJURIES TTOO TTHHEE GGEENNIITTAALL
TTRRAACCTT
• IN FEMALES, GRAVID UTERUS IS COMMONLY
RUPTURED WHEN INSTRUMENTATION IS DONE TO
PROCURE CRIMINAL ABORTION.
• RUPTURE OF FOLLAPIAN TUBES IS COMMON IN
ECTOPIC GESTATION.
• BRUISING AND LACERATION IS COMMON IN
FEMALE GENITAL TRACT IN SEXUAL ASSAULT.
• IN MALES, INJURY TO TESTES BY A KICK CAN
CAUSE DEATH DUE TO SHOCK,SOME TIMES
CONTUSIONS, LACERATIONS AND EVEN
INFARCTION IS SEEN.
• SOME TIMES THERE MAY BE RUPTURE OF
URETHRA DUE TO FALL IN MANHOLE(GUTTER)
WITH FRACTURE OF FEMUR OR PELVIS.
• AMPUTATION OF PENIS MAY ALSO BE SEEN.

PPEELLVVIICC IINNJJUURRIIEESS
In severe trauma , the pelvis undergoes various
fractures as well as dislocations such as : (i) When
there is application of great pressure to the front of
the abdomen or pubic area such as in run over by the
wheel, the pelvis is splayed open, symphysis pubis
separates and one or both sacroiliac joints also
dislocate (ii) When an impact occurs from the side ,
superior and inferior pubic ramus are fractured with
dislocation of sacroiliac joint on the side of impact
(iii) In circumstances of fall from height on to the
feet , due to transmission of force up the legs , both
the sacroiliac joints may dislocate and even one or
both femoral head may also be driven into
acetabulum. When the hip joints remain intact, the
pelvic girdle may fracture and sacroiliac joints may
dislocate (iv) Due to a kick or heavy fall on to the base
of spine , fracture of sacrum or coccyx may result
CCAAPPTT DDRR FF HH MMIIRRZZAA

(v) Empty bladder is rarely injured in trauma
but a full bladder gets injured from blows ,
kicks and other blunt trauma. Other pelvic
organs are quite protected from blunt injuries
(vi) Male urethra may be injured as a result of
direct trauma such as falling astride a solid
object like a gate or being kicked in the crutch,
due to being compressed against the
undersurface of the pubis (vii) External
genitalia may suffer injuries especially
scrotum is quite vulnerable to severe bruising
resulting from kicks. Scrotum and vulva may
suffer injuries from falling astride on objects
and in vehicular accidents.
CCAAPPTT DDRR FF HH MMIIRRZZAA

• FOR ANY SUGGESTIONS/PROBLEMS RELATED TO THE
DEPARTMENT-E
MAIL ON captdrmirza@hotmail.com
OR
CONTACT
03009230198
YOUR WELL WISHER
CAPT DR FARHAT H MIRZA

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