1. Assoc. Prof. Beatrice Ioan MD, PhD, MA
INJURIES
Assoc. Prof. Beatrice Ioan
MD, PhD, MA

2. Definition & classification
Definition → damages to the tissues of the body caused by mechanical forces
I. Intact skin
- Traumatic eritema
Bruise (contusion)
Hematoma
II. Injured skin
Abrasion (scratch, graze)
Wounds

3. Traumatic eritema
produced by a light slap or a continuous pressure against the tissues
transient irritation of the nervous endings- dilatation of the vessels
pain, redness of the skin/ red points on the skin, tumefaction
all signs and simptoms dissapear in a few hours

4. Bruise/contusion Blunt injury to the tissue- strike or compression
Blunt objects: rock, stick, club, hammer, fist, leg ↓
Damage of the small and middle blood vessels beneath the skin- the blood leaks into the surrounding tissues
Most frequent under the skin
Possible deep bruising- any organ, tissue

5. Bruise changes with time and position
Bruise/contusion
Usually it does not reproduce the pattern of the causative object- the blood leaks in a diffuse manner
Bruise changes with time and position
The bruise may become visible at a later moment from the trauma - repeated examinations
The bruise may appear at a different site than the injury site

6. Bruise/contusion Timing → colour changes
Chemical changes of hemoglobin
the first hours- red (HbO2)
few hours- bluish (reduced Hb)
3-5 days- green-yellow (biliverdin)
7-8 days- yellow- brownish (hemosiderin)
7-20 days- normal skin colour (depend on the size and depth of the bruise).

7. Bruise/contusion The speed of the changes is variable- 7-10 days
Recognition of bruises of different colours in the same person- inflicted at different times- repeated aggressions- child/adult abuse
Differentiated from postmortem lividities

9. Bruise/contusion - Size
space outside the vessels for free blood to accumulate;
gravity of the bleeding, depending on:
* the intensity of the traumatism;
* the size and the density of the vascular network in the damaged region;
presence of the bone directly under the skin;
depth of blood accumulation;
fragility of blood vessels;
coagulability of the blood

10. Particular types of causation- mark bruises
Bruise/contusion
Particular types of causation- mark bruises
“Tram-line”/”railway-line
Bilateral ovalar bruises on the throat- manual strangulation
Envelope imprint

11. “Tram-line”/”railway-line” - two parallel lines of bruising with a pale undamaged area between- rod-like weapon, either cylindrical or square-sectioned

15. Localization: tissues, organs, natural cavities
Hematoma
Definition- an important collection of blood- the rupture of a big vessel- blunt injury
Localization: tissues, organs, natural cavities
Superficial hematoma- the covering skin is bruised;
May compress the muscles, nerves, vessels- surgical treatment to evacuate the blood;
Hematomas in the natural cavities or inside the organs have, frequently, a severe evolution- even death

16. Abrasion
The most superficial type of injury which destroys the integrity of the skin
Mechanism:
- Friction of a sharp or irregular object against the surface of the skin, determining the abrasion of the superficial layers.
Less often- vertical impact- crushed injury
Two possibilities:
An object strikes the skin (a bite from a tooth)
The body hits a stationary object (fall)

17. Abrasion Usualy confined to epidermis- no bleeding
Some abrasions enter the dermis- slight bleeding (dermal papillae)
Shape:
Linear
Broader- brush abrasion
E.g., dragging across a rough road in traffic accidents- multiple parallel linear abrasions
When the skin is protected by clothing- “friction burn”- reddened, excoriated area

20. Abrasion
Evolution
the first hours- crust (yellow or redish-brownish);
3-4 days- the crust begins to detach;
7-8 days- a white track on the skin - dissapears without any traces

21. Fingernail abrasions - strangulation by hand- curved /on the neck; - linear abrasions- the finger are dragged down the skin (sexual attacks, child abuse)

22. Marker- abrasion - usually when the impact is vertical to the surface of the skin (crushing abrasion);

24. Draging - linear, thin, parallel abrasions - direction of the force causing the abrasion- close examination- the torn epidermis will be pulled towards the distal (final) end of the abrasion

25. Laceration Blunt injury- the weapon crushes the tissues ↓
Penetrates the full thickness of the skin

26. Laceration- characteristics
irregular edges;
blood infiltration in the edges;
bruises and abrasions in the surrounding tissues;
persistance of tissue strands across the interior of the wound;
the hair is not destroyed / may be crushed;
content- crushed tissues, clots of blood, small pieces from the clothes, dirt;
main complication- infection

27. Laceration- particular types
Crack wound
the skin is compressed between the bone and the blunt object- e.g. scalp;
the margins are regular, sharp;
must be differentiated from the cut wounds
- the crack wound presents tissue strands across the margins
- injuries in the surrounding tissues

29. Bite wound - preserve the shape of the teeth - samples of saliva- identification of the aggressor

32. Sting- pricking wound Mechanism
Lateral compression of the tissues by a thin object with acute point - needle, screw driver (pricking object)
Characteristics
Entry wound
on the skin/mucosal surface
a red point if the weapon’s diameter is small (sharp needle) or a small wound with sharp edges if the weapon’s diameter is bigger

33. Sting- pricking wound Channel in the depth of the tissues Exit wound
rare
the damaged part of the body is small/thin
the weapon is long enough

34. Sting- pricking wound Complications
severe, even lethal bleeding when blood accumulates inside a natural cavity (e.g. pericardium)
death- when the heart or fontanel (infanticide) are damaged

35. Cuts Sharply cut injuries
Produced by objects with at least one cutting edge- pressure and movement of a sharp edged object against the tissues
Classification
cuts (slashes)- larger than deeper, usually linear;
partial detachment of the tissues- the cut is oblique;
complete section of a part of tissue, an organ (nose) or a part of a limb

36. Cuts - characteristics
regular edges;
surrounding tissues- intact;
no tissue strands in the interior of the wound;
the hair is divided;
the cut is deeper at the entry, becomes progressively shallower as the wound approaches the distal end → linear abrasion - mouse tail
content- blood (liquid or clots);
main complication- bleeding

39. Cuts
Defence wounds
passive defence- cuts on the dorsal part of the hands and forearms;
active defence- cuts on the palms (the victim tryes to catch the knife).

41. Stab wound
Mechanism: pricking and cutting the tissues, by an object with an acute point and sharp edge/edges
Characteristics
Entry wound
on the skin;
characteristics of a cut wound;
according to its aspect, is possible to determine if the knife has one or more cutting edges edges
* buttonhole- two cutting edges
* triangle- one cutting edge

43. Stab wound Channel In the depth of the tissues
its direction shows the weapon’s direction inside the tissues;
Exit wound
characteristics of a cut wound
According to the aspect of the entry wound and channel is possible to estimate the dimensions of the knife in the cavities with a bony wall

45. Split wound Mechanism: heavy objects with a sharp
edge- axe, hoe, heavy sword
Appearance - combination between cut wound on the surface of the skin and laceration in depth
Frequent
Bone fractures
Damages in the vital organs
danger for life

47. Description Location Dimensions Shape Direction Aspect
- bruise – colour
- abrasion – crust
- wound - margins
- surrounding tissues
- ends
- content
- stage of healing

48. Injuries - forensic relevance
The damaging weapon → marker injury
Producing mechanism
- injuries located on the prominent parts of the body → fall
- bruises and abrasions on the neck – strangulation by hand/ligature
Timing of trauma
- bruise - colour
- abrasions - aspect of the crust
- wounds – stage of the healing – aspect of the scar