This document provides an overview of forensic traumatology and the classification and analysis of wounds. It discusses the different types of wounds including abrasions, bruises, lacerations, and their characteristics. Abrasion wounds involve destruction of just the epidermis. Bruises are effusions of blood into the tissues. Lacerations are tears of the skin or internal organs caused by blunt force. The document also covers wound healing, determining the age of wounds, and differentiating between ante-mortem and post-mortem wounds. Causes of death related to wounds include haemorrhage, shock, infection, and organ damage.

1. Bases of forensic medical
traumatology

2. PLAN
• 1. General questions of forensic medical
traumatology
• 2. Abrasions.
• 3. Bruises (contusion).
• 4. Lacerations.
• 5. Damage of skull and bones

3. FORENSIC TRAUMATOLOGY
An Injury or a Wound
means a solution or disruption of the anatomical
continuity of any of the body tissues
Factors Responsible For a Mechanical Injury:
1) force;
2) area over which it acts;
3) specific effect of the force;
4) time taken over which the kinetic energy is
transferred.

4. CLASSIFICATION OF WOUNDS
A. Classification of Injuries according to causative factors:
I. MechanicalorPhysicalinjuries
Injuries produced by application of blunt force:
1. Abrasion
2. Bruise or contusion
3. Laceration
4. Fracture or dislocation of a bone, tooth or joint
Injuries produced by application of sharp weapon:
5. Incised wound
6. Punctured (stab) wound
7. Incised- stab wound
8. Chopped wound
9. Sawn wound
Injuries produced by application of teeth:
10. Bite marks.
Injuries caused by a high velocity projectile:
11. Firearm wound

5. Sponsored
Medical Lecture Notes – All Subjects
USMLE Exam (America) – Practice

6. CLASSIFICATION OF WOUNDS (2)
II. Thermal injuries
1.Due to application of heat:
a)General effects of exposure to heat, hot atmosphere -
Hyperpyrexia (heat stroke orsun stroke)
b) Effects of local application of heat:
•
•
Burn (due to application of dryheat);
Scald (due to application of moist heat).
2. Due to application of cold:
a) General effect of exposure to cold – Hypothermia;
b) Local effects of exposure to cold:
•
•
Frost bite (due to dry cold);
Trench foot (due to moist cold).
III Chemical injuries: Corrosive poisons.

7. CLASSIFICATION OF WOUNDS (3)
IV. Miscellaneous injuries
1. Electrical injury;
2. Radiation injuries;
3. Lightning injuries (a combination of electrical
injury, mechanical injury and thermal injury);
4. Blast injuries (a combination of mechanical
and thermal injuries).

8. CLASSIFICATION OF WOUNDS (4)
B. Medico-legal classification of injuries:
I. Self-inflicted or Suicidal
II. Injuries inflicted by others or Homicidal
III. Accidental injuries
IV. Defence wounds
V. Fabricated wounds
C. Classification in relation to moment of Death:
•
•
Ante-mortem wounds
Post-mortem wounds

9. VariousContactSurfacesofBluntObjects

10. InjuringActionofaFlatSurface:Unlimited,
Limited,and Mixed.

11. ABRASIONS
An abrasion is
a destruction of the epidermis only.
The exposed raw surface is covered by exudation
of lymph and blood, which produces a protective
covering known as a scab or crust.
They are simple injuries, bleed slightly, and heal
rapidly without scar formation.

12. MechanismoftheAbrasion Formation

13. Destruction of the Epidermis
in Abrasion

14. Types:
1) Scratches:
2) Grazes (sliding, scraping orgrinding abrasions):
“drag marks”

15. Ligature Mark
(3) Pressure Abrasions (crushing or friction
abrasions):

16. MANUAL STRANGULATION
crescentic abrasions

17. 4) Impact
Abrasions
(contact or
imprint
abrasions):

18. Age of Abrasions:
• Fresh: Bright red.
• 12to 24 hours: Lymph and blood dries up leaving a
bright scab.
• 3 to 4days: Reddish-brown scab.
• 4 to 5days: Epithelium grows and covers defect
under the scab.
• After 7 days: Scab dries, shrinks and falls off.

19. On post-mortem drying, abrasions become
dark-brown or even black

20. Medico-legal Importance:
1) Idea about the site of impact and direction of the force.
2) Patterned abrasions are helpful in connecting the
wounds with the object which produced them.
3) The age of the injury can be determined.
4) Dirt, dust, grease orparticles of stone orsand are usually
present, which may connect the injuries to the Scene of
crime.
5) Character and manner of injury may be known from its
distribution.

21. CONTUSIONS (BRUISES)
Acontusion
(or bruise)
is an effusion of
blood into the
tissues, due to
the rupture of
blood vessels,
due to blunt
violence.

22. Spectacle haematoma; black eye)
Haematoma

23. Patterned Bruises

24. Deep Tissue and Organ Contusions:
Contusions of Heart and Kidney

25. The Age of Bruise:
• At first: Purple
• Few hours to 2 days: Blue-purple
• 3 - 4 days: Brown (haemosiderin) - greenish
(biliverdine)
• 5 to 6 days: Yellow (bilirubin)
• 7 to 8 days: Three-coloured: on periphery -
brown-yellow, in media part - greenish -brown,
in the center - blue-purple
• 2 weeks: Normal
Alove bite (Hickey) may vanish in 2 or 3 days.

26. Ante-mortem and Post-mortem Bruising:
In ante-mortem bruising there is :
• swelling,
• damage to epithelium,
• extravasation,
• coagulation,
• infiltration of the tissue with blood and color
changes.
These signs are absent in post-mortem bruises.

27. Complications
• Acontusion may contain 20 to 30 ml of blood
or even more. Multiple contusions can cause
death from shock and internal haemorrhage.
• Gangrene and death of tissue can result.
• Pooled blood can serve as a site for strong
bacterial growth, especially for Clostridia group.
• Rarely in severe sudden compression of the
subcutaneous tissue, pulmonary fat embolism
may occur.

28. Medico-legal Importance:
I) The degree of violence may be determined from
their size.
2)Patterned bruises may connect the victim and the
object or weapon.
3) The age of the injury can be determined.
4)Character and manner of injury may be known
from its distribution.

29. Homicidal bruises

30. LACERATIONS
Lacerations are
tears of skin,
mucous
membrane,
muscle or
internal
produced
organs
by
application of
blunt force to
broad area of the
body.
They are also called
tears or ruptures.

31. Types:
1) Split Lacerations: Splitting occurs by crushing of the skin between two
hard objects. Scalp lacerations occur due to the tissues being crushed
between skull and some hard object, such as the ground or a blunt
instrument.
2) Stretch Lacerations: Overstretching of the skin if it is fixed will cause
laceration. There is a local pressure with pull, which increases until
tearing occurs and produces a flap. This is seen in cases of run-over by
a motor vehicle, and the flap may indicate the direction of the
vehicle's movement.
3) Avulsionis a laceration produced by sufficient force (shearing force)
applied at an acute angle to detach (tear off) a portion of the
traumatized surface of an organ from its attachment. The shearing
and grinding force produced by a weight, such as a lorry wheel
passing over a limb, may cause separation of the skin from the
underlying tissues (avulsion) over a relatively large area. This is called
"flaying". The underlying muscles are crushed, and the bones may be
fractured. The separated skin may show extensive abrasions from the
rotating frictional effect of the tyre.
4) Tears:Tearing of the skin and tissues can occur from impact by or
against irregular or semi-sharp objects, such as the door handle of a
car. This is another form of overstretching.

32. Characters:
1. Margins are irregular
2. Ends are blunt
3. Bruising is seen around the wound.
4. Deeper tissues are unevenly divided with tags of tissue at the
bottom of the wound bridging across the margin. Tissue
bridges consist of nerves, blood vessels and elastic and
connective tissue fibres.
5. Hair bulbs are crushed.
Lacerations on the
cut:
(1) wound canal:
(2, 4) central zone;
(3) peripheral zone;
(5) margins.

33. Wound Healing (Age of wound)
• The phase of traumatic inflammation (from 1 to
3 days after wounding)
• The destructive phase (from 4 to 6 days)
• The proliferative phase (from 4 to14 days)
• The phase formation of scar (from 7 to14 days)

34. Ante-mortem Lacerations show
• bruising of margins
• vital reaction
• eversion and gaping of the margins.

35. Complications
• Laceration of an internal organ may cause severe
or even fatal bleeding. Multiple lacerations,
involving only the skin and subcutaneous tissue,
each causing some haemorrhage, may combine
to cause shock and death.
• Pulmonary or systemic fat embolism may occur
due to crushing of subcutaneous tissue.
• Infection.

36. Difference between Ante-mortem and Post-mortem Wounds
Characteristics
Margins
Ante-mortem wound
The edges are swollen, everted,
retracted, and gaping.
Haemorrhage Abundant and usually arterial.
Spurting
Extravasations
Coagulation
Vital reaction
Enzyme
histochemistry
Signs of spurting of arterial blood on
the body, clothing or in its vicinity
. Staining of the edges of the wound
and extravasations in the neighbouring
subcutaneous and interstitial tissues
which can not be removed by washing.
Firmly coagulated blood in wounds
and tissues
Signs of vital reaction, i.e., in
flammation and repair.
Increased activity of
adenosinetriphospate, aminopeptidase,
acid and alkaline phosphatase.
Post-mortem wound
The edges do not gape but are
close to each other.
Slight or larger than slight,
venous.
No spurting of blood.
The edges and cellular tissues are
not deeply stained.
No clotting or soft clots.
No signs of vital reaction.
Diminished or no enzyme
activity.

37. Causes of Death due to Wounds
• Immediate or direct.
• Remote or indirect.

38. Immediate Causes
•
•
•
Haemorrhage.
Mechanical Injury to a Vital Organ.
Shock.
Types:
• Haemorrhagic shock: This occurs when the blood loss is
sufficient to impair peripheral perfusion that produces a
sufficient degree of systemic anoxia. Loss of 10 to 40 % of the
total blood volume produces shock.
• Traumatic or wound shock.
• Burn shock: It results from loss of plasma, absorption of
necrotic tissue, and bacterial sepsis following extensive burns
• Surgical shock.
• Cardiac or cardiogenic shock.
• Septic shock.
• Endotoxic shock.
• Reflex Vagal Inhibition.

39. Remote Causes
•
•
•
•
•
•
•
•
•
Infection.
Gangrene or Necrosis.
Crush Syndrome.
Neglect of Injured Person.
Surgical Operation.
Natural Disease.
Fibrous scar tissue formed due to healing may contract and
produce complications, e.g., fibrous scar in a hollow muscular
organ may produce stricture and obstruction.
Thrombosis and Thromboembolism.
Embolism (Air, Fat, Tissue).

40. Medico-legalImportance:
1) The type of laceration may indicate the cause
of the injury and the shape of the blunt weapon.
2)Foreign bodies found in the wound may
indicate the circumstances in which the crime
has been committed.
3) The age of the injury can be determined.

41. Types of skull fractures
● fissured
● stellate or radiating
● depressed (including terrace-like)
● elevated
● perforating (buttonhole) fracture
● guttered
● crushed or comminuted.

44. Conclusion.
• Thus, knowledge of characteristics, stages of
progress of damage by blunt objects help the
doctor in his professional activities, as often was
he who first described it in the medical records.

45. LIST OF LITERATURE
Main literature
1. Babanin A.A., Belovitsky O.V., Skrebkova O.Yu. Forensic
medicine. Textbook / / Simferopol, 2007. – 464p.
2.Simpson’s forensic medicine. 10-th ed, 1991.
Additional literature
1.Forensic pathology: 2-nd ed. / Vincent J.Di Maio, Dominick Di
Maio. – CRC Press. - 2001.
2. Color atlas of Forensic pathology / by JayDix. – 2000.
3. Forensic evidence: science and the criminal law/ Terrence F.
Kiely – CRC Press. - 2001.
4. Forensic science: an illustrated dictionary / by John C. Brenner. –
CRC Press. - 2000.
5. Guide to forensic pathology / JayDix, Roben Calaluce;with
contributions by Mary Fran Ernst. – 1999.
6. Molecular forensics / edited by Ralph Rapley, David Whitehouse.
– Wiley.– 2007.1. Babanin A.A., Belovitsky O.V., Skrebkova
O.Yu. Forensic Medicine. Textbook.- Simferopol, 2007.- 464 p.