BLUNT FORCE INJURIES

Dr. Harihar Wasti

Visiting Professor
 Blunt force injuries
Definition
Blunt force injuries are injuries that cause
break in the continuity of tissue due to
impact with a blunt object
 Factors affecting blunt force injuries:
• Amount of force delivered
• Time interval over which force is delivered
• Body region involved
• Amount of surface over which force is
delivered
• Nature of the weapon
• Others: elasticity/plasticity/inertia/ hydrostatic
forces
 ABRASION
• Abrasion is a blunt force injury resulting in
break in the continuity of superficial
epidermal layer
 Characteristics of Abrasion
• Superficial injuries
• Caused usually due to friction with rough,
blunt, hard objects.( except scratches )
• Site of abrasion is the site of impact.
• They bleed slightly, sometimes there may be
only lymph exudation.
• They heal rapidly within 1 to 2 weeks without
scarring.
Determination of the direction of impact in an
abrasion caused by tangential force.
 Types of Abrasion
• SCRATCHES
• GRAZES
• PATTERN
– Imprint by contact
– Pressure
 Scratch abrasion

Caused by scratching with a sharp tip, e.g. pins, needles, knife,

thorn, nail etc.
 GRAZED ABRASION

This injury results when the body is

dragged on the rough surface, e.g.
during vehicular accidents.
Grazed abrasion over chest and abdomen
Grazed abrasion
Pattern injury:- It results from pressure of object on the
body with no or little friction, sometimes it may reproduce its
print on the body.

Pattern injuries associated with impacts from

the bottom of a shoe while being stomped
Pedestrians struck by cars with grill pattern
injuries.
 Patterned abrasion

This individual impacted a fence at a high rate of speed, leaving a

pattern injury from the top of the fencepost’s contacting his chest.
 Bite mark reveals (A) semi-circular and (B)circular
pattern with a central region of contusion.

A B
 Age of Abrasion
Duration Features
Fresh Bright red, oozing of serum and blood
रातो घाउ, रक्तश्राब
12-24 hours Exudation dries to form a reddish scab
रातो पाप्रा
2-3 days Reddish-brown scab, less tender
खैरो पाप्रा, कम दुखाई
4-5 days Dark Brown scab
गाडा खैरो पाप्रा
5-7 days Scab starts breaking and falls
पाप्रा झर्न थाल्छ
7-10 days Scab dries, shrinks and falls off
पाप्रा झरे पछि छाला सेतो देखिन्छ
Postmortem abrasion

Antemortem abrasion
 CONTUSION ( BRUISE )
• Definition
Blunt force injury caused by impact with a
blunt and hard object, leading to rupture of
vessels under the skin & therefore
extravasations of blood.
 Contusion may occur in one of the
following ways
• Blow
• Fall
• Hitting a hard & blunt objects or
• Compression of body parts.
 Types of Contusion
• Superficial- It may occur immediately after the
impact, due to accumulation of fluid blood
subcutaneously.
• Deep/Delayed/Migratory/Ectopic- This signifies
bleeding deeper to the subcutaneous tissues. It
may takes hours or 1 – 2 days to appear at the
surface.
• Patterned- Due to compression of body part,
some imprint of the object may be reproduced.
Factors influencing the size and severity
of contusions:
• Age of the individual – the children and
elderly bruise more easily
• Gender – women bruise more easily
• Physical condition and health
• Type of tissue and site struck
 Deep contusion

The large areas of contusion following trauma in these

individuals with chronic alcoholism, hepatic cirrhosis,
and coagulopathy.
 Pattern contusion

Bruising of the upper arm. The pattern of these bruises is

typical of forceful gripping. Small abrasions from fingernails
are also seen.
Neck dissection in strangulation
Typical ‘tram-line’ contusion caused by a wooden rod.
Note that the centre of the parallel contusions is
unmarked.
Tyre imprint
 Contusion and time since injury
(It is very rough estimate only)

Color Time since injury

Bright red - Freshly produce

Bluish (deoxygenated Hb) -Few hours to 3 days

Bluish black/brown(haemosederin) -4th 5th days

Greenish (biliverdin) -5th to 7th days

Yellowish (bilirubin) -7th to 12th days

Normal -2 weeks
 Colour changes in contusion

Recent purple contusion of Older yellow-brown contusion.

arm.
 Healing contusion

Colour changes in a bruise. This injury contains

brown, blue and purple components.
 Medico-legal significance
• Age of injury
• Patterned contusion – weapon or object
• Contusions produced in the peri-mortem
period cannot be distinguished from ante-
mortem
• Manner ; self inflicted contusions -unlikely
• Size of contusion may not correspond with
size of weapon
• Direction of impact not known
• May become visible after hours after impact
• May be present at a site away from the site of
impact
• Should be differentiated from Post-mortem
staining
 The myth of the
‘bokshi bites’:

• only in the villages,

• only women,
• only married women,
• and only on specific sites like the arms,
breasts, and thighs…
Why?
• These are spontaneous bruises
• The cause is some defect or disease of blood
and or small vessels
Spontaneous bruise
 LACERATION
• Definition
Laceration is blunt force injury resulting in
tearing or splitting of tissue due to shearing or
crushing force

It may be caused in one of the following ways

– Violent blow with heavy, hard & blunt objects
– Being run over during vehicular & railway accidents
– Machinery accidents.
 Characteristics of laceration

• It is caused by heavy, hard & blunt objects.

• Deep injury.
• Site of injury is the site of impact.
• Shape of injury is irregular.
• Margins of injury are usually abraded or
contused, showing irregular tags of tissues.
• Foreign body in the form of earth, hairs, cloth
etc is usually present
 Types of lacerated wound
• Split laceration - perpendicular impact causing
crushing
• Stretch laceration - stretching of the skin,
beyond its elasticity
• Avulsions - impact of heavy grinding force
being tangential to the body part so that flap
of uniform thickness is raised
Split laceration of scalp
Split /incised–like lacerations on forehead with
abraded margin and tissue tags and bridges
Avulsed laceration with tibia fracture
 Avulsed laceration

These individuals were run over by a motor vehicle

while lying on the ground. Note the flap of skin
being torn away from the thigh as the tire rolled
over the leg.
 Medico legal aspect
• Laceration are usually homicidal or accidental.
Suicidal are very rare because of extreme
force required & extensive pain.
• These are usually grievous injuries.
 Fracture and Dislocation
(skeletal injuries)

• The application of force either directly or

indirectly to bone can result in skeletal injuries
or fractures.
• Dislocation is displacement of bones in joints

• Fractures can be classified as

– Direct fractures
– Indirect fractures
 Direct fractures
• Focal (tapping) fractures – associated soft
tissue injuries minimal; usually transverse;
may be seen together with other injuries.
• Crush fractures – soft tissue injuries extensive
and comminuted fractures possible; in road-
traffic accidents
• Penetrating fractures – gunshot wounds.
 Indirect fractures:
• Traction – fracture of patella (knee-cap)
• Angulation – as a result of bending of bone
• Rotational fractures – produces spiral
fractures
• Vertical compression – in road-traffic
accidents
Fracture of the vault of skull
• Fissured fracture • Diastatic fracture
• Depressed fracture • Gutter fracture
• Comminuted fracture • Perforating fracture
• Stellate fracture • Pond fracture
• Mosaic fracture • Cut fracture
• Elevated fracture • Combined fracture
Fissured fracture
• Pond fracture Depressed
fracture
Gutter fracture and depressed fr.
Diastatic fracture (fracture along suture line
Skull fracture with wide gaping
Base of skull fracture both sides
Cut fracture of skull
bone with incised
wound on head
HW