Karaganda state medical University Department pathological anatomy and forensic medicine

1. Karaganda state medical UniversityDepartment pathological anatomy and forensic medicine Topic: The general questions of juridical traumatology

2. Plan • The basic classification of damages & types of a traumatism • General characteristic of mechanical damages • Damages from blunt object • Damages from sharp instruments

3. In the forensic medicine, the definition of the bodity injuries is the following: the bodity injury is the consequence (result) of violent acts for health & live of a victim. The bodity injury or trauma is the disruption of the anatomical structure & physiological functions of human organism under an influence of any factors of the external environment which produce a death or different degree of disorders

4. What are the factors of the external environment producing a death or disorders of an organism? • ???

5. CLASSIFICATION OF DAMAGES • Damages by physical factors • Damages by chemical factors • Damages by biological factors • Damages by psychical factors • Combine damages

6. Damages by physical factors • mechanical damages (by blunt, sharp objects; guns & weapons; firearm weapon) • high & low temperature • electricity • radiant energy • Changes of pressure of gases

7. Damages by chemical factors Poisons causing chemical burns & poisoning Damages by biological factors Infectious & toxic reagents of the biological origin (under the condition of an infection by the violent way) A disorder or death as a result of the violent deprivation of food & drinking

8. Damages by psychical factors A psychical trauma as a result of fear or intenseemotions, etc… Combine damages It is the simultaneouslyimpactofheterogeneous factors of the external environment

9. Types of a traumatism • industrial injuries (industrial & agricultural) • Not industrial injuries (transport, pedestrian movement, everyday, sports) • militaryinjuries (battle or not battle)

10. Classification (clinical) of mechanical damages • isolated damages (one region of a body, one internal organ, one segment of the support-movement apparatus) • Plural damages (two or more organs of one cavity or system, two or more segments of the support-movement apparatus) • Combined damages (two or more organs from different cavities or systems of the body, as well as internal organs in the combination with a trauma of the support-movement apparatus)

11. disruption of the anatomical structure of organs disruption of physiological functions of organs Classification (in the forensic medicine) of mechanical damages

12. Damages with disruption of the anatomical structure of tissues & organs: Abrasions, bruises, lacerations, wounds, fractures, dislocations & stretching, injuries of internals, crushing & separation of parts of the body Damages with disruption of physiological functions of organs: Causing the pain, concussion of the brain; death from a blow at the reflexogenic regions (of the neck, heart, coeliac plexus)

13. Main tasks of the medico-legal examination of damages: • ascertainment (in victim) of the present damages, their localization, number, character • Determination of a character of a damaging factor and mechanism of an appearing of injure • Determination of a time, when a damages was made • Determination of an importance of injure for a health, remarkable capacity for work & live of victims

14. Methods of the medico-legal examination of damages: • Study & description • Spectroscopic examination • Colored imprints & chemical reactions • X-ray method • Histological methods (and other clinical and criminal)

15. The scheme of the description of damages • Localization • Kind of an injure • Shape • Size • Character of margins and angles (ends) • Properties of a surface • Condition of surrounding tissues

16. Classification of mechanical damages by blunt object : • Damages are made by blunt weapon (knuckleduster, bludgeon) • Damages are made by an unarmed man • Damages are made by moving transport or details of machines • Damages by pressing of a different heavy objects (load, land-slide, snow-slide, etc…) • Damages under the fall from high & on the plate • Most of industrial & sports traumas

17. Blow Squeezing Stretching Rubbing Mechanism of the blunt trauma: Not big force blow produces abrasions & bruises Blows of a big force cause the formation of wounds, fractures, rupture of internal organs, concussions…

18. What is the bruise? How can you identify the age of a bruise? Answer: Tasks for self-study:

19. Bruises are caused due to rupture of capillaries and veins leading to escape of blood into the tissue beneath the skin, called extravasation of blood, without discontinuity of skin or covering of an organ

20. What is the abrasion? How can you identify the age of an abrasion? Answer: Tasks for self-study:

21. This type of wound damages only the epidermis (uppermost skin layer), and should not therefore bleed. However, abrasions do usually extend into the dermis causing slight bleeding. Larger abrasions are very painful since the injury extents to the many fine nerve endings subjacent to the skin. An abrasion is a superficial injury, commonly known as a 'graze' or 'scratch'. Abrasions

22. Main types of surfaces of blunt objects • Big flat surface (board, slab) • Big spheroid surface (weight, cobblestone) • Cylindrical surface (stick, crow-bar, etc.) • Long facetted surface with edges • Small flat surface with edges (hammer, back of an axe) • Corner (angle) or edge of facetted object (iron, brick, etc.)

23. Splits (fissured fractures)of vault of the skull • Multiple fracturesof the base of the skull (the orbital plate)

24. Blunt trauma to the head can be suggested by scalp

25. Injures causing by big spheroid surface (weight, cobblestone) • Wounds are star-like with 3, 4, 5 rays. • There are abrasions of spheroid or oval shape around the wound. • Borders of the wound are crushed at its centre. • In skull bones: splits, fractures of spheroid shape like an impression; fractures with fragments of bone.

26. Injures causing by cylindrical surface (stick, crow-bar) • Single or double stripe-like bruises, some time with abrasions • On the head: rectilinear and arched wounds with irregular and crushed margins; long-oval shaped fractures

27. Injures causing by long facetted surface with edges • Wound looked-like cutting wounds, linear or spindle-like shaped, with straight margins (not crushed) • In skull bones: fractures are looking as an impression, or impression with a gap

28. Injures causing by small flat surface with edges (hammer, back of an axe) • Wounds, shape of which depend on following factors: by which part of object it was made, direction of a blow (usually, wounds have arched, П- or Г- shaped) • abrasion & bruise (under the blow of perpendicular direction, they correspond with shape & size of the object) • On the head: damages of skin, gaping fractures of bones or looking as an impression (corresponding to shape & size of the object)

29. Transversal fractures of bones of the vault of the skull from influence of the blunt object of an elongate shape

30. The mechanism of the forming of the fracture of bones of the vault of the skullfrom influence of the blunt object like a hammer

32. The fracture of bones of the skull like impression & terrace from the blow under the sharp angle by the object having spherical surface The mechanism of the fracture of bones of the skull like terrace from the blow by the object having plate surface

34. Injures from squeezing: • Degree & volume of injures depend on mass of object & square of its contact with the body • Abrasion & bruise • Laceration (usually over bony prominences) • Deformation of the body or its parts • Different types of fractures of bones • Ruptures, disposition of internal organs

35. Injures from stretching mostly characterized by: • Lacerations (usually irregular in shape and irregular margins; abrasions, crushing aren’t present) • Separation of parts of a body

36. Injures from rubbing • Abrasions • Wounds • Separation of the skin • Separation of muscles and periosteum

37. Typical damages from sharp objects are wounds. The classification of wounds depends on a kind of sharp objects & way of their influence. Types of wounds are the following: • Cuts (incised, slicing) wounds • Slashing (рубка саблей, chop -рубить )wounds (as is made by axe or saber) • Stab (prickle) wounds • Stab-incised wounds • Sawing wounds

38. This scene illustrates the mechanism for "defense wounds". • Such wounds result from an attempt to ward off the assailant. The victim holds up forearms and hands in front of the body.

39. Morphological characteristic of incised wounds • Shape is linear or spindle-like • Margin is clean cut and everted • Wounds is longer than deep but often gaping • Hemorrhage is usually profuse • Hair & blood vessels – clean cut • Bruising not present • Wounds are normally free from foreign bodies • The heavy bleeding of the wound ensures good cleansing with little risk of wound infection.

40. Here is an incised wound of the skin of the hand. An incision has clean, straight edges made by a sharp object such as a knife

41. Morphological characteristic of slashingwounds • Shape is linear or spindle-like (in soft tissues) • Margin is clean cut, ends are sharp, some time one is rounded and other is П-shaped • Dept of wounds varies: is large in rounded or П-shaped end; is smaller in opposite end • Hemorrhage is usually profuse • Foreign bodies may or may not be present

42. Is made across the front of the neck. The larynx and great vessels are cut. The patient shows the chop wounds Slashing (chop) wounds

43. Morphological characteristic of stab wounds • Shape depends on the weapon • Margin corresponds to nature of weapon, inverted et entry • The dept of a wound is greater then length & breadth • Hemorrhage varies • Wounds abraded or bruised due to thrusting force or if the weapon is not quite sharp • Foreign bodies may or may not be present

44. Morphological characteristic of stab-incised wounds • Shape is linear, spindle-like or oval • Ends are sharp, some time one is rounded and other is П-shaped • Some time is abraded at the end, forming by the back of wound • Margins (in skin) is clean cut • Abraded & bruised (near margins & around the wound) under complete penetrating of wound in a body

45. Seen in this clay model is the pattern of a wound from a double edge knife on the left and a single edge knife on the right. The Bowie knife shown here illustrates a single edge knife with a hilt.

46. [Image contributed by Todd Grey, MD, University of Utah] A single-edge blade Stab-incised wound • There is a "hilt" mark at the left. The sharp blade edge is at the right.

47. Note the sharp point of the blade at the left and the notch of the opposite side of the knife at the right. The shape of stab wounds can vary considerably, depending upon whether the incision is along the axis of, or perpendicular to, Langer's lines. Those perpendicular will tend to pull apart and gape open, while those parallel to the lines of stress will tend to remain slit-like. [Image contributed by Todd Grey, MD, University of Utah] This is a Stab-incised wound with a single edge blade.

48. Morphological characteristic of sawing wounds • Shape is linear or like irregular line • Margins are irregular (indented), abraded • Foreign bodies commonly present • Hemorrhage varies