Medico Legal Aspects of Injuries

Injuries: Medico Legal Aspects

Lecturer: Dr. Ajith Tennakoon MD-Hon (USSR), MD, DLM (SL), Dip. RCPA (Aus), MFFLM (UK), FFCFM(RCPA)
Specialty: Forensic medicine
Position: Former Chief Judicial Medical Officer Colombo

What is Injury?

  • Definition (penal code of SL):

    • Injury is described as any harm caused illegally to a person in the following aspects:

    • Body

    • Mind

    • Reputation

    • Property

  • Physical Trauma:

    • Generally refers to damage to the body caused by an external force, which can occur due to:

    • Accidents

    • Falls

    • Hits

    • Weapons

    • Other causes

  • Major Trauma:

    • Refers to injuries that have the potential to cause prolonged disability or death.

What is Hurt?

  • Section 310 of penal code:

    • Defines “causing hurt” as someone who causes bodily:

    • Pain

    • Disease

    • Infirmity to another person.

  • Related Sections:

    • Section 311: Grievous hurt.

    • Section 312: Voluntarily causing hurt.

    • Section 313: Voluntarily causing grievous hurt.

What is Wound?

  • Definition:

    • A wound is characterized as a discontinuity of the skin or mucous membrane due to the physical transmission of energy.

  • Types of Physical Transmission:

    • Mechanical

    • Blunt force

    • Sharp force

    • Thermal (heat)

    • Dry

    • Wet

    • Radiation

    • Chemicals

Medico Legal Importance

  • During Medico Legal Examination:

    • Identify all injuries that cause bodily pain.

    • Classify injuries based on the seriousness of “hurt”:

    • Non-grievous

    • Grievous

    • Important to assess if grievous injury is:

    • Endangering life

    • Fatal in the ordinary course of nature

    • Discussion on whether seriousness of injury can demonstrate intention.

    • Identify the causative weapon of the injury.

    • Mark special patterns of distribution of injuries.

    • Compatibility with the given history is vital.

    • Intention may be assessed during trials.

Injury to the Mind

  • Assessment:

    • Always associated with bodily injuries, but may occur without physical injuries.

  • Importance of Assessment:

    • Particularly in cases involving:

    • Child abuse

    • Gender-based violence

    • Torture

    • Sexual abuse

    • Other forms of abuse

    • Referrals to a psychiatrist for assessment and treatment are mandatory.

    • Psychiatrist's opinion must be included in the Medico Legal Report (MLR).

Medico Legal Examination of Living Victims

  • Who:

    • Examination by a medical / forensic medicine expert known as JMO (Judicial Medical Officer).

  • Where:

    • Conducted at a hospital.

  • Documentation:

    • Use of MLEF (Medico Legal Examination Form) followed by MLR or PMR (Post Mortem Report).

  • Purpose:

    • Determine type of injury, category of hurt, weapon used, and other relevant issues.

  • Why:

    • For police to file a case under the relevant section and to identify other legal issues for trials in magistrate courts, serving as evidence or later oral evidence for trials in High Courts.

Blunt Force Injuries

  • Types of Blunt Injuries:

    • Abrasions

    • Contusions

    • Lacerations

    • Fractures

  • Types of Blunt Force Causes:

    • Blow with a blunt weapon

    • Falls

Abrasions

  • Definition:

    • The most superficial injury to the skin; it involves damage to the epidermis.

  • Characteristics:

    • Mild or no bleeding

    • Heals rapidly

    • No scarring

Types of Abrasions

  • Linear Abrasion:

    • A single linear scratch caused by pointed objects (e.g., nail or pin).

  • Grazed Abrasion:

    • Close parallel scratches resulting from the impact of a rigid rough surface on the skin.

    • Epidermal tags at one end indicate the direction of the force.

  • Imprint Abrasion:

    • Results from the impact of a rigid tough surface on the skin (e.g., nail marks or pressure marks).

    • Gives the shape of the weapon used.

  • Friction Abrasions:

    • Produced from pressure on the skin with some movements (e.g., ligature mark in hanging).

Medico Legal Importance of Abrasions

  • Significance:

    • Characteristics of the striking surface provide clues to the weapon used.

    • Direction of the force can give insights into the type of crime and nature of the incident.

    • Aiding in the aging of the injury/incident and in identifying the perpetrator.

    • Ensures compatibility with the provided history.

Aging of Abrasions

  • Stages of Aging:

    • Fresh: Bleeding present

    • Drying of blood occurs

    • Formation of scab takes place over time

    • Falling off the scab leads to new white epidermis

    • Replacement of the skin with normal pigments occurs over time

    • No scarring upon complete healing

Healing of Abrasions

  • Healing Timeline:

    • 0-12 hours: Bright red bleeding.

    • 12-24 hours: Dried reddish color.

    • 12-48 hours: Brown scab formation.

    • 2-5 days: Scab becomes dark brown/black.

    • 5-8 days: Scab starts falling from the periphery to the center.

    • 7-10 days: Complete falling off leaves a de-pigmented area.

Contusions

  • Definition:

    • Extravasation, infiltration, and coagulation of blood in the tissues following the traumatic rupture of capillaries.

  • Causes:

    • Results from blunt weapon or blunt edge of sharp weapon.

  • Types of Contusions:

    • Finger tip contusions / discoid contusions (e.g., from manual strangulations, child abuse).

    • Tram line contusion (often from torture).

    • Irregular shape contusions.

    • Deep contusions in muscles or subcutaneous tissue.

    • Delayed presentation of deep contusions may occur.

Medico Legal Importance of Contusions

  • Importance in Forensic Analysis:

    • Aging of injury through color changes (red → blue → green → yellow → disappearance).

    • Identification of the weapon used.

    • Nature of the incident (determining intentional violence based on weapon and injury compatibility).

    • Associated injuries may provide additional insights.

Factors Affecting Appearance of Contusions

  • Factors Include:

    • Type of tissue (muscular more visible).

    • Age of the individual.

    • Underlying structures (e.g., underlying bones may cause more bleeding).

    • Volume of blood extravasated.

    • Force applied during the incident.

    • Individual complexion affects visibility.

    • Contusions can move due to gravity.

    • Differentiate from hypostasis (pooling of blood).

Aging of Contusions by Color

  • Study Findings:

    • Development of yellow color occurs significantly faster in subjects aged < 65 years (P < 0.001).

    • Appearance of blue and purple/black colors was relatively less significant.

    • Appearance of red color did not significantly alter with time.

    • Concludes that a bruise with yellow color is more than 18 hours old.

Lacerations

  • Definition:

    • Discontinuation of tissue due to blunt trauma characterized by splits and tears.

  • Characteristics:

    • Edges and ends are blunt, irregular, and bruised.

    • Tissue bridging may be evident.

    • Degloving injury and lacerations on the scalp may mimic cuts.

    • Blast wave injuries can occur in lungs due to explosions.

  • Medico Legal Importance:

    • Helps in identifying the nature of the weapon, type of crime/incident, aging of the injury, and reconstruction of the incident.

Cut Injuries

  • Definition:

    • A discontinuation of tissue caused by a sharp weapon, where the surface length is greater than the depth.

  • Characteristics:

    • Margins are regular, absence of marginal bruises, ends are sharp with trailing effects, and hair follicles are cut at the base.

    • Profuse bleeding can occur.

  • Types:

    • Self-inflicted cuts (hesitant cuts, accessible areas, handedness).

    • Slashed cuts (involving long-bladed weapons).

    • Defense cuts.

Medico Legal Importance of Cut Injuries

  • Importance:

    • Helps identify the nature of the weapon.

    • Circumstances of the incident must be considered.

    • Assess compatibility with the history provided.

    • Assist in reconstruction of the incident.

Stab Wounds

  • Definition:

    • Caused by sharp long-bladed weapons penetrating deeper tissues or cavities.

  • Characteristics:

    • Depth is generally greater than the length.

    • Length and width give clues about the weapon's dimensions.

    • Internal injuries from stab wounds can be significantly serious.

    • A hilt mark (guard) may present at the wound site.

    • Ends of stab wounds correspond to the edges of the weapon.

Medico Legal Importance of Stab Wounds

  • Key Aspects:

    • Identification of the weapon's nature.

    • Direction from which the force was applied.

    • Length of the weapon indicates dynamics of the attack.

    • Reentry or rocking of the weapon can complicate diagnoses.

    • Size and shape of wounds may differ from weapon dimensions.

Fractures

  • Definition:

    • A fracture is a complete or incomplete break in the continuity of a bone, and can also occur through cartilage or teeth.

  • Causes:

    • Blunt trauma, and may also involve cut fractures from sharp force.

    • Can result from direct trauma (impact from Road Traffic Accidents) or indirect trauma (twisting or pulling, commonly seen in child abuse scenarios).

  • Types of Fractures:

    • Closed (simple) or open (compound).

    • Fragmented based on the severity of break.

  • Types of Fractures Classification:

    • Transverse

    • Linear

    • Oblique

    • Non-displaced

    • Displaced

    • Spiral

    • Greenstick

    • Comminuted

Medico Legal Importance of Fractures

  • Key Considerations:

    • Site and distribution of fractures provide crucial evidence.

    • Direction of applied force may be inferred.

    • Differential diagnosis must consider diseases affecting bones leading to pathological fractures.

    • Patterns observed in bone fractures must be noted.

    • Typically categorized as grievous hurt due to severe nature of injuries.

    • Aging in healed bones can provide insights into the timeline of trauma.

Categories of Hurt (Section 311 of Penal Code)

  • Classifications:

    • Non-grievous

    • Grievous

    • Endangering life

    • Fatal in the ordinary course of nature

Non-Grievous Injuries

  • Definition:

    • Any injury that does not fall under grievous or fatal categories.

  • Examples:

    • Abrasion

    • Contusion

    • Superficial cut

    • Superficial lacerations

Grievous Hurt

  • Definition:

    • Section 311 (Amendment Act No. 22 of 1995) clarifies grievous hurt through nine limbs outlined in the back of the MLR.

Grievous Hurt Categories

  • a) Emasculation (castration) must exclude preexisting diseases leading to impotence, sterility.

  • b) Permanent impairment of sight in either eye; temporary impairment not considered unless exceeding 21 days. Requires eye surgeon's opinion.

  • c) Permanent impairment of hearing in either ear; requires ENT surgeon's opinion, with no consideration for temporary impairment.

  • d) Loss of any member or joint includes:

    • Definition of “member” as an organ or a limb capable of performing a distinct function (e.g., eye, ear, hands, feet, etc.).

  • e) Destruction or permanent impairment of function of any member or joint follows injury, requiring medical intervention. Natural recovery considered, with preexisting diseases excluded.

  • f) Permanent disfigurement of head or face should consider individual differences (sex, age, marital status, occupation).

  • g) Cut or fracture of bone, cartilage, tooth, dislocation, or subluxation should consider previously diseased conditions of the affected structures.

  • h) Any injury causing an endangerment to life or necessitating surgery involving thoracic, abdominal, or cranial cavities.

  • i) Any injury causing severe pain or inability to follow ordinary pursuits for a minimum of 20 days owing to the injury or operations necessitated by the injury.

Fatal in the Ordinary Course of Nature

  • Definition:

    • Refers to injuries which, if left untreated, will lead to certain death due to lack of immediate medical intervention.

Endangering Life vs. Fatality in Ordinary Course of Nature (FOCN)

  • Endangering Life:

    • Describes an existing threat to life at the time of infliction or examination.

  • FOCN:

    • Discussion on injuries that guarantee death if unattended, clarifying the level of urgency required for medical care.

Necessarily Fatal Injuries

  • Definition:

    • Such injuries result in death despite the best possible medical care and are deemed beyond medical redemption.

  • Examples of Necessarily Fatal Injuries:

    • Decapitation

    • Crush injury of the head

    • Severance of the brain stem

    • Complete transaction of the upper cervical spinal cord

    • Complete transaction of the aorta

    • Multiple stab injuries to the heart affecting all chambers

    • Extensive laceration of the liver beyond surgical repair

Conclusion

  • Acknowledgement:

    • Dr. Ajith Tennakoon's contribution to the field of forensic medicine and his critical insights into the medico-legal aspects of injuries.

Thank you!