TRAUMA, WOUNDS

AND REGIONAL
INJURIES.

Dr. M Badana
Department: Forensic Medicine and
Pathology
University: Sefako Makgatho Health
Sciences University
Introduction

This presentation will provide an

in-depth analysis of wounds and
Forensic pathology is the branch of
injuries in forensic pathology,
pathology that focuses on the
including their classification,
investigation of deaths and injuries
examination, and significance in
for legal purposes.
determining the cause and manner
of death.
Overview of Wounds
Wounds are injuries that result from an external
force applied to the body.

They can be classified based on various

characteristics, such as:

• Mechanism of injury (blunt force, sharp

force,Thermal, etc.)
• Depth and extent of the wound
• Location on the body
Blunt Force Blunt force injuries are caused by the application of force to the body
without the presence of a sharp or penetrating object. These injuries
are often the result of incidents such as falls, assaults, or motor
Injuries vehicle accidents. The force involved in these injuries can cause
tissue damage and disruption to bodily functions.

This force can lead to a variety of injuries, including.

• Contusions (bruises)
• Abrasions (superficial scrapes)
• Lacerations (deep cuts)
• Fractures (broken bone
 types of Blunt Force
Description Examples
Injuries

Contusions result from the

- Black eye resulting from blunt
rupture of blood vessels beneath
trauma around the eye area. -
Contusions (Bruises) the skin due to blunt impact,
Area of skin discoloration on the
leading to discoloration or "black
shin following impact.

Types of
and blue" appearance.

Abrasions refer to superficial

- Scratches on the knees from
scrapes or grazes on the skin
Abrasions (Superficial falling on a rough surface. -

blunt force
caused by friction or scraping
Scrapes) "Road rash" on the skin due to
against a rough surface, often
sliding on pavement after a fall.
resulting in minor tissue damage.

Lacerations are deep, irregular - Irregular, deep cuts to the scalp

injuries Lacerations
cuts to the skin caused by blunt
force trauma, leading to
significant tissue tearing and
potential blood loss.
from impact with a blunt object. -
Profound and jagged laceration
resulting from blunt force trauma
to the arm.

Blunt force impacts can lead to - Broken ribs from a powerful

fractures or breaks in bones, impact on the chest area. -
Fractures (Broken Bones) ranging from hairline cracks to Hairline fractures in the tibial
complete breaks, depending on bones resulting from blunt
the force and area of impact. trauma.
• Understanding the characteristics
of blunt force injuries is essential
in forensic pathology for
accurately assessing the nature of
trauma and its implications in
forensic investigations
Contusions / bruises
Contusions result from the rupture of blood vessels beneath the skin due to blunt impact, leading to
discoloration or "black and blue" appearance……
Characteristics of Contusions Description Examples
Manifests as skin discoloration resulting from small - Black eye - Bruising from impact with blunt object -
Colour
blood vessel rupture beneath the skin Discoloration around a wound site
Sensitivity or pain upon touching or palpating the - Soreness on the site of bruising - Pain upon
Tenderness
affected area touching a contusion
May involve localized swelling or inflammation at the - Swelling around a bruised area - Inflammation
Edema
contusion site accompanying bruising
- Initial redness followed by purplish discoloration -
Colors may change from red/purple to green/yellow
Changes Over Time Gradual transition to green and yellow hues during
as the contusion heals
healing
Range from small, circular marks to extensive areas - Roundish contusions resulting from impact -
Size and Shape
of discoloration Irregular-shaped bruising
Tram track bruises
Type of Injury Characteristics Common Causes
Linear or parallel Trauma from objects
bruises resembling with linear patterned
Tram Track Bruises tram tracks caused by surfaces, tool marks,
blunt-object impacts objects with parallel
or pressure ridges
Sharp object injuries,
Linear, non-branched
machinery or tool
cuts often result from
Lacerations accidents, clean
impact with objects
straight cuts from
with straight edges
sharp objects
Superficial scrapes or
grazes on the skin Falls, sliding, contact
Abrasions caused by friction or with rough surfaces,
impact against an scraping or impact
object
 Abrasions
Abrasions refer to superficial scrapes or grazes on the skin caused by friction or scraping against a rough
surface,

Type of Abrasion Description Examples

Long, narrow abrasions caused by scraping along the - Abrasions from skidding on pavement during a fall -
Linear Abrasions
skin's surface. Scrapes from contact with rough surfaces
- Abrasions from contact with gravel resulting in
Involves foreign material embedded in the skin from
Abrasions with Embedded Material embedded particles - Scrapes with foreign material
the impacting surface.
lodged in the skin

Display specific patterns imprinted on the skin from - Abrasions from contact with a patterned tool or
Patterned Abrasions
contact with patterned objects or surfaces. object - Scrapes from contact with textured surfaces

- Postmortem abrasions observed during autopsy

Occur after death and are due to postmortem
Postmortem Abrasions examinations – could be abrasions resulting from
movement or contact with surfaces.
handling and movement of the body after death
 lacerations
Lacerations are deep, irregular cuts to the skin caused by blunt
force trauma, leading to significant tissue tearing and potential
blood loss.
• Margins: irregular, ragged, abraded/contused.
• Bridging of tissues (uneven tearing of deeper
tissues, crushing of hair bulbs).
• Variable depth and presence of foreign
material.
• Haemorrhage.
 Types of lacerations

Types of Lacerations Description Examples

Straight, non-branched cuts often resulting from
Linear Lacerations - Lacerations from glass shards
impact with straight edges.
- Wounds from a high-energy impact, such as in
Star-shaped or radiating cuts, indicative of a
Stellate Lacerations motor vehicle accidents - Lacerations from
wider impact or tearing force.
explosive incidents
Result from tissue being torn away from the - Skin tears in industrial accidents - Injuries from
Avulsion Lacerations
body, often caused by high-force trauma. machinery entanglement
- Degloving injuries from industrial or vehicular
Involve a piece of tissue being partially or fully
Flap Lacerations accidents - Lacerations with substantial tissue
detached, creating a flap of skin.
loss resulting in a skin flap
 Sharp force injuries involve the use of a sharp-edged
or pointed object, causing cutting or stabbing

Sharp Force wounds. They can be classified into:

Injuries • Incised wounds (clean , sharp cuts)

• Stab wounds (deep, narrow wounds)
• Chop wounds (blunt force with sharp-edged
object)
• Puncture wounds (small, deep holes)
Types of Sharp Force Injuries Description Examples

Characterized by clean, sharp cuts with - Surgical incisions - Slash injuries

Incised Wounds (Clean, Sharp Cuts) distinct edges, often caused by a sharp- caused by a sharp knife - Carving tool
edged instrument. injuries with clean, sharp cuts
Deep, narrow injuries resulting from a - Penetrating chest wound from a knife -
pointed object penetrating the body, often Narrow track injuries from a screwdriver
Stab Wounds (Deep, Narrow Wounds)
characterized by their depth and relatively assault - Stabbing with an ice pick resulting
narrow track. in deep, narrow wound tracks

- Injuries from an axe, combining

Displays a combination of cutting and
cutting and blunt force trauma - Chop
Chop Wounds (Blunt Force with blunt impact, often resulting from a
wounds from a heavy, sharp-edged
Sharp-Edged Object) sharp-edged object used with a blunt
tool resulting in lacerations and
force.
contusions
- Small puncture wounds from a screwdriver
Identified by small, deep holes caused by puncturing the skin - Stab wounds from an
Puncture Wounds (Small, Deep Holes)
pointed or sharp-edged objects. awl or similar pointed object - Needle
puncture wounds
Characteristics of
incised wounds
• Length: greater than width and
depth
• Width: is greater than edge of the
weapon
• Margins: clean cut, well defined,
and usually everted
• Shape: usually spindle-shaped;
gaping is more if the underlying
muscle fibers are cut transversely
or obliquely
• Haemorrhage , wound deeper at
beginning; tailing at end
Chop wounds
• Caused by a heavy object with an
element of sharpness on the cutting
edge.
• Chopping wounds cause deep
wounds, which might show mixed
features of laceration and incision.
• Classification:
• Classified according to the dominant
feature e.g., lacerated chopping or
incised chopping wound
 Sharp force vs blunt force injuries

Aspect Sharp Force Injuries Blunt Force Injuries

Injury Mechanism Result from sharp-edged or pointed objects Caused by blunt or non-penetrating impacts
Wound Appearance Cuts, stabs, puncture wounds Abrasions, contusions, lacerations, fractures
Injury Pattern Precise, highly localized injuries Variable, with broader impact areas
Internal Damage Limited depth but with distinct tracks Broad tissue damage, diverse injury patterns
Objects Involved Knives, broken glass, sharp tools Blunt objects, surfaces, tools, or impacts

Wound Healing Typically requires careful suturing/stitching May entail extensive tissue repair and reconstruction

Potential for Tissue Damage Emphasizes penetration and organ damage potential Focuses on impact-related tissue injuries and trauma
Gunshot Wounds

“ full ballistics lecture coming”

Gunshot wounds occur when a firearm discharges projectiles into the body. They can be
divided into:

• Entrance wounds (small, circular or oval-shaped)

• Exit wounds (larger, irregular-shaped)
• Intermediate range wounds (powder tattooing or stippling)
• Contact range wounds (muzzle imprint and soot deposition)
Firearm Injuries

In addition to gunshot wounds, firearms can cause other injuries, such as:

• Fractures and bone damage

• Internal organ injuries (e.g., from bullet fragments)
• Soft tissue injuries
• Wound tracks and trajectories
Asphyxial Injuries

• Asphyxia refers to the interruption of breathing, leading to oxygen

deprivation. Asphyxial injuries include:
• Strangulation and hanging
• Suffocation (e.g., smothering, plastic bag over the head)
• Drowning
• Positional asphyxia (restraint-related
 Different Type of Wound Description Example

examples of Petechiae
Small red or purple spots
caused by bursting of
capillaries
Petechiae in the eyes,
face, or conjunctiva

wounds Ligature marks

Indicative of pressure from
a ligature object
Marks on the neck,
wrists, or ankles from
strangulation

associated Abrasions and

contusions
Skin injuries from struggle
or restraint
Scratches, bruises, or
skin marks from struggle

with asphyxia: Fractures

Neck bones fractured due
to hanging or manual
Hyoid bone or thyroid
cartilage fractures in
strangulation hanging
 1.Infection: When bacteria or other pathogens enter a
wound, it can lead to infection, which can cause redness,
swelling, pain, and discharge from the wound.
2.Delayed healing: Certain wounds may take longer to
heal, especially in individuals with underlying health
conditions such as diabetes or poor circulation.
3.Excessive bleeding: In some cases, wounds may result in
WOUNDS significant or prolonged bleeding, which may lead to
death
COMPLICATIONS
4.Scar tissue formation: Healing wounds can sometimes
lead to the formation of excessive scar tissue, particularly
in deeper or more extensive injuries.
5.Nerve and tissue damage: Severe wounds can damage
nerves and underlying tissues, leading to long-term
complication
Forensic Examination of Wounds

TO DETERMINE THE EXTERNAL AND INTERNAL PHOTOGRAPHY AND COLLECTION OF SAMPLES MICROSCOPIC RADIOLOGICAL IMAGING
NATURE AND EXAMINATION AND MEASUREMENT OF (E.G., DNA, TRACE EXAMINATION OF TISSUES (X-RAYS, CT SCANS)
SIGNIFICANCE OF A DOCUMENTATION WOUNDS EVIDENCE)
WOUND, FORENSIC
PATHOLOGISTS PERFORM
DETAILED EXAMINATIONS
THAT MAY INVOLVE:
Wound Understanding the
stages of wound
healing is important in

healing forensic pathology. It

includes:

process
Hemostasis (blood
Remodeling phase
clotting)

Proliferative phase Inflammatory phase

Wound healing process

Wound Healing Phase Description Duration

Minutes to an hour after the initial injury.

Hemostasis Involves blood clotting to stop bleeding histological findings would include platelet aggregation and
the formation of a fibrin mesh to stop bleeding

Body's response to clear debris and combat potential Typically lasts for a few days.
Inflammatory Phase
infections Influx of neutrophils to clear debris and combat infections

Occurs over several days to weeks.

Rebuilding of damaged tissue through cell
Proliferative Phase histology might reveal fibroblast migration and proliferation,
proliferation and formation of new blood vessels
along with angiogenesis to form new blood vessels

Can last for several weeks to months.

Rearrangement and strengthening of the new tissue,
Remodeling Phase histological findings could show increased collagen
as well as maturation of scar tissue
deposition and remodeling as the scar tissue matures
 Forensic pathologists must document their
findings accurately and provide detailed
reports that include:

Documentation • Description of the wounds and injuries

and Reporting • Interpretation of findings
• Opinions on cause and manner of death, if
applicable
• Collateral findings (e.g., evidence of self-
defense
 • Certain patterns of injuries can provide
valuable insights in forensic pathology,
such as:
• Defensive wounds (indicative of a
Patterns of struggle)
• Bite marks (human or animal)
Injury
• Patterned injuries (from specific objects
or tools)
• Multiple injuries (suggestive of assault or
abuse)
 In cases of homicides, studying the
characteristics of wounds can aid the
investigation by:

Wounds in • Determining the weapon used (e.g.,

blunt force, sharp force)
Homicides • Identifying potential assailants (e.g.,
size and strength)
• Establishing the sequence of injuries
• Assessing the manner of death (e.g.,
intentional, accidental)
 Self-inflicted wounds can raise important
questions in forensic pathology, including:
Wounds Location and characteristics of the wounds

in Presence of hesitation marks

Suicides Compatibility of the wounds with the

claimed method

Investigation of underlying psychological

factors
 • Accidental injuries necessitate a meticulous investigation to determine their cause,
with a focus on the following considerations:

• Mechanism of Injury (e.g., fall, motor vehicle accident): Understanding the specific
mechanism through which the injury occurred provides critical insights into the
Wounds in circumstances of the accident, aiding in the reconstruction and assessment of the
injury.

Accidents: • Contributing Factors (e.g., intoxication, negligence): Evaluating contributory factors,

such as the influence of alcohol, drug intoxication, or negligence, is essential for
understanding the sequence of events leading to the accident and the potential
implications for injury severity.
• Identification of Potential Hazards or Defects: Identifying hazards or defects in the
environment or equipment involved in the accident is crucial for recognizing and
addressing potential risks that may have contributed to the injury.
• Assessing the Role of External Agencies (e.g., workplace accidents): In the case of
workplace accidents, evaluating the role of those entities and their adherence to
safety protocols is important for understanding the broader context of the accident
and potential liabilities.
 Wounds in child abuse

Wounds in Child Abuse Description Examples

- Circular or linear bruises consistent with belt buckles or
Recognizing patterned injuries, such as bruises or marks in
cords - Bite marks with distinct patterns of teeth indicating
Patterned Injuries and Non-Accidental Trauma specific shapes or arrangements, can be indicative of
intentional harm - Burns with clear boundaries suggestive of
intentional harm and non-accidental trauma.
deliberate abuse

Assessing skeletal fractures in various stages of healing provides - Multiple fractures in different stages of healing pointing to
Skeletal Fractures in Different Stages of Healing valuable insights into the recurrent nature of abuse, aiding in repeated instances of abuse - Old fractures indicating
the determination of the timeline and chronicity of the injuries. historical abuse, providing evidence of chronic mistreatment

- Internal hemorrhaging resulting from physical abuse - Organ

Recognizing and documenting internal injuries resulting from
damage indicative of prolonged and severe mistreatment -
Internal Injuries Associated with Abusive Acts abusive acts is essential for comprehensive assessment and
Evidence of sexual abuse through documented genital
understanding the full extent of harm inflicted upon the child.
injuries or trauma

Collaboration with child protection agencies is vital for - Presenting forensic evidence to child protection agencies for
Collaboration with SAPS, Social workers and Child facilitating the safeguarding and welfare of abused children. immediate intervention and protective measures - Providing
Protection Agencies Sharing forensic findings with these agencies is essential for comprehensive forensic reports to support legal proceedings
ensuring appropriate interventions and support. and child welfare interventions
Documentation Challenges

Forensic pathologists may encounter challenges when documenting wounds and injuries:

• Decomposed or skeletonized remains

• burns, scalds, and electrical injuries
• Overlapping injuries or multiple causes of death
• Absence of clear history / circumstances leading to injury
 Role of Expert Witness

Forensic pathologists may serve as expert

witnesses in legal proceedings. Their role
includes:

• Providing an unbiased opinion based on

scientific evidence
• Educating the court on wound
characteristics
• Analyzing conflicting interpretations of
injury patterns
• Assisting in the determination of cause and
manner of death
Challenges in Court

01 02 03 04 05
Presenting wounds Simplifying complex Answering questions Anticipating Maintaining
and injuries in court scientific concepts from lawyers potential challenges professionalism and
can involve some for a “non-medical- accurately and to expert testimony objectivity
challenges: expert” audience confidently throughout the
proceedings
Legal and Ethical Considerations

LEGAL AND ETHICAL OBTAINING INFORMED ENSURING OBJECTIVITY SAFEGUARDING THE COMPLYING WITH
CONSIDERATIONS ARISE, CONSENT FOR AND UNBIASED ANALYSIS CONFIDENTIALITY OF RELEVANT LAWS AND
INCLUDING EXAMINATION OF INJURIES OF EVIDENCE SENSITIVE INFORMATION REGULATIONS
References

Clark, D. E., & Marshall, S. W. (2016). Characteristics of injuries resulting

in hospitalization from firearm violence. JAMA, 316(5), 515-516.

DiMaio, V.J., & DiMaio, D.J. (2001). Forensic pathology. Boca Raton: CRC
Press.

Knight, B. (2013). Forensic pathology, 3rd Edition. London: Arnold