Chapter 10.

Mechanical Injury
Table of Contents
ABRASION ....................................................................................................................................... 2
Definition .................................................................................................................................. 2
Features ..................................................................................................................................... 2
Mechanism of Production ............................................................................................................. 3
Sliding Force (Figs. 10.1A) .......................................................................................................... 3
Compression Force (Figs. 10.1B) .................................................................................................. 3
Types ........................................................................................................................................ 3
Linear Abrasion .......................................................................................................................... 3
Graze Abrasion .......................................................................................................................... 5
Imprint abrasion ......................................................................................................................... 5
Pressure Abrasion ....................................................................................................................... 7
Other Types of Abrasions ............................................................................................................ 8
Differential Diagnosis ................................................................................................................ 10
Healing of Abrasion .................................................................................................................. 11
Age of Abrasion ....................................................................................................................... 12
Medicolegal Importance ............................................................................................................. 12
Contusion ................................................................................................................................ 17
Definition ................................................................................................................................ 17
Mechanism ............................................................................................................................... 17
Types ...................................................................................................................................... 18
Intradermal Bruise ..................................................................................................................... 18
Subcutaneous Bruise .................................................................................................................. 19
Patterned Contusion ................................................................................................................... 19
Shifting Bruise .......................................................................................................................... 20
Tram-line Contusion .................................................................................................................. 20
Six-penny Bruises ..................................................................................................................... 21
Tissue and Organ Contusion4 ...................................................................................................... 23
Factors .................................................................................................................................... 23
Repair and Healing .................................................................................................................... 25
Age of Contusion ...................................................................................................................... 26
Other Conditions ....................................................................................................................... 26
Value of Bruise ........................................................................................................................ 27
Complications13 ....................................................................................................................... 27
Differential Diagnosis ................................................................................................................ 31
Artificial Bruises ....................................................................................................................... 33
Medicolegal Importance ............................................................................................................. 33
LACERATED WOUNDS ................................................................................................................... 34
Definition ................................................................................................................................ 34
Mechanism ............................................................................................................................... 34
Types ...................................................................................................................................... 34
Split Laceration ........................................................................................................................ 35
Stretch Laceration ..................................................................................................................... 36
Tear Laceration ......................................................................................................................... 36
Avulsion Laceration ................................................................................................................... 36
Crush Laceration ....................................................................................................................... 38
Cut Laceration .......................................................................................................................... 38
Patterned Laceration .................................................................................................................. 39

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Boxer's Laceration ..................................................................................................................... 39

Features (Figs. 10.43 to 10.45) .................................................................................................... 40
Laceration of Organs ................................................................................................................. 41
Complication ............................................................................................................................ 43
Medicolegal Importance ............................................................................................................. 43
INCISED WOUND ........................................................................................................................... 44
Definition ................................................................................................................................ 44
Mechanism ............................................................................................................................... 44
Features ................................................................................................................................... 45
Glassing Injuries ....................................................................................................................... 50
Defense Wounds ....................................................................................................................... 52
Medicolegal Importance ............................................................................................................. 53
CHOP WOUND ............................................................................................................................... 53
Definition ................................................................................................................................ 53
Features ................................................................................................................................... 53
Medicolegal Importance ............................................................................................................. 53
STAB WOUNDS (PUNCTURE WOUNDS) ......................................................................................... 55
Definition ................................................................................................................................ 55
Classification ............................................................................................................................ 55
Penetrating Wounds ................................................................................................................... 56
Perforating Wounds ................................................................................................................... 57
Features ................................................................................................................................... 58
Medicolegal Importance ............................................................................................................. 64
Healing of Injury (Lacerated Wound, Incised Wound and Stab) ........................................................ 64
FRACTURES ................................................................................................................................... 64
Definition ................................................................................................................................ 64
Classification ............................................................................................................................ 65
Complication of Fracture20 ......................................................................................................... 66
Medicolegal Importance ............................................................................................................. 67
REFERENCES ................................................................................................................................. 68

Violence is the last refuge of the incompetent

— Isaac Asimov

ABRASION
Definition
An abrasion is a type of mechanical injury characterized by loss of superficial layer of skin (i.e. epidermis) or mucous
membrane due to application of mechanical force.

Features
• Pure abrasion involves only epidermis.

• Abrasions do not ordinarily bleed because vessels are located in the dermis. However, due to corrugated nature of
dermal papillae, quite often, dermis is also involved and thus abrasion exhibits bleeding.1

• Pure abrasion does not leave scar on healing.

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Mechanism of Production
The mechanical force producing abrasion acts on the skin in one of the following way. However, combination of force
may also act, at times, to produce abrasion (Flowchart 10.1).

Flowchart 10.1. Mechanism of abrasion.

1. Sliding force (friction) or

2. Compression force.

Sliding Force (Figs. 10.1A)

• If causative force is narrow and sharp, linear abrasion is produced.

• If causative force is wider or broad and rough, the abrasion caused will be wider and called as graze abrasion

Compression Force (Figs. 10.1B)

• Imprint abrasions are produced by perpendicular force acting on skin with imprint of acting object over superficial
layer of skin. Such mechanism will imprint the design of object or weapon. Examples include— radiator mark of
vehicle.

• Pressure abrasions are produced by relatively perpendicular force acting on skin with movement of object with
crushing of superficial layer of epidermis. Such mechanism will imprint the design of object or weapon. Examples
include—ligature mark in hanging or ligature strangulation.

Types
1. Linear abrasion

2. Graze abrasion

3. Pressure abrasion

4. Imprint abrasion

Linear Abrasion
• Also called as scratch abrasion.

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• These abrasions are caused by sliding movement of sharp, narrow object such as pin, thorn, barb, prickle, pointed
end of weapon, etc. (Figs. 10.2A and B).

• The feature of this abrasion is that it is wider at the starting point and shows heaping of epithelium (accumulation)
at the end. This heaping up of epithelium indicates the direction of movement of causative weapon or object (Fig.
10.3, also see Figs. 10.1A and B).

Figs. 10.1A and B. Mechanism of production of abrasion, (A) Force acting tangentially
producing linear or graze abrasion whereas in (B) Force acting perpendicularly causing
imprint abrasion

Figs. 10.2A and B. Linear abrasion.

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Graze Abrasion
• Also called as sliding abrasion, gliding abrasion, brush abrasion, scrape abrasion (Figs. 10.4 and 10.5).

• These abrasions are produced by sliding movement of broad or wider surface against skin.

• Graze abrasions are wider at the starting point and they get narrower at the end with heaping of epithelium at the
end (Fig. 10.6).

• The abrasion shows, uneven, longitudinal, parallel lines (grooves or furrows) with epithelium heaped up at the ends.
The heaping of epithelium gives indication regarding the direction of movement of causative object or surface.

• When the friction force is great, grazed area appears like burn injury. Such graze abrasions are called as brush burn.

Imprint abrasion
• Also called as patterned abrasion or impact abrasion or contact abrasion (Figs. 10.7A and B).

• These abrasions are produced, when; force is applied perpendicular to the skin, i.e. at right angle.

• These abrasions are caused due to direct impact or imprint of the object or weapon to the skin at right angle. When
object strikes the skin, the object stamped the skin; skin gets depressed or compressed as per the pattern of the object
and reproduces the pattern of object.

Fig. 10.3. From the heaping of epithelium, direction of movement of causative weapon or
object can be known.

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Figs. 10.4A and B. Graze abrasion.

Fig. 10.5. Brush burn.

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Fig. 10.6. Graze abrasion formation.

• Examples—motor-tyre mark or radiator grill mark over skin in vehicular accident cases or whip marks on beating
with whip.

Pressure Abrasion
• Also called as crushing abrasion (Figs. 10.8A and B)

• Some authorities consider pressure abrasion as a type of imprint abrasion.

• These abrasions are caused by direct impact or pressure of an object over the skin accompanied by slight movement
resulting in crushing of superficial layer of skin. The pressure abrasion, due to crushing, on getting dried up resembles
parchment like and appears brown to black.

• Example of pressure abrasion includes—ligature mark found in hanging or ligature strangulation.

Figs. 10.7A and B. Imprint abrasion.

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Figs. 10.8A and B. Pressure abrasion; example: ligature mark in hanging.

Other Types of Abrasions

1. Contused abrasion (Fig. 10.9) and abraded contusion (Fig. 10.10): When the crushing force of the causative
object is more, then the weapon or object fails to imprint the pattern or design. The crushing will cause damage
of capillaries in the dermis with extravasation of blood (contusion) surrounding the abrasion. If the contused area
is more marked than abrasion, it is called as abraded contusion. Alternatively, if abraded area is more prominent
than contusion, it is called as contused abrasion.2

2. Postmortem abrasion (Figs. 10.11A and B): are the abrasions produced after death. These abrasions are pale white in
color and dry. Differentiation between postmortem and antemortem abrasion is given in Table 10.1. These abrasions
may be caused by ant bites or by mechanical force for e.g. dragging of body etc.

3. Ant bite marks in postmortem state may resemble abrasion. Ant bite marks are usually pale and are irregular in
shape (map like). They are mostly located in most regions of body such as axilla, groins, scrotum, nose, and mouth
or around eyes (Figs. 10.12A and B).

4. Fabricated abrasion: These are the abrasions inflicted by a person by oneself or with the help of others, with a
motive to implicate another person for false allegation of injuries.

5. Nappy abrasions: These abrasions are seen in infants due to excoriation of skin at the nappy area, i.e. groin and
buttocks. Fecal matter or excreta cause excoriation.

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Fig. 10.9. Contused abrasion.

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Fig. 10.10. Abraded contusion.

Figs. 10.11A and B. Postmortem abrasion.

Differential Diagnosis
Abrasions may be confused with:

1. Postmortem abrasions

2. Excoriation of skin by excreta

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3. Pressure sore/bed sore

4. Ant bites

Healing of Abrasion
• Abrasion heals by undergoing contraction of wound and replacement of lost tissues. Initially the abrasion will be
bright red in color and it is covered by scab composed of blood and lymph.

• Microscopically, there is cellular infiltration seen at about 4–6 hours and about 12 hours three layers are identified
consisting of surface zone of fibrin and red cells, a middle zone of polymorphonuclear cells and deeper layer of
damaged and abnormally staining collagen. At about 48 hours, epithelial regeneration is evident at periphery with
formation of granulation tissue at sub-epithelial area.

• Abrasions heal from periphery by new growth of epithelial cells. Usually, scab falls off by 7–10 days and leaves
pale hypopigmented area.

Figs. 10.12A and B. Ant bites resembling abrasion.

Table 10.1. Difference between antemortem and postmortem abrasion.

Features Antemortem abrasion Postmortem abrasion
Site At anywhere on body Over bony prominences
Color Bright red Pale, dry and parchment like
Covering Covered with scab composed of No such scab
coagulation of blood and lymph
Inflammation Signs of inflammation present No
Microscopy Congestion and vital reaction present No

Table 10.2. Age of abrasion.

Age Features
Fresh Reddish, no scab
12–24 hours Dark red scab
1–2 days Reddish brown scab

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Age Features
3–5 days Dark brown scab
5–7 days Blackish scab shrinks and falling begins from margin
7–10 days Scab falls off, leaving hypopigmented area

Age of Abrasion
Age of abrasion can be estimated. The features from which age is estimated are presented in Table 10.2. Also see
Figures 10.13 to 10.18.

Medicolegal Importance
1. Site of impact and direction of force used to inflict abrasion can be known.

2. Type of weapon/object that causes abrasion can be identified.

3. Time of assault can be determined from the age of abrasion.

4. Abrasions are usually simple injuries. However, abrasion over cornea may produce corneal opacity and restrict
vision of a person. Such hurt becomes grievous one.

5. Can give idea about some type of offenses committed. For example, abrasion near private parts of female may be
suggestive of sexual offense attempted or committed. Similarly abrasion at neck may be indicative of throttling.
Abrasion around mouth and nose may be suggestive of smothering.

Fig. 10.13. Fresh abrasion.

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Fig. 10.14. Dark red scab.

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Fig. 10.15. Reddish brown scab.

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Fig. 10.16. Dark brown scab.

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Fig. 10.17. Abrasion with falling of scab from periphery (margin).

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Fig. 10.18. Scab falls leaving hypopigmented area.

6. Abrasion may be only injuries present surface of deep seated or internal injury.

7. Presence of foreign material along with abrasions, such as sand particles, mud, dirt, grease etc. may connect the
injuries with scene of crime.

Contusion
Synonym: bruise

Definition
A contusion is an extravasation or collection of blood due to rupture of blood vessels caused by application of
mechanical force of blunt nature without loss of continuity of tissue.

Mechanism
Contusion is caused by blunt force impact causing crushing or tearing of subcutaneous tissue or dermis without
breaking the overlying skin (or mucous membrane). Due to rupture of blood vessels, there is extravasation of blood
out of vessels and collected underneath the tissue. Collection of blood is accompanied by swelling and pain. A pure
bruise lies beneath the intact epidermis (Fig. 10.19).

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Types
• Intradermal bruise

• Subcutaneous bruise

• Patterned contusion

• Deep bruise

• Tram-line contusion

• Six-penny bruises

• Horse-shoe-shaped contusion

• Contusion over organs

• Gravitating or shifting contusion

• Spectacle hematoma

Fig. 10.19. Mechanism of contusion formation.

Intradermal Bruise
• In this type, the bruise is situated in the sub-epidermal layer of skin.

• Patterned bruises are often associated with intradermal bruise. Due to superficial position of these bruises and
translucency of the skin that overlies these bruises, the patterned contusion becomes more prominent.

• The bruises are usually occurs at the point of application of force

• The margins in intradermal bruises are quite distinct.

• Examples—motor-tyre marks, impacts from whip, impact from rubber soles of shoes (Fig. 10.20).

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Subcutaneous Bruise
• These bruises are the commoner types and are located in the subcutaneous tissue often in the fat layer above the
deep fascia and therefore are fairly visible through the skin. Such bruise is called as superficial bruise (Fig. 10.21).

• If such bruises are located below the deep fascia, such bruises are called as deep contusions and these bruise take
time to appear over surface.

• The features of these bruises are that the margins appear blurred especially at the edges.3

Patterned Contusion
• In certain cases, the surface may show patterned contusion. These contusions are called as patterned contusions
because in such contusions, the imprint or design of the offending weapon or objected is imprinted over the skin.

Fig. 10.20. Intradermal bruise or patterned contusion.

• If such patterned contusions are present, they provide vital information regarding the nature of the offending object
or weapon.

• Examples—discoid contusions produced over neck in manual strangulation by finger tips, impression of motor-tyre,
impression of rubber sole of shoe, tram-line contusion etc. (Fig. 10.20).

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Shifting Bruise
• A bruise may appear at the site of application of mechanical force or may appear at different site from the initial
point of contact. Such bruises that appear at different site from the actual site of application of mechanical force
are called as shifting bruises.

• This sort of feature is frequently associated with deep-seated contusions.

• When the bruise is located in deep tissue then it takes time to appear at skin surface. The movement of bruise from
deep-seated tissue to surface is governed by number of factors such as fascial planes, anatomical structure of that
particular location and gravitational force acting.

• Example—let us take an example of contusion in forehead. If the victim survives for some period after sustaining
bruise than the contusion in forehead can slide downwards over the eyebrow and appear as black eye (Fig. 10.22).
Similarly bruises situated at arm or thigh may gravitate downward to appear at lower surface at elbow or knee.

• Such shifting of bruises from the point of impact to newer area are also called as migratory contusions and if they
appear at newer areas then such contusions are called as ectopic contusions or percolated contusions. Similarly
the occurrence of bruises to come out from deep site to surface is also called as come-out-bruise. This phenomenon
is due to hemolysis of blood. The freed hemoglobin stains the tissue more and more densely as time lapses.

Fig. 10.21. Superficial contusion.

Tram-line Contusion
• Also called as rail-road contusion or tram-track contusion.

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• These contusions are caused by blow with rod, stick, whip or belt etc.

• The contusion is characterized by two-parallel tram-track like lines of hemorrhages with intermediary area of skin
remains intact (Figs. 10.23A and B).

• Mechanism—blow with object like stick or rod over skin causes the skin beneath the part of contact of weapon to
get compressed. Due to compression of skin by the offending object or weapon, the blood in that part is displaced
sideways causing tram-track like hemorrhages on the side of the skin.

Six-penny Bruises
• These are the discoid shaped bruises of about a centimeter in diameter and resulted from fingertip pressure.

• These bruises are called as six-penny bruises because of the apparent resemblance with six penny.

• These bruises are usually found in neck region in case of manual strangulation.

Fig. 10.22. Shifting bruise—black eye.

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Figs. 10.23A and B. Tram-line contusion.

Fig. 10.24. Contusion of brain.

They may also be noted over the arms, forearms or wrist of children in child abuse cases caused by holding a child.

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Tissue and Organ Contusion
• Internal organs can be contused. A contusion of the brain with bleeding into the substance of the brain, may
initiate swelling with generalized accumulation of acid byproducts of metabolism that causes further swelling and
impairment of brain functions (Fig. 10.24). Contusion over brainstem often proves fatal.

• Heart is also vulnerable to contusion (Fig. 10.25). A small contusion on the heart may cause serious disruption of the
normal rhythm or cessation of cardiac actions by interfering with initiation and conduction of impulse responsible
for heart beating. Similarly, large contusion, due to swelling and interference with muscle action, often prevent
adequate cardiac emptying and lead to cardiac failure.

• Contusion of other organs may cause rupture of that organ's cellular covering with resulting bleeding, either slow
or brisk into the body cavity containing that organ (Figs. 10.26 and 10.27).

Fig. 10.25. Contusion over heart.

Factors
1. Condition of tissue—contusion results from extravasation of blood in the surrounding tissue. To accommodate
this extravasated blood, space should be present in the tissue. In lax tissue, comparatively more space is available
and therefore bruising occurs with ease in lax tissue such as eye socket or scrotum, whereas it is rare in dense tissue
such as sole of foot or palm of hand. Similarly, in fat people, there is greater volume of fat and therefore they are
more susceptible for easy bruising than the thin people.

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Fig. 10.26. Contusion over liver.

2. Body part—apparent prominence of contusion depends on the body part affected by the impact. Resilient areas or
yielding areas such as abdominal wall or buttock will bruise lesser than unyielding or rigid surface such as head,
chest or shin.

3. Situation of bruise—contusions located in dermis or in subcutaneous tissue above deep fascia are fairly visible
whereas bruises situated in deeper tissues are visible on dissection.

4. Condition of blood vessels—the amount of blood extravasated in the surrounding area depends upon the state of
blood vessels and coagulability of blood. In older individuals, the vessels being more fragile bruises easily and
heavily even with trivial trauma.

5. Presence of disease—concomitant presence of any disease such as bleeding diathesis, scurvy, liver disorder,
arteriosclerosis, purpura, leukemia, hemophilia, vitamin C and K deficiency, chronic alcoholic or certain
medications such as aspirin will leads to bruising easily in comparison with normal people.

6. Sex—women will bruise easily in comparison with male counterparts because of presence of abundant
subcutaneous fat and delicate tissues.

7. Age—older individuals’ bruises easily—vide supra. Children tend to bruise more easily than adult because of softer
tissue composition and less volume of protecting tissue.

8. Color of skin—bruising is more apparent and easily visible in fair skin person than dark complexion persons.

9. Optical character of skin—bruises localized near the surface have more reddish appearance while bruises in
deeper layer (subcutaneous) give a more bluish color impression. This is because of optical characteristics of skin.

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Blood localized in the subcutaneous tissue appears blue on the surface due to scattering processes in the dermis
(Rayleigh scattering) as the blue wavelengths of light are scattered (and thus reflected) to a greater extent than
the red wavelengths.5

Fig. 10.27. Contusion over kidney.

Repair and Healing

• With advancement in the age of bruise, the blood collected in contusion will begin to disintegrate causing hemolysis.
The process of hemolysis liberates hemoglobin. The freed hemoglobin breakdown into hemosiderin → hematoidin
→ bilirubin by tissue enzymes and histiocytes. With breakdown of hemoglobin and formation of these pigments,
certain colors changes are imparted to bruise that can be visualized by naked eye examination. These color changes
are utilized to estimate the age of bruises.

• The time taken for a bruise to disappear will depend on its size.6 In larger extravasation—the changes usually begin
at the margin and takes longer time to be absorbed than smaller contusions.3

• Microscopic examination—hemosiderin within macrophages may be seen as early as 24 hours after injury.7
Hematoidin is deposited as amorphous yellow granules. Neutrophils appear within one hour after injury and their
count increases gradually. Lymphocytes make their appearance after 24–30 hours.8

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Fig. 10.28. Age of contusion—diagrammatic representation.

Table 10.3. Age of contusion.

Age Changes Caused by

Fresh Red Fresh extravasation of blood
1–3 days Bluish Deoxyhemoglobin
4 days Bluish black to brown Hemosiderin pigment
5–6 days Greenish Hematoidin pigments
7–12 days Yellow Bilirubin pigments
2 weeks Complete disappearance of contusion —

Age of Contusion
There is temporal series of changes occurring in contusion in living person (Fig. 10.28). These changes are utilized to
estimate age of contusions. The changes are enumerated8–11 in Table 10.3. (Also see Figures 10.29 to 10.33).

Other Conditions
• Stomping—kicking and jumping on a person is known as stomping

• Battle sign—here hemorrhage gravitates along the fascial planes from basilar fracture of skull and percolates behind
and below the ear (see Chapter 12 for details).

• Postmortem contusion—it is stated that with greater degree of application of mechanical force in immediate
postmortem period results in contusion. In such cases, the hemorrhage is little and scarce and these contusions are
easily differentiated from antemortem bruises. The differentiating features are mentioned in Table 10.4.

• Love bites (hickeys)—they are usually elliptical type of patterned bruises. They are caused due to mixture of suction
and application of tongue pressure.12 These bruises are usually found over neck, breast and thighs. These lover bite
mark occurs, usually, during consensual lovemaking.

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Fig. 10.29. Fresh contusion.

Value of Bruise
Bruises have less value than abrasion because

• The size may not correspond with the size of offending weapon.

• The bruise may visible immediately or may be delayed in appearance.

• The bruise may shift from the actual site of assault to other site as ectopic contusion.

• The contusions do not indicate the direction of the force applied.

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Complications
• If inflicted on vital parts (e.g. neck, heart), the contusions may cause death.

• Multiple contusions may cause death due to shock and hemorrhage.

• The contusions are painful lesions.

• Multiple contusions of intestine may cause ischemia or gangrene.

• The collected blood in contusion may act as a broth for proliferation and multiplication of bacteria.

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• Pulmonary fat embolism—due to fat expressed from fat cells and then liquid fat entering the injured and torn blood
vessel may lead to pulmonary fat embolism.

Fig. 10.30. Bluish contusion.

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Fig. 10.31. Bluish black contusion.

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Fig. 10.32. Bluish black to brown contusion.

Fig. 10.33. Greenish contusion.

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Table 10.4. Differences between antemortem and postmortem contusion.

Features Antemortem contusion Postmortem contusion
Swelling Present Absent
Extravasation of blood Present Absent
Signs of inflammation Present Absent
Hemorrhage Considerable Insignificant

Differential Diagnosis
The bruise may be confused with:

1. Postmortem lividity (Table 10.5)

2. Congestion (Table 10.6)

3. Artificial bruise

4. Purpura—bruising need to be differentiated from purpura. Purpura develops spontaneously in those persons with
a hemorrhagic tendency (Fig. 10.34). If confusion exists then give superficial incision over the lesion. Contusion
will reveal extravasation of blood whereas purpura or other pathological bleed will have clear area. This is called
“cut test” (Fig. 10.35).

Table 10.5. Differences between contusion and postmortem lividity.

Features Contusion Postmortem lividity
Caused by Rupture of vessels with extravasation Due to stasis of blood in the vessels
of blood due to application of
mechanical force
Site Any site Only on dependent part
Surface Elevated due to swelling Not elevated
Swelling Present Absent
Color Variable, depends on the age of Usually purplish blue
contusion
Edges Ill-defined Well-defined
Incision Show extravasation of blood in the Shows blood in vessels with oozing
surrounding tissue and cannot be of blood from vessel and can be
washed off washed off
Microscopy Signs of inflammation No signs of inflammation

Table 10.6. Differences between contusion and congestion.

Features Contusion Congestion
Caused by Blunt mechanical force Pathological condition
Color Variable, depends on the age of No change of color
contusion
Margins Diffuse and ill-defined Well-defined

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Features Contusion Congestion

On dissection Extravasation of blood Engorged vessels with blood

Fig. 10.34. Purpura or spontaneous pathological bleed may be confused with contusion.

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Fig. 10.35. Cut test to differentiate between contusion and pathological bleed. Here, in this
photograph, no extravasation of blood therefore said lesion is not contusion.

Artificial Bruises
Artificial bruises are produced due to application of some irritant substance or juice to the skin. Such irritant substance
produces inflammation and vesication simulating bruises. These contusions are produced with malicious intention
to make false allegations against somebody or to implicate someone else. Table 10.7 provides substances causing
artificial bruises and Table 10.8 mention differentiating features between contusion and artificial bruises.

Medicolegal Importance
1. Offending weapon can be known.

2. The age of injury can be determined.

3. Character and manner of injury can be known.

4. Application of degree of violence can be estimated.

5. A bruise is usually simple injury but if present on vital parts or organs may amount to grievous hurt or may cause
death.

6. Injection of embalming fluid often enhances the appearance of a contusion on the body surface.14

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LACERATED WOUNDS
Definition
Lacerated wound is form of mechanical injury caused by hard and blunt force impact characterized by splitting or
tearing of tissues.

Table 10.7. Causes of artificial bruises.

Marking nut
Calotropis
Plumbago rosea
Plumbago zeylanica

Table 10.8. Differences between contusion and artificial bruise.

Features Contusion Artificial bruise
Cause Blunt mechanical force Application of irritating substance/
juice
Situation Anywhere On accessible part of body
Color Variable, depends on the age of Dark brown
contusion
Margin Diffuse and ill-defined Well-defined
Shape May take shape of offending weapon Irregular
Contents Blood Serum
Itching Absent Present
Vesication Absent Present
Chemical analysis Negative Positive for causative substance

Mechanism
When the skin or other structures are subjected to blunt forces, the tissue gets crushed or stretched beyond the limits
of their elasticity leading to tearing of the skin or other tissue thus producing laceration. Laceration differs from the
incised wounds because in laceration, the continuity of the tissues is disrupted by tearing rather than clean slicing
(Figs. 10.36A and B).

Types
Following are the types of lacerated wounds:

1. Split laceration

2. Stretch laceration

3. Tear laceration

4. Avulsion laceration

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5. Crush laceration

6. Cut laceration

Split Laceration
• Also called as incised looking laceration (Fig. 10.37A)

• Split lacerations are caused by blunt force splitting the thickness of the skin most frequently when the skin and soft
tissues are crushed between impacting force and underlying bone.

• These types of lacerations are usually found in body parts with underlying bones without much tissue in between.

• Common sites include—scalp, face, shin etc.

• Due to splitting of skin these lacerations appear like incised wounds.

Figs. 10.36A and B. Mechanism of lacerated wound formation. (A) The head is hit by hard
and blunt object that results in lacerated wound as shown in Figure B.

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Figs. 10.37A and B. Split laceration.

Stretch Laceration
• Stretch laceration results due to over-stretching of the fixed skin till it ruptures. In such type of lacerated wound,
there is localized pressure with pull that causes tearing of the skin. Thus, a pulling force causes stretch laceration
(Figs. 10.38A to C).

• Example—if pressure is applied over the thigh stretching the skin toward knee, then such force can cause laceration
along the inguinal line.

• Striae-like lacerations or stretch mark-like lacerations are also considered as a variety of stretch laceration (Fig.
10.39). These lacerations are superficial and multiple and mostly located at groins. They are usually present in road
traffic accident victim when body part (usually thigh or abdomen) is run over. The crushing weight of the vehicle's
wheel provides the pulling and stretching of the skin (Fig. 10.38B).

Tear Laceration
• It is common form of laceration (Figs. 10.40A and B).

• In this type, tearing of the skin and subcutaneous tissue occurs from localized impact by hard and blunt force.

• The acting force from object or weapon rips the skin or tissues producing the laceration.

Avulsion Laceration
• Also called as flaying injury or grind laceration (Figs. 10.41A and B).

• Avulsion laceration occurs due to grinding compression of the tissues to such an extent that the skin gets detached
from the deeper tissues thus resulting in the gloving of the skin.

• Here, large area of the skin and subcutaneous tissue is rolled off from body part, almost always by the rotary action
of the causative object such as rotating motor wheel or tyre.

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Figs. 10.38A to C. Stretch laceration.

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Fig. 10.39. Striae-like lacerations.

Crush Laceration
• Here grinding and compression force causes crushing of tissues underneath. This form of injury may cause total or
partial amputation of the affected body part for example, limb (Figs. 10.42A to D).

• It may also be associated with avulsion and/or stretch laceration.

Cut Laceration
• Some textbook describes this form of laceration and stated that it is caused by not-so-sharp edge of weapon.8,9
However, many authorities consider it as a sort of incised wound and prefer not to group such injuries under the
term—lacerated wound.1,15

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Figs. 10.40A and B. Tear laceration.

Figs. 10.41A and B. Avulsion laceration.

Patterned Laceration
• Up to some extent, some weapons may produce patterned laceration but the patterns are not prominent like patterned
abrasion or bruises. From some injury pattern, some weapons shape may be recognizable. The examples are given
below:

• Blow with hammer head with circular face may produce a circular or an arc of circle (crescentic) shaped laceration.

• Long and thin objects may produce linear laceration.

• Heavy focal blow may cause a linear or a stellate shaped laceration.

Boxer's Laceration
These are found in boxer's engaged in active boxing and develops when a boxing glance presses on the orbital margin.

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Features (Figs. 10.43 to 10.45)

• In lacerated wounds, continuity of the tissues or skin is disrupted by tearing or splitting rather than by clean slicing
as observed in incised wound.

• Lacerated wound is a three-dimensional injury having length, breadth (width) and depth.

• Margins—the margins are irregular and ragged and may be slightly inverted.

• Lacerated wounds gape open

• There may be bruising and crushing of the edges often placed in a narrow zone and requires lens for viewing.

• The underlying blood vessels, nerves and delicate tissue bridges may be observed in the depth of wound.

• Hairs bulbs are crushed.

• There is absence of sharply linear injury in the underlying bone.

• The ends of the lacerations at angles may show shallow tears, diverging from main laceration itself. Such small
tears are known as shallow tails.

• Bleeding from lacerated wound is less in comparison to incised wound because the vessels are torn and crushed.
The crushed vessels are capable of retracting and undergo thrombosis thus causing less hemorrhage.

• Foreign body or matter may be driven in the lacerated wound or may be soiled by grit, paints, fragments or glass etc.

• The shape and size of lacerated wound may not correspond to the causative weapon or object. However, sometimes
peculiar weapon may leave patterned lacerated wound—vide supra.

• Examination of lacerated wound will reveal the direction of the application of the force or how the blow was applied
to effect the laceration. The more undermined edge of the laceration is the side toward which the force of striking
object was directed; the slopped side of the laceration is that side from which the blow was directed. Similarly the
side of laceration with adjacent contusion is often the side from which the force was directed.4

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Figs. 10.42A to D. Crush laceration.

Laceration of Organs
Lacerations of the internal organs are caused due to application of blunt mechanical trauma. It may possible that
externally no injury may be evident but internal organs may suffer damage. For example, if kick is applied over yielding
surface such as abdomen, externally there may be no evidence of injury but internally may cause injury to pancreas.16

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Fig. 10.43. Features of lacerated wound.

Fig. 10.44. Lacerated wound. Note the margin and protrusion of subcutaneous fat.

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Fig. 10.45. Incised wound. Note the clean margin, subcutaneous tissue and fat and shape.

Courtesy: Dr. Mukund Jadhav.

Complication
1. Hemorrhage and shock

2. Death

3. Infection—act as portal of entry for bacteria

4. Pain and dysfunction of the affected body part

Medicolegal Importance
1. Cause of injury can be known.

2. Type of lacerated wound may be known.

3. Nature of injury can be ascertained—whether (simple) hurt or grievous.

4. Foreign bodies present in wound may help in identification of the offending weapon/place of incident etc.

5. Age of injury can be estimated.

6. It can be known whether the injury is accidental or suicidal or homicidal.

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7. Direction of application of force can be known.

8. It may be confused with incised wound. The differentiating features are mentioned in Table 10.9.

9. Differences between antemortem and postmortem laceration are mentioned in Table 10.10.

INCISED WOUND
Synonyms: slash, cut.

Definition
An incised wound is form of mechanical injury characterized by orderly solution of skin and tissues by a sharp cutting
weapon or force.

Mechanism
• Incised wound may be produced by light sharp cutting weapons like kitchen knife, razor, scalpel etc. moderately
heavy sharp cutting weapons like knife, kookri etc. or heavy sharp cutting weapons like sword, chopper, axe etc.

• The force is delivered over a very narrow area corresponding with the cutting edge of the blade of weapon.

• An incised wound may be produced by following mechanism (Figs. 10.46A to D):

• By striking the body with sharp cutting edge.

• By drawing or swiping action of the weapon on the body—such action will produce tailing at one end of incised
wound (Fig. 10.47).

• By sawing—using the weapon saw-like. Sawing action of weapon results in production of more than one incised
wounds on the skin at the beginning of the wound, which merges into one wound at the end (Fig. 10.48).

Table 10.9. Differences between lacerated wound and incised wound.

Feature Lacerated wound Incised wound
Edges Lacerated, irregular, ragged Clean cut
Bruising of margins Present No bruising
Injury to blood vessels, nerves Crushed Clean cut
Hair bulbs Crushed Clean cut
Bleeding Less More
Underlying bone No sharp injury Sharp linear injury

Table 10.10. Differences between antemortem and postmortem lacerated wound.

Feature Antemortem Postmortem
Extravasation of blood Present Absent
Coagulation of blood Present Absent
Increase enzyme activity Present Absent
Signs of healing Present Absent
Pus/infection Present Absent

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Features
• Incised wounds are always broader than the edge of the weapon causing it because of retraction of the divided tissues.

• Often, it is somewhat spindle-shaped and gaping but may be zigzag if the skin is lax like skin of scrotum or axilla
(Figs. 10.45 and 10.49).

Figs. 10.46A to D. Mechanism of incised wound production. (A and B) Incised wound

produced by striking force. (C and D) Incised wound produced by drawing the weapon.

• The length of incised wound is greater than the breadth or depth of wound.

• Margins—margins of incised wounds are clean-cut, well-defined (Fig. 10.50). Mostly the margins are everted but
may be inverted in some, especially if thin layers of muscle fibers are closely attached to the skin as in scrotum.15

• Deeper tissues are all cut cleanly in the same plane.

• The length of incised wound has no relation to the length of the cutting edge of the weapon.

• If incised wounds are inflicted on body areas with loose skin, as in axilla, the wound appears irregular due to
puckering of skin occurring at the time of cutting the tissue.

• Usually, the starting end of incised wound is deeper than end part because the wound gradually becomes shallower
and may ends in a “tailing” or scratch tailing. The tailing off of an incised wound indicates the direction in which
the weapon was drawn off (Fig. 10.51).

• Hemorrhage in case of incised wound is more in comparison with lacerated wound because the blood vessels are
cleanly cut. The clean-cut ends are not effectively retracted and bleed considerably.

• If the weapon is struck obliquely on the body part, it will cause beveling of one edge and undermining of other edge.
Undermined edge indicates the direction from which the slashing stroke was made (Figs. 10.52 and 10.53).

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Fig. 10.47. Drawing or swiping action of the weapon on the body can produce tail.

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Fig. 10.48. Incised wound produced by sawing like mechanism. Note more than one wound
merging into each other.

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Fig. 10.49. Features of incised wound.

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Fig. 10.50. Note the clean cut margins of incised wound.

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Fig. 10.51. Tailing at end of incised wound.

Glassing Injuries
These are the slash injuries caused by broken glass or broken glass bottle.

Self-inflicted wounds (Figs. 10.54A and B)

• These injuries are on the accessible part of the body.

• They are usually superficial or minor.

• They are regular.

• Similar in style or shape.

• Multiple.

• Parallel or grouped together.

• Handedness—in right-handed person, injuries are predominantly on the left side and for left handed person; the
injuries are inflicted on right part of body.

• Tentative cuts (also called as sympathy cuts) may be evident:

• Old scars of previous attempt of self-infliction may be noted.

• There may be any underlying psychiatric disorder.

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Fig. 10.52. Incised wound showing beveling of one edge and undermining of other edge.

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Fig. 10.53. Incised wound showing beveling of one edge and undermining of other edge.

Figs. 10.54A and B. Self-inflicted incised wounds.

Defense Wounds
• Defense wounds are the injuries inflicted to a person when he tries to defend himself against an attack and are the
result of instinctive reactions to assault (Fig. 10.55).

• The person may ward-off the weapon or trying to catch or grabbing the weapon—cuts the palm and ulnar aspect
of hand.

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• To protect the exposed surface of body, the upper limbs—extensor surface of forearms (ulnar side), the lateral/
posterior aspect of arm and dorsum of hand may receive injuries.

• Similarly the anterior and posterior aspects of lower limbs and back may be injured when an individual curls into a
ball with flexion of spine, knees and hips to protect the anterior part of body.17

Medicolegal Importance
1. Cause of injury can be known.

2. Nature of injury can be ascertained—whether simple or grievous.

3. Age of injury can be estimated.

4. It can be known whether the injury is accidental or suicidal or homicidal.

5. Direction of application of force can be known.

6. It may be confused with lacerated wound. The differentiating features are mentioned in Table 10.9.

7. Self-inflicted injuries—vide supra

8. Defense injury—vide supra

9. Fabricated wounds—refer Chapter 14.

CHOP WOUND
Definition
Chop wounds are type of incised wounds made by hacking or chopping motion with a fairly sharp and relatively heavy
weapon.

Features
• Chop wounds are produced by relatively heavy sharp cutting weapons such as axe, chopper, sword (Figs. 10.56A
and B).

• The edges of chop wounds are not so sharp akin to incised wound and often the margin shows bruising or abrasion.

• The weight of weapon act as crucial force to penetrate the weapon into tissues considerably.

• The wound is comparatively wider and deeper than incised wound.

• If the wound is inflicted obliquely, margin may show beveling.

• Two parts in the chop wounds may be identified. The part of wound nearer to the assailant, known as heel end of the
chop, is deeper than distal part from the assailant—known as toe end of the chop (Fig. 10.57). Thus identification
of toe and heel end of the wound may offer help to know the relative position of the assailant and the victim.8

Medicolegal Importance
1. Chop wounds are usually homicidal in nature however, accidental injuries may be sustained by a person working
in factories etc.

2. From the heel or toe end, the relative position of the assailant and the victim can be known.

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Fig. 10.55. Defense wound.

Figs. 10.56A and B. Chop wound.

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Fig. 10.57. Features of chop wound.

3. The type of weapon used can be known.

4. Age of injury can be known.

STAB WOUNDS (PUNCTURE WOUNDS)

Definition
Stab wound is a piercing wound produced by application of mechanical force along the long axis of a narrow or
pointed object.

Classification
Stab wounds are classified on following basis (Fig. 10.58):

• Based on depth of penetration

• Penetrating wounds

• Perforating wounds

• Based on the causative weapon

• Incised stab wounds – these wounds are caused by sharp edged, pointed weapons. They are further sub-classified
as:

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• Penetrating wounds

• Perforating wounds

• Lacerated stab wounds—these wounds are caused by not so-sharp weapons or relatively blunt penetrating
weapons. Such injuries can be caused by metal spike, wooden stake, garden fork, farm fork, screwdrivers, work-
tool etc. They are further sub-classified as:

• Penetrating wounds

• Perforating wounds

Penetrating Wounds
• These are the stab wounds that terminate in the tissue/organ/cavity (Fig. 10.59A)

• In these wounds, only one surface wound is present on body due to entry of blade and no exit wound as the stab
terminates in the tissues/organ/cavity.

Fig. 10.58. Classification of stab injuries.

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Figs. 10.59A and B. Stab wound. (A) Penetrating wound. (B) Perforating wound.

Perforating Wounds
• These are the stab wounds that are passing the body through-and-through (Figs. 10.59B and 10.60)

• In these wounds, two separate surface wounds will be observed over body; one caused by the entry of weapon and
another caused by the exit of the weapon. The former is called as entry wound and later, the exit wound.

• Entry wound is usually larger than the exit wound because the weapon tapers toward the tip.

• The edges of entry wound are usually inverted while in case of exit wounds, the edges are everted.

• Foreign bodies such as cloth fabric/hairs etc may be found in tract or near entry wound. The clothes may be pushed
in the entry wound.

• Joining the entry and exit wound gives direction of infliction of injury.

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Fig. 10.60. Diagrammatic representation showing entry wound, exit wound and track.

Features
Puncture wounds are popularly called as stab wounds. A stab wound by sharp, pointed and cutting edge weapon is a
kind of incised wound that is deeper than its width.

1. Type of weapon used and wound caused (shape of wound):

• The type of weapon usually means the type of blade and it includes whether it is sharp cutting or blunt edge?
Whether it is single edged weapon or double-edged weapon? If single edged, what is the nature of the back edge?
Whether it is serrated or squared-off? Whether the blade tapers from hilt to tip? (Figs. 10.61A to E).

• Commonly knife is used to inflict stab wounds however, any weapon with pointed end or relatively pointed end
can be used such as—knife, scissors, sword, sharp tools, modified tools, screwdrivers, shears, ice-picks, broken
bottle, broken china etc.

• Most of the knives have a single sharp edge and other edge being blunt or modified. Such weapon may produce
wedge shaped stab wound with one end of the stab appear sharply cut like “V” point and other blunt (see Figs.
10.61A to E). The sharp angle represents injury caused by sharp edge of blade and blunt angle by blunt edge of
weapon. However, it has to be remember that such pattern is caused by weapons which have obvious differences
between one sharp edge and other blunt edge (it may be modified as rounded or square-off).3 If such pattern of
injury is visible, a medical examiner can say that a single-edge weapon was used. Moreover, it is not necessary
that it almost have such feature as discussed above. If the blunt edge is not obvious, the weapon may cause both
angles sharp instead of one blunt and other sharp angle. In some weapons, one edge is sharp throughout and other
edge is made sharp at distal part near the tip of blade with residual part of edge remaining blunt. When such
weapon is used, the initial part of blade being sharp on both edges pierces the skin and as weapon advances in
the body, the skin often splits behind the blunt edge to produce a symmetrical appearance.

Figs. 10.61A to E. Stab wound. (A) Stab wound caused by blade with both edges sharp
resulting in spindle shaped; (B) Wedge shaped wound or tear drop wound if one edge
of blade is sharp and other is blunt; (C) Round shape wound resulting from round
object; (D) Fishtail appearance of wound resulting from weapon with one edge sharp

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and other edge square-off; (E) Rectangular shape or slit like wound that is caused due
to rectangular objects.

• When one edge of weapon is sharp and other edge is made squared or flat, such weapon when used for stabbing
may split back slightly from each corner of the angle, produced by non-sharp edge of weapon, forming the so
called “fish-tail appearance”18,19 (see Figs. 10.61A to E).

• If one edge of a weapon is sharp and other edge is serrated, the angle produced by serrated edge may be torn or
ragged in appearance and at times, when weapon is thrust obliquely, may leave serrated abrasions on the skin
adjacent to the end of wound.

• If the weapon has a hilt and is propelled into full extent of the blade in the body, then there may be a hilt contusion
or abrasion on the skin surrounding the wound. Presence of such hilt abrasion or contusion indicates that blade
of weapon was pushed completely in the body and indicates force used for stabbing (Figs. 10.62 and 10.63).

• External appearance of the wound may vary and resemble the cross-section of the weapon or blade of the
weapon. Therefore, a stab wound may have spindle shape (Figs. 10.64A to C) or elliptical appearance or fish-
tail appearance or ovoid or rounded or may be notched if accompanied by rocking.

2. Depth and thrust

• If, for example, knife is used for stabbing and the knife is withdrawn along the same track then it will form a track
inside the body and the measurements of wound will indicate the dimensions of weapon. Thus the depth of stab
wound is important parameter to assess the length of weapon used. However, as routine in forensic medicine,
caution should be exercised while assessing the length of weapon blade from depth of the wound. Because, the
depth measured at autopsy may be actually more than the length of blade of a weapon and this phenomenon is

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commonly encountered over body parts that are yielding or compressible such as abdomen, chest. Due to forceful
thrust of weapon (for example, with knife) over abdomen, the abdomen may be momentarily compressed or get
indented at the impact site. Due to compression of body part, the tip of blade will penetrate more in depth than
anticipated and apparently wounded that part that would have been out of reach. Now if same weapon is used to
inflict on non-yielding part, say for example, head then blade would not penetrate deeper than its length.

Figs. 10.62A and B. Stab wound with hilt abrasion. (A) Weapon is penetrating skin
perpendicularly and completely thus producing hilt abrasion around wound. (B)

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Weapon is being thrust obliquely thus producing hilt impression on one side where hilt
comes in contact (see text for details).

Fig. 10.63. Stab wound with hilt abrasion. (black arrow indicates abrasion)

3. Movement of weapon in the wound

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• If, for example, knife is used for stabbing a person and the knife is withdrawn along the same track after inflicting
the stab then the knife will form a injury inside the body called as tract of stab wound. Measurement of such
track would indicate the dimension of the knife used to cause stab. However, caution should be exercised while
opining the dimension of alleged weapon by mere track measurement. Now suppose, if a person causes stab to
another person with knife and he do not withdraw the knife along the same track but rotate the knife (rocking of
weapon), then there will be greater wound defect. The term rocking is used when the weapon is moved inside the
wound with leverage or angulation in the plane of wound. Due to rocking, the cutting edge of weapon extends the
wound. The rocking can be done by the assailant with active movement of weapon inside the wound or may be
done by the victim due to body movement in relation to knife (weapon). In some cases, both mechanisms may act.

4. Direction of stab wound

• A Doctor has to determine the direction of the wound in relation to the axis of the body. Direction depends upon
the entry wound, the track and the exit wound if present. Careful dissection of the body in layers would reveal
the track of the wound. With advancement in imaging techniques, attempts had been made to gauge the direction
of wound by filling the wound defect with radio-padue dye and X-ray films taken. However, these radiopaque
substances often exhibit leaks making more difficult to access the track. In similar pursuit, magnetic resonance
imaging (MRI scan) has been attempted but these facilities are lacking in developing countries like India.

Figs. 10.64A to C. Stab wound.

5. Pattern of stab injuries

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• If the weapon used for stabbing, enters the skin obliquely, the edge of the wound that first cut the skin becomes
beveled while the other edge overhangs the wound.

6. Dimension of wound

• Length of stab wound is usually corresponds with that of breadth of blade. However, the length of wound may
be shorter in measurement than actual breadth of blade. This shortening of wound is due to elasticity of skin,
gaping of wound and contraction or postmortem shortening of underlying muscles, especially when the muscle
fibers are cut across.

• The wound usually gaps across the center to form a long ellipse. The extent of gaping depends upon the anatomical
situation of wound over the body and whether the stab wound inflicted is in the line with or across the tension of
Langer's lines or underlying muscle fibers. Therefore, a stab wound with the long axis at right angle to the elastic
tissue of Langer's lines will gape open with the edges pulled apart by elastic tissues. Thus, the wound appears
wide and short (Figs. 10.65A and B). If the wound is parallel to the elastic tissue lines, it will appear narrow and
long and the gaping of wound will not be prominent.4

• When the edges are apposed, the length of wound should be measured as it more accurately approximates to the
breadth of blade when it was in situ.

• Depth of stab wound is more than length and breadth.

Figs. 10.65A and B. Stab wound. (A) Stab wound appears short and wide because the long
axis of wound is at across to muscle fibers or elastic tissue of skin; (B) The wound is parallel
to muscle or skin plane and thus it appears narrow and long.

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Medicolegal Importance
1. Type of weapon used can be known.

2. Dimensions of weapon can be known.

3. Movement of knife in the wound can be known.

4. Depth of thrust can be known.

5. Direction of thrust can be known.

6. Amount of force used can be known.

7. Age of wounds can be known.

8. Manner of infliction—suicidal/homicidal/accidental can be known.

Healing of Injury (Lacerated Wound, Incised Wound and

Stab)
• Healing is a body response in an attempt to restore normal structure and function of the injured body part.

• Healing is accomplished with regeneration and repair process.

• Either a wound heals with primary union (first intention) or secondary union (second intention).

• Immediately after injury, the space between the wound is filled with blood and then blood get clotted and seal the
wound.

• There is acute inflammatory response and within 24 hours polymorphs appear. On gross examination, the margins
become dry.

• By 3rd day polymorphs are replaced by macrophages. On gross examination swelling subsides. Fibroblasts arrive
at the wound part.

• The basal cell of epidermis from wound margin starts proliferation in form of epithelial spurs.

• Approximately the wound is covered by a layer of epithelium in 48 hours.

• By 5th day, a multi-layer new epidermis is formed and then differentiates into superficial and deep layer.

• By 5th day collagen fibrils start forming.

• In 4 weeks the scar tissue with epithelialized surface is formed.

FRACTURES
Definition
Breach in the continuity of bone due to application of mechanical force or other traumatic agent is called as fracture.
The force applied to bone may be direct or may be indirect.

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Classification
Fracture are classified by various means such as:

1. Based on etiology

• Traumatic fracture—fracture resulting from application of mechanical force.

• Pathological fracture—due to some pathology or disease, the bone is weak and sustains fracture.

2. Based on displacements

• Undisplaced

• Displaced

3. With relation to skin and external environment

• Simple fracture (close fracture)—the overlying skin and tissues are intact (Fig. 10.66).

• Compound fracture or open fracture—here the overlying skin and tissues are torn and communicating with the
exterior (Fig. 10.67)

4. Based on pattern of fracture

• Transverse fracture

• Spiral fracture

• Oblique fracture

• Segmental fracture

• Comminuted fracture

5. Direct fracture

• Focal fracture

• Crush fracture

• Penetrating fracture

6. Indirect fracture

• Traction fracture

• Angulation fracture

• Rotational fracture

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Fig. 10.66. Close fracture.

• Vertical compression fracture

• Angulation-compression fracture

20
Complication of Fracture
Early Complications
• Shock

• Injury to vessels, muscles, tendons

• Injury to joints

• ARDS

• Fat embolism

• Deep vein thrombosis

• Pulmonary embolism

• Compartment syndrome

• Crush syndrome

• Aseptic traumatic fever

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Delayed Complications
• Septicemia

• Delayed union

• Nonunion

• Malunion

• Avascular necrosis

• Joint stiffness

• Sudeck's dystrophy

• Osteomyelitis

• Ischemic contracture

• Myositis ossificans

Medicolegal Importance
1. Fracture of bone constitute grievous hurt.

2. Fracture accompanied with vessel injury may endanger life.

3. Fracture associated with injury to nerve may cause deformity or loss of function.

4. Multiple fracture with hemorrhage may cause death of a person.

5. Age of injury can be known.

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Fig. 10.67. Compound fracture.

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