INJURIES ON LIMBS AND OTHER AREAS

INJURIES ON LIMBS AND OTHER AREAS

Injuries to the upper limbs act as very important landmarks for various medicolegal informations. Apart from the different types of injuries located at different sites, there are many other informations which can be known from them. These are –

1. Self-inflicted or fabricated injuries, are most commonly inflicted on the upper limbs and sometimes on the lower limbs and other places. The sites of self inflicted incised wounds on the upper limb may be at the anterior aspect of the wrist or forearm.

2. Defence wounds are most commonly incised wounds, and are most commonly located on the medial and postero-medial aspects of the forearm, on the dorsum of hand, wrist, and on the palmar aspects of hand and fingers. On the arms and the dorsal aspect of the hands, these injuries are due to the attempt on the part of the victim, to prevent a serious assault. The features of the defence cuts on the palmar aspect of the hand and fingers will depend on whether the blade of the weapon is single edged or double edged. Here the defence cuts are caused due to holding of the blade of the weapon by the victim with an attempt to prevent its use on him.

INJURIES ON LIMBS AND OTHER AREAS3. Amputation of the arm or the hand at any level may be caused due to chopping with a sharp-cutting heavy weapon.

4. Abrasions or sometimes contusions may be caused during struggle or due to fall on the ground, these injuries may be caused over the back of the elbow or at the base of the palm.

Injection marks over the deltoid area, at the fold of the elbow or on the dorsum of the hand may easily be overlooked, if not searched for very cautiously.

Over the BUTTOCK, there may be linear bruises or abrasions. Grazed abrasions over these areas may also be caused in traffic accidents, as secondary injuries. Recent or old injuries may be present involving the anal sphincter in a passive sodomite in case of recent or old act of sodomy respectively.

Injuries over the PRIVATE PARTS may be caused in connection with sexual assault or otherwise. There may be nail-scratch abrasions or bruises over the labias and inner aspects of the thighs, in addition to the rupture of the hymen and congestion around the introitus and in the vagina in a woman who has been recently sexually violated.

Nail scratch abrasions on the penis with tear of the frenum may be present in the rapist, when the victim attempts to prevent intermission of the penis.

Occasionally, the penis of a rapist is amputed.

A kick over the scrotum may produce a haematocele. In being run over by a vehicle, the skin from over the penis and the scrotum may get removed, exposing the testicles.

Attempt to procure abortion with the help of an abortion stick or a root or an instrument may injure the vaginal wall, particularly near the fomix, the cervix, the uterus and the intra-abdominal structures.

Incised wound over the scrotum may take irregular shape due to looseness of the skin and due to the presence and contraction of the superficial dartos muscles.

Any type of injury may be caused on the thighs and the legs due to various types of impacts. Abrasions are common on the anterior aspects of the knee joints, due to a fall. Snake bite punctures are usually found on the legs or feet. Medial malleoli are the usual sites for venesection.

Fracture of the neck of the femur is a common occurrence in elderly subjects which may be caused even due to fall from a cot of low height. Fracture of femur is particularly likely to cause fat emboli.

In road traffic accident cases, fracture of hip bones is very common with excessive haemorrhage in the pelvic cavity.

Fracture of the vertebral column may occur at any level due to direct or indirect impact. With fracture of vertebral bone or bones, there will be corresponding injury to the spinal cord, along with the covering meninges. As a result, there may be paraplegia or hemiplegia with loss of sensory function alongwith. Fracture of the lumbar vertebrae at 3rd or 4th level may cause impotence.

RAILWAY SPINE is a condition which occurs due to mild to moderate degree compression of the spinal cord, met with in cases of railway accidents, when there is temporary paralysis of the parts of the body covered by the spinal cord and the nerves, at or below the level of the compressed area. The compression of the spinal cord is usually due to effusion of blood or due to oedema. Such paralysis is gradually relieved within 2-3 days. Whip lash injury (contusion) of the spinal cord is caused due to forceful to-and-fro movement of the vertebral column, in case of vehicular or railway accident.

Injury to the vessels or nerves usually occurs alongwith injury of the neighbouring soft tissue or the bone. In suicidal or homicidal attempts, sometimes the superficial veins or arteries are selectively cut. The vessels usually injured are – jugular vein, radial or brachial artery or femoral vessels. Sharp tear of a vessel with excessive haemorrhage may occur even due to a blunt force impact, when the vessel is superficial and over a bone. Arterial bleeding has a spurting effect but venous bleeding occurs in drops. Loss of about 1/3rd of the total amount of the blood of the body in a short period if not replaced immediately at least partially, may cause rapid death.

Injury to the DIAPHRAGM may occur due to the upward punctured wounds of the abdomen, downward punctured wounds of the chest or transverse punctured wound of the lower part of the chest. Though very unusual, rupture of the diaphragm may occur indirectly due to heavy pressure over the abdomen. Fracture rib or crush injury involving the chest and abdomen may cause rupture of the diaphragm.

BURN INJURIES of any degree may involve any part of the body, but burns of palms, of the scalp tissue (being covered by hair) and the soles are comparatively less common. Burns of the face neck, and pudendal region are most dangerous. Absence of burn injury on the back part, when it is present on all other parts of the body, indicate that the burning is either postmortem in nature or has been caused in an unconscious state of the victim.