It is important that anyone who is involved in injury assessment understand the range of terms that can be applied to different injury, and this may depend on certain factors, such as country of origin or medical specialty. Thus, each practitioner should have a system of his or her own that ensures that the nature of each injury is described clearly, reproducibly, and unambiguously in note form, using accepted terms of classification. The most common reason why medical evidence on injuries given in court is contentious is the confusing assortment of terms used by doctors and the inappropriate or inaccurate description of a wound, for example, using the term laceration to describe a clean-cut wound caused by a bladed weapon, such as a knife, when the wound was, in fact, an incision (4). It is therefore essential that for medicolegal purposes a standard nomenclature be adopted when describing injuries. The following classification is one that is appropriate and clear, and most visible injuries will fall into one of the groups listed in Table 3. These injuries type are explained in the following paragraphs.
Deliberate injury may be divided into two main types: blunt impact or blunt force injury and sharp implement injury. Blunt force injury describes the cause of injuries not caused by instruments or objects with cutting edges. The injury may be caused by traction, torsion, or shear stresses. The body may move toward the blunt object (e.g., a fall or push against a wall), or the blunt object may move towards the body. Examples of objects that cause blunt impact injuries include fists, feet, baseball bats, and police batons. A blunt force blow can cause a range of symptoms or signs, and the resultant injuries depend on numerous factors, including force, location, and impacting surface, which range from no visible evidence of injury to tenderness or pain at the impact sites, reddening, swelling, bruising, abrasions, cuts (lacerations), and broken bones. Each injury type may be present alone or in combination. Such injuries are seen at the point of contact of the impacting object on the body. Bruises may migrate from the point of contact by gravity after a period of time. Abrasions give a clear indication of the impact site. In some cases, injury patterns may indicate whether a particular impacting object was involved. Blunt impact injuries can be described in terms of force applied as being weak, weak/moderate, moderate, moderate/severe, or severe.
Sharp injuries are those caused by any implement with cutting edges (e.g., knives, scissors, or glass). The injuries may be of varied types, including incised, where the cutting edge runs tangentially to the skin surface cutting through skin and deeper anatomical structures, or stab, where the sharp edge penetrates the skin into deeper structures. An incised wound is generally longer than it is deep, whereas a stab wound is generally deeper than it is wide. Forces required to cause sharp injuries and the effect of such injuries are variable because a sharp pointed object may penetrate vital structures with minimal force. Special types of cutting injuries included slash- or chop-type injuries from weapons such as machetes.
Many impacts may cause initial pain and discomfort, which resolves within a few minutes, and tenderness, which may still be elicited hours or days later, with no visible sign of injury. The lay person must be aware that the absence of visible injury does not imply that no assault or injury has occurred.
Wheals and erythema are also nonpermanent evidence of trauma caused by initial vasodilatation and local release of vasoactive peptides after an injury, such as a slap, scratch, or punch, which will leave no mark after a few hours. The classic features of the triple reaction are present, but no specific damage is done to any tissues. Thus, an initial reddening associated with pain with possible subsequent development of local swelling may be present initially, but after a few hours has completely resolved, unlike bruising, which will still be present after 24 hours or more.
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Since World War II, there has been a tremendous change in the makeup and direction of kid baseball, as it is called. Adults, showing an unprecedented interest in the activity, have initiated and developed programs in thousands of towns across the United States programs that providebr wholesome recreation for millions of youngsters and are often a source of pride and joy to the community in which they exist.