Classification of injuries caused by blunt objects. Types of mechanical damage from the action of blunt solid objects

LECTURE No. 7 Forensic medical examination of mechanical asphyxia Mechanical asphyxia is a violation of external respiration caused by mechanical causes, leading to difficulty or complete cessation of oxygen intake and accumulation in the body

LECTURE No. 8 Forensic medical examination of living persons. Examination of harm to health, state of health, determination of age, feigned and artificial diseases

LECTURE No. 9 Forensic medical examination of living persons. Examination of sexual conditions and in case of sexual crimes 1. General provisions

LECTURE No. 10 Forensic examination of poisoning According to the World Federation of Poison Centers (2000), a toxicological situation has developed in the modern world, which is caused by an increase in the number of acute accidental and deliberate poisonings with medicinal and

LECTURE No. 11 Forensic medical examination of injuries from exposure to high and low temperatures 1. The effect of high temperature. Local damage Tissue damage from local action of high temperature is called a thermal or thermal burn.

LECTURE No. 12 Forensic medical examination of electrical injury Electrical injury is the result of the action on a living organism of technical (from power and lighting networks) and atmospheric (lightning) electricity.1. Damage by technical electricityMostly these

LECTURE No. 13 Forensic thanatology 1. The concept of death Death is the inevitable and irreversible cessation of the interaction of protein structures, which is expressed in the complete cessation of all vital functions of the body. In multicellular organisms, the interaction

LECTURE No. 15 Forensic Examination of Physical Evidence of Biological Origin 1. Preliminary blood samples When finding blood traces is particularly difficult, preliminary blood samples can be used.

Section IX. MEDICAL EXAMINATION Article 49

Article 52. Forensic medical and forensic psychiatric examinations

11.16. Forensic medical examination in civil proceedings 11.16.1. In what cases is an examination assigned? As follows from Part 1 of Art. 79 Code of Civil Procedure of the Russian Federation: “If issues arise in the process of considering a case that require special knowledge in various fields of science, technology, art,

Gordon E. S. Forensic medical examination: problems and

1.1 Forensic medical examination as a type of forensic examination in criminal cases When initiating, investigating and judicial consideration of criminal cases, the investigator (the person conducting the inquiry), the prosecutor, the court, as well as other participants in the Soviet criminal process

2.1 Classification of forensic medical examinations by object and subject of research Forensic medical examination of corpses, living persons, material evidence

With all the variety of traumatic factors and circumstances of injury in blunt trauma, the mechanisms of injury are limited to four: impact, compression, stretching and friction.

In general, the mechanism of damage is understood as the process of contact interaction between the traumatic surface and the damaged part of the body, leading to the occurrence of anatomical and functional damage of a certain type and nature.

Hit, those. a sharp strong push, when in a relatively short period of time there is a collision of an object and a human body relative to each other. In the place of their contact, various injuries occur, the nature of which depends on the force of the blow, its direction, the shape and size of the striking surface, the presence and characteristics of clothing or other pads, the anatomical structure of the damaged part of the body, and some other factors.

Typical impact injuries will be abrasions, bruises, contusions, direct bone fractures, ruptures of organs at the point of application of force.

bruised wounds arise from blows with blunt objects on parts of the body with a thin layer of soft tissues, under which the bones are located. Their shape depends on the shape and size of the striking object. In typical cases, the edges of the wounds are uneven, raw, bruised, crushed, sometimes exfoliated from the underlying tissues. In the depths of the wounds, jumpers of more durable tissues are visible. The hair follicles along the edges of the wound retain their structure.

fractures when struck with a blunt object, they are characterized by uneven jagged edges of damaged bones.

When struck with a sufficiently large force by an object with a wide striking surface, in addition to damage at the site of direct impact, there is also shake the whole body or parts of it, mainly internal organs. Mild concussion may not cause noticeable anatomical changes, but be limited to functional disorders. In this regard, concussion is of particular importance. If it is accompanied by local changes in the form of hemorrhages and areas of crushing of the medulla at the site of impact and counter-impact, then such changes are diagnosed as brain contusion.

At severe concussions internal organs, characteristic lesions are formed: multiple hemorrhages in the fixing apparatus of the organ and the surrounding tissue under the capsule and in the parenchyma of the organ. If the force of impact and shaking of the body is large, then, as a rule, there are multiple, located parallel to each other, lacerations of internal organs.

compression, unlike impact, it occurs when two centripetal forces act on the body from opposite sides. The speed of movement of squeezing objects, as a rule, is low, and the time of their interaction with the human body is much longer than with an impact. The severity and volume of damage is determined by the mass of the object and the area of ​​its contact with the damaged part of the body.

The most typical injuries during compression are: crushing, dismemberment, separation and displacement of organs, bilateral multiple direct and indirect bone fractures.

stretching, in essence, is a mechanism directly opposite to compression, i.e. forces act centrifugally and lead to characteristic injuries: separation of body parts, ruptures of ligaments, intervertebral discs, superficial linear tears of the skin from overstretching, bruised and lacerated wounds.

lacerations arise from stretching the skin with bone fragments and when struck with blunt objects at an acute angle. They are localized mainly in the area of ​​bone fractures or along the edges of detachments of body parts. When these wounds are localized in the area of ​​impact with a blunt object along the tangent, their initial part often has signs of bruising. In such cases, wounds are more correctly called bruised and torn(This group also includes bitten wounds).

The shape of the wounds is linear or L-shaped with uneven patchwork edges, in which there is no settling, crushing and bruising, which distinguishes these wounds from bruised ones.

Friction as a mechanism for the formation of injuries, it consists either in the contact of the traumatic object with the human body and movement in relation to it tangentially, or in the sliding of the body on some object. In this case, as a rule, superficial damage is formed: abrasions, wounds, detachments of the skin from the underlying tissues in the form of "pockets". In some cases, during prolonged dragging of the body (traffic injury), deeper damage appears in the form of “erasing” or “sawing” of the bones.

Often, individual mechanisms of damage occur in combination with each other, which creates certain difficulties in the production of examinations.

Let us consider some morphological features of injuries caused by blunt objects. First of all, the dimensions of the acting surface in relation to the damaged part of the body or, more precisely, the contact zone of the object and the human body, the shape of the surface and the mass of the object matter. The nature of damage is influenced by the presence of faces, edges and corners of blunt objects. The same object can inflict damage of different characteristics depending on which part of the object was hit.

Blunt objects with a large flat surface lead to abrasions, bruising, and, rarely, wounds. So, when hitting the head, wounds of a rectilinear, arcuate, zigzag and star-shaped form are formed, surrounded by extensive areas of sedimentation of an irregular round shape. The edges of these wounds are uneven, bruising and often crushed, and when struck at an angle, their detachment is possible.

In addition, blows to the head form vault cracks and grounds skulls, coinciding mainly with the direction of the traumatic force, as well as comminuted fractures with characteristic small fragments in the impact area and radially divergent fractures from bone cracking. Sometimes a large bone fragment surrounded by small ones is revealed at the site of impact.

A blunt object with a large spherical surface, when exposed, leaves wounds mainly star shape with settling around and crushing of the edges. Cracks form in the bones of the skull, depressed fractures rounded and comminuted fractures.

Elongated objects with a cylindrical surface form upon impact band-like bruising with precipitation. Sufficiently thick objects can be left on the body upon impact two parallel band-like bruises, i.e. bruises are more easily formed when the skin is stretched at the border of the cylindrical surface than when its vessels are squeezed by the convex part of the object.

Rectilinear and arcuate wounds with uneven crushed edges and sedimentation appear on the scalp, and depressed fractures of an elongated oval shape with cracks and free fragments in the center are formed in the bones of the skull.

The edge of a faceted object, on impact, causes a bruised wound, which may resemble a chopped and even cut one. Shape them linear, and when gaping - fusiform. The edges are relatively even without crushing and with weakly pronounced sedimentation. Detachment of the skin is possible when the object is applied at an angle. In the bones of the skull, the edge of a faceted object forms depressed and depressed-perforated fractures.

Obtuse objects with a small surface form wounds, the shape of which depends on which part of the object and at what angle the damage is applied. In this case, the wounds only partially reflect the shape of the edge due to the predominant action of the edge of the object from one side. Depressed and perforated fractures occur in the bones of the skull, the shape and size of which are determined by the striking face of the object.

The corners (protrusions) of a blunt object upon impact form star-shaped wounds with three rays of tears from the edges of the corner and by upsetting the edges with faces. Depressed fractures are formed in the bones of the skull, sometimes having a distinct shape of a trihedral pyramid, the top of which turned into the cranial cavity.

In addition, damage, similar in nature and mechanism to damage with blunt objects, can be inflicted by an unarmed person with parts of his body or animals.

Among the injuries inflicted by an unarmed person, in the first place are injuries by hands: fingers, nails, fist, palm. Next in frequency are injuries to the legs (foot) and teeth. Much less common are injuries from blows to the head, knee, shin and elbow.

Hand damage. Compression by the fingers of any part of the body leads to the formation of round or oval bruises: on the side of the thumb - one, on the side of the rest - several bruises, sometimes merging with each other. In the area of ​​bruising, crescentic abrasions from the nails may be visible. Pinch fingers leave behind paired bruises. Soft tissue ruptures are possible with fingers inserted into natural openings. Sliding movements with the nails form one or more parallel oblong abrasions.

Punching lead to the formation of bruises, sometimes - abrasions. Bruised wounds can occur in the area of ​​bony protrusions located directly under the skin. With blows to the mouth area, abrasions and bruised wounds from the teeth are formed on the mucous membrane of the lips. Strong punches can cause damage to bones (nasal, zygomatic, lower jaw, ribs, sternum), teeth, ruptures of internal organs and fractures of the cartilage of the larynx. Blows to the head sometimes result in a concussion.

In forensic practice, cases of death are known after punches in the reflexogenic areas of the body.

Flat palm strikes, as a rule, do not leave any objective signs. Much more dangerous are blows with the edge of the palm, especially in the neck area, which can lead to vertebral fractures and spinal cord injury.

Leg injuries are applied on the legs, in the lower abdomen and genital area when the victim is standing or sitting. The shape of the resulting extensive bruising, sometimes merging with each other, may reflect the shape of the part of the shoe that was struck.

Multiple fractures of bones (ribs, sternum), ruptures of internal organs and closed craniocerebral injury, causing significant health problems, up to death, can occur when a lying person is kicked and trampled.

Tooth damage (when bitten) can be found in both the perpetrators and the victim. The resulting abrasions, bruises or wounds are located in two arcuate lines facing each other with concave sides, and repeat the shape of the teeth. The result of strong compression by the jaws of small protruding parts of the body (finger, nose, auricle) can be biting them off completely.

Human damage can be large animals (teeth, hooves and horns).

Hoof strikes horse or bull can cause fractures of the ribs, sternum, ruptures of internal organs and severe traumatic brain injury, and blows with horns- extensive lacerated, bruised-lacerated and stab wounds with penetration into the body cavities. Biting teeth cause the formation of arcuate bruised-lacerated wounds, sometimes with tearing out significant fragments of the skin and small tissues.

Bites with teeth of animals such as dog, wolf, fox, cat characterized by the formation of lacerations with ruptures of muscles and, sometimes, internal organs (esophagus, trachea, etc.). The sharp claws of these animals inflict multiple lacerated skin wounds.

Falling from height. One of the types of blunt trauma, characterized by a special mechanism of damage, is a fall from a height. In this case, the human body moves (falls), and the damaging object (the surface on which the body falls) is motionless.

In practice, there are two types of fall: from a height and on a plane.

A fall from a height is most often the result of an accident, less often a suicide or murder. People fall from windows and roofs of buildings, rocks, trees, scaffolding, stairs, shafts, wells, etc. As you can see, circumstances can be very diverse. And yet, it is possible to find common, characteristic, signs for the whole set of fall options to establish the mechanism of injury.

So, the type of fall, the height of the fall, the mass of the human body, the features of the traumatic surface and the position of the body at the time of impact on the surface affect the nature of damage during a fall from a height.

The fall could be direct when a body falls directly onto a surface and remains on it, or indirect(stepped) with additional impacts on objects located at different heights. In addition, allocate falls free(independent) and not free(together with any object, including in a vehicle).

The most characteristic damage occurs in a direct free fall.

There are two phases of injury: primary impact and secondary. In this case, the mechanism of damage can be divided into 3 groups: direct, indirect primary and secondary.

• Primary direct damage occurs at the site of the primary interaction of the body and the surface of the object.
• Primary indirect damage occurs at the time of the primary impact, but at a distance from the impact site.
• Secondary damage are formed in other parts of the body from secondary impact.

The localization of damage depends on the landing options, and one of the common signs of a fall from a height is the predominance of internal damage over external ones. Outside, there are usually unilateral abrasions, bruises or bruised wounds at the points of contact between the body and the traumatic surface. Complicating the issue of the fall mechanism may be additional damage in a non-free or indirect fall. Inside - a variety of damage of various localization.

And yet, it is possible to distinguish the most typical internal injuries in various types of falls from a height.

Fall to your feet leads to the occurrence, most often symmetrical, direct fractures of the calcaneal bones; indirect fractures of the ankles and the bones of the lower leg, femoral necks and acetabulum of the pelvis; fractures of the ribs at the places of their attachment to the spine, compression fractures of the vertebrae, secondary fractures of the sternum from a blow with the chin; primary indirect ring-shaped fractures of the base of the skull. With inertial movement forward and a blow with the hands, paired fractures of the bones of the forearm occur.

When you fall to your knees primary direct fractures of the diaphysis of the bones of the lower leg and damage to other bones of the skeleton are formed, similar to cases of falling on the legs, except for the distal sections of the lower leg and feet.

Fall on the buttocks leads to the formation of primary fractures of the pelvic bones, compression fractures of the vertebrae and, less often, ring-shaped fractures of the base of the skull.

When falling on the head there are comminuted fractures of the bones of the skull, sometimes - driving the spine into the cranial cavity, compression and comminuted fractures of the spine, sternum and ribs.

With all variants of falling from a height, damage to internal organs often occurs as a result of their sudden movement and concussion. The most characteristic are the following injuries: ligaments, capsules and tissues of the liver, spleen, kidneys; tears, ruptures and hemorrhages of the pleura and roots of the lungs, aorta, large vessels of the base of the heart, mesentery of the intestine, peritoneum. When falling on the head, in addition, there is a severe craniocerebral injury with massive hemorrhages in the soft tissues of the head, bruised wounds, head deformity, and gross brain damage.

For falls on the body (i.e. flat) is characterized by a smaller amount of damage, tk. a large inertial stability of the human body is manifested in the anterior-posterior or lateral directions, in relation to the vertical. In addition, the impact force is distributed in these cases over a larger area. Such injuries may resemble a transport injury or injury from compression of the body with blunt objects, characterized by a predominance of massive hemorrhages in soft tissues, gross injuries of the chest and abdominal organs, multiple bone fractures, mainly from the impact side.

In a forensic medical assessment of the nature and localization of injuries in a fall from a height, the elasticity and shock-absorbing properties of the tissues of the part of the body on which the fall occurs, the resistance of the surface of the traumatic object to impact are taken into account. In addition, a thick layer of clothing can play a certain protective role in reducing the amount of damage.

Fall to the plane. The second type of fall is fall of a standing or falling person from a height of his own height, i.e. on the plane on which the person was.

Such a fall happens passive(spontaneous) or active(with giving the body additional acceleration).

With this injury, fractures of the bones of the upper and lower extremities, concussions and bruises of the brain, sometimes with fractures of the bones of the skull, and ruptures of internal organs (rarely) occur. External injuries at the site of impact are limited to abrasions, bruises, and with a hard impact surface, in addition, bruised wounds. Consider the most typical types of damage.

Fall on the back of the head the mechanism of which is most fully studied on biomannequins, leads to the formation of cracks in the occipital bone, leading to the foramen magnum or pyramids of the temporal bone. In a supine fall, the point of impact may be at the level of the occiput, above, or to the side of it, depending on the active or passive mechanism of the fall.

Brain contusions at the site of application of force are observed only in some cases, while multiple hemorrhages, foci of softening of the brain substance and subarachnoid hemorrhages in the area of ​​anti-impact (frontal and temporal regions of the brain) are detected.

Falls on the sides of the head the most typical damage is the occurrence of cracks in the temporal bone. The degree of severity of damage to the substance of the brain is also much greater in the area of ​​the counterblow compared to the site of the blow.

Fall on forehead is much less common and the nature of the damage is less typical, tk. they are localized mainly at the site of impact.

During the expert assessment of damage when falling on a plane It is necessary to take into account a number of related factors that affect the force of impact. These include: the presence of a previous acceleration (when the impact sometimes exceeds 2000 kg); height and body weight of a person; the presence, especially in women, of long thick hair, leading to a known cushioning and contributing to a reduction in the severity of the injury, the presence of a headgear (a hat with earflaps increased, in modeling, the impact time by 5–9 times compared to cases of falling without a headgear), shape head, in particular the shape of the occipital region.

Characteristic lesions are formed when crushed by massive objects. In cases where these objects have a large (disproportionate) plane, the integrity of the skin is rarely violated, and damage is limited to extensive abrasions and bruises with crushing of the underlying soft tissues. At the same time, they can reflect the features of the squeezing surfaces and clothing located on the damaged part of the body.

However, bone injuries are most typical for compression, especially in such bone formations as the skull, chest and pelvis. The nature of the resulting damage allows you to set the direction of the compressive forces. So on the bones of the skull, in places where compressive forces are applied, bilateral areas of small fragments of bones or two large fragments of a rounded shape are formed, surrounded by a ring of smaller ones. Between these areas, from the stretching of the bone tissue, connecting lines of fractures are formed, and from the bending of the bones, equatorial and parallel lines of fractures are formed.

With chest compression bilateral direct and indirect fractures of the ribs along many vertical lines are formed. For direct fractures an oblique direction is characteristic in relation to the length of the rib with a displacement of the fragments inward, while the pleura and lungs are injured.

Indirect fractures have a transverse direction, and the fragments are displaced to the outer side of the body (and therefore the parietal pleura is not damaged), the edges of the fragments are even or finely serrated.

Unlike hitting, with compression of the pelvic bones multiple symmetrical bilateral fractures occur.

The direct impact of traumatic objects on the internal organs causes their damage in the form of ruptures, detachments, displacements or complete destruction.

Death can result from mechanical asphyxia from compression of the chest and abdomen , even without pronounced anatomical damage.

During a forensic medical examination of injuries with blunt objects, the expert can qualify the severity of the bodily injury, supplement and clarify the circumstances of the incident, the testimony of the victim, the accused and witnesses.

Injury with blunt objects is the most numerous group of mechanical injuries. As a blunt instrument for inflicting damage, a wide variety of objects found in everyday life and at work (hammer, iron, stick, stone, etc.) can be used, as well as specially made for attacks weapons - brass knuckles, handheld, flail. Injuries caused by hands, feet, teeth, etc., are most often also in the nature of blunt trauma.

Most of the damage caused by parts of a moving vehicle, damage resulting from a fall from a height or as a result of body compression, for example, during landslides, leave traces on the human body that are characteristic of the action of a blunt solid object.

For a blunt tool, the characteristic feature is primarily the presence of a blunt striking surface (in the presence of edges and faces - blunt), and its effect on the body is expressed in squeezing and displacement of tissues.

Depending on the force with which a blunt object acts, extremely diverse injuries are formed on the body, ranging from the lightest to the most severe (abrasions, bruises, wounds, bone fractures, dislocations of joints, ruptures and crushing, crushing and dismemberment). However, despite the variety of blunt objects and the damage they cause, the mechanism of formation of these damages can be reduced mainly to three types: impact and concussion, compression and friction.

On impact at the point of contact of the body with a blunt solid object, various injuries occur, the nature of which is determined by the force of impact, the size and shape of the striking surface of the tool, the anatomical features of the body structure in the area of ​​damage, the condition of clothing, and many other factors.

A blow of small force is accompanied by the formation of abrasions and bruises without violating the integrity of the skin of the body. Strong blows with blunt solid objects directly at the place of application of force cause wounds, bone fractures, ruptures of internal organs and other injuries. In addition, they are usually accompanied body concussion with the formation of multiple hemorrhages in different parts of it, including at a distance from the impact site.

The main mechanism for the formation of injuries when moving vehicles, in cases of collapse and pressing down of the body with heavy objects is body squeezing, which is characterized primarily by mashing of soft tissues and internal organs, multiple comminuted fractures of bones, and often, when moving by rail transport wheels, division of the body into parts.

When a blunt object comes into contact with the body at a tangent, as well as in cases of dragging the body along the ground during a transport injury, the main mechanism for the formation of damage is friction. In this case, relatively superficial injuries in the form of abrasions and shallow wounds are most often formed. However, sometimes as a result of dragging and friction, deep injuries can also occur, involving not only soft tissues, but also bones.

Forensic practice shows that the above-described types of mechanisms for the occurrence of damage under the action of a blunt solid object are often combined with each other, which leads to the formation combined injuries and sometimes creates great difficulties in the examination.

One of the characteristic features of trauma with blunt objects is the often found discrepancy between relatively minor injuries on the surface of the body in the form of abrasions and bruises and extensive ruptures and crush injuries of internal organs, multiple bone fractures, etc., established during autopsy.

Characteristics of certain types of damage by blunt objects.Abrasion is a superficial violation of the integrity of the skin or mucous membranes; with deeper damage to the skin and mucous membranes, superficial wounds occur. Abrasions are formed as a result of impact, friction or compression of the body by blunt and hard objects that have an uneven (rough) surface. The integrity of the skin and mucous membranes can also be broken when sliding on the body surface of the pointed end of objects such as a needle, knife, nail, etc.; the resulting linear abrasions are called scratches.

The forensic value of abrasions and scratches is very high. First of all, it is an objective indicator of the fact of injury and the place of application of force. The shape, size, direction and location of abrasions help to find out the mechanism of injury - one of the main issues of interest to the investigation.

The form of abrasions is very diverse and depends largely on the nature of the striking surface of the object. Sometimes the shape of the abrasion reflects the shape of the damaging object, but in practice this is rare. The exception is very characteristic abrasions caused by nails and teeth.

In some cases, with a detailed study of the abrasion (according to the degree of its severity along and at the ends, the surface topography, the direction of the scales of the desquamated surface layer of the skin, etc.), it seems possible to establish the direction of movement of the damaging object. The solution of this issue is facilitated by the presence of multiple parallel linear abrasions, which are often formed when dragging the body. Establishing the direction of movement of the damaging object is important for reconstructing the picture of the incident, for example, in road accidents.

Sometimes the localization and form of abrasions are so typical that they even indicate a certain type of violence. Thus, crescentic abrasions from the nails on the neck, in the circumference of the mouth and nose, are characteristic of strangulation; the presence of such abrasions and bruises on the inner surface of the thighs and near the genitals in women indicates a possible rape or an attempt to do so.

Precipitation can also be formed after death as a result of the action of blunt solid objects. It usually has the appearance of uniform dense yellow-brown spots, somewhat sunken in relation to the level of the surrounding skin. In appearance and touch, these spots resemble parchment and are therefore called “parchment stains”.

Evidence of the lifetime origin of abrasion is the detection of a bruise in the subcutaneous tissue, as well as signs of its healing, in particular the presence of a crust that rises above the level of the skin. However, these signs are expressed only in those cases when several hours have passed from the moment of damage to the onset of death. It is difficult, and sometimes impossible, to distinguish between abrasions caused immediately before death or shortly after it.

The successive changes that occur in the intravital abrasion in the process of its healing make it possible to judge the prescription of the injury. A fresh abrasion has a wet surface, then it dries up and a crust forms (after 12 - 24 hours). Under the formed crust, the abrasion is healing. Gradually, starting from the edges, the crust peels off and disappears 7–12 days after the injury. After healing, a smooth pinkish spot forms at the site of the abrasion, which becomes invisible after 10-15 days.

Bruise, is an accumulation under the skin of a certain amount of blood that has poured out as a result of rupture of small blood vessels. Translucent through the skin, it changes its color, gives the skin a blue-purple color and is therefore called a bruise in everyday life.

The degree of severity of bruising depends primarily on the amount of blood that has poured out, the depth of its location and the localization of damage. In places where there is a lot of loose fatty tissue, for example, in the area of ​​\u200b\u200bthe eyelids, mammary glands, genital organs, bruises occur with relatively light strokes, often reach significant sizes and are accompanied by severe swelling.

Sometimes, in severe trauma, crushing and stratification of soft tissues are observed with the formation of cavities filled with blood. Such large accumulations of blood in the cavities or in the interstitial layers are called a hematoma,

The forensic significance of bruises and hematomas is basically this same, like abrasions. First of all, they are objective indicators of mechanical action and indicate the place of application of force.

The shape of the bruise is irregularly rounded or oval. Only in some cases, it can indicate the object that was damaged. So, very characteristic bruises are formed when struck with a belt buckle, chain, stick, rope loop, etc. (Fig. 2).

Small round or oval bruises are formed when the soft tissues are squeezed with the fingers. Localization of such bruises in certain places, for example, on the lateral surfaces of the neck, on the inner surfaces of the thighs or in the genital area of ​​a woman, sometimes makes it possible to judge the nature of the violence that took place.

A certain importance is attached to bruising when deciding on the age of injury. In the first days after the injury, the bruise usually has a blue-reddish or purple-blue color, which gradually changes: along the periphery, the bruise begins to acquire a greenish color, after 6-9 days after the injury it becomes yellow, and after 12-14 days it disappears completely. These changes in color are associated with the transformation in the bruise of the coloring substance of the blood - hemoglobin.

Rice. 2. Bruising from being hit by a belt loop

The vast majority of blunt force injuries are accompanied by bruising. Therefore, they serve as an important indicator of lifetime damage. However, it should be borne in mind that injuries caused shortly after the onset of death (after 10 - 30 minutes) may also be accompanied by the formation of bruises, outwardly similar to those in life. Therefore, in a number of cases it is very difficult to resolve the issue of intravital or postmortem origin of injuries.

And finally, it should be borne in mind that sometimes cadaveric spots can be mistaken for bruises (see Ch. 25), which outwardly are sometimes very similar to them.

Wound is a damage accompanied by a violation of the integrity of the entire thickness of the skin or mucous membrane, and often the underlying soft tissues. If the wound penetrates into any body cavity (cranial, thoracic or abdominal), it is called a penetrating wound.

Depending on the mechanism of formation, wounds caused by blunt solid objects can be divided into two main types: bruised and lacerated. Bruised wounds are formed as a result of squeezing, stretching the skin and breaking its integrity. Most often they occur in those parts of the body where bones are located close under the skin, for example, on the head, front surface of the lower leg, knee joint, etc.

The size and shape of bruised wounds are very diverse and depend primarily on the size and shape of the striking surface of the object and the structural features of the body in the area of ​​damage. When hit with blunt objects with a more or less wide flat surface, bruised wounds of an arcuate, stellate, zigzag or indefinite shape are formed. When struck with blunt solid objects with a cylindrical striking surface (log, pipe, etc.), bruised wounds of irregular shape are observed with skin sedimentation along the edges and crushing of soft tissues in the center.

Sometimes blunt objects, such as a hammer, an ax butt, an iron, inflict bruised wounds that reflect some of the features of the striking part of the object. So, from a blow with a quadrangular hammer, a U-shaped wound is often formed, when struck with a round hammer, an arcuate wound, etc.

Rice. 3. Bruised wounds

Wounds from blunt objects have characteristic edges, corners and a wound surface (bottom). Their edges are uneven, raw, soaked in blood, crushed and often exfoliated from the underlying tissues (Fig. 3); the bottom is uneven, hemorrhagic; in the depth of the wound, especially in its corners, between the edges of the damage, thin thread-like jumpers of unruptured tissues are found. Wounds caused by blunt objects usually bleed very little.

The described signs make it possible to recognize bruised wounds with their careful examination without much difficulty. The exception is bruised wounds of a linear shape with relatively smooth edges and pointed corners. In appearance, they are very similar to incised or chopped wounds. To avoid errors, it is necessary to carefully examine the bottom and edges to detect connective tissue bridges, which always occur in bruised wounds and are not observed with incised and stab-cut injuries.

Bruised wounds are of great forensic and forensic significance. They make it possible to establish the fact of the use of a blunt weapon, often make it possible to judge the features of the damaging object (the presence of edges, corners, etc.), and their location, number and severity often make it possible to determine the nature of the violence.

Sometimes in the depths and along the edges of the wound, particles of the object that caused the injury (wood chips, glass fragments, bricks) can be found, which can help in identifying the instrument of crime.

If a solid blunt object acts at an acute angle to the surface of the body, then as a result of stretching and tearing the skin, lacerations are formed. They have many features in common with bruised ones, but crushing and bruising of the edges, as well as sedimentation of the surrounding skin, are mild or absent. In forensic practice, bruised and lacerated wounds are often encountered, in which signs of both wounds are observed.

A variety of lacerated wounds are bitten wounds caused by the teeth of animals and humans. Bite marks from a person's teeth can sometimes be the subject of a forensic medical examination to identify the person who caused the injury.

Lacerations are also formed as a result of rupture of soft tissues and skin in the direction from the inside outward by fragments of broken bones. Unlike bruised ones, such wounds do not have skin sedimentation and crushing of the edges.

In forensic practice, it is often necessary to resolve the issue of the limitation of inflicting a wound. This is done on the basis of studying the signs of healing. It should be borne in mind that the healing time of bruised and lacerated wounds largely depends on the size, location, infection, method of treatment and other factors. Therefore, the assessment of the prescription of wounds caused by blunt objects must be approached with caution. If the wound has healed and a scar has formed in its place, it is extremely difficult to determine the prescription of the injury.

bone fracture often occurs as a result of the impact of blunt solid objects. In the long tubular bones of the upper and lower extremities, transverse, oblique, comminuted and spiral fractures are observed.

Bone fractures, accompanied by a violation of the integrity of the skin, are called open, and without violation - closed. According to the mechanism of origin, direct fractures are distinguished, which form at the place of application of force, and indirect or indirect, which occur at a distance from the place of impact.

By the nature of fractures, it is sometimes possible to judge the mechanism of injury, the direction of impact and the position of the victim at the time of injury.

In forensic medicine, damage to the bones of the skull is of the greatest importance: cracks, divergence of sutures and fractures - depressed, perforated and comminuted. Cracks in the bones of the skull are through (penetrating through the entire thickness of the bone) and non-through. They are formed as a result of the deflection of the bones of the skull in the area of ​​\u200b\u200bstrong impact. Cracks often branch out at an acute angle, with its apex, as a rule, facing the place where the force is applied. The greatest gaping of cracks is observed near the impact site, and their direction usually coincides with the direction of the damaging force. The divergence of the sutures between the bones of the skull according to the mechanism of formation is similar to the origin of cracks and is often combined with them.

As a result of blows to the head with blunt hard objects with a small surface, such as a hammer, so-called perforated fractures are formed on the bones of the skull, reflecting to one degree or another the shape and dimensions of the striking surface, and in shape and size they sometimes exactly correspond to the striking surface of the tool that caused trauma, which is important for identification.

When struck by blunt solid objects with a limited cylindrical or blunt surface (crowbar, brick, etc.). depressed fractures are formed on the bones of the skull, consisting of several interconnected fragments that protrude into the cranial cavity and injure the brain (Fig. 4).

As a result of impact with massive heavy objects, for example, during a transport injury, a fall from a height, comminuted fractures of the bones of the vault and base of the skull are formed. The direction of the main fracture lines, as a rule, coincides with the direction of the external impact. Comminuted fractures can also occur as a result of multiple blows to the head with a relatively small blunt object; this is characterized by the presence of multiple bruised wounds on the soft tissues of the head.

Rice. 4. Depressed fracture of the skull from a stone strike

A strong impact with an object with a wide striking surface causes the formation of a multi-comminuted fracture as a result of cracking of the skull (Fig. 5). The extreme degree of compression of the skull, for example, by the wheel of a car, is characterized by flattening of the head and crushing of the brain. Such an injury in most cases ends in death already at the scene.

As a result of the action of a blunt force on the human body, there are also sprains and dislocations of the joints. In forensic practice, these injuries are less common than bone fractures and are usually associated with them. By dislocations, one can sometimes judge the mechanism of injury and the strength of external influence.

Damage to internal organs from the action of blunt objects are in the form of hemorrhages, detachments, ruptures and crushing. The nature of these injuries is also of some importance for establishing the mechanism of injury.

Hemorrhages are formed both from blows and from concussions and are usually combined with ruptures and crushing. With strong impacts and concussions, for example, with a transport injury, falls from a height, landslides and compression of the body by heavy objects, separations and ruptures of internal organs are observed. However, it should be borne in mind that ruptures can also occur from blows with relatively small objects, such as a stick, a stone, as well as a fist with a shod leg.

Rice. 5. Multi-splintered fracture

The nature of the damage depends not only on the force of impact, compression or concussion, but also on the anatomical structure of the organ itself. Most often, the liver, spleen, and less often the lungs, stomach, intestines, and bladder are torn.

Compression of the body with a very large force, for example, when moving the wheels of a vehicle or crushing between cars, when heavy objects fall on the body, it is accompanied by crushing and kneading of individual organs and even the whole body.

With crushing, complete destruction of the organ is observed, and as a result, crushed, along with crushing of tissues and organs, fractures and crushing of bones also occur.

Complete or incomplete separation of the body into separate parts occurs when a blunt solid object with a limited surface is acted upon with great force, for example, when crossing a rail vehicle with a wheel.

Hitting the head with a blunt object or hitting the head with a blunt object while falling can cause a concussion. At the same time, in the impact area, sometimes there are no noticeable traces of damage.

A concussion is accompanied by loss of consciousness lasting from several minutes to several hours or even days (depending on the severity of the injury). In severe forms of concussion, death can occur quite quickly due to dysfunction of the central nervous system. At the same time, no noticeable anatomical lesions in the brain were found at the autopsy.

Blows to the head are often accompanied by ruptures of blood vessels with hemorrhages under the membranes of the brain. Blood flowing from a ruptured vessel accumulates in the cranial cavity, causing compression of the brain and disruption of its functions, which can lead to death. Blows to the head with a blunt hard object sometimes cause contusion of the brain with hemorrhage into the substance; it should be borne in mind that a brain contusion is often located not at the site of a blow to the head, but on the opposite side, in the area of ​​the so-called counter-strike.

If there are multiple injuries on the corpse with blunt objects, it is difficult to decide whether they were caused by one or more objects, since, on the one hand, different blunt objects often cause similar injuries, and on the other hand, traces of the action of the same object can have a different look. Only a sharp difference in the nature of the damage itself allows us to judge that they were caused not by one, but by several blunt objects.

The main tasks of a forensic medical examination in case of damage by blunt objects is to establish signs by which one can judge the nature of the damaging object, its shape, size and individual qualities, the direction of the blow, the sequence of damage (if there are several injuries on the body), the damage one or more tools, the posture of the victim during the injury, the relative position of the victim and the attacker, etc. In addition, in all cases, the issue of the severity of bodily injuries in a living person and the cause of death in a deceased person is decided.

Impact damage from a fall from a height are accompanied by the formation of characteristic damage, which makes it possible to exclude other types of mechanical injury. The predominance of internal injuries over external ones is typical. On the skin, in places of contact of the body with the striking surface, only small abrasions, bruises, and sometimes lacerations and bruises are formed. An internal study, as a rule, reveals deep massive hemorrhages, ruptures, and sometimes separations of internal organs, comminuted fractures of many bones (ribs, skull, limbs, etc.).

A fall on the legs causes symmetrical fractures of the calcaneal bones, the so-called impacted fractures of the legs, hips, fractures of the base of the skull, in which the cervical spine is wedged into the cranial cavity and the head is, as it were, planted on the spinal column. A fall on the buttocks is accompanied by fractures of the spine, and a fall on the head is accompanied by multi-fragmented skull fractures, brain injuries and fractures of the cervical spine.

Falling from a height is usually an accident, less commonly a suicide; killing by dropping from a height is rare. There are essentially no forensic medical signs that make it possible to judge the type of death in a fall from a height, and an expert often cannot determine the type of violent death based on the examination of a corpse. However, he can detect other types of injuries on the corpse (knife, gunshot wounds, marks on the neck from pressure with fingers, etc.), suggesting that the corpse of a previously killed person was dropped from a height. At the same time, both intravital injuries that led to death and post-mortem injuries, formed as a result of dropping the corpse from a height, are found on the corpse.

When falling from a small height, for example, from a height of one's own height, fractures of the upper and lower extremities, ribs, concussions and bruises of the brain, cracks and fractures of the skull are also sometimes observed. The latter are more often located in the occipital or temporal regions, where, as a rule, there are bruises, abrasions and bruised wounds in the soft tissues, according to the place of impact.

Causes of sports injury most often are the wrong organization of sports activities, ignoring protective equipment and injury prevention measures, non-compliance with the rules of "insurance" of the athlete, premature admission to classes after an illness, and sometimes the deliberate use of prohibited techniques by athletes.

A sports injury usually becomes the object of a forensic medical examination in cases of causing fatal injuries. Among them, fractures of the cervical spine with damage to the spinal cord are most common (when jumping headfirst into the water, falling from gymnastic equipment), less often - severe head trauma with fractures of the skull bones and hemorrhages under the meninges (during wrestling, boxing, falls) and even less often - damage to the organs of the chest and abdomen.

When investigating sports injuries, in addition to the forensic physician, physical education doctors, qualified athletes, instructors and coaches should be involved as experts and carefully study the circumstances of the injury. Strict adherence to sports rules and medical control requirements is the best way to prevent sports injuries.

3.1. The concept of forensic traumatology. Classification of damaging factors. Mechanisms of the traumatic action of blunt objects

In forensic medicine, damage or injury is understood as a violation of the anatomical integrity or normal functions of the human body, caused by some environmental factor and resulting in a health disorder or death. All environmental factors that have a damaging effect on the human body can be divided into physical, chemical, biological and mental. Among the physical factors, mechanical, thermal, electrical effects, as well as sudden changes in atmospheric pressure and radiant energy are distinguished. In expert practice, damage caused by mechanical factors is more common. Such injuries occur as a result of the interaction of a damaging object with the human body. The following damaging objects have a mechanical effect: weapons - products specially designed for attack and defense, tools - products that have a domestic or industrial purpose, other objects that do not have a direct purpose (stone, stick, bottle, etc.). Depending on the nature of the action, damaging objects (weapons, tools) are divided into blunt solid (crushing), sharp and firearms.

Injuries by blunt objects more often than other mechanical impacts are the object of forensic medical examination. The number of deaths from them is 45-80% of the total number of deaths due to mechanical damage.

The forensic medical examination, carried out in cases of the use of such items, should solve the following main tasks:

1) establishing the nature of the damage;

2) establishing the properties of the damaging item;

3) identification of a number of conditions for the occurrence of damage (injury mechanism).

There are various classifications of blunt objects depending on the shape of their striking surfaces. The most widespread in forensic practice is the following (A. I. Mukhanov, 1974):

1) blunt objects with an extensive (predominant) flat traumatic surface.

Their effective surface is larger than the contact area of ​​the object with the body. It is impossible to determine the properties and features of the edge of the striking surface from damage from such objects, since it is located outside the contact area. An example is a part of a wide board, a wall, a side of a car body, etc.);

2) blunt objects with a limited traumatic surface.

Damage from them fully or partially reflects the shape of the active surface and the properties of its edge. Limited traumatic surfaces can be flat, spherical, cylindrical, sometimes have a characteristic relief (the surface of a gear, brass knuckles, belt buckles, etc.). Objects with a limited traumatic surface also include those that, depending on their position upon impact, have a trihedral, dihedral angle or edge (for example, a brick, a hammer, an ax butt, etc.);

Blunt objects can interact with the human body in different ways, depending on the speed of movement, time, force and angle of contact. In this regard, there are several mechanisms (types) of action of blunt objects.

Impact is a short-term interaction of an object and a body during movement. The impact force depends on the speed of movement and the mass of the object. The traumatic effect upon impact is centripetal. Pressure is the continuous interaction of an object and a body upon contact. Depends on the strength of the interaction and the mass of the object.

Stretching - manifests itself in cases where the traumatic force is directed away from the body, causing tissue ruptures, separation of body parts.

Sliding - occurs when an object moves tangentially with respect to the body.

3.2. Characteristics of individual types of damage

3.2.1. abrasions

Abrasion - superficial mechanical damage to the epidermis of the skin or epithelium of the mucous membranes. In the mechanism of formation, the main role is played by sliding, i.e., the movement of an object along the surface of the body, and sometimes significant pressure. Sliding and friction lead to peeling off the upper layers of the skin.

The form of abrasions is varied. If the sliding surface is wide and uneven, it causes a series of abrasions parallel to each other. Band-like abrasions usually occur in connection with the dragging of the body during transport injuries. When bitten by teeth, focal deposits occur with a characteristic arrangement in the form of two arcs, the ends facing each other, the action of the nails is accompanied by the formation of semilunar abrasions.

The surface of a fresh abrasion is pinkish-red, moist, soft, painful, located below the level of intact skin. After 6-12 hours, the bottom of the abrasion dries up, redness and swelling appear around. By the end of the first day, all abrasions have a brownish crust. After 1-2 days, the surface of the abrasion levels off and begins to rise above the border areas of the skin. By the 7-10th day, the healing process (epithelialization), going from the periphery of the abrasion to the center, leads to a gradual separation of the crust. The fallen off crust exposes a denser, smooth, pinkish area, which disappears over time.

Forensic medical significance of abrasions.

An indicator of the action of a blunt solid object;

Indicate the place of application of force;

May indicate the nature of violence, the method of causing damage (for example, semilunar abrasions on the neck when squeezed by her hands; in the circumference of the mouth and nose - when closing them with a hand; on the hips of females - during forced sexual intercourse or an attempt to do it; in the area hands, wrists, forearms, shoulders - as a sign of struggle, defense, etc.).

By abrasions, you can set the direction of the traumatic effect (by the position of fragments of the epidermis, which are usually directed in the direction of movement of a blunt object; by the layer of the upper layers of the skin collected in folds, found at the end of the abrasion).

Abrasions may reflect the shape of the traumatic surface. This happens when the object or its active part is small, has a clearly defined configuration, acts at an angle close to a straight line, and the path it has traveled along the surface of the body is small.

Analysis of the stages of formation and reverse development of abrasions allows us to determine the prescription of their application.

3.2.2. bruising

Hemorrhages as a result of traumatic rupture of blood vessels can form in any internal organs and tissues. Bruising usually refers only to those hemorrhages in which accumulations of blood form under the skin.

Hemorrhages in soft tissues can also have a non-traumatic origin due to painful changes in blood vessels, leading to an increase in the permeability of their walls (hemorrhagic vasculitis, beriberi, exposure to penetrating radiation, certain types of poisoning, acute oxygen starvation, etc.). This circumstance must be taken into account during the examination.

Localization, shape, size of bruises can be different. Small round pinpoint bruises are called petechiae; small indefinite form - ecchymosis. Hematomas are also distinguished - abundant accumulations of blood with tissue expansion. The shape of the bruises is often oval, which corresponds to the configuration of the contact area of ​​the object with a rounded area of ​​the body.

The oxygen-rich bright red blood poured out of the damaged vessels, accumulating in the surrounding tissues, impregnates them and then undergoes a number of changes, that is, it has the ability to “bloom”. The “blooming” of bruises is due to the transformation of the coloring pigment of the blood (hemoglobin) into a series of successively formed decay products that have a different color.

Initially, the bruise has a purple or purple-cyanotic hue (sometimes it becomes a deep blue color), which lasts for 1-4 days. After 4-8 days, the bruise becomes purple with greenish, yellowish hues. Mixed shades persist up to 9-12 days, and on the 12-16th day the bruise looks yellowish-gray.

The intensity of the “blooming” of the bruise depends on its size, prevalence, localization, constitutional features of the victim. The deeper the bruise is localized, the longer its color does not appear. Superficial bruising becomes visible within 10-30 minutes after injury, deep bruising may appear after a few days.

In loose adipose tissue (perirenal), hemorrhages can spread over considerable distances from the site of application of the traumatic force.

Forensic significance of bruising:

They are an indicator of the action of a blunt solid object;

They indicate the place of application of the traumatic force (where there is a bruise, a blunt object directly affected). However, in the presence of appropriate anatomical conditions, the bruise is capable of moving along the loose fatty tissue to the underlying areas (when hit on the forehead or bridge of the nose, bruises form around the eyes, a “points symptom” with fractures of the bones of the base of the skull, orbit, with blows to the lower abdomen - on the thigh);

By bruising, the (approximately) prescription of their application can be established. Since the change in their color depends on many conditions that are not always amenable to accounting, the determination of the prescription of a bruise in days should be carried out with caution;

By the shape of the bruises, the outlines of the active part of the object can sometimes be established (if it had a limited traumatic surface), which in some cases makes it possible to determine the object itself.

The bruises found on the corpse may indicate the nature of the violence.

Wounds are mechanical damage to the integument of the body, penetrating deep into the dermis of the skin or into the subcutaneous (submucosal) tissue.

Depending on the damaging blunt object and the mechanism of injury, wounds are bruised, bruised-torn, torn, patchwork, scalped, bitten.

Features of wounds are associated with the mechanism of action of the traumatic factor. Contacting with the body at the moment of impact, a blunt object compresses and displaces the tissues, causing them to stretch, and then crush, leading to rupture of the integument with the formation of a wound.

A specific feature of wounds is the presence of edges, which abrasions and bruises do not have. The edges of the wound are called lateral newly formed tissue surfaces due to injury. When examining and describing wounds, it is necessary to note the relief of the edges and walls (smooth, uneven, torn), the presence of sedimentation, the connection of two opposite edges with tissue bridges, their integrity or crushing, soaking with blood or bloodlessness, the introduction of foreign particles into the thickness of the edges and other features.

When struck with a blunt object at a right angle, bruised wounds are formed that have uneven jagged edges, rounded, U-shaped ends (on the head, the ends of the wounds are often sharp, due to the close location of the underlying bone), sedation of the edges, bruising in the wound area, uneven walls of the wound channels, from which protrude hair torn out with hair follicles, connective tissue bridges, crushed edges, sometimes exfoliated from bones.

Settling of the edges of the wound - occurs in the place of direct action of the object or its edges and is expressed more or less evenly. Where the skin is not so much crushed by the object itself as torn from tension, the edges of the tears may not be upset.

Since a blunt object, when crushing the skin and deep layers, kneads the tissues, the edges of the wound in depth turn out to be uneven. The tissues are not torn deep into the entire length, as a result of which tissue bridges remain that connect the edges of the wound. Hemorrhages into the wound and surrounding tissues occur due to rupture of blood vessels at the site of their compression. Where the soft integuments are thin and the bone lies under them, there is a uniform exfoliation of the skin from the underlying bone.

When struck with a blunt object at an angle, the wound acquires the character of a bruised-torn. It differs from a bruised wound by uneven sedimentation of the edges and detachment of soft tissues. The edges of such a wound are deposited mainly on the side from which the object acts, and the detachment of the skin from the underlying layers is more pronounced on the opposite side. Detachment of the skin in the area of ​​a bruised-lacerated wound is presented in the form of a "pocket" directed towards the action of the traumatic force.

When struck at an angle to the surface of the body, followed by displacement and separation of the skin in the form of a flap, a patchwork wound is formed. Its variety - a scalped wound - occurs when the skin is torn off from the underlying layers over a considerable distance.

From the action of the teeth, bitten and torn-bitten wounds arise, and wounds from bites by human teeth are of particular importance. Bite wounds are located in the form of one, or, more often, two arcs and consist of individual lesions, to some extent reflecting the shape of the active surface of the teeth. The general curvature of the arches, the size and shape of individual damage elements, the distance between them, traces of defects or the absence of one or another tooth, and other features, being quite well expressed in some cases, can be used for identification. Such injuries should be photographed as soon as possible using a scale bar already at the scene of the crime.

Forensic medical significance of wounds:

Bruised, bruised-lacerated wounds and their varieties, which have a combination of certain signs (roughness, rawness, bruising of the edges, tissue bridges, etc.), are an indicator of the action of a blunt object;

Indicate the place of application of the action of a blunt object;

When a blunt object acts at an angle, the properties of the wounds make it possible to establish the direction of the traumatic force (the maximum settling of the edges is from the side of the blow, the predominant detachment of the skin from the underlying bone is in the direction of the acting force);

The degree of wound healing and the condition of the scars that appear in their place makes it possible to speak about the prescription of damage;

Features of wounds (shape, size, nature of sedimentation, etc.) sometimes make it possible to judge the configuration and size of a blunt object or part of it, to speak about its assignment to a certain group, the possibility of inflicting a wound with an object submitted for examination. However, it should be borne in mind that the conclusion of the expert in such cases is conjectural.

3.2.4. Bone damage

Features of fractures largely depend on the type of bones, the nature of the damaging object, on the strength and speed of the traumatic effect, as well as on the direction of the force in relation to the damaging surface. In this case, fractures can occur both at the site of application of the acting force (direct, contact), and at a distance from it (indirect, distant). The mechanisms of fracture formation are stretching, compression of the bone, or a combination of both.

There are complete (separation of the bone throughout the entire thickness) and incomplete (partial damage to the bone), open and closed fractures. Among incomplete fractures, cracks and fractures are distinguished. Bone damage has certain properties that indicate the impact of blunt objects acting with great force. Features of some fractures (perforated, depressed) allow us to judge the shape and size of the surface of the damaging object. Bone damage makes it possible to differentiate direct and distant fractures and thereby judge the nature of the deformation, the place of application of force and the direction of the traumatic effect.

The relative position of local fractures and cracks extending from them, arising from repeated impacts of the object, sometimes makes it possible to establish the number of blows and the sequence of their infliction. According to the features of bone fractures, a certain mechanism of injury can be established (impact, one- or two-sided impact, torsion, rupture, and other options).

Damage to the bones of the skull in forensic practice is observed relatively often. Their occurrence is associated with a change in the configuration of the skull under the influence of impact. Damage to the bones of the skull (fractures and cracks) can be closed (without breaking the integrity) and open, accompanied by a violation of the integrity of the soft tissues and exposure of the damaged area of ​​the bone. Open fractures can be non-penetrating and penetrating into the cranial cavity.

Among the closed fractures of the skull, the most frequent are fractures of the vault, in second place are fractures of the vault and base, and in the third place are fractures of the base of the skull.

On the round vault of the skull, at the site of action of a blunt object with a limited traumatic surface, the compressed area of ​​the bone bends. If the elasticity of the bone is sufficient, and the flattening is small, then after the termination of the action, the bone returns to its original position. Bone tissue is more resistant to compression than to tension. Therefore, it may happen that at the site of impact, the outer plate of the bone, which has undergone predominant compression, is also thicker, remains intact. In the internal, which experiences tension during deflection, a fracture will occur in the form of a crack. With a greater impact force, the outer bone plate is also damaged, and not only at the site of impact, but also at some distance. With a perpendicular action of the object, the cracks more or less uniformly diverge along the radii. If a blunt object acts at an angle, the cracks are located more in the direction of impact.

Characteristic violations of the integrity of the bones of the skull cause blunt objects with a limited surface if it does not exceed 16 cm2. With a significant impact force, perforated fractures occur, when a section of the bone is, as it were, knocked out by the edges of the damaging tool. The edges of such a fracture are beveled from the inside, and its outer outlines often reflect the size and configuration of the damaging tool. If an object with edges acts not perpendicularly, but at an acute angle, then only part of its surface comes into contact with the tissues, for example, some corner of the hammer. This part of the object, penetrating relatively deeply, presses the bones here, and the opposite part may not even touch the bones. With such an uneven deepening of a blunt object, terrace-like fractures are obtained. With them, the depression in the bones forms an inclination, sometimes consisting of 2-3 steps rising one above the other, forming a staircase in the section. Stepped impressions indicate the action of a blunt object at an angle.

With a lower force and speed of impact and a larger area of ​​the striking surface, depressed fractures are formed, which can repeat the outlines of a traumatic object or part of it, as well as comminuted fractures with fragments not immersed or partially immersed in the cranial cavity. The outline of the object is most pronounced at the site of action of the edges of the damaging object.

Fractures that occur at the site of direct traumatization of the bone are often accompanied by the formation of cracks extending away from the point of application of force (radial cracks). If the impact is applied perpendicularly, then the cracks diverge evenly along the radii. If a blunt object acts at an angle in a certain direction, then this direction dominates among the outgoing cracks. Therefore, the direction of the cracks from the place of depression indicates the direction of the force acting at the injury. With strong impacts, leading to a flattening of the part of the skull, the injured segments are bent, and, as a result, circular (concentric) cracks occur. Often occurring cracks at the base of the skull are also an indicator of the direction of the impact force. Since blows to the head are applied from top to bottom, cracks most often go to the base and to the base of the skull. They are rare in the direction towards the top of the skull, for example, from the forehead or occiput to the top of the head.

If the blows are applied repeatedly, then in this case it is very important for the expert to decide on the sequence of damage. In some cases, this can be established using the sign of mutual crack limitation (Chavigny-Nikiforov sign). The crack of the subsequent application does not cross the cracks from the previous impact.

Under the action of blunt objects with an extensive traumatic surface, the patterns of damage to the bones of the skull are the same as when exposed to blunt objects with a limited surface, but these injuries are more extensive.

One of the most common types of injuries, along with skull fractures, is a violation of the integrity of the bones of the chest. The chest is a complex complex, including the ribs, collarbones, shoulder blades, sternum, thoracic spine. The most commonly injured ribs. They are flat bones with outer and inner compact plates with a spongy substance enclosed between them. In front, the bone part of the rib (except for XI and XII) passes into the cartilage, which is attached to the sternum, from behind the ribs are attached to the bodies and processes of the vertebrae.

When struck by an object with a limited traumatic surface, the rib at the site of application bends inward, while the outer plate is subjected to compression, and the inner plate is stretched. This leads to a fracture of the rib (partial or complete) at the site of application of force, with predominant damage to the internal bone plate. The outer plate can remain intact or be damaged, and then a complete fracture of the rib occurs.

With a complete fracture, additional cracks can be found on the inner plate, the ends of the rib fragments face the inside of the chest cavity, often damaging the pleura. Severe hemorrhages occur in the soft tissues in the area of ​​the fracture. At the moment of impact, the costal arch is bent and on its outer surface, at a considerable distance from the place of impact of the object, tension occurs, in connection with which a distant fracture is formed with a predominant lesion of the outer bone plate. If such a fracture is complete, the broken ends of the ribs are turned outward, the parietal pleura is not damaged, and hemorrhages in the surrounding tissues are insignificant.

In case of damage to the pelvic bones from a blow with a blunt object from the front, the destruction is localized in the anterior semicircle, mainly in the area of ​​the horizontal branches of the pubic bones with the formation of small fragments. With side impacts, fractures of the pelvic bones are localized at the site of application of force. When struck from behind, the greatest destruction of bones also occurs at the site of application of force - a transverse fracture of the sacrum occurs, as well as damage to the wings of the ilium and ruptures of the sacroiliac joints.

3.2.5. Damage to internal organs

Among the injuries of the internal organs, a special place is occupied by a brain injury, which can accompany skull fractures, or be observed while maintaining the integrity of the cranial bones. Traumatic brain injury is often the cause of death of the victim.

Traumatic brain injury can be open or closed. The most difficult to diagnose is a closed craniocerebral injury, which occurs from a blow to the head with a blunt object, or as a result of a fall. There are the following main types of closed craniocerebral injury: brain concussion; brain injury; compression of the brain by blood flowing out of damaged vessels (hematoma).

A concussion is characterized by molecular shifts and is not accompanied by macroscopically pronounced changes. Of decisive importance in concussion are not anatomical, but functional disorders (in some cases, these disorders can lead to severe disorders, even death).

A contusion of the brain is usually combined with a concussion and is accompanied by local anatomical disorders in the medulla, in the form of one or more foci of destruction (crush, hemorrhage). The destruction of the substance of the brain can be both directly at the site of impact, and on the opposite side. The occurrence of direct or anti-shock (counter-shock) injuries is largely due to the mechanism of the traumatic effect.

When a head is struck at rest, the configuration of the bone changes: it bends inward, and then straightens due to elasticity. When the bone deflects inward at the impact site, a positive pressure first arises, which changes to a negative one. In this case, gas bubbles are released from the tissues and blood, followed by their collapse, causing the destruction of the brain substance (this phenomenon in physics is called cavitation). So there is a bruise at the site of impact. Anti-shock injuries of the brain when hit with a blunt object on the head, as a rule, are absent or appear with a very large force of impact and turn out to be insignificant.

A blow to the head moving at a certain speed, which happens when the victim falls or brakes hard when colliding with an obstacle. Under these conditions, there is a craniocerebral injury of "acceleration" of the type "blow - counterstrike". According to the place of application of force in the cranial cavity, a positive pressure arises, decreasing in the direction of impact and turning into negative pressure due to the “lag” of the brain on the side opposite to the impact. Exactly in this place, as a result of negative pressure and the resulting cavitation, extensive foci of brain contusion typical of an acceleration injury from a counterblow are formed. At the site of the impact, there may not be a brain injury, and if it is formed, it is always less pronounced than in the area of ​​the counter-impact.

Compression of the brain occurs due to the development of a traumatic hematoma - an accumulation of blood in the cranial cavity. Hematomas are formed when the vessels of the membranes or the brain itself are damaged. When struck with a blunt object in the temporal or parietal region, an epidural hematoma occurs (accumulation of blood between the dura mater and the bones of the cranial vault. The dura mater is damaged by the sharp edge of a crack in the inner bone plate, as a result of which blood flows out between the wall of the skull and the brain and, accumulating, compresses the brain In this case, painful disorders do not occur immediately, but after some time has passed, which is necessary for the formation of a hematoma in a critical volume (at least 60-70 cm3).The duration of the "light gap" depends on the caliber of the damaged vessel, the rate of blood flow and a number of other circumstances ( This is of particular importance when evaluating a specific version, when bodily injuries that ended in the death of the victim are inflicted at different times and, moreover, by different persons.

Other internal organs can be injured to a large extent due to impact and shaking them, while the skin is often intact. The propagation of a shock wave through a parenchymal organ (spleen, liver, kidneys) causes rupture and cracking of the capsule and tissues of the organ. Damage occurs in a zigzag, slit-like shape, located parallel to each other. There may also be ruptures of the heart, lungs. The latter are more often torn from direct damage to their fragments of the ribs. The impact can also manifest itself in the form of hemorrhages or ruptures in the area of ​​the suspensory ligaments, due to their overstretching, which is especially characteristic when falling from a height.

When analyzing each specific case, the forensic expert evaluates the damage to soft tissues, bones and internal organs in their totality, comparing them with each other and with damage to the victim's clothing. Only with such an approach can one of the main and most important issues, the question of the mechanism of injury, be correctly resolved.

The degree of reliability of the expert's conclusion is even more enhanced if, in addition to assessing morphological data, the results of additional laboratory studies are used, which is especially important when deciding on the possibility of causing damage to an object or tool submitted for examination as material evidence. Among the main issues that are subject to resolution during the forensic medical examination of injuries with blunt objects, the following can be distinguished:

What is the nature of the victim's bodily injuries (abrasions, bruises, wounds, dislocation, fracture, rupture of an organ, etc.)?

What item caused damage? In particular, could these damages have been caused by an object or tool presented for examination as material evidence?

Was one or more items damaged?

How many blows were inflicted on the victim, in which direction or from which side were they delivered?

If there was a compression of the body or part of it, then from which side and in what direction did the squeezing object act?

In what position (standing, sitting, lying) or in what position was the victim and what was the relationship between the victim and the hitter at the time of injury?

What is the age of the injuries on the body of the victim?

In the forensic medical examination of corpses, in addition to the main questions, a number of others are posed, which are common to all cases of traumatic death. These are questions about the cause and prescription of death; about signs pointing to struggle and defense; about the possibility of committing any independent actions by the victim after receiving an injury; about whether the victim took food, when, what kind and in what quantity; whether he had consumed alcohol shortly before his death and what was the degree of intoxication. A special place (especially in the examination of living persons) is occupied by the question of the severity of the injuries received.