Forensic Medicine and Toxicology
Clinical Forensic Medicine: Injuries and Identification
Clinical forensic medicine for MBBS: wound types, ageing of bruises, firearm range, grievous hurt, sexual assault examination and child abuse, mapped to NMC codes FM3.3 to FM3.29.
MedNext Academy | 3 min read
Clinical Forensic Medicine: Injuries and Identification
Clinical forensic medicine for MBBS: wound types, ageing of bruises, firearm range, grievous hurt, sexual assault examination and child abuse, mapped to NMC codes FM3.3 to FM3.29.
Clinical forensic medicine deals with the living patient in a legal context. This chapter covers the description and ageing of mechanical, sharp and firearm injuries, the legal grading of hurt, the identification of unknown persons, and the sensitive examination of survivors of sexual assault and suspected child abuse under current Indian law.
High-yield: Clinical Forensic Medicine: Injuries and Identification
- An abrasion is a graze that shows the direction of force and can carry a patterned imprint of the causative object.
- A bruise (contusion) changes colour over days, moving from red-purple through green and yellow as haemoglobin breaks down, which helps age the injury.
- A laceration is a tear with ragged margins, crushed edges and tissue bridges, caused by blunt force.
- An incised wound is clean-cut, longer than it is deep and gapes, while a stab wound is deeper than it is long.
- Chop wounds are made by heavy sharp-edged weapons such as an axe and combine cutting with crushing.
- Grievous hurt under current law includes loss of a limb, sight or hearing, fracture, or any injury endangering life or causing 20 days of disability.
- An entry firearm wound is usually small, round and inverted with a collar of abrasion, whereas an exit wound is larger and everted.
- Contact firearm wounds show blackening, tattooing and singeing, which are lost as the muzzle distance increases.
- Tattooing (stippling) from unburnt powder cannot be wiped off, unlike soot soiling, and indicates a close range of fire.
- Antemortem wounds show signs of vital reaction such as bleeding, swelling and inflammation, absent in postmortem wounds.
- The primary sex characters, teeth, pubic symphysis and long bone ossification centres are used to estimate age and identity.
- Under current law consent for sexual intercourse is not valid below 18 years, and the two-finger test in rape examination is prohibited.
- The examining doctor documents injuries, collects swabs and clothing and preserves the chain of custody in alleged sexual assault.
- The PC-PNDT Act prohibits disclosure of the sex of the foetus to curb female foeticide.
- Non-accidental injury in children is suspected from injuries of different ages, patterned marks and a history inconsistent with the findings.
Wound types at a glance
- **Abrasion:** Graze of the skin surface. Shows direction of force and may carry a pattern of the object.
- **Laceration:** Blunt tear with ragged crushed margins and tissue bridges across the gap.
- **Incised wound:** Sharp, clean margins, length greater than depth, gapes widely.
- **Stab wound:** Depth greater than surface length, made by a pointed weapon.
NMC competencies in this chapter
- **FM3.3:** Mechanical injuries: abrasions, bruises, lacerations, incised, stab and chop wounds
- **FM3.4:** Injury, assault, hurt and grievous hurt under current law
- **FM3.7:** Wound examination, certification and the cause of death
- **FM3.9:** Firearms and ammunition
- **FM3.10:** Firearm wounds, blast injury and trace evidence
- **FM3.13:** Sexual offences and current rape law anchors
- **FM3.14:** Examination and report of a survivor of alleged rape
- **FM3.29:** Recognition of paediatric non-accidental injury
Frequently Asked Questions
How is an incised wound distinguished from a laceration?
An incised wound has clean, straight margins with no tissue bridges and is longer than it is deep, while a laceration has ragged, crushed edges with tissue bridges and is caused by blunt force.
How can the range of a firearm be judged from the wound?
By the pattern of blackening, tattooing and singeing. Contact and close-range shots show these; as distance increases they disappear and only the wound with an abrasion collar remains.
Is the two-finger test allowed in rape examination?
No. The per-vaginal two-finger test has been prohibited as it has no scientific value and is degrading. Examination now focuses on documented injury and forensic sample collection.
What raises suspicion of child abuse on examination?
Injuries of clearly different ages, patterned marks such as bites or ligature loops, unusual sites, and a caregiver's history that does not fit the pattern or severity of the injuries.
Continue reading
MBBSAll Forensic Medicine and Toxicology chapters
Continue through the Forensic Medicine and Toxicology chapter map.
Continue studying Forensic Medicine and Toxicology
Explore clinician-written learning resources, structured revision and practice across the MedNext platform.
Open in the MedNext appSee plans