Pathology of Sharp Force Trauma

Peter Vanezis

• Publisher: CRC Press
• Year: 2021
• ISBN:
  9781000389401
• Edition: 1
• Topic: Medizin
• Subtopic: Pathologie

Pathology of Sharp Force Trauma illustrates and details sharp force trauma as seen in forensic pathology case work as well as in the clinical setting, outlining how one informs the other in interpreting such trauma for medico-legal purposes.

For the purposes of discussion, the author defines sharp force trauma as: "The application of force to produce an injury which results in a clear division or separation of the skin and underlying tissues". Sharp force trauma may be caused by all manner of implements with a sharp edge and/or pointed end, whether or not they have been produced for use as a weapon, and includes knives, broken glass, scissors and many others, to name but a few. Certain tools, such as axes or machetes, combine a sharp edge with heavy weight and produce injuries with both sharp and blunt impact elements.

In many countries, with the exception of those where firearms are readily available, sharp force trauma—particularly the use of knives—is the most common method of homicide and a frequent source of morbidity seen in emergency departments. Also, there has recently been an alarming upsurge in the use of knives in gang-related assaults and in terrorist incidents. As such, the book takes a comprehensive approach in explaining the different aspects of such trauma, most importantly the manner in which the victim has died. This includes cases of homicide, suicide or accident, indicating the type of weapon responsible, explaining how it was used, and presenting other such information to the investigation of such cases.

Features:

• Includes over 400 full-color graphic and illustrative images throughout

• Addresses all aspects of the investigation including trauma, crime scene findings, post-mortem examination, characteristics of injuries and categorization into homicide, suicide or accident

• Covers the biomechanics of knife trauma and tool mark examination techniques to identify implements used

• Illustrates penetrating injuries caused by pointed implements which have linear components, such as arrows, nails, spears, stakes and others

• Details cutting, penetrating, and other sharp force injuries resulting from medical intervention in a healthcare environment, such as might occur during surgical procedures

• Examines sharp injuries caused by domesticated and wild animals

• Written by one of the premier forensic pathologists in the world with over 40 years of first-hand case experience

Pathology of Sharp Force Trauma is the first substantive book published in English to look exclusively at this subject. Although primarily intended for pathologists and clinicians who are involved in the examination of such injuries in the post-mortem room or in a hospital environment, it will also be of interest to medical examiners, police and criminal investigators, attorneys and legal professionals, personnel in other forensic disciplines, and all doctors and medical students with an interested in trauma and its management.

Chapter 1

Introduction, Scope and Historical Perspectives

Introduction

This textbook gives an account of sharp force trauma as seen in forensic pathology case work and includes the clinical setting where relevant, and how one informs the other in interpreting such trauma for medico-legal purposes. Its aim is for the reader to gain a comprehensive understanding of different aspects of such trauma, most importantly the manner in which the victim has died, whether homicide, suicide or accident, the type of weapon responsible, how it was used and other such areas that are useful to the investigation of such cases.

It is important at this stage to define what we mean by sharp force trauma and how different terms are used in referring to such injuries by pathologists and other medical practitioners. A concise and useful but not an entirely watertight definition, as will be readily appreciated by the experienced forensic practitioner is: The application of force to produce an injury which results in a clear division or separation of the skin and underlying tissues.

Sharp force trauma may be caused by all manner of implements with a sharp edge and/or pointed end, whether or not they have been produced for use as a weapon and include knives, broken glass, scissors and many others, to name but a few. Certain tools, such as axes or machetes, combine a sharp edge with heavy weight and produce injuries with both sharp and blunt impact elements. In particular, propeller injuries show a distinct pattern of clean cut injuries in soft tissue yet demonstrate bone fractures typical of blunt force injury. Indeed, sharp force trauma has been regarded by some such as Kroman (2010) to be a continuum of injury progressing from sharp to blunt, arguing that the current classification system for trauma is too restrictive.

Among the various types of sharp force trauma, I have also included:

• penetrating injuries caused by pointed objects which have a linear component. Such implements include arrows, nails, spears, stakes and many others,
• cutting, penetrating and other sharp force injuries resulting from medical intervention in a healthcare environment, such as might occur during surgical procedures, as well as needle stick and other sharp injuries,
• sharp injuries caused by domesticated and wild animals in the chapter on accidental injuries.

A number of different terms as shown below, are used in the description of the resulting wounds seen in sharp force trauma and confusion can easily arise if there is ambiguity about the exact meaning of the different types that are being referred to.

• The general public and even many medical professionals use the word laceration as a general term for when the skin is breached whether the injury is caused by sharp or blunt trauma (Milroy and Rutty 1997). It is important to emphasise at the outset that a laceration is the result of blunt trauma and is a crushing injury. The skin splits, especially when such impact is over a bony area such as the face. There is bridging of tissue and the surface in most cases is slightly abraded with some bruising around the edges and does not consist of clean cut edges, except on occasions when there is a rapid splitting of the skin over bone (see also Chapter 7). In addition, occasionally, in medical records, one sees the use of the word cut to describe any breach of the skin whether due to sharp or blunt force trauma which can also cause confusion when reviewing clinical notes.
• The term stab wound means that the implement has penetrated the skin and underlying tissues and has produced a wound in which its length of penetration (track length) is longer than the length of the wound on the skin surface.
• Incised wound is a term which some pathologists use, as an overarching general term to refer to all injuries produced by a sharp implement, whether they are longer on the skin surface or are stab wounds. Others reserve the term incised wound for an injury which is longer on the skin surface rather than longer in its depth and do not regard it as being synonymous with a stab wound. In this book, in common with most others, the term incised wound will be used synonymously with cutting injury or sharp force trauma when discussing sharp force trauma in general terms. However, when discussing the detailed morphology of the various types of wounds, incised wounds will refer to wounds which are longer on the skin rather than in depth.
• A slash wound is a term used for an incised wound which expresses the way the weapon is used. It particularly describes the sweeping motion of a knife across the body (Bleetman et al., 2003). It is not a blanket term for all wounds which are incised and is only used in the text when it is appropriate to do so.
• A puncture wound is also used by some authorities synonymously with stab wound when the latter appears pointed. Most authorities prefer to use the word puncture when referring to a wound that has a small pointed round appearance and caused by the pointed end of an implement. The wound may be either superficial or deep. Sometimes the word punctate is used when the mark appears like a tiny dot and is superficial.
• A chopping wound is used when sharp force trauma is caused by a heavy object with a sharp edge. The resulting incised skin and underlying soft tissue wound is accompanied by significant additional blunt force trauma.
• The term perforating wound should not be confused with one which is described as penetrating. The term perforation applies both to wounds which have passed all the way through the body or all the way through one or more organs of the body. A good example would be a stab wound entering the body and passing through the heart leaving an entry and exit wound through the organ. On the other hand, a penetrating injury implies that the object has not passed all the way through the organ, other anatomical structures or indeed the whole body.

Historic Accounts

Sharp force trauma has always been a common method of injury since pointed and sharp implements existed. I have included some material that many readers may already be aware of including the interesting recent findings in the exhumation of Richard III and a brief description of seppuku (hara-kiri) because of its importance in Japanese historical culture. I have consciously omitted the Whitechapel murders of 1888 as these are universally known to readers, and there are many texts available expounding the latest theories on the identity of “Jack the Ripper” or “Rippers.”

Archaeological Finds

There are many examples from early archaeological finds of examples of human remains found with injuries that have been caused by sharp trauma. Early man, being a hunter-gatherer, used sharp-edged weapons for hunting and as utility tools for various purposes including attacking any apparent enemies. Flohr et al. 2015 report one of the earliest finds from the Bronze Age site in the Tollense valley, Germany, of a human humerus with an embedded flint arrowhead. When the arrowhead lesion was examined using micro-CT it showed no signs of healing confirming that it was a peri-mortem injury.

Otzi (Iceman)

A celebrated find from the early copper age of forensic as well as archaeological interest is that of the mummy found in the Otzaler Alps between Austria and Italy (Figures 1.1 and 1.2) It is one of the chronologically oldest discoveries of human remains which led to worldwide interest and extensive study. The ...