CHAPTER XI

PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY

1. HEAD AND NECK INJURIES
Factors Influencing the Degree and Extent of Head Injuries
a. Nature of the Wounding Agent
Weapons with a small striking face usually produce a localized depressed
fracture with laceration of the scalp.
b. Intensity of the Force
As a general rule, the intensity of force is proportional to the degree of
damage it will produce.
c. Point of Impact
d. Mobility of the Skull at the Time of the Application of Force
If the head is mobile, unsupported and free, the principal effects on the
brain is due to the shearing movement imparted to the brain.
Head Injuries are Classified as to the Site of the Application of Force
a. Direct or Coup Injuries
These are injuries which occur at the site of the application of force and
will develop as a natural consequence of the force applied.
Direct Injuries may Result to:
(1) In compression of the head by the wheel of a vehicle
(2) When the head strikes an object in motion, as bullets.
(3) When the head is in motion and strikes a n object, as in vehicular
accident

skull

b. Indirect Injuries
These are injuries in the head which are not found at the site of the
application of force.
(1) Contre Coup Injuries
These are injuries which develop opposite the site of the
application of force.
(2) Remote Injuries
Produced in cases where the force is applied in some areas of the
body which have no relation to the head.
(3) Locus Minoris Resistencia"
The injury sustained in the head may not be at or opposite the
application of force but may be found in some areas of the
offering the least resistance.

application

c. Coup-contre-coup Injuries (Direct and Indirect Injuries)

The injuries may be at the site of impact and at the same time found in
some other parts of the head which may be opposite the site of
of force, or elsewhere.

Wounds of the Scalp

A wound of the scalp although small and negligible is potentially serious.
Fractures of the Skull
a. Fissure Fractures - involves the inner and outer table.
b. Localized Depressed Fracture - sometimes called "Fracture a La Signature".
c. Penetrating Injuries of the Skull
d. Comminuted Fractures
e. Pond or Indented Fracture
f. Gutter fractures
g. Bursting Fracture
Intracranial Hemorrhages
may occur even in the absence of a fracture
a. Extradural or Epidural Hemorrhage (almost exclusively due to trauma)
b. Subdural Hemorrhage -subdural bleeding is essentially venous or capillary
c. Subarachnoidal Hemorrhage
d. Cerebral Hemorrhage
Brain
a. Laceration of the Brain
(1) Direct or Coup Laceration
(2) Contre-coup Laceration
b. Edemas of the Brain
(1) Localized Edema
(2) Generalized Edema
c. Concussion of the Brain
d. Compression of the Brain
Medico-Legal Questions in Intracranial Injuries
a. Is the origin of the Intracranial hemorrhage due to trauma or disease?
b. In cases of cerebral concussion, can the victim remember the incidents before, during
or after the accidents?
c. Can the victim of head injuries still retain voluntary movement and speech?
d. Post-traumatic Automatism.
e. In gunshot wounds of the head, how can the point of entrance be determined?
f. Post-traumatic Irritability
Face
Wounds on the face heal relatively faster as compared with wounds of the others parts of
the body on account of its great vascularity.
a. Eye - Contusion of the soft tissue about the eyes is sub-conjunctival.
b. Nose - Fracture of the nasal bone is a common sequelae of fist blows, and may cause
severe epistaxis and facial deformity.

c. Ear - A blow on the ear may produce a rupture of the tympanic membrane leading to
permanent or temporary deafness.
d. Mouth - Contusion, laceration and swelling of the lips are usually observed in a fist
blow, kick or bite.
Neck
Abrasions of the neck may be present in cases of manual strangulation.
Vertebral Column and Spinal Cord
a. Fracture of the Vertebrae
Dangerous to life because of the involvement of the spinal cord.
(1) Direct Violence
(2) Indirect Violence
b. Concussion of the Spine
Jarring of the spinal cord may occur even without any visible signs of external
injuries.
2. INJURIES TO THE CHEST
Injuries in the chest are important because vital organs are inside the chest cavity,
namely: the heart, lungs and the principal blood vessels.
Injuries to the Chest Wall
The chest wall is easily contused by the application of moderate force on account of the
superficial location of the ribs.
Fracture of the Ribs may be Caused by:
a. Direct Violence
b. Indirect Violence
Injuries to the Lungs
Hemorrhage in the pleural cavity coming from the inter-costal vessels or from the lung
tissue itself may cause compression and collapse of the lungs and the patient may die of
respiratory embarrassment or anemia.
Complication of Lung Injuries
a. Hemorrhage
b. Compression of the Lungs
c. Severe Pneumothorax
d. Cerebral air embolism
e. Hemoptysis
f. Subcutaneous emphysema
Injuries to the Heart
The heart may fail and causes death due to an existing natural disease independent of
trauma.

Injuries of the Diaphragm

Wounds of the diaphragm due to a sharp instrument and bullets are caused by injuries
either of the chest or abdomen.
3. ABDOMINAL INJURIES
Abdominal Wall
The areas most vulnerable are the point of attachment of internal organs, especially at the
source of its blood supply and at the point where blood vessels change direction.
Stomach
Spontaneous rupture of the stomach may be observed in cases of gastric ulcer or new
growth.
Intestine
Ulcer at the duodenum may rupture spontaneously. The same is true in cases of
tuberculous, amoebic, cancerous or typhoid ulcerations. Peritonitis and hemorrhage are
the common causes of death.
The mesentery may be contused, lacerated or crushed but in most cases its
involvement is secondary to lesion in the intestine.
Liver
The liver is one of the most vulnerable organs in the abdominal cavity because of its size,
weight, location, friability, and fixed position.
Spleen
The spleen usually suffers traumatic rupture resulting from the impact of a fall or blow
from the crushing and grinding effects of wheels of motor vehicles.
Kidney
Traumatic injury of the kidney may be due to a blow at the lumbar region somewhere at
the region of the 12th rib.
Injury to the kidney is accompanied by peri-renal hematoma which consists ob
blood and urine.
Pancreas
The pancreas may be injured by a violent blow at the epigastric region. Death may be due
to hemorrhage, shock, or insulin insufficiency.

4. PELVIC INJURIES
Uterus
A non-gravid uterus is rarely involved in pelvic injuries, but a gravid uterus is likely to be
ruptured in a blow, kick, or crush injuries.

Vagina
Laceration of the vagina may be due to a sexual act or faulty instrumentation to induce a
criminal abortion.
5. EXTREMITIES
Physical injuries on both upper and lower extremities are usually due to direct violence,
crushing or some indirect force:
a. Direct violence will result in a contusion.
b. Indirect violence, such as twisting or pathological fracture of the bone underneath,
causes laceration
c. Crushing injuries of the limb can result in severe soft tissue trauma and are most
commonly caused by vehicular accidents.

CHAPTER XIX
DEATH OR PHYSICAL INJURIES DUE TO ATHLETIC SPORTS
Some Aspects of Sports Development:

1. Training Method
2. Injuries
3. Nutrition
A. BOXING
Boxing as a sport is sometimes described as an "organized brutality", "slaughter" and
"carnage". Generally, in most sports, the infliction of physical injuries are purely accidental but
in boxing, it is direct and primary objective of the combatants.
Reasons Why Boxing Should Not be Prohibited:
a. It takes wayward youths who are victims of the educational system off the streets.
b. It teaches them self-discipline and controls and reinforces the adage that nothing of
value is acquired without hardwork and sacrifice.
c. Self-confidence can only be promoted through an individual sport where the athlete
must rely in his own talent and believes in his own ability.
Reasons Why Boxing Should be Prohibited:
a. There is too much risk of death or injury to the participants.
b. Unlike other sports, the intention of the combatants is to produce injury as principal
way to win the contest.
Potential Injuries Suffered by Combatant in Boxing
a. Inasmuch as the face is the target of the attack by the combatants, the most common
site of lacerated wound is the region of the eyebrow and the cheek (malar
region).
b. Serous effusion on the loose tissue around the eyeball and in the eyelid may cause
puffiness and closing of the eye.
c. Trauma on the pinna of the ear may produce hematoma with subsequent necrosis of the
articular cartilage.
d. Fracture of the nasal septum, mandible and maxillary bone may develop as a
consequence of a hard hook or a straight blow.
e. Retinal detachment is one of the serious hazards of boxing as it may cause partial or
complete loss of vision.
f. Muscle cramps, sprain and dislocation may occur and may force the boxer to give up
the fight.
g. A kidney punch may cause peri-renal hemorrhage or laceration of the kidney that
causes it to lose its function and subsequent uremia.
h. A blow on the face may cause laceration of the lip and buccal mucosa with loosening
or detachment of the teeth.
Intracranial injuries may cause serious sequelae of death to the boxer.
1. Cerebral concussion
2. Subdural hemorrhage
3. Pontine hemorrhage

The effect on the brain of a boxing blow depends on the location, direction, intensity,
velocity and number of blows.
(1) Rotation (angular) Acceleration
a. Subdural Hematoma
b. Intracerebral Hemorrhage
c. Diffused Axonal Injury
(2) Linear (Translational Acceleration)
(3) Injury to the Carotid
(4) Impact Deceleration
Cerebral Edema, Ischhemia and Herneation
Severe trauma on the head is usually followed by cerebral edema. It increases pressure on
the swollen brain within a confined space of the cranial cavity which affects the blood flow. The
vessels are squeezed resulting in Ischemia which further contributes to edema.
Delayed Consequence of Brain Damage
The delayed sequelae of intracranial damages in boxing is summed up to what is
commonly known as punch-drunkenness or traumatic or pugilistic encephalopathy.
Post-Mortem Findings
(1) In case of death after the injury due to intracranial hemorrhage:
a. Generalized edema of the brain
b. Presence of intracranial hemorrhage usually subdural.
c. Compression of the brain on account of massive hemorrhage.
d. Petechial hemorrhage in the white matter.
e. Compression of the brain stem at the region of the foramen magnun.
f. Small areas of contusion on the brain surface.
g. Histologically:
i. Perivascular and pericellular space.
ii. Capillaries show congestion with endothelial swelling
iii. Axons are swollen and poorly stained.
iv. Astrocytes appear swollen and nerve cells show chromatolysis and
cystoplasm vacuolated
(2) In case of death after a chronic sequelae:
a. Abnormality in the septum pellucidum
b. Cerebellar and other scarring
c. Small areas of scarring in the cerebellar tonsil and medula oblongata
d. Reduction of the brain weight
e. Lateral ventricle widely dilated with thinning of the corpus callosum
f. Loss of pigmented nerve cells in the substantia nigra.
Wrestling

Common Injuries Suffered by Combatants:

a. Injury to the cervical spine especially when the wrestler forms a bridge during the
contest
b. Knee injury, usually meniscus or ligament tear that follows hyperextension and
rotation of the leg.
c. Injuries to the shoulder joint and rotator cuff result from twisting of the trunk and
upper extremities
d. Facial injuries and mat burns due to contact of the face to the floor.
e. Abdominal hemorrhage due to rupture of organs in violent fall.