Original Article
Atypical fatal entry wound to the thigh – a case report
Medico-Legal Journal 2014, Vol. 82(3) 116–118 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0025817213517347 mlj.sagepub.com
Basappa S Hugar1, Prashantha Bhagavath2, SH Harish1 and S Anitha2
Abstract Stab wounds encountered in medico-legal practice are caused by sharp or blunt pointed weapons such as a kitchen knife, dagger, screwdriver, iron rod, etc. Atypical entry wounds may result from elasticity of skin, relative movement of the victim or the offending weapon or both. These are often described in the literature. We report an unusual incised stab injury of the thigh where a single atypical entry wound resulted in injury to the femoral vessels. The precise causation of such a peculiar entry wound cannot be explained, though it can be considered within the dynamic processes involved between victim, assailant and the offending weapon. It is recorded because of its academic curiosity.
Keywords Forensic science, forensic pathology, stab injury, sharp weapon, blunt weapon, haemorrhage
Introduction A stab wound is a three-dimensional injury, i.e. it has length, breadth and depth. The external appearance of stab wounds depends on the weapon used.1 When the wound is caused by weapons like a kitchen knife, dagger, etc, the skin and underlying tissues are incised, whereas when it is caused by weapons such as a screwdriver, iron rod, etc, the skin and underlying tissues are lacerated. The shape of the wound depends on the type of the weapon. For example, a double-edged knife or dagger causes an elliptical wound, whereas a singleedged knife causes a wedge or triangular wound. A pointed round weapon causes a circular wound and an irregular pointed weapon causes a cruciate wound.2 There is less information in the forensic literature regarding atypical or peculiar wounds of entry in fatal stab wounds. Peculiarities of external entry wounds result from multiple factors such as the amount of force used, twisting the weapon either during entry or withdrawal of the weapon, or whether the weapon had been thrust up to its hilt.3 Stab injuries are dangerous because they often penetrate the body deeply. The neck, chest, abdomen and proximal parts of the limbs contain vital structures that are not adequately protected from external trauma. We report a case of an atypical fatal stab injury to the thigh caused
by a double-edged knife because such injuries are rarely encountered.
Case report A male aged about 26 years was brought in dead to a tertiary health care centre in Bangalore. He was alleged to have been stabbed in his thigh during a road rage altercation. Examination of the jeans worn by the deceased at the time of the incident revealed a tear measuring 4.5 cm in length over the front of the right trouser leg corresponding to the middle one-third of the front of the right thigh. A gaping stab injury, measuring 5 cm 1.5 cm an approximation of 6.5 cm in depth, was present in the front of the middle one-third of the right thigh in its inner aspect (Figure 1). The upper end 1 Department of Forensic Medicine, MS Ramaiah Medical College, Karnataka, India 2 Department of Forensic Medicine, Kasturba Medical College Manipal, India
Corresponding author: Dr Basappa S Hugar, MD, DNB, Associate Professor, Department of Forensic Medicine, MS Ramaiah Medical College, MSRIT Post, MSR Nagar, Bangalore 560054, Karnataka, India. Emails: [email protected]; [email protected]
Hugar et al.
117 17.5 cm long and 3.5 cm wide and tapered to a pointed tip with bloodstains in places. After examining the alleged weapon and considering how this may have caused the stab wound, the opinion was given that ‘‘the stab injuries mentioned in the autopsy report could be caused by the type of knife examined’’.
Discussion
Figure 1. Peculiar stab injury over the inner aspect of right thigh.
Figure 2. Alleged weapon in the case concerned.
of the wound had a single sharply tapered end, and at the lower end there were two sharply tapered ends. On internal examination, the wound was directed backwards, upwards and towards the left side, traversing subcutaneous tissue, the sartorius muscle, the adductor longus muscle, the femoral artery and the femoral vein. These structures were traversed in two places very close to each other. The lungs, liver and kidney were pale on cut section. The opinion was formed that the cause of death was haemorrhage secondary to a stab injury to the right thigh. Initially, a single-edged knife was suspected to have caused this injury. Subsequently, the alleged weapon brought in by the police for examination was a double-edged knife (Figure 2) measuring 27.5 cm in length. The blade was
Road rage is the aggressive or angry behaviour of a driver of an automobile or other motor vehicle. This may include rude gestures, verbal insults, deliberately driving in an unsafe or threatening manner, or making threats. Road rage can lead to altercations, assaults and collisions, which result in injuries and even deaths. It can be thought of as an extreme case of aggressive driving. In this case, a petty argument regarding the manner of overtaking led to infliction of a fatal stab injury to the right thigh of the deceased. Injuries to peripheral vessels have a potential to cause morbidity and mortality if they are not recognised and treated promptly. Cases of sharp wound fatality are common when vital organs are injured, and a single stab wound to the extremity can also prove fatal if it damages a major vessel. When plunging the knife into the body, in the process of its withdrawal, it may be rotated or there may be relative movement between the assailant and the victim. In such a case, any sharp-edged weapon with a pointed tip such as a knife may produce a wound with an atypical entry pattern. There will be an initial primary stab wound with an extension on one or both of the edges of the wound due to the sharp edge producing a secondary path as it is withdrawn. Such variations are seen when the knife is slightly rotated or the victim moves considerably, resulting in an inverted V-shaped notch or fork.4,5 Thus, with a single-edged knife, one end of the wound will be blunted and the sharp tapering end forked.3 Some of these features may be simulated by the blunt weapons having a pointed tip. If a double-edged weapon is used to stab an individual, the wound produced will show bilateral pointed ends. If a single-edged weapon is used, theoretically, one end of the stab wound is pointed and the other is squared off or blunted. Thus, while in theory one can look at a stab wound and say the weapon was singleedged or double-edged, in reality, this is not always possible through examination of a single wound. Sometimes as the knife is withdrawn from the body, it may be twisted or the person stabbed may move. In this situation with a single-edged knife, one end of the stab wound will be squared or blunted and the other will be forked.4 Exceptions arise when the stab wound is not the result of a single in and out thrust but is inflicted with the cutting edge moving forward as the
118 knife entered the body.6 Rarely, some stab wounds caused by a single-edged weapon have bilateral pointed ends like those due to double-edged weapons.7 The commonsense interpretation of the relative position of the bodies is less easy, because one has to take into account variations in posture of the deceased and the assailant. All these matters must be carefully considered in order to avoid making false interpretations, which may result in miscarriage of justice.8 In the present case, the single upper end of the wound is relatively blunt with two lower ends being sharp. During the first plunge by the perpetrator, the double-edged knife could have caused a stab wound with two sharp ends and then the perpetrator could have withdrawn the knife slightly and taken the second plunge which might have caused relative blunting of one end due to overlap with the sharp end of first wound and a second sharp end on the opposite side. Hence, detailed examination of a stab injury can provide useful information regarding the type of weapon that has probably inflicted the wounds. A single-edged weapon can cause an injury, which resembles that caused by a double-edged knife. However, conversely, in this case a double-edged knife caused an injury like that of a single-edged knife as the upper blunt end is formed by merging of two sharp ends. However, the second plunge being slightly tilted from the first has caused two separate sharp ends.
Conclusion The role of the forensic pathologist is to explain the wounds in their entirety, thereby helping the judiciary to reconstruct the events that have taken place, which may go a long way in helping the administration of justice. The exact cause of typical or atypical wounds can only be speculated upon with proper reasoning.
Medico-Legal Journal 82(3) The job becomes much more difficult when the offending weapon is not traceable or recovered. Therefore, it is important for the autopsy surgeon to record the wound with all its findings however subtle it may be thereby giving ample scope for its scrutiny at a later stage. Conflict of interest None declared.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References 1. Karmakar RN. Forensic medicine and toxicology, 3rd ed. Kolkata: Academic Publishers, 2010, p.246. 2. Bardale R. Principles of forensic medicine and toxicology. New Delhi: Jaypee Brothers Medical Publishers Ltd., 2011, p.191. 3. Menon A, Kanchan T, Monteiro FN, et al. Atypical wound of entry and unusual presentation in a fatal stab injury. J Forensic Leg Med 2008; 8: 524–526. 4. Dimaio VJ and Dimaio D. Forensic pathology, 2nd ed. Florida: CRC Press, 2001, p.187. 5. Spitz WU and Fischer RS. Medicolegal investigation of death, 2nd ed. Springfield: Charles C. Thomas Publishers, 1980, pp.159–201. 6. Mant AK. Taylor’s principles and practice of medical jurisprudence, 13th ed. Edinburgh: Churchill Livingstone, 1984, p.240. 7. Stab wound or punctured wound June 18, 2011, http:// healthdrip.com/stab-wound-or-punctured-wound (2011, accessed 7 January 2012). 8. Knight B and Cox HWV. Medical jurisprudence and toxicology, 6th ed. Allahabad: The Law Book Company (P)? Ltd, 1995, p.293.
Atypical fatal entry wound to the thigh – a case report
Medico-Legal Journal 2014, Vol. 82(3) 116–118 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0025817213517347 mlj.sagepub.com
Basappa S Hugar1, Prashantha Bhagavath2, SH Harish1 and S Anitha2
Abstract Stab wounds encountered in medico-legal practice are caused by sharp or blunt pointed weapons such as a kitchen knife, dagger, screwdriver, iron rod, etc. Atypical entry wounds may result from elasticity of skin, relative movement of the victim or the offending weapon or both. These are often described in the literature. We report an unusual incised stab injury of the thigh where a single atypical entry wound resulted in injury to the femoral vessels. The precise causation of such a peculiar entry wound cannot be explained, though it can be considered within the dynamic processes involved between victim, assailant and the offending weapon. It is recorded because of its academic curiosity.
Keywords Forensic science, forensic pathology, stab injury, sharp weapon, blunt weapon, haemorrhage
Introduction A stab wound is a three-dimensional injury, i.e. it has length, breadth and depth. The external appearance of stab wounds depends on the weapon used.1 When the wound is caused by weapons like a kitchen knife, dagger, etc, the skin and underlying tissues are incised, whereas when it is caused by weapons such as a screwdriver, iron rod, etc, the skin and underlying tissues are lacerated. The shape of the wound depends on the type of the weapon. For example, a double-edged knife or dagger causes an elliptical wound, whereas a singleedged knife causes a wedge or triangular wound. A pointed round weapon causes a circular wound and an irregular pointed weapon causes a cruciate wound.2 There is less information in the forensic literature regarding atypical or peculiar wounds of entry in fatal stab wounds. Peculiarities of external entry wounds result from multiple factors such as the amount of force used, twisting the weapon either during entry or withdrawal of the weapon, or whether the weapon had been thrust up to its hilt.3 Stab injuries are dangerous because they often penetrate the body deeply. The neck, chest, abdomen and proximal parts of the limbs contain vital structures that are not adequately protected from external trauma. We report a case of an atypical fatal stab injury to the thigh caused
by a double-edged knife because such injuries are rarely encountered.
Case report A male aged about 26 years was brought in dead to a tertiary health care centre in Bangalore. He was alleged to have been stabbed in his thigh during a road rage altercation. Examination of the jeans worn by the deceased at the time of the incident revealed a tear measuring 4.5 cm in length over the front of the right trouser leg corresponding to the middle one-third of the front of the right thigh. A gaping stab injury, measuring 5 cm 1.5 cm an approximation of 6.5 cm in depth, was present in the front of the middle one-third of the right thigh in its inner aspect (Figure 1). The upper end 1 Department of Forensic Medicine, MS Ramaiah Medical College, Karnataka, India 2 Department of Forensic Medicine, Kasturba Medical College Manipal, India
Corresponding author: Dr Basappa S Hugar, MD, DNB, Associate Professor, Department of Forensic Medicine, MS Ramaiah Medical College, MSRIT Post, MSR Nagar, Bangalore 560054, Karnataka, India. Emails: [email protected]; [email protected]
Hugar et al.
117 17.5 cm long and 3.5 cm wide and tapered to a pointed tip with bloodstains in places. After examining the alleged weapon and considering how this may have caused the stab wound, the opinion was given that ‘‘the stab injuries mentioned in the autopsy report could be caused by the type of knife examined’’.
Discussion
Figure 1. Peculiar stab injury over the inner aspect of right thigh.
Figure 2. Alleged weapon in the case concerned.
of the wound had a single sharply tapered end, and at the lower end there were two sharply tapered ends. On internal examination, the wound was directed backwards, upwards and towards the left side, traversing subcutaneous tissue, the sartorius muscle, the adductor longus muscle, the femoral artery and the femoral vein. These structures were traversed in two places very close to each other. The lungs, liver and kidney were pale on cut section. The opinion was formed that the cause of death was haemorrhage secondary to a stab injury to the right thigh. Initially, a single-edged knife was suspected to have caused this injury. Subsequently, the alleged weapon brought in by the police for examination was a double-edged knife (Figure 2) measuring 27.5 cm in length. The blade was
Road rage is the aggressive or angry behaviour of a driver of an automobile or other motor vehicle. This may include rude gestures, verbal insults, deliberately driving in an unsafe or threatening manner, or making threats. Road rage can lead to altercations, assaults and collisions, which result in injuries and even deaths. It can be thought of as an extreme case of aggressive driving. In this case, a petty argument regarding the manner of overtaking led to infliction of a fatal stab injury to the right thigh of the deceased. Injuries to peripheral vessels have a potential to cause morbidity and mortality if they are not recognised and treated promptly. Cases of sharp wound fatality are common when vital organs are injured, and a single stab wound to the extremity can also prove fatal if it damages a major vessel. When plunging the knife into the body, in the process of its withdrawal, it may be rotated or there may be relative movement between the assailant and the victim. In such a case, any sharp-edged weapon with a pointed tip such as a knife may produce a wound with an atypical entry pattern. There will be an initial primary stab wound with an extension on one or both of the edges of the wound due to the sharp edge producing a secondary path as it is withdrawn. Such variations are seen when the knife is slightly rotated or the victim moves considerably, resulting in an inverted V-shaped notch or fork.4,5 Thus, with a single-edged knife, one end of the wound will be blunted and the sharp tapering end forked.3 Some of these features may be simulated by the blunt weapons having a pointed tip. If a double-edged weapon is used to stab an individual, the wound produced will show bilateral pointed ends. If a single-edged weapon is used, theoretically, one end of the stab wound is pointed and the other is squared off or blunted. Thus, while in theory one can look at a stab wound and say the weapon was singleedged or double-edged, in reality, this is not always possible through examination of a single wound. Sometimes as the knife is withdrawn from the body, it may be twisted or the person stabbed may move. In this situation with a single-edged knife, one end of the stab wound will be squared or blunted and the other will be forked.4 Exceptions arise when the stab wound is not the result of a single in and out thrust but is inflicted with the cutting edge moving forward as the
118 knife entered the body.6 Rarely, some stab wounds caused by a single-edged weapon have bilateral pointed ends like those due to double-edged weapons.7 The commonsense interpretation of the relative position of the bodies is less easy, because one has to take into account variations in posture of the deceased and the assailant. All these matters must be carefully considered in order to avoid making false interpretations, which may result in miscarriage of justice.8 In the present case, the single upper end of the wound is relatively blunt with two lower ends being sharp. During the first plunge by the perpetrator, the double-edged knife could have caused a stab wound with two sharp ends and then the perpetrator could have withdrawn the knife slightly and taken the second plunge which might have caused relative blunting of one end due to overlap with the sharp end of first wound and a second sharp end on the opposite side. Hence, detailed examination of a stab injury can provide useful information regarding the type of weapon that has probably inflicted the wounds. A single-edged weapon can cause an injury, which resembles that caused by a double-edged knife. However, conversely, in this case a double-edged knife caused an injury like that of a single-edged knife as the upper blunt end is formed by merging of two sharp ends. However, the second plunge being slightly tilted from the first has caused two separate sharp ends.
Conclusion The role of the forensic pathologist is to explain the wounds in their entirety, thereby helping the judiciary to reconstruct the events that have taken place, which may go a long way in helping the administration of justice. The exact cause of typical or atypical wounds can only be speculated upon with proper reasoning.
Medico-Legal Journal 82(3) The job becomes much more difficult when the offending weapon is not traceable or recovered. Therefore, it is important for the autopsy surgeon to record the wound with all its findings however subtle it may be thereby giving ample scope for its scrutiny at a later stage. Conflict of interest None declared.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References 1. Karmakar RN. Forensic medicine and toxicology, 3rd ed. Kolkata: Academic Publishers, 2010, p.246. 2. Bardale R. Principles of forensic medicine and toxicology. New Delhi: Jaypee Brothers Medical Publishers Ltd., 2011, p.191. 3. Menon A, Kanchan T, Monteiro FN, et al. Atypical wound of entry and unusual presentation in a fatal stab injury. J Forensic Leg Med 2008; 8: 524–526. 4. Dimaio VJ and Dimaio D. Forensic pathology, 2nd ed. Florida: CRC Press, 2001, p.187. 5. Spitz WU and Fischer RS. Medicolegal investigation of death, 2nd ed. Springfield: Charles C. Thomas Publishers, 1980, pp.159–201. 6. Mant AK. Taylor’s principles and practice of medical jurisprudence, 13th ed. Edinburgh: Churchill Livingstone, 1984, p.240. 7. Stab wound or punctured wound June 18, 2011, http:// healthdrip.com/stab-wound-or-punctured-wound (2011, accessed 7 January 2012). 8. Knight B and Cox HWV. Medical jurisprudence and toxicology, 6th ed. Allahabad: The Law Book Company (P)? Ltd, 1995, p.293.
