Contusion/Bruise-Factors and Color changes

Contusion/Bruise-Factors and Color changes


Factors modifying the appearance of contusion
  • The laxity of tissues – 
    • Lax scrotal tissues allow more extravasation of blood
    • Restrictive fascial planes prevent the accumulation of extravasated blood. 
    • The Turkish torture method ‘falaka’ relies on this principle – the soles of the feet are targets of a beating with sticks, causing severe pain but little outward sign of any injury 
  • The location of the bruise 
    • Highly vascular areas will be more heavily bruised, and tissues overlying bony support will bruise more readily than the unsupported and resilient tissues of the abdomen
  • Age – 
    • Take longer to resolve in the elderly who tend to have more fragile vessels 
    •  Children have a comparatively smaller volume of ‘supporting tissue’;
  • The person’s skin pigmentation –
    • Easily recognised in those with pigmented skin.
  • The force of impact – 
    • The amount of force used may determine the extent of bruising, as well as the characteristics 
    •  The extent of bruising is also inversely proportional to the sharpness of the object causing it – bruises represent blunt force trauma;
  • The existence of co-morbidities –
    • Some people have the tendency to bruise more easily than others, particularly those with bleeding diatheses, chronic alcoholism and liver failure, scurvy and hypertension. I
  • The use of drugs – 
    • particularly anticoagulants such as warfarin and steroids;
  • Any delay in presentation –
    •  bruises ‘migrate’ along anatomical fascial planes, and may appear some time after the injurious assault; and
  • The effects of treatment –
    •  for example the timely application of ice-packs etc

 Colour changes in the contusion

  • Colour changes in the contusion is due to disintegration and haemolysis of red blood cells.
  1. At first : Red (oxyhemoglobin)
  2. Few hours to 3 days : blue (reduced hemoglobin)
  3. 4th day : Bluish-black to brown (haemosiderin)
  4. 5-6 days : Greenish (haematodin)
  5. 7-12 days : Yellow (Bilirubin)
  6. 2 weeks : Normal (absorption of pigment)
  • Pigments are removed by phagocytes.

Healing process depends on:

  • Size and situation of contusion.
  • Age and physique of the person
  • Presence and absence of disease.

Antemortem contusion

  • Sharp,well defined margins.
  • Swelling of the tissues.
  • Discoloration of the skin.
  • Extravasation of blood into the true skin and subcutaneous tissue.
  • Doubtful cases-Microscopic examination.

Postmortem contusion

  • Can be produced with in 1-2 hrs after death.
  • If body is decomposed it is difficult to differentiate between antemortem and postmortem contusions.

Self inflicted contusion

  • Rare-can be inflicted by irritant substances like Marking nut(Latin name: Semecarpus anacardium),root of plumbago zeyloxica or rosea.
  • Can be differentiated by chemical analysis.
Artificial bruise True bruise
Caused by Juice of marking nut, calotropis,Plumbago rosea Trauma
Dark brown color Color changes
Well defined margins Merge with surrounding areas
Vesicles present Absent
Redness seen in the surrounding skin Redness in the site of injury
Itching present Absent

Homicidal contusion

  • Shape and size of contusion,indicates the weapon used.

Accidental contusion

  • Their position,arrangement,circumstances and surroundings.

Exam Important

Colour Changes of Bruise:

Time Color change Pigment
At first Red Hemoglobin
Few hrs to 3 days Blue Reduced Hb
4th day Bluish black to brown, Hemosiderin
5-6 days Green Hematoidin
7-12 days Yellow Bilirubin
2 weeks Normal
  • A contusion can be differentiated from postmortem staining by doing Incision  test.
  • Postmortem staining is easliy washable.
Feature of artificial bruising :
  1. Seen on exposed easily accessible parts
  2. Dark brown in colour
  3. Well defined wound covered with vesicles
  4. Inflammation around the surrounding site
  5. Itching
  6. Vesicles on the fingertip and other parts of the body due to scratching
Note: Artificial bruises can be caused by juice of marking nut, calotropis or plumbago rosea

 

Don’t Forget to Solve all the previous Year Question asked on Contusion/Bruise-Factors and Color changes

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