Forensic Insights into a Traumatic Right-Hand Amputation in an 11-Year-Old Male Following Assault: A Case Report

Global Journal of Pathology & Laboratory Medicine
Volume 2, Issue 1, August 2025
Received: August 1, 2025, Reviewed: August 7, 2025, Accepted: August 20, 2025, Published: August 21, 2025

Unified Citation Journals, Pathology 2025, 1-11; https://doi.org/10.52402/Pathology223
ISSN2754-0952

Authors: Dr. Arun K. S 1, Dr. Chandrakala Gadige 2, and Dr. Akhilesh Pathak 3

¹Junior Resident, Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Bathinda, Punjab

²Senior Resident, Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Bathinda, Punjab

³Professor and Head, Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Bathinda, Punjab

Keywords: Traumatic Amputation, Assault, Antemortem injury, Paediatrics, Limb viability

Abstract:
Introduction and Need: Traumatic amputation due to assault is rare in children and carries serious forensic implications. This case report discuss the clinical, surgical, and medico-legal aspects of a traumatic amputation in an 11-year-old male caused by a kirpan assault. It highlights key wound features, antemortem findings, and medico-legal considerations for identifying such injuries in autopsy and emergency care.

Case History: This case report describes the traumatic amputation of right hand of a 11-year-old male following a conflict.

Findings:  The patient’s vital signs were stable upon presentation. Upon local examination the Patient presented with Total amputation of the right hand at the level of the distal forearm, with clean-cut margins suggestive of sharp weapon trauma associated with arterial spurting and bleeding at the stump side along with Retraction of the wound edges and extravasation of blood into adjacent tissues indicating the injury as antemortem.

Discussion: This case emphasizes the critical importance of early recognition and management of sharp-force trauma in paediatric patients. It also highlights important antemortem findings, including active haemorrhage and tissue viability, which are crucial for forensic pathologists when assessing similar injuries in postmortem cases with an unknown history and recent advances that can be applied in forensic aspects.

Conclusion: Traumatic amputation from a kirpan assault is rare in paediatric cases. This report provides key insights for emergency care, surgical management, and forensic analysis, helping differentiate antemortem injuries from postmortem wounds and highlighting the medico-legal aspects of such cases.

INTRODUCTION:
In forensic context, traumatic amputation refers to the loss of a body part, typically a limb or digit, caused by external trauma from violent crimes, accidents, or natural disasters which is considered grievous and falls under Section 116 BNS (320IPC) [1]. Globally, the incidence number of traumatic amputations increased from 11.37 million in 1990 to 13.23 million in 2019, which might have increased more to date [2].

Traumatic amputation of the hand can result from various mechanisms, broadly categorized as accidental, intentional, or criminal. Common causes include accidents involving heavy machinery, agricultural tools, or vehicular crashes; intentional acts such as self-inflicted injuries due to mental health issues, substance use or rare cultural rituals; and criminal acts, including assaults with bladed weapons, firearms, or acts of torture [3]. Each category presents unique forensic challenges in determining the exact circumstances surrounding the injury. Injuries of this nature in children are exceedingly rare and severe and possess a great challenge for reimplantation of the amputated part especially in Paediatric age group. This case emphasizes the critical importance of sharp-force trauma in paediatric patients. It also highlights important antemortem findings, including active haemorrhage and tissue viability, which are crucial for forensic pathologists when assessing similar injuries in postmortem cases with an unknown history. This article discusses the mechanisms and injuries associated with these events is crucial for understanding the cause, manner, and timing of death or injury and the recent advances that can be applicable in the field of forensic medicine in cases of antemortem, perimortem and postmortem cases with history of amputation and association of this type of violence with substance use.

CASE HISTORY:
An 11-year-old male busker on his way home was assaulted by kirpan (a heavy sharp force blunt weapon) by substance abusers and was presented to Emergency of AIIMS, Bathinda with right hand amputation accompanied by his parents more than six hours after the incident with the amputated hand in a polythene bag as shown in “Figure 1”. The patient was conscious and oriented, with stable vitals of B.P: 130/90 mm Hg, P.R: 110/min, R.R: 18/min, and SpO2 of 100% on room air and with GCS of 15/15.

Total amputation of the right hand at the level of the distal forearm, with clean-cut margins as shown in “Figure 2”, which were indicative of sharp and heavy weapon trauma -Kirpan, associated with arterial spurting and bleeding at the stump side along with retraction of the wound edges and extravasation of blood into adjacent tissues as shown in “Figure 3”. X-ray of the patient depicted in “Figure 4” showing amputation at the level of the base of metacarpals. The patient was surgically managed, including debridement, arterial ligation, and complete amputation of the right hand as shown in “Figure 5” along with administration of IV fluids, antibiotics, and analgesics. The surgeons were not able to reimplant the amputated part due to the loss of viability.

Figure 1- Amputated hand in a polythene bag

Figure 2- Total amputation of the right hand at the level of the distal forearm, with clean-cut margins

Figure 3 – arterial spurting and bleeding at the stump site along with retraction of the wound edges

Figure 4 – Preoperative X-ray of patient showing amputation at the level of base of metacarpals

Figure 5 – Post operative X-ray after debridement, arterial ligation, and complete amputation of the right hand

DISCUSSION:
Sudden separation of a limb from the body following trauma or limb loss caused by severe injury is termed traumatic amputation. Traumatic limb amputations may occur due to agricultural, environmental, occupational, road traffic accidents and domestic accidents as well as assaults and suicidal injuries These injuries can occur due to falls from height, railway and machine accidents, mine, bomb and industrial explosions, snake and crocodile bites, firearms shots, cutting tools, electrocutions, hypothermia, and entrapment under rubble (particularly after earthquake) [4]. Injuries caused due to traumatic amputation are Avulsion, degloving and laceration [5]. The human body usually absorbs such forces either by the resilience and elasticity of its soft tissues or the rigid strength of its skeletal framework and the injury occurs only when the intensity of applied force obeying the laws of kinetic energy () exceeds the capability of the tissues to adapt or resist the wound [6].

The forensic examination of traumatic hand amputation involves a meticulous approach. Scene investigation is critical for gathering clues about the cause and manner of amputation, including the recovery and preservation of severed parts and related evidence, such as blood patterns and tools. If the amputation is caused due to blunt trauma (car accidents, industrial accidents, or falls from great heights) injuries often result in jagged, irregular wound edges which may be accompanied by bone fractures. Whereas application of sharp force results in injuries with clean-cut margins typically exhibiting clean, smooth edges, as seen in this case “Figure 2”.

Once determining the force and manner of injury it is very crucial to determine whether the injury is antemortem or post-mortem. In this case we find injury associated with arterial spurting and bleeding at the stump side along with retraction of the wound edges and extravasation of blood into adjacent tissues which are coagulated “Figure 2” accompanied by signs of vital reaction and cellular proliferation indicating the trauma was antemortem in nature. Whereas in cases of postmortem trauma there would be no haemorrhage, if present would be of venous blood with no spurting, coagulation and wound edges show less gaping with no retraction accompanied by absence of vital reaction and cellular proliferation [1]. The distinction between perimortem and antemortem trauma lies in the presence of healing. Perimortem fractures share the biomechanics of antemortem fractures; however, due to death, the natural healing process does not occur. Without evidence of healing, perimortem fractures are further differentiated from postmortem fractures, which arise after decomposition, as they retain the same biomechanical characteristics present in antemortem injuries [7].

In antemortem amputations, Replantation involves the reconstitution of all the separated components of an extremity, including anastomosis of the arterial inflow and venous return. Replantation depends on the time elapsed (Prolonged ischemia time), part affected and presence of muscle bulk which decides the viability of the amputated part. The contraindication of replantation includes severe crushed injuries with decreased vascularisation and prolonged ischemia time more than 6 hours. The limb will be amputated/ salvaged if prolonged ischemia time exceeds more than 6 hours in presence of muscle bulk and if prolonged ischemia time exceeds more than 12 hours in absence of muscle bulk [8].

Postmortem examination (if fatal) focuses on analysing the stump to determine the injury mechanism, documenting defensive wounds, and assessing tissue changes to estimate the timing of the injury. Analysis of the amputated hand includes examining tool marks or trace evidence, like paint or biological material, linking the injury to specific instruments or environments.

Radiological assessment, through X-rays or CT scans, evaluates bone and soft tissue damage and identifies embedded foreign objects., The radiological investigation such as CT which helps in differentiating old versus new fractures whereas MRI shows whether the fractures are antemortem or perimortem based on the signals from the bone marrow. Ruder TD et al, in a case due to fall from height established the nature of trauma whether it is antemortem or perimortem by describing the lack of bone marrow oedema on PMMR due to absence of active blood circulation at time on injury [9]. Postmortem imaging can also be used as non-invasive method of examining the body and supplying additional information for reconstructive questions for the sake of reconstruction of events [10].

In cases of decomposition, amputated parts are better suited to a protein-based approach. Among all the proteins present in the body, muscle protein shows the strongest evidence to date, predominantly Skeletal muscle contains various types of proteins, such as troponin, myoglobin, actin, and many more. The kinetics of several proteins and proteases were particularly correlated with PMI. Different proteins degrade differently after death: alpha-actinin, GAPDH, and alpha-tubulin breakdown slowly, but meta-vinculin breaks down early. Tropomyosin does not change for a long time after death, up to 10 days whereas Laminin 2 showed stability in human bones that had been buried for up to 20 years [11]. Lastly, DNA profiling of the amputated hand and stump confirms identity in disputed cases, providing crucial evidence for forensic investigations and application of recent advances for establishing the postmortem interval aiding in police investigations [12]. Available technologies such as PCR, Southern blot, and electrophoresis offer variety of approaches to the problems addressed by identity testing in the clinical laboratory giving forensic field a statistical accuracy and technical powers [13].

Finally, apart from the forensic investigations, History taking plays a crucial role in determining the way the injury would have been occurred, and involvement of weapon and reconstruction of events leading to traumatic amputation. Ignasi Galtes et. al in a rare case of finger amputation concluded that there was no involvement of weapon and amputation was caused by the victim gripping her husband’s t-shirt when he made a sudden, violent movement of his arm where the victim’s fingers became firmly trapped in the fabric, causing a forced hyperextension of the fingers and caused avulsion of distal finger [14].

A significant association exists between substance use and severe injuries among adolescents, mediated by interpersonal violence exposure [15]. The forensic aspects of substance use, violence are complex and multifaceted. They involve the combination of substance abuse, criminal behaviour, mental health, and legal responsibility. Forensic professionals are tasked with assessing how substance use affects both the perpetrator’s actions and the victim’s experience to inform legal decisions, treatment plans, and sentencing outcomes which requires the through understanding of Forensic psychology and toxicology.

CONCLUSION:
Traumatic hand amputation is a complex and multifaceted injury with significant implications for both medical and forensic professionals. The case presented underscores the importance of a comprehensive and multidisciplinary approach in understanding the circumstances of such injuries. Detailed forensic analysis, including scene investigation, radiological assessment, and DNA profiling, and application of recent advances in the field of forensic medicine plays a pivotal role in establishing the cause and manner of the injury while aiding legal proceedings. Additionally, this case highlights the necessity of cultural sensitivity when addressing incidents involving culturally significant objects like the kirpan. By combining advanced forensic techniques with a nuanced understanding of the cultural and medicolegal context, medical and forensic experts can ensure accurate investigation outcomes and justice for affected individuals.

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