Changing Pattern Of Fabricated Injuries In Larkana Region

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J Ayub Med Coll Abbottabad 2009;21(3) 76
Zawar Hussain Khichi, Muhammad Humayun*, Kanwal Kumar N Prithiani,
Qazi Muhammad Akbar**, Ghulam Qadir Kaheri
Department of Forensic Medicine and Toxicology, Chandka Medical College Larkana, *Bannu Medical College, Bannu,
**Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
Background: Man has been egotist by nature and from Ancient time man has been endeavouring to
bring under power other human beings. With the passage of time and growth of civilization this trend
has been increased. Now there are more dangerous ways of violence and torture in use for twisting and
turning people around. Inflection of fabricated injuries is one of the ways for fulfilment of his lust.
Incidence of fabricated injuries is related with crime rate in any society, and this practice is carried out
through out the world. Fabricated Injury is a major problem which forensic expert/causality medical
officer face during their duty. Very little literature is available regarding study of fabricated injuries and
no authentic criteria has so for been developed for labelling an injury as fabricated one. Methodology:
The present study is about 130 challenged medico-legal cases in Larkana Division which were studied
in special medical board held in the Department of Urology Chandka Medical College Larkana. Out of
130 cases 50 were proved to be fabricated. Results: The total number of challenged cases was 130, out
of these 50 (38.46%) cases were of fabricated injuries. Out of 50 fabricated cases, 46 (92%) were males
and 4 (8%) were female, thus the male to female ratio was approximately 11:1. Maximum cases (25)
were from Larkana District, 15 cases were from Shikarpur and 10 cases from Jacobabad. The majority
of fabricated injuries from Larkana District were nose injuries as out of 25 fabricated injuries from
Larkana district 10 were nasal injuries, while from district Jacobabad and Shikarpur there was no nasal
fabricated injury. Conclusion: Most of the fabricated injuries are caused on accessible part of the body
like arms, legs, abdomen, chest etc. The pattern of fabricated injuries is changing in Larkana District as
out of 25 fabricated injuries in this district 10 were nasal injuries while in District Jacobabad and
Shikarpur there was no nasal fabricated injury.
Keywords: Ancient, Fabricated, Injuries, Torture, Endeavouring, Authentic, Egotist
Fabricated/Self inflicted or forged/invented wounds are
usually multiple. These injuries are commonly seen over
those parts of the body which are easily accessible, for
example on top of head, forehead, front of chest and
abdomen, outer side of thigh, neck, nose, outer side of
the arm.1 Fabricated injury is a major problem which
forensic expert, causality medical officer face during
their duty. Very little literature is available about study
of fabricated injuries and no authentic criteria has so for
been developed labelling an injury as fabricated one.2
Present study consists of 130 cases during the period
January 2005 to June 2007 from whole Larkana
Division. Out of 130 challenged medico-legal cases 50
were of fabricated nature. 46 cases were male (92%)
while 4 cases (8%) were female. Thus the male to
female ratio was approximately 11:1. This is because
the fabricators feel dishonour while incurring the
injuries to the female. Infliction of fabricated injuries is
practice all over the world for criminal reasons.
Fabricated/self inflicted injuries are of two types:
 Self Inflicted, Produced by the person on his/her own
 Self Suffered, Caused by another person acting in
agreement with him/her.3
Aims of the Fabricators3:
 To support false charge against enemy/another person
 To convert simple injury into grievous one
 To destroy evidence of certain injury that might
connect the person with the crime
 By an assailant to show that he was acting in self
 Sometimes injuries are inflected to obtain release from
defence forces.
The objective of the study was to probe into
the increased incidence of fabricated injuries in
Larkana region and to look into the underlying causes
for this practice.
The present study was conducted in the department of
Forensic Medicine and toxicology Chandka Medical
College, Larkana. The study period extends over
January 2005 to June 2007. Data collected includes 130
challenged medico-legal cases from whole of Larkana
Division. A special medical board was constituted in the
Department of Urology Chandka Medical College,
Larkana. The challenged cases were scrutinized in detail
regarding size shape and exact site of injury related to a
fixed anatomical landmark was established. On the basis
of diagnostic characteristic 50 cases were labelled as
J Ayub Med Coll Abbottabad 2009;21(3) 77
In this study, the total number of challenged cases
were 130 out of these were 50 cases of fabricated
injuries, 46 (92%) cases were males and 4 (8%) were
females. Thus the male to female ratio was
approximately 11:1. This shows male prevalence is
more than female.
This is because the fabricators feel
dishonour while incurring the fabricated injuries to
the females relative.
In this study victims sustaining fabricated
injuries were divided in to six groups, i.e., 0–10
years, 11–20 years, 21–30 years, 31–40 years, 41–50
years, 51 years and above. Maximum number, i.e., 20
cases were between 21–30 years and fewer cases, i.e.,
0–2 cases were in the extreme of age, i.e., 51 years
and above as shown in Table-1.
Table-1: Age distribution of victims of fabricated
Age group (years) No. of cases Percentage
0–10 – –
11–20 3 06
21–30 20 40
31–40 15 30
41–50 10 20
≥51 2 4
In this study age group between 21–30 years
showed the high incidence. It may be because this
age group is highly vulnerable to emotional ups and
downs, which predisposes the said population for self
inflicted injuries.
Fabrication of injury, like nose breaking
must be very painful but it seems that fabricator
assumes that this age group has high threshold for
pain so they may easily sustain this injury.
This study shows that maximum victims
(25) were from Larkana District, followed by
Shikarpur District, i.e., 15 cases and lastly District
Jacobabad, i.e., 10 cases shown in Figure-1.
Larkana Shikarpur Jacobabad
Figure-1: Incidence rate of fabricated injuries in
Larkana Division
This study shows that maximum victims
(25) were from Larkana District, out of these 25
cases, 16 cases were from Casualty Department
Chandka Medical College, Hospital Larkana and out
of these 16 cases, 10 cases of fabricated injuries were
due to the fracture of nose and rest of the wounds
were fracture of phalangeal bones of the hand. In
Shikarpur and Jacobabad district all fabricated
injuries were the fractures of phalangeal bones not a
nasal bone fracture.
During service of a Doctor Sitting in a Causality
Department/Forensic Medicine Department dealing
with cases of hurt is a routine practice. Similarly
weather an injury is homicidal/suicidal/accidental or
fabricated are common questions which are asked
from a doctor in the Court of Law/Police who deals
with Medico-legal cases. Therefore, it is mandatory for
a doctor to have sound knowledge about characteristics
of different types of mechanical injuries, which man
faces during life time. Unluckily most of the doctors
do not abreast them with proper knowledge of the field
or they wrongly diagnose the cases with criminal
intent. This behaviour of doctor indirectly becomes
source of defame for the profession. People who are
involved in crimes inflict injuries upon their persons
either to escape from hurt charges when they are
assailant or change the nature of injuries when they are
victims. Peoples in US where vehicle and person are
often insured often claim insurance about false injuries
to soft tissue of the body. These things are not only
practiced in Pakistan but all over the world.4 During
injury on face as a result of quarrel teeth are often
injured or shaky tooth is often dislocated by the person
injured and then it is claimed that the broken tooth is
result of injury, or with malafide cooperation of
investigating police officer false charges are made
against assailant. Sometime alleged criminals make
fabricated injuries on their bodies and blame that they
were tortured badly in Police custody for making
confession in murder charges.
Self Injury or Self Harm sometime is a result
of some psychological problem. Here the intent is not
to implicate some one else, rather it is self mutilation
act. People suffering from major psychotic disorders,
sometimes do major mutilation act.5 Fabricated
wounds are often cut wounds, usually associated with
fracture of small bone of hands. These injuries are
regular with an equal depth at origin and termination.
Contused or Lacerated wounds are rarely fabricated
on account of pain they cause and force required to
produce them.6 We are not far behind regarding the
number of occurrence of fabricated injuries in
medico-legal cases from our neighbouring country
India. In our study the percentage of fabricated
injuries in challenged 130 cases is 38.46% which is
almost equal to fabricated injuries in medico-legal
cases in India.2
J Ayub Med Coll Abbottabad 2009;21(3) 78
As far as the changing pattern of fabricated
nasal injury in Larkana District is concerned, this is
because in Casualty Department, the medical and
paramedical staff is working since long, and they have
become expert and well trained in doing this crime.
Secondly, they believe that if there is any serious
consequence they either call the expert or injured may
be shifted to the ward. Thirdly the nasal area can be
easily anaesthetised locally by putting anaesthetic
swab in to the nostrils.
Every medico-legal officer knows that by fracturing the
small bones of the hands, the certificate will be declared
by the medico-legal board as incorrect, so they have
changed the pattern of fabricated injuries to fracturing
the nasal bone by twisting the nose manually or by other
Fabricated injuries are very common injuries
which a Medico-legal officer faces not only in our
county but all over the world. It is directly related with
the crime incidence/violence in a county.
Certification of fabricated injuries depends on
three things:
i. Criminal Intent of assailant/victim
ii. Knowledge and intent of examining doctor
iii. Behaviour of police investigating/reporting officer.
The incidence of fabricated injuries can be
reduced by changing the behaviours of general public
about indulging in crimes by means of education, by
giving better training to dealing doctors and provision of
certification fee/incentive and highly educated Police
Officer should be recruited with maximum incentive in
the form of salary.
1. Blaoch N. Self inflacted wound. In: Blauch N ed. Text book
of forensic Medicine and Toxicology. Multan Pakistan:
Carwan Books; 2005. p. 151.
2. Gorea RK, Gargi J, Agrawal AD, incidence and pattern of
fabricated injuries. J Punjab Acad Forensic Med and Toxicol
2007; 7(2):54–8.
3. Parikh CK. Self inflicted wound. In: text book of Forensic
Medicine and Toxicology (6th Ed). New Delhi: CBS
Publishers; 1999. p. 4.24.
4. Palmer WS. Combating Soft Tissue Injury Fraud in the U. S.
Auto Insurance Industry. February 10, 2004. Available at:
5. Favazza AR, Conterio K. The plight of chronic self
mutrilator. Community Mental Health J 1988;24:22–30.
6. Awan NR. Wounding and Accidental Trauma. In: Awan NR.
(ed) Principles and practice of Forensic Medicine. Lahore:
Subline Arts; 2002. p. 65.
Address for Correspondence:
Dr. Muhammad Humayun, Associate Professor, Department of Forensic Medicine, Bannu Medical College,
Bannu, Pakistan. Tel: +92-928-620856 Cell: +92-300-5627879

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