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Crushing and Stretching Injuries

Many torturers injure their victims by stamping on their hands or feet with heavy boots, leaving scarring and fractures of the digits, which may give a good indication of how the injuries were inflicted. However, it is not usually possible to differentiate nails damaged by trauma from the subjects of previous chronic infection.

Cheera” is the Punjabi word for tearing. It is the nickname given to a technique common in the northwest of the Indian subcontinent. The victim is seated on the floor, often with an officer behind him with a knee in his back and pulling the head back by the hair. The legs are stretched apart, either suddenly or gradually, until they reach as much as 180 degrees. There is often a sound and sensation of tearing and, of course, the pain is excruciating. Often there is the additional trauma of kicks aimed at the inner aspect of the thighs or the genitals. In extreme cases the femur may fracture. The usual immediate result is the appearance of extensive haematomata in the groins or lower on the inner aspect of the thighs depending on whether the adductors have been torn off their origins or the bellies of the muscles have been disrupted. Naturally, walking is almost impossible for a long time. The late findings are pain on walking long distances, tenderness over the origins or bellies of the muscles and extreme limitation of abduction of the hips by pain. If the legs have been kicked, there are sometimes circular or irregular scars on the inner aspect of the thighs, an unusual site for accidental trauma. It may be impossible to squat, kneel or sit cross-legged for months or years afterwards.

“Cheera” After being disrobed and beaten, this 34 year-old man was restrained in a sitting position with his hands tied behind his back. Two policemen forced his legs apart, causing intense pain and loss of consciousness. The leg stretching was repeated three times. Five days after the torture, physical examination revealed echymosis over the adductor muscles of both lower extremities. There was pain to palpation of the adductor muscles, especially at points of muscle origin on the pelvis. (Courtesy of Vincent Iacopino, M.D. , Ph.D.)

In the same part of the world the ghotna is routinely used in police stations and interrogation centres. It is a traditional domestic implement, a pole about four feet long and four inches in diameter used for grinding corn or spices. In many police stations implements specially made of metal are used instead. These may be filled with concrete and are extremely heavy. The most common method is, with the victim seated or lying supine on the floor, for the ghotna to be rolled up and down the front of the thighs with one or more of the heaviest policemen standing on it. Occasionally, with the victim prone, it is rolled over the buttocks and back of the thighs or calves, but it is usual for bony areas like the shins to be avoided. The immediate effects are extensive bruising and inability to walk and even years later there is usually pain on walking far. On examination there is marked tenderness on palpation of the thigh muscles. Occasionally areas of fat necrosis can be palpated. If a rough or angular log has been used, there may be some scarring of the skin. Sometimes scars are found over the anterior superior spine, the patellae or the shins.

“Ghotna” acute effects: This seventeen year-old man was detained by Indian security forces and a heavy wooden roller was applied to his back, buttocks and posterior thighs. The weight of the roller was amplified by one of the perpetrators standing on it. The torture lasted approximately one hour. He presented to a local hospital with signs of acute renal failure secondary to rhabdomyolysis. The photograph was taken 4 days after the torture and demonstrates marked ecchymoses that extended from the mid-posterior thighs to the upper lumbar region, highly consistent with a crush-type injury resulting from the “roller” method of torture. (Courtey of Vincent Iacopino, M.D., Ph.D.)

“Ghotna” late effects: A 28 year-old man tortured extensively with a heavy wooden roller applied to anterior aspect of his thighs. The weight of the roller was amplified by one of the perpetrators standing on it. After the torture, he experienced severe pain and swelling in the anterior region of his thighs and observed dark black and blue discoloration over these areas for several months. A medical evaluation five years later revealed marked atrophy and fibrosis of the quadriceps muscles bilaterally.The normal contour of the thigh was deformed bilaterally, leaving concave depressions measuring 10 cm by 5 cm and about 2 cm deep. (Courtey of Vincent Iacopino, M.D., Ph.D.)

Another way for the ghotna to be used is, with the victim lying prone, the ghotna to be placed behind the knees and then the legs bent forcibly over it, straining and possibly disrupting the cruciate ligaments. The late effects of this depend on the amount of internal damage to the knee joints that has been caused. If severe, there may be permanent difficulty in walking, tenderness on palpating the joint margins and marked limitation by pain of flexion of the knees. Squatting, kneeling or sitting cross-legged may be extremely painful and impossible to maintain for long periods.