It may be some personal distinction to the doctor? I visualize puncture wounds being caused by something pointy and round (ice pick, arrow). But medically speaking, I only come across differentians between stabbing and incised wounds. From Pathology Outlines, "Definition / general
Sharp force injuries: injuries produced by sharp objects
Sharp object: an object that has a sharp edge or pointed extremity
Numerous objects can produce sharp force injuries; knives are the most commonly used weapons (Int J Legal Med 2000;113:259, J Forensic Sci 2020;65:833)
Typical knife contains:
Handle: the portion that can be gripped; it can be used as a blunt force weapon, producing patterned injuries
Guard (or finger guard): a metal bar at right angles between the blade and the hilt; the guard may include the quillon, protuberances extending perpendicularly to the long axis of the knife that stop the fingers from sliding forward onto the knife blade and cutting edge; the quillon may produce patterned skin injuries (Italian Journal of Legal Medicine 2012;1:4)
Blade: can have a plain edge or serrated edge with rounded or pointed extremity and a single or double edge
Atypical sharp and pointed objects that can be used to produce sharp force injuries include but are not limited to scissors, screwdrivers, fragments of glass (e.g. broken bottleneck or glasses), forks, ice picks, etc. (Forensic Sci Int 2001;123:135)
Sharp force wounds typically show cleanly divided edges and may involve different types of tissue with the same contact
Depth of the wound track relative to the length of the cutaneous wound distinguishes a stab from an incision
Sharp force injuries can be subcategorized as follows:
Incised wounds
Stab wounds
Chop wounds
Atypical wounds (atypical weapons, combined incised and stab wounds) "Stab wounds
Also called puncture wounds
Wounds caused by a sharp pointed object that enters the body during a more or less perpendicular movement
Penetration mechanism is the critical feature of stab wounds
Penetration is related to pressure (P), which is the force (F) applied perpendicular to a surface per unit area (A)
P = F/A
Stab wounds are typically deeper than their cutaneous length (Med Sci Law 1994;34:67)
Sharp pointed objects penetrate the body producing:
Entrance wound: may show additional injuries due to the blunt mechanism of the knife's handle or guard (patterned injuries, abrasions, bruises, etc.)
Wound track, usually with a dead end
Rarely, an exit wound; for example, stab wounds to the upper extremities or high energy stab wounds (e.g. arrows)
No tissue bridges are present in the center of the wound
Critical feature to differentiate stab wounds from laceration
When the knife is twisted into the body before withdrawal, there may be peculiar wound shapes: V, L, Y or irregular
Imprint abrasions from the handle can be present (handle's mark) (Italian Journal of Legal Medicine 2012;1:4)
Indicates that the entire blade penetrated the body
Requires vigorous pressure.
Atypical weapons
Scissors (J Am Acad Dermatol 2020 Sep 15 [Epub ahead of print]):
Closed pair of scissors usually produce a singular skin wound with a triangular, rhomboid or Z shape
Open scissors usually produce 2 separate stabs wounds separated by a bridge of intact skin
Broken glass (Med Leg J 2019;87:196, Med Sci Law 2005;45:81):
Broken bottleneck or glass injuries may resemble the shape and diameter of the object; 1 or more glass spikes can produce multiple stab wounds connected by a circular or superficial semicircular cut
Screwdrivers (J Forensic Sci 2007;52:1243):
Cross shaped tip screwdrivers generally result in wounds showing 4 equally spaced cuts, resembling the cross shape of the tip
Flathead screwdrivers generally result in wounds showing a rectangular morphology, resembling the flat end of the tip
Ice pick (J Forensic Leg Med 2013;20:803):
Purely pointed with no or very limited sharp surfaceMechanism of injury is related to its high penetration ability
Resulting wounds are usually small, round or slit-like; their diameter may vary based on the depth of penetration of the object
May grossly resemble a mole
Forks (Int J Image Graph Signal Process 2018;10:1):
Kitchen forks generally cause 4 circular defects separated by a short distance, corresponding to the fork prongs
Barbecue forks with 2 or 3 prongs generally cause groups of 2 or 3 wounds, with regular or irregular unremarkable skin between the wounds based on the angle of penetration".
www.google.com/url?sa=t&source=web&rct=j&url=https://www.pathologyoutlines.com/topic/autopsysharpforce.html&ved=2ahUKEwiasJWYzujyAhVkCjQIHbXdCJ84ChAWegQIBRAB&usg=AOvVaw1Wxgw5LOtdUybHMFExScl_And then we have this,
"The skin is punctured by a pointed narrow object
Causes of Puncture Wounds
Metal: nail, sewing needle, pin, tack
Pencil: pencil lead is actually graphite (harmless). It is not poisonous lead. Even colored leads are not toxic.
Wood: toothpick
www.seattlechildrens.org/conditions/a-z/puncture-wound/