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ROAD TRAFFIC INJURY by

Dr Mohd Kaleem Khan Assistant Professor

Department Of Forensic Medicine JNMCH AMU Aligarh

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• The road traffic accidents, injuries may be sustained to.

1. Pedestrian .

2. Cyclist / motorcyclist.

3. Occupants of a vehicle.

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Traffic Accidents

• A large variety of injuries are sustained by persons involved in traffic accidents..

• A traffic collision, also known as a traffic

accident, motor vehicle collision, motor vehicle

accident, car accident, automobile accidents,

road traffic collision, road traffic accident.

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1. INJURIES TO PEDESTRAINS

Three patterns of injury are often seen.

1. Impact Injuries- when vehicle strike the victim

2. Secondary Injuries- due to victim falling on

ground or striking any other stationary object

3. Run-over Injuries- d/t vehicle running over

some part of victim

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Impact Injuries

Primary Impact Injuries:

d/t initial impact of vehicle

Projections of vehicle may cause specific injuries e.g. bumper fracture (# of tibia & fibula of one or both the legs)

Height of pedestrian often determines site of injury

Secondary impact injuries:

Subsequent impact with the same vehicle

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Secondary Injuries

– Usually found on parts opposite to primary impact

– Most pronounced over the unclothed areas of the body

Run-over Injuries

– Severity of injury will depend upon the part of body run over and weight of the vehicle.

– E.g. degloving injury, tyre marks, burns, avulsion etc.

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I. In Primary Impact injury:-

• These are the injuries caused by vehicle when it first struck and Hit the person whether crossing the road from one side to the other side or walking with or against the traffic.

• The importance of primary impact injury is that the body of victim may bear design / pattern of the part of vehicle in form of imprint abrasion pattern bruised.

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Common parts of vehicle which may struck or hit a person includes..

1. Bumper 2. Wing 3. Grill

4. Head Light 5. Fender 6. Radiator 7. Door handle

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The body part which bears the injury depends upon the position of the person such as

1. Was the pedestrian struck by front of Car/Vehicle?

2. Was the pedestrian struck by side of Car/Vehicle?

3. Was the pedestrian standing on road?

4. Was the pedestrian walking on road?

5. Was the pedestrian lying on road?

• If the vehicle was braking violently at the movement of impact, the font end of the vehicle dips down an the legs get injured at a lower level.

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The injury comprises of damage to skin and fracture of bone (k/w as Bumper fracture).

• The Bumper fracture usually involves Tibia. The fracture is wedge shaped with base of triangular fragment indicating the site of impact and apex pointing the direction of vehicle.

• Frequently Bumper injuries are at different level

of the two legs or absent on one leg, which

suggest that the victim was walking or running

when Struck.

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• Frequently Bumper injuries are at different level of the two legs or absent on one leg, which suggest that the victim was walking or running when Struck

• In children the bumper usually produces fracture of the femur.

• If bumper injury are at the same level on both legs then it means the person is standing.

• The level of bumper injury (i.e the height of injury from ground level) varies with height of bumper of different vehicle. It means than the offending vehicle can be identified.

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• At impact against the headlamp or mudguard may result in fracture of the pelvis or fracture dislocation of the sacroiliac joint.

• The findings of primary impact injury are

important to find out the relative position of

pedestrian and vehicle and kind of vehicle

involved in the Incident.

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II. In Secondary Impact Injury

• After sustaining primary impact of injury, the person may be lifted off the ground and thrown of the vehicle.

• Thus these secondary impact injuries are resulted from the impact of body of a person and the vehicle for a second time.

• Here the person strike to windshield or bonnet or

placed on the top of car/ vehicle.

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After the second impact injuries, the victim will be thrown on the ground.

– Extensive abrasions, bruises and laceration may be seen.

– Some times pedestrians are ‘run over’ if knocked down by the vehicle.

– This will tend to occur if the pedestrian’s center of gravity is lower then the impact side or scooped-up victim being run over by other vehicle.

– Injuries are variable, depending on the area of the body involved.

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The weight of the vehicle and the surface area of the contact. There may be:

1. Tyre trade marks marks over the unclothed or clothed areas on one surface of body with graze like abrasions on the opposite side of body.

2. The head may be crushed causing gross distortion and externalization of the brain and severe injuries my occur to the chest, pelvis &

abdomen.

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iii. Compression of the chest may result in multiple rib fractures, causing a ‘flail chest ’ with rupture of internal organs along with the fracture of spine, sternum & ribs.

iv. Burning and singeing of skin and hair resulting

from discharge of hot exhaust

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Flail Chest:-

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III. Secondary Injuries

• These are the injuries that occur after second

impact injuries when the victim is thrown off

the vehicle on the ground.

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• Here the victim sustain secondary injuries from the ground. Head injury is more common though injuries to other part may occur.

• Some times the victim may be run over by the same vehicle and another vehicle.

• Brain damage is frequent without any associated skull fractures.

• Fracture of the skull and ribs due direct contact with a surface, and fracture of spine due to hyperflexion or extension may be seen.

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• Fracture of the limbs are common but apart from toes of the legs.

• Usually it is very difficult to classify the injuries as Primary impact, secondary impact or secondary injuries.

• In pedestrian accidents, the common cause of death is head injuries and fracture dislocation of cervical spine.

• Injuries to the chest and abdomen are minimal or absent.

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2. Injuries by motorcycle & cycle:-

• Injuries sustained by motorcyclist are much more serious then car travelers because:-

1) Inherent instability of two wheeler.

2) Unprotected and lack of protective gear.

3) Rush and negligent driving .

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The common causes of motorcycle accidents are

1. Alcohol, 2. Drugs,

3. Environmental factors,

4. Reckless driving and failure by drivers of Cars to see the motorcycle

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.

5) The most common cause of motorcycle fatality is running of road.

6) Most injuries are due to ejection from the vehicle into the roads, due to high speed and instability of the vehicle.

7) Primary injuries are mostly open fracture of the Tibia and Fibula.

8) Secondary injuries are mostly fracture of the Skull, Ribs &

cervical spine, as well as contusions of the Brain.

9) There are graze abrasions due to sliding across the road.

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Any part of body may sustain injury but regions are

:

more affected and are:

Head:-

1. Injury sustained to head is common in motorcyclist followed by thoracic and abdominal region.

2. Fall on road surface and sustaining injury to lateral part with fracture of temporo – parietal bone is very common.

3. Fracture occurring in skull of motorcyclist can be summarized as:

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Fall on side with side impact to head causes basal skull fracture especially hinge type .

Impact on face causes fracture of facial skeleton.

Impact on forehead causes sagittal fracture of base of skull.

Impact on chin causes mandibular fracture.

Impact on crow of head by fall may cause ring fracture.

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4. Injuries by occupant of a vehicle:

– Driver.

– Ejection of driver and passenger – Door often burst open.

– Unbelted rear seat occupants.

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– Tissue injury is caused by a change of rate of movement.

– A constant speed, however rapid, has no effect whatsoever as is evident from space travel or the rotation of the earth

– It is the change of rate that is traumatic – that is, acceleration or deceleration.

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The Driver And Passenger Injuries

can be:-

1.

Front impact crash

:

This happen when one car strikes

Another car head- on or

Strike a stationary object,

Like an electric pole/ tree

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Unrestrained Driver

• First slides forwards so that his legs strike the fascia/parcel-shelf area, and his abdomen or lower chest contacts the lower edge of the steering wheel.

• The body then flexes across the steering wheel and begins to rise.

• The heavy head goes forwards, and there is flexion of the cervical and thoracic spines.

• The upward and forward component causes the head to strike the windscreen, the upper windscreen rim or the side pillar.

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• The windscreen is often perforated by the head or face, And the whole body may be ejected through the broken glass, to land on the bonnet or even on the roadway ahead.

• The intrusion of structural parts into the passenger compartment

• The engine or front-wheel assembly may be forced back into the seating area, intruding upon the driver.

• The roof or front corner pillar (the so-called ‘a’-frame) may cave in on top of the driver

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• The steering column may be forced back to ‘stab’ or crush the driver’s chest or abdomen.

• Column, engine, or gearbox intrusion may be to force the floor up and backwards against the driver’s feet and

legs.

• Pedals cause transmitted force up the legs and into the pelvic girdle

• Door may burst open and the driver, if unrestrained, ejected sideways onto the road, especially in a crash that has a roll-over component.

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• Rear impact, the driver is violently accelerated

• If no rigid head restraint is fitted to the seat, severe hyperextension of the neck occurs, causing ‘whiplash’.

• In side impacts, the injuries depend upon the amount of intrusion of the driver’s door and side panels.

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The driver receive.

1. Fracture of wrist and arms occur when driver brace himself against the steering wheel.

2. The fracture or dislocation of

1. Tibia, fibula &

2. Pelvis

3. Impact from pressing on the break and clutch pedals.

3. Impact of the knees against the dashboard

1. Fracture of the tibia, fibula, femur & pelvis.

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1. Severe impact against the windshield pillar may cause

1. Avulsion of the skin of the forehead, 2. Basilar skull fractures,

3. Closed head injury and 4. Fracture or dislocation.

2. Steering wheel impact injury: The steering wheel may cause

1. Fracture Of The Jaws And 2. Facial Bones.

3. Abrasions, Bruises And Contusions Of The Chest Or 4. Bilateral Rib Fracture.

5. Laceration Of Spleen & Liver May Be Seen.

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Front Seat Passenger/

1. Whiplash injury:

2. “Sparrow Foot marks”.

3. injured against internal fittings, like

1. Doors, 2. Handles or

3. Ejected through burst-open doors.

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2. Rear impact crash:-

• Low velocity rear impacts

– cause whiplash injury – Neck fractures are rare.

• A high velocity rear impact crash can deform

and rupture the gas tank with ignition of the

fuel.

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• In a rear impact, the driver is violently

accelerated and, if no rigid head restraint

is fitted to the seat, severe hyperextension

of the neck occurs, often followed by the

sequence of deceleration events when the

car is cannoned into the vehicle or other

obstruction in front, causing the popular, if

inaccurate name of ‘whiplash’.

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Whiplash injury:-

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3. Side impact crash:-

• The vehicle strikes on the – Side of another vehicle or

– Skids sideways into a fixed object.

– Injuries are often severe, because

– The side of a car has a thin metal wall door and

– No other components to absorb the force of impact.

I. Dicing injuries may occur which are superficial cuts of the skin caused by fragments of tempered glass.

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II. They are

Linear,

Right angel or

V- shaped laceration

Seen typically on the face, forehead and arms On the right side of the driver and left or

Right side passenger.

III. Other injuries

Cervical spine fracture , Fractured ribs,

Contusions, lacerations and

Explosive tearing of the lung on the right side of the impact common.

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III.In the abdomen,

– A lateral impact on right causes laceration of the right lobe of the liver and right kidney.

– The pelvis may be fractured from an impact on the either side.

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4.Roll-over crash:-

• A roll over crash, the occupants receive the surprisingly moderate impact, if the vehicle is not brought to a sudden stop.

– The crashing of different sides of the vehicle absorbs the forces of impact.

– If the passenger compartments remains intact,

– The belted occupants frequently survive the crash.

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• Non belted occupants are involved into two types of injury:

Tumbling around inside and striking

Ejection out from the vehicle.

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 Role of seat belts and air bags:-

• Numerous safety features such as

– Safety belts, – Air bags,

– Collapsible steering columns, – Softened interior dashboard and – Anti lock breaks

• The air bag system reduced chest and facial trauma, in those individuals not using seat belt.

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• Wearing seat belts reduces the risk of fatalities to front seat occupants by 45% since.

i. Injuries are of less severity, except whiplash injury.

ii. Probability of severe head injury is lower.

iii. Probability of being ejected from the vehicle is lower.

iv.There are fewer fatal/ major injuries to head, neck, chest &

abdomen.

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• Lap belts can produce tears of the mesentery, omentum and laceration of the bowel .

• Shoulder belt may produce a linear abrasion running downward and medially on the right side of the driver and left side of front seat passenger.

• Although seat belts reduce mortality, they cause

a specific pattern of internal injuries.

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Injury By Seat belt

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References

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