ROAD TRAFFIC

INJURY
 The road traffic accidents, injuries may
be sustained to.
1. Pedestrian .
2. Cyclist / motorcyclist.
3. Occupants of a vehicle.
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.
1. INJURIES TO PEDESTRAINS:-
Three patterns of injury are often seen.
1. Primary impact injuries.(the first part
struck).
2. Secondary injuries.( further injury
caused by vehicles).
&
3. Tertiary injuries.(injuries caused by
victim‟s striking objects, such as the
ground).
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.
 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

 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.
 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.
 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.
 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.
II. IN SECONDARY IMPACT OF 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.
 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.
 The weight of the vehicle and the
surface area of the contact.
There may be:
i. 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.
ii. The head may be crushed causing
gross distortion and externalization of
the brain and severe injuries my
occur to the chest, pelvis & abdomen.
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
FLAIL CHEST:-
III. SECONDARY INJURIES/ TERTIARY
INJURIES :-
 These are the injuries that occur after
second impact injuries when the victim
is thrown off the vehicle on the ground
.
 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.
 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.
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.
4) The common causes of motorcycle
accidents are
Alcohol, drugs, environmental
factors, reckless driving and failure by
Cars to see the motorcycle.
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.
 :
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:
 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.
 4. INJURIES BY OCCUPANT OF A
VEHICLE:
 After pedestrians, the driver is the most
frequent casually in road traffic accidents as
a high proportion of vehicles are occupied
by only driver.
 Ejection of driver and passenger from a
vehicle is associated with significantly
severe injuries or fatality as the door often
burst open.
 Unbelted rear seat occupants are also at
increased risk of serious injuries in motor
vehicle accidents.
The driver and passenger injuries
depend upon the type of impact crash
it
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( approx 80% of impact).
I. The driver tends to receive a different pattern of
injury as compared to either the front seat or
rare seat passenger.
II. Fracture of wrist and arms occur when driver
brace himself against the steering wheel.
III. The fracture or dislocation of Tibia, fibula &
pelvis may occur from transmission of the force
of impact from pressing on the Break and
Clutch pedals.
IV. An impact of the knees against the dashboard
commonly causes fracture of the
Tibia, Fibula, Femur & pelvis.
V. Severe impact against the windshield pillar
may cause avulsion of the skin of the
forehead, basilar skull fractures, closed head
injury and fracture or dislocation.
VI. Steering wheel impact injury: The circular rim
of the steering wheel may cause fracture of
the jaws and facial bones.
VII. As well as imprint abrasions, minor bruises
and contusions of the chest or bilateral rib
fracture.
VIII. Laceration of spleen & Liver may be seen.
IX. Front seat passenger/ Whiplash injury: It is
due to a violent acceleration or deceleration
force applied to the passenger, usually front
seat occupant.
X. He may not get the momentary warning of the
impending collision.
XI. There may be peculiar facial lacerations due
to contact with the shattered windscreen
known as “Sparrow Foot marks”.
XII. Passenger of the rare seat often escape such
injuries, they may be injured against internal
fittings, like Doors, Handles or ejected through
burst-open doors.
WHIPLASH INJURY:-
2.REAR IMPACT CRASH:-
Low velocity rear impacts are
relatively common.
Usually, they cause whiplash
injury
Neck fractures are rare.
A high velocity rare impact crash
can deform and rupture the gas
tank with ignition of the fuel.
3.SIDE IMPACT CRASH:-
 The vehicle strikes on the side of
another vehicle or skids sideways into
a fixed object.
I. 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.
II. Dicing injuries may occur which are
superficial cuts of the skin caused by
fragments of tempered glass.
III. 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.
IV. Cervical spine fracture , fractured
ribs, contusions, lacerations and explosive
tearing of the lung on the right side of the
impact common.
V. In the abdomen, a lateral impact on the right
side commonly causes laceration of the right
lobe of the Liver and right Kidney.
VI. The pelvis may be fractured from an impact on
the either side.
4.ROLL-OVER CRASH:-
 Although the automobiles may suffer severe
damage in a roll over crash, the occupants
receive the surprisingly moderate impact, if the
vehicle is not brought to a sudden stop and the
impact is spread over a period of time.
 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.
 Non belted occupants are involved into
two types of injury:
 Tumbling around inside and striking the
interior of vehicle.
 Ejection out from the vehicle.
  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 have contributed to the saving of
lives.
 The air bag system has reduced the gravity and
incidence of chest and facial trauma, especially
in those individuals not using seat belt.
 Seat belts offer the greatest benefits in frontal
and roll over crashes.
 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.
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.
INJURY BY SEAT BELT
 Air bags alone reduce fatalities by
about 14% in drivers compared with
45% of lap- Shoulder belts used alone.
 Delayed Deaths:- Delayed deaths can
be caused by continuing
bleeding, secondary haemorrhage
,renal failure from hypertension and or
extensive muscle damage, fat
embolism. Local or systemic
infection, myocardial or cerebral
infraction.
POSTMORTEM EXAMINATION:-
 Photographs of the seen, clothing and
injuries should be taken routinely. Since
some countries limit the damage to be
recovered if the victim was not wearing a
seat belt, any injuries consistent with seat
belt injuries should be noted. The role of the
auto mobile to commit homicide is also
postulated.
HISTORY :-
The history should include the condition of the eyes
(corneal opacities), blindness, if the victim was
suffering from any disease e.g. Heart, epilepsy or
diabetes, drugs that he was using(or abusing) and
if he was depressed or under unusual stress.
Clothing:- The clothing should be described
with special attention to tyre imprint
marks, tears, amount of bleeding and foreign
bodies especially glass
particles, metal, grease, marks or oil stains and
paint which may indicate the parts of the vehicle
that struck the victim and provide valuable
evidence with respect to the suspected vehicle
(Hit and Run Case).
 Similarly hair blood and other tissue can be
transferred from the pedestrian to the vehicle. For
this reason, autopsy surgeon should preserve
hair and blood samples for comparison.

INJURIES:
External injuries:- It should include.
I. The nature if the wound, i.e. whether it is a
bruise abrasion or laceration.
II. The wound dimensions, e.g. length, width and
depth. It is helpful to take a photograph of
wound with an indication of dimension (e.g. a
tape measure placed next to the wound.)
III. The position of the wound in relation to fixed
anatomical land marks, e.g. distance from the
midline or below the clavicle.
IV. The height of the wound from heel- this is
important in case where pedestrians have
been struck by motor vehicles so that the
height of an impact point can be compared
with any suspect vehicle.
Internal injuries:- The distribution of fatal
injuries is mostly related to the head and chest.
Due to extraordinary resilience of the
skin, serious internal injuries may be present
without any evidence of a corresponding
external injuries. It is there for necessary to incise
suspected areas of impact.
LABORATORY SPECIMENS:-
A blood sample (of the driver and pedestrians)
should be taken analyzed for the presence and
amount of alcohol (taken from peripheral vein
and not from viscera, if death occurred in 12-24
h of accident.) and drugs, since the question of
contributory negligence may subsequently
arise.
 If sufficient blood is not obtainable, vitreous fluid
from the eye can be analyzed for alcohol.
 The urine should be screened for commonly
abused drugs.
 Whether the victim was the driver or the passenger?
Some times it is necessary to know who was driving the
vehicle for insurance purpose. Following can assist the
autopsy surgeon in determining if a particular occupant
was the driver.
Steering wheel impact abrasions may be seen on the
chest.
Dicing injuries on the right side of the body.
Pattern seat belt abrasions is seen on the right side of
the shoulder going diagonally across the chest of the
left.
Imprint marks of the break and clutch pedals on the
sole of shoe is pressed at the time of impact.
 In different jurisdictions autopsy, surgeons may
rule the manner of death in Hit and run
pedestrian fatalities as „Homicide‟ or „accident‟
or „undetermined‟ depending on the existing
protocol.

Alcohol, Drugs And Trauma:-

 Alcohol and substance abuse are major
associated factors in all major trauma.
 About 10% of drivers with blood alcohol level
higher then the legal limit account of nearly
1/3rd of non fetal and half of fatal driver deaths.
 Drugs tested for should include
alcohol, carbon mono oxide, acid, basic
and neutral drugs.
 Marijuana and opiates testing are
indicated in select cases .
 Blood used for testing should be the one
which has been drawn prior to starting of
IV fluids and blood transfusion.
 In case of Death, analysis of vitreous
fluid is valuable as it reflects the alcohol
and drug levels 1-2 h prior of Death.