Ankle joint injuries as a reconstruction parameter in car-to-pedestrian accidents

The study has assessed the usefulness of ankle joint injuries for deducing about the presumable location of a pedestrian in relation to a motor vehicle at the moment of collision. A statistically significant correlation was found between the direction of impact and the mechanism of ankle joint injuries. Such injuries were found in 113 of 317 pedestrian, fatal victims of road traffic accidents (36%). In the cases of impacts on the medial surface of the lower limb, the injuries associated with the supination mechanism were six times more frequent than the injuries associated with the pronation mechanism, while in the group of impacts on the limbs from the lateral side those connected with the pronation mechanism were four times more frequent. In victims hit from the back, the injuries connected with the plantarflexion mechanism were found almost four times more frequent than the dorsiflexion mechanism and in victims hit from the front in three of the five damaged joints the dorsiflexion component was observed (without any plantarflexion case). Less frequent "pronation injuries" in the limbs hit from the medial side and "supination injuries" in the limbs hit from the lateral side as well as "dorsiflexion injuries" in victims hit from the back predominantly occurred in impacts to the pelvic area, i.e. resulting from collisions with a van or lorry. Injuries of upper ankle joints are, thus, useful for reconstructing the presumable location of the pedestrian in relation to the vehicle at the moment of collision, especially, when the vehicle involved in the accident is known.     

Atypical injury pattern of a pedestrian run over by an unimog in the epigastric region

Strongly intoxicated, a 37-year-old man fell in front of the right back wheel of an emergency vehicle (MB Unimog) and was run over according to eye witnesses. He died in hospital shortly afterwards. The autopsy revealed that he bled to death from a traumatic liver rupture (bursting of the right hepatic lobe and severing of a piece of tissue measuring 17 x 8 x 4 cm). There were no injuries classicaly seen in victims run over by a car. The atypical injury findings in this case are due to the special features of the accident vehicle: The Unimog (an all-wheel vehicle with a fixed rear axle and flat coils) struck the right side of the body lying on the street with its rear wheel and was then lifted over the body by its fixed axle without touching the left side.     

Knee joint injuries as a reconstructive factors in car-to-pedestrian accidents.

Knee joint injuries were found in 214 out of 357 fatal pedestrian victims of traffic accidents (60%). The cross-sections of tibial and femoral epiphyses revealed bone bruises (due to compression and avulsion) and the percentage of victims with knee injuries increased to 80% (in the group of lateral impacts - 94%). The bone bruises in the central tibial and femoral condyles were observed only in victims hit in an upright position. There was a strong correlation between the side of impact on the extremities in medium sized pedestrians (from the front, back, lateral and medial side) caused by passenger cars and the mechanism of knee injuries (hyperextension, anterior dislocation of the proximal tibial epiphysis in relation to the femoral condyles, valgus and varus flexion). In the cases of very low impacts (e.g. in very tall victims hit by rapidly breaking wedge-shaped cars) or very high impact (e.g. in very short victims or truck hits) the "reversed" complexes of injuries were found (lever principle). These findings showed that knee joint injuries are useful for determining the car-pedestrian location on collision and the type of vehicle (in hit-and-run accidents).     

Neck injuries caused by being run over by a motor vehicle

We report a homicide involving the use of a motor vehicle and simulating a traffic accident. This observation was the reason for a retrospective analysis of neck injuries in victims of traffic accidents, in which a person has been run over (RO) by a motor vehicle. The autopsy material of two institutes from 1990-1996 was used. The following findings were obtained in 63 victims: laryngohyoid fractures (LH-fx): 10 cases (16%) with a clear difference between the institutes (22% versus 7%). This resulted from examination with special regard to such injuries in many cases at one of the institutes, whereas only autopsy reports were taken retrospectively from the other institute. Five of these cases had suffered only minor LH-fx (as seen frequently in strangulation), although extensive run over (RO) injuries of the other cervical tissues were present. All LH-fx were caused by direct compression of the neck; in eight of the cases they were combined with mandibular fractures. Petechial hemorrhages (petH) at the eye lids/conjunctivae were seen in 19 cases (30%); 16 of these were related to thorax RO injuries, three to abdominal RO only. Four cases involved LH-fx, petH as well as cervical skin lesions and additional cervical soft tissue hemorrhages. Interpretation can be extremely difficult with this combination of findings if the character of the event cannot be established as accidental beyond doubt on the basis of the circumstances.     

Reconstrudive significance of stretch mark tears of the skin

Stretchmark-like tears of the inguinal region are commonly referred to as typical lesions in pedestrian accidents when the victim is run over by a motorcar. These lesions can also be observed when a pedestrian is hit by a vehicle while being in an upright position. Stretchmark-like tears are due to hyperextension or excessive abduction of the hip joint. Characteristic morphological features are variable numbers of equally superficial and parallel tears of the skin following the skin's cleavage lines. Drivers of two-wheeled vehicles may exhibit inguinal stretchmark-like tears when they hit an obstacle with their bent knee, suffering excessive abduction of the hip joint. Finally, stretchmark-like tears are described in victims of collisions with railed vehicles, of aircraft crashes and--very rarely--in severely injured car passengers.     

车外人员撞击伤特点分析

目的以真实案例为基础,研究汽车碰撞事故中,不同机动车车型、不同交通方式等因素造成车外人员撞击伤的特征。方法选取上海地区发生的汽车与车外人员碰撞事故案例200例,通过对事故中的人、车等检验对比,分析车外人员撞击伤的特点。结果车外人员撞击伤主要出现在下肢,其次为胸部和头部;行人（含推车人）撞击伤出现频次与骑车人（含自行车或摩托车后座乘员）无明显差异;小轿车和小客车事故中撞击伤多见于下肢,大客车多见于胸部;车外人员被撞击后发生抛甩频率随车速的加大而增高,且通过车体痕迹检验,人体与车辆挡风玻璃发生（二次）撞击伤匹配程度最高。结论分析汽车与车外人员碰撞事故人体撞击伤特点,对于交通伤法医学鉴定及深化交通伤机制研究具有参考价值。     

Evidential value of injuries useful for reconstruction of the pedestrian-vehicle location at the moment of collision

The paper presents final results of the studies concerning the usefulness of knee, ankle, hip, pelvis and neck injuries in reconstructing the circumstances of car-to-pedestrian accidents. Each type of injuries was evaluated with regard to possible reconstruction of the victim's position (upright or recumbent) at the moment of collision and in the upright hits-the side of the pedestrian's body hit. In each group, a chance of proper reconstruction of the pedestrian's location (which determined the frequency of injury pattern assumed as the typical one of a given position or impact side) and error risk (percentage of cases in which the injury pattern showed improper position or impact side) were calculated. These data were compared with similarly calculated possibilities of deducing based on the classical "bumper" injuries to soft tissues and "bending" fractures of the lower limb bone diaphyses. It was shown that the bone bruises within the knee epiphyses were very specific evidence for upright hits as they confirm the limb load by body mass at the moment of pathological dislocation of joint structures on impact. The evidential value of knee injuries was found to be similar to that of other "classical" methods based on bumper injuries or even higher in lateral and front hits. The injuries to the remaining structures were less frequently found and their correlation with the victim's position or impact side was lower. Nevertheless, once the whole complex of these injuries is taken into consideration the chances of proper reconstruction of the pedestrian-vehicle location increase and the risk of opinion error is minimized.     

Characterization and Comparison of Injuries Caused by Accidental and Non‐accidental Blunt Force Trauma in Dogs and Cats

Motor vehicle accidents (MVA) are often difficult to distinguish from non‐accidental injury (NAI). This retrospective case–control study compared animals with known MVA trauma against those with known NAI. Medical records of 426 dogs and cats treated after MVA and 50 after NAI were evaluated. Injuries significantly associated with MVA were pelvic fractures, pneumothorax, pulmonary contusion, abrasions, and degloving wounds. Injuries associated with NAI were fractures of the skull, teeth, vertebrae, and ribs, scleral hemorrhage, damage to claws, and evidence of older fractures. Odds ratios are reported for these injuries. MVA rib fractures were found to occur in clusters on one side of the body, with cranial ribs more likely to fracture, while NAI rib fractures were found to occur bilaterally with no cranial–caudal pattern. Establishing evidence‐based patterns of injury may help clinicians differentiate causes of trauma and may aid in the documentation and prosecution of animal abuse.     

Was the pedestrian hit in an erect position before being run over?

If a pedestrian was run over by a car, the question can arise whether there was a preceding collision while the pedestrian was in an erect position. From a total of 53 selected autopsy reports, the findings associated with accidents known to involve running over in isolation (n=32) were compared to findings associated with a combined mechanism of a primary impact in an erect position and subsequent running over (n=21). Findings exclusively present in the combined group were wedge-shaped bone fractures ("Messerer"-wedges, 38%), glass fragment injuries (24%), traumatic amputations (10%), traces of car paint on the lower extremities (50%) and abrasions of the shoe soles (17%). These findings can be considered specific for a primary impact in an erect position. Fractures of the cervical and lumbar spine were present in the combined group in 33 and 17%, respectively. In contrast, in the run over group, there was only one case of fracture of the cervical and one of the lumbar spine and both cases involved direct contact with a car wheel. Fractures of the cervical and lumbar spine are, therefore, very indicative for a primary impact. "Bumper injuries", sacroiliac dislocations and fractures of the thoracic spine were approximately 2.5 times more common in the combined group than in the run over group. In the vast majority of cases, a clear differentiation between the two groups is, therefore, possible on the basis of the autopsy findings. This is especially relevant if an inspection of the car cannot be performed after a hit-and-run accident, which occurred in 26% of the cases in this study. In addition, the blood alcohol levels were higher in the run over group (mean=2.14g/l) as compared to the combined group (mean=1.53g/l).     

The influence of behavior on freefall injury patterns: possible implications for forensic anthropological investigations

Case studies of freefall injuries suggest that most falls from heights result in lower extremity, pelvic, and vertebral fractures. These injuries are largely a consequence of the fact that most falls are accidental with victims landing feet first. This study investigates whether human behavioral response affects body orientation at impact and whether the human body tends to align in a particular way as a result of physical laws. The investigation was undertaken by observing nine experimental falls of an anthropomorphic dummy from a height of 65 ft (9.8 m). In all nine falls, the dummy landed horizontally, suggesting that the human form has a tendency to align horizontally during freefall for falls greater than 50 ft (15.24 m). This has important implications for the potential use of injury patterns in the deduction of pre-fall circumstances, which are discussed here with respect to a case study of a fall victim.     

Sudden death from pelvic hemorrhage after bilateral central fracture dislocations of the hip due to an epileptic seizure

Fracture and dislocation of major joints may be caused by the forceful tonic muscular contractions of seizure activity. A 77-year-old man who was found dead in bed with no sign of external trauma had bilateral central fracture dislocations of the femoral head through the acetabular floor with fatal pelvic hemorrhage and extensive pulmonary fat and bone marrow embolism. He had epilepsy, but the last seizure was 6 years earlier, and he had long discontinued medication. The fractures were attributed to a new unwitnessed seizure. This is the twentieth case of central fracture dislocation of the hip since 1970, when better anesthesia eliminated convulsive therapy-induced fractures. The authors review these 20 cases. Seizures followed inflammation, infarction or neoplasia of the brain, eclampsia, metabolic or iatrogenic causes, or epilepsy (6 cases, 2 of which had no prior seizures for 5 years). There were 11 men (mean age, 64 years) and 9 women (mean age, 47 years). Fractures were unilateral in 13 and bilateral in 7. Additional fractures (in vertebrae, shoulders, or femur) were present in eight. Only eight had prior bone disease. Local symptoms led to diagnosis in most, but two were identified incidentally on imaging. The current patient was the only one to die suddenly, but six other patients presented with shock and three died (one of whom had injuries that led to a suspicion of manslaughter). Central fracture-dislocation of the hip is a rare and little known consequence of seizures, with strong potential for misdiagnosis and lethal complications.     

Neck injuries as a reconstructive parameter in car-to-pedestrian accidents

The study has assessed the usefulness of injuries to the ligamentous, muscular and vascular neck structures for deducing about the presumable location of a pedestrian in relation to a motor vehicle at the moment of collision. The localisation of haemorrhagic suffusions in the lower insertions of the scalene (mainly) and sternocleidomastoid muscles has shown a correlation with the direction of the inertia force. No correlation has been observed between the direction of impact and damages to the cervical vascular bundles and the localisation of haemorrhagic suffusions in the upper insertions of the nape muscles. In some cases, injuries to the ligaments of the cervical vertebrae made up the complex characteristic of the direction of acting forces. The injuries of soft tissues and ligaments can, thus, facilitate the deductions about the direction of impact. However, the type of a car involved in the accident and the possibility that these injuries resulted from direct head or neck trauma should be considered.     

Patterns of Ecchymoses Caused by Manner of Death and Collateral Injuries Sustained in Bruising Incidents: Decedent Injuries,Profiles, Comparisons,and Clinicopathologic Significance

Abstract: We investigated how ecchymoses could be used to predict other injuries, or help establish the cause of death. Ecchymoses, fractures, lacerations, abrasions, and other data were recorded. Eleven percent of decedents had ecchymoses. Motor vehicle accident by car (MVA‐C) was the most common cause of ecchymoses and showed the most collateral injuries. Decedents of natural causes were more likely to have ecchymoses without collateral injuries. There appeared to be two groups of decedents with ecchymoses: one group is younger, comprised of victims of MVA‐C and homicides, with more injuries related to ecchymoses than others; another is an older group of victims of other accidents, natural causes, and suicide. There were no indeterminate causes of death among decedents with ecchymoses. Therefore, ecchymoses may be a surrogate marker to direct the pathologist to continue to seek a cause of death should be seen, even if the case, otherwise, appears to be indeterminate.     

Neck injuries caused by automatic two-point seat belts: an analysis of four cases

Although seat belts significantly reduce the extent and severity of injuries sustained by motor vehicle occupants, seat belts are known to be associated with chest and abdominal trauma. Less commonly understood are severe neck injuries caused by the use of two-point automatic shoulder harnesses without concurrent use of a manual lap belt. Such injuries may include cervical spine fractures, craniocervical dislocations and rarely decapitation. Recognizing patterned injuries caused by seat belts and the ability to correlate autopsy findings with the circumstances surrounding the death will allow for correct interpretation of seat-belt related trauma. The four cases described detail fatal neck injuries as a result of improper seat belt use in which an automatic two-point shoulder harness was used without a manual lap restraint. In two of the cases, the victims were decapitated.     

Death due to superficial soft tissue injuries.

A series of deaths due to multiple superficial injuries is reported. These cases represented 5% of a consecutive homicide series in the Northern Territory of Australia. All cases were characterized by extensive superficial injuries, particularly involving soft tissue, which were present over much of the body including the face, head, arms, legs, and trunk. Upper-limb fractures were present in some cases, as were fractured ribs. The internal organs and tissues were pale, but there was either little or no organ damage. No significant volume of free blood was found in any of the body cavities. In one case, fat emboli were identified in moderate numbers in the lung and kidney. Death due to multiple superficial soft tissue injuries has not previously been characterized in the literature.     

Severity of vehicle bumper location in vehicle-to-pedestrian impact accidents

Pedestrian protection is one of the key topics for safety measures in traffic accidents all over the world. To analyze the relation between the collision site of the vehicle bumper and the severity of the lower extremity injuries, we performed biomechanical experiments. We compared the applied external force and the risks of subsequent injuries between the impact of the center and side positions of the front bumper. These comparisons were performed by practical impact tests with eight typical different types of cars which were typical of the current vehicle fleets. The tests were made using the TRL legform impactor which was a mechanical substitute of a pedestrian lower extremity. The TRL impactor is used all over the world for assessing the safety of car bumpers. It was found that the risks of lower extremity injuries in the impacts at the side positions, in front of the vehicle's side member, were significantly higher than those at the center. In the tests, we found that foam materials around the rigid front cross member had a significant effect on reducing the lower extremity injury risks and especially tibia fracture risk against vehicle bumper center collisions, but had little effect at the sides of the bumper over the vehicle's side members where the foam was thinner. We also found that the front shape of the vehicle affected the risk of ligaments injuries. According to these results, the information of impact locations of cars in vehicle-to-pedestrian traffic accidents is valuable for clinicians to diagnose patients with lower extremity injuries in traffic accidents and for forensic pathologists to analyze the accident reconstruction. Furthermore, the results suggest that testing of the bumper area in front of the main longitudinal beams should be included in the car safety legislation to require pedestrian safety.     

Classification of Pelvic Ring Fractures in Skeletonized Human Remains

Pelvic ring fractures are associated with high rates of mortality and thus can provide key information about circumstances surrounding death. These injuries can be particularly informative in skeletonized remains, yet difficult to diagnose and interpret. This study adapted a clinical system of classifying pelvic ring fractures according to their resultant degree of pelvic stability for application to gross human skeletal remains. The modified Tile criteria were applied to the skeletal remains of 22 individuals from the Cleveland Museum of Natural History and Universidad Nacional Autónoma de México that displayed evidence of pelvic injury. Because these categories are tied directly to clinical assessments concerning the severity and treatment of injuries, this approach can aid in the identification of manner and cause of death, as well as interpretations of possible mechanisms of injury, such as those typical in car-to-pedestrian and motor vehicle accidents.     

Analysis of the incidence of pelvic trauma in fatal automobile accidents

Pelvic fractures are frequent complications of motor vehicle accidents, and motor vehicle accidents are the most common cause of pelvic fracture. Although pelvic fractures are associated with considerable morbidity and mortality, there has traditionally been no attempt to grade or classify pelvic fractures during postmortem examination. The authors performed a retrospective study of cases examined at the Jefferson County Coroner/Medical Examiner Office from 1994 to 1996, reviewing investigative reports and autopsy findings. Radiographs were examined for the presence and Tile type of pelvic fracture. Pelvic fractures were identified in 88 of 392 cases (23%). In most (89%), the pelvic fracture was readily classified according to Tile type on the basis of radiographs and the inferred mechanism of injury. This study indicates that current estimates of the mortality of pelvic fractures are low because of the exclusion of individuals who do not survive to hospitalization. Furthermore, pelvic fractures in rapidly fatal motor vehicle accidents tend to be more severe than fractures in individuals who have a significant interval of survival. The presence and classification of pelvic fractures may be readily determined by radiographs in most cases. The Tile classification scheme is easy to apply and has important implications in the comparison of study groups.     

Fatal traffic injuries among children and adolescents in three cities (capital Budapest, Vilnius, and Tallinn)

Motor vehicle accidental injuries are a frequent cause of death among young children and adolescents. The goal of this study was to compare patterns of injury between three capitals (Budapest, Vilnius, and Tallinn). Information on 190 fatal traffic accidents (69 pedestrians, 14 bicyclists, and 107 motor vehicle occupants) between 2002 and 2006 was collected from databases of medico-legal autopsies. The role of victims in accidents, the location of injuries, cause of death, survival period, and blood alcohol levels were evaluated. One-hundred and forty-one (74%) victims had a passive role in traffic as pedestrians, passengers in cars, or public transport. In victims who died at the scene, the rate of head injury was higher than in cases who received medical treatment (odds ratio = 2.58, CI = 1.2-5.55, p = 0.0127). These results underline the importance of postmortem studies to examine the pathomechanism of fatal traffic accidental injuries and to provide information for the prevention of road traffic accidents against children and adolescents.     

A fatal elephant attack

A rare case of an elephant attack is presented. A 44-year-old man working as an elephant keeper was attacked by a cow elephant when he tripped over a foot chain while the animal was being medically treated. The man fell down and was consequently repeatedly attacked with elephant tusks. The man sustained multiple stab injuries to both groin regions, a penetrating injury to the abdominal wall with traumatic prolapse of the loops of the small bowel, multiple defects of the mesentery, and incomplete laceration of the abdominal aorta with massive bleeding into the abdominal cavity. In addition to the penetrating injuries, the man sustained multiple rib fractures with contusion of both lungs and laceration of the right lobe of the liver, and comminuted fractures of the pelvic arch and left femoral body. The man died shortly after he had been received at the hospital. The cause of death was attributed to traumatic shock.