Transportation injuries.pptx

Forensic Medicine

1. Dr Nikita Prabhakaran Senior Resident

2. Classification (1) Pedestrian injuries (2) Injuries sustained by a cyclist (3) Injuries sustained by a motorcyclist (4) Injuries sustained by occupants

3. Pedestrian injuries Can be classified into (a) Primary impact injury (b) secondary impact injury (c) secondary injuries

4. Primary impact Injury Occur when a pedestrian is first hit by the vehicle Injuries depend on: on the relative position of the victim height of the victim height of the bumper action of the pedestrian- crossing, walking, etc position of hit

5. Injuries sustained: In adults, usually it is the legs leg bones get fractured, BUMPER FRACTURE Hit from behind  both bones fractured in both legs Hit while crossing  usually in one leg In children, usually femur is affected

6. 1. Bumper fracture Usually a wedge shaped/ spiral fracture But if the leg is lifted, transverse Distance of the fracture from heel  height of the bumper

7. MLI : identification of the vehicle direction of hit apex of the wedge in th direction of force spiral fracture, distal fragment apex- point towards direction of force action of the victim can be guessed

8. Other primary impact injuries 2. Violent bending  thoraco lumbar dislocation 3. Contact with hot parts  may cause burns on that side

9. Secondary impact Feet slides forward and patient rotates back on the vehicle Scooped up victim  thrown over the bonnet

10. Injuries produced Head  hit the windscreen  contusion/ haemorrhages Face windscreen may break glass pieces may cause penetrating injuries in the vital structures/ face Chest  bonnet fractures  tortional injuries to aorta-> just below origin of subclavian artery  heart rupture Abdomen  liver / spleen rupture Pelvis: fracture

11. MLI When vehicle is in high speed  rather than person being hit on the bonnet may be thrown into the air and will fall on the back part of the vehicle Children very rarely may occur as centre of gravity is lower

12. Secondary injuries Thrown out on the ground May hit some objects and can sustain fatal injuries Injuries  extensive graze abrasions  fracture of vertebrae due to hyperflexion and hyper extension  fatal internal injuries

13. Waddell’s triad Pedestrian children: Fracture of femur Chest/ abdominal injuries Contralateral head injury

14. Run over accidents Tyre- tread marks MLI: identification of the vehicle

15. Whiplash injury Due to acceleration- deceleration force Applied to the passenger Who is usually on the front seat Hit from behind  sudden acceleration hyperextension followed by hyperflexion Sudden breaking hyperflexion followed by hyperextension

16. Injury caused Fracture dislocation of atlanto -occipital joint C1-C2 C5-C6 Accompanied by severe contusions of spinal cord/ laceration MLI: survivors- bedridden can solely be the cause of death

17. Seat belt syndrome Severe collisions  chest and abdominal injuries may be caused Abrasions, contusions, haematoma Lacerations of spleen, liver, urinary bladder Mediastinal injuries/ chest wall trauma Mesentric laceration

18. Hinge fracture/ motorcyclist fracture

19. Railway spine Concussion of spinal cord Due to momentary collision of the spinal cord against the vertebral canal Due to violent deceleration/ acceleration Rotational injury Incidence: railway and motor car collision severe blow to the neck falls

20. Temporary paralysis Focal paralysis Symptoms may appear suddenly/ after few hours Headache, giddiness, weakness in limbs, sleeplessness May resolve by 48 hours or may prolong