Road Traffic Accidents : Causes, Injuries

Introduction to Road Traffic Accidents

As Indians, we don’t need to be introduced to road traffic accidents. These are fairly common in India, and the reasons could vary from the bad condition of roads to cattle blocking roads. Road Traffic Accidents can involve Motorcyclist injuries, which are caused while riding a bike; pedestrian injuries, which are due to accidents while walking; and Vehicle injuries, which are accidents involving big vehicles. The severity of the injury depends on the Speed of the Vehicle and the Point of Impact. Let us discuss each of these in detail, but before that, it is important to discuss the main causes of road traffic accidents.

Causes of Road Traffic Accidents

• Poor road maintenance
• Not following the road traffic rules.
• Driving under the influence of drugs and alcohol
• Using a mobile phone while driving
• Inexperienced driver
• Distractions while driving

Motorcyclist Injuries  

1. Motorcyclist fracture

Motorcyclist fracture is also a type of regional injury. The main site of the motorcycle injury is the motor Base of the skull (BOS). It is a type 1 hinge fracture. Motorcyclist fracture divides the skull into 2 halves: Anterior and Posterior. It is a side-by-side fracture where force is from one side and it goes to the other side.

2. Tailgating/ Under Running

Running into a large/ heavy vehicle from the back is known as tailgating/underrunning. An example is when a motorcycle is crushed to the back of a truck/car. In such accidents, head injury is the most common type to occur. It may also cause decapitation, that is removal of the head/ removal of the face or chest or abdomen.

Pedestrian Injuries

In a Pedestrian road traffic accident the Person is walking or standing on the road can have an injury. Following are the main types of Pedestrian Injuries.

1. Primary Impact Injury
   • The bumper of the vehicle is the main object, so the most common injuries are bumper injuries. Injuries due to bumper are namely Abrasions, Contusions, Lacerations and Fractures. The most common site is Leg. In Adults, the Most common is the fracture of the tibial bone, Mostly on the lateral side of the tibial plateau. It is a Wedge/triangle-shaped fracture. The Base is a point of impact that is triangle-shaped, and the Apex is the direction of impact of a car or vehicle. If the bumper fracture is from the back side, then the vehicle is coming from the backside. If the bumper fracture is from the front side – the vehicle is coming from the front side. If the Victim is standing - Injuries will be at the same level on both legs. If the Victim is running or walking, the Injuries will be at different levels on both legs.
   • If the oncoming vehicle applies breaks then the injuries will be lower than the bumper. 
2. Secondary Impact Injury
   • A secondary impact injury occurs when the same person is hit by the same vehicle for the second time. It is also known as a second contact injury. The Person usually moves over the vehicle. The victim may hit the Bonnet or Windshield. The Possible injuries Can lead to multiple injuries. The most common injury is a Head injury; however, Cervical fracture or injury and Skeletal injuries may also occur.
3. Tertiary Impact
   • Injury due to impact with an object other than the same vehicle is known as tertiary impact injury. The object could be from the Road, divider, other vehicles, or pole. The tertiary impact injuries are of two types:

Roll-on or Roll-over injuries (victim rolling on)

It is caused by vehicles having low chassis. For Example, Car/ Small vehicles like auto rickshaw.

The main Characteristics of Roll on or roll over injuries are 

• Grazed abrasions - around the circumference.
• Fractures - Of bones.
• Patterned abrasions - Due to the Chassis of the vehicle.
• Burning of skin - Due to hot exhaust.
• Grease stains - Due to grease from the car.

Runover Injuries (Vehicle Runs Over)

It is caused by vehicles having high chassis. For Example, Heavy vehicles like trucks and lorries. The main Characteristics of Runover injuries are:

• Tyre marks - Most specific (patterned abrasions/bruises).
• Grazed abrasions - Multiple abrasions on the body due to friction.
• Avulsion - Separation of tissue (shearing lacerations).
• Crushing injuries - Crushing of head or body or internal organs.
• Burning of skin - Due to hot exhaust.
• Grease stains - Due to grease from the car.

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Car Occupant Injuries

A Car has two occupants who usually get injured the most during a road traffic incident: the driver and the front-seat passenger. 

Car Driver Injuries

1. Windshield Injuries

Windshield injuries happen when the windshield of the car is broken into pieces during a road traffic incident. A windshield injury leads to a Sparrow's foot mark as the driver rummages through the glass. Sparrow foot mark are multiple, small and superficial punctate laceration. A windshield injury can also cause a Diving injury due to broken glass falling on the driver.

2. Neck Injuries

There are 2 types of neck inuries  that can happen in a road traffic accident. They are Whiplash injury (soft tissue injury) and Neck fracture (cervical). These injuries can happen due to Violent neck movements.

In case of Whiplash injury there is a sudden Acceleration and Deceleration. The acceleration causes Hyperextension of the neck followed by hyperflexion and the deacceleration causes Hyperflexion of the neck followed by hyperextension. Hyperextension is more common and dangerous in a Whiplash injury.

Contusion of the soft tissue of the cervical spinal area is seen in whiplash injury which is fatal. This injury is usually at the level of C5 and C6 level. 

3. Steering Wheel Injuries

Steering wheel injuries are injuries caused by the steering wheel in a road traffic accident. Steering injuries can cause Sternum and rib fractures. Other sites for this injury could include the Elbow or forearm. The most common site for Pattern Bruises is the Chest.

The Organs involved in steering wheel injury are the Lung, Heart, and Aorta. A direct impact on the aorta shows Torsion force, and the Part involved is the isthmus, which is distal to the subclavian artery. 

There could also be a Ladder rung tear in which there will be a transverse tear in the intima of the isthmus. Steering wheel injury is a Deceleration injury, and it can cause Stretching or straining of the aorta.

4. Seat Belt Injuries

The purpose of seat belts is to protect the passengers seated inside the car. But sometimes, they can also cause serious injuries. Seat belt syndrome is the presence of Seat belt signs, Intra-abdominal injuries, and Vertebral injuries. Seat belt syndrome has three categories of injuries that can happen.

• Seat belt sign (Patterned bruise)- this is seen in drivers and it starts from the right shoulder. In the front passenger seat belt sign is seen from the left shoulder.
• Intra-abdominal injuries- These injuries are due to deceleration and compression. The Common sites of injury are Mesentery (most common), Small intestine - Duodenojejunal flexure (primary),  ileocecal junctions (secondary), and the Liver
• Vertebral injuries- vertebral injury is due to distraction and compression.
  • Distraction (separation of the joint)
    • If only lap belt - Hyperflexion of the spine (lumbar vertebra).
    • Seen on the posterior side
  • Compression
    • Seen on the anterior side

Chance\ Fulcrum fracture can also be seen in the case of Seat Belt injury, where there is Distraction on the posterior side and Compression on the anterior side, which causes a Posteroanterior fracture of the vertebra (transverse fracture).

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Front Seat Passenger Injuries

All driver injuries like Windshield (sparrow foot sign, dicing injury), Whiplash injury (cervical injury, soft tissue injury), and Seat belt injury (patterned bruise in the front passenger, starts from the left shoulder)

 are equally seen in the front seat passenger as well, except for the steering injury. But Instead of steering injury, we can see dashboard injury.

In a Dashboard Injury, the Front seat passenger is sitting in a position where the knee and hip are flexed. During the accident, the dashboard hits the flexed knee and causes a Patellar fracture, a Posterior cruciate ligament injury, or even a Posterior dislocation of the hip. The most common nerve affected is the sciatica nerve. Sometimes, femur damage is also seen.

Also Read: Infanticide: Causes, Implications, and Prevention

Frequently Asked Questions

Question: What is the most common neck injury in a road traffic accident?

Answer: Whiplash injury.

Question: What type of injury is Whiplash injury?

Answer: Hyperflexion and Hyperextension injury

Question: What is the most common organ injured in seat belt injury?

Answer: Spleen 

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