Forensic Medicine

1. Transportation injuries
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

5. 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

6. 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

7. 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

8. • 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

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

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

11. 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

12. 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

13. 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

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

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

16. 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

17. 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

18. 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

19. Hinge fracture/ motorcyclist fracture

20. 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

21. • 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

22. THANK YOU