This document discusses classifications and types of injuries that can occur in transportation accidents. It classifies injuries as those sustained by pedestrians, cyclists, motorcyclists, or vehicle occupants. For pedestrians, injuries are broken down into primary impact injuries from the initial collision and secondary impact injuries from being thrown or sliding after the initial collision. Primary impact injuries depend on factors like the victim's position and height of impact. Common injuries are fractures of the legs. Secondary impact injuries include head injuries from striking the windshield or injuries to the chest, abdomen, and pelvis from striking the vehicle. The document discusses various medical legal indicators for different types of collisions and injuries.

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