https://pgblazer.

com/primary-impact-injury-in-road-traffic-accident-forensic-medicine-mcq/\

 Primary impact injuries are caused by the first impact of the vehicle with the
pedestrian in an accident
 The legs get hit most often (by the bumper in front of the vehicle)
 The other injuries associated with a road traffic accident are the secondary
impact injuries and secondary injuries
 Secondary impact injury is caused by the second impact with the vehicle (eg:
the body of thrown onto the vehicle / the vehicle runs over the body)
 Secondary injuries are caused when the body strikes the ground after the
collision

https://www.slideshare.net/neharikasingh9678/road-traffic-injury

2. Secondary impact injuries

DESCRIPTION

these secondary impact injuries are resulted from the impact of body of a person and the
vehicle for a second time

eg: the body of thrown onto the vehicle

the vehicle runs over the body)
Here the person strike to windshield or bonnet or placed on the top of car/
vehicle.

INJURIES

Extensive abrasions, bruises and laceration may be seen.

Injuries are variable, depending on the area of the body involved

Sometimes pedestrians are run over‟ if knocked down by the vehicle.  This will tend to
occur if the pedestrian’s center of gravity is lower than the impact side or scooped-up victim
being run over by other vehicle.

There may be:

 Tyre trade marks over the unclothed or clothed areas on one surface of body with graze
like abrasions on the opposite side of body.
 The head may be crushed causing gross distortion and externalization of the brain and
severe injuries my occur to the chest, pelvis & abdomen.
 Compression of the chest may result in multiple rib fractures, causing a „flail chest ‟ with
rupture of internal organs along with the fracture of spine, sternum & ribs.
 Burning and singeing of skin and hair resulting from discharge of hot exhaust
3. Tertiary injuries.(injuries caused by victims striking objects, such as the ground).

DESCRIPTION

These are the injuries that occur after second impact injuries when the victim is thrown off
the vehicle on the ground.

Here the victim sustains secondary injuries from the ground.

INJURIES

Head injury is more common though injuries to other part may occur.

Sometimes the victim may be run over by the same vehicle and another vehicle.

Brain damage is frequent without any associated skull fractures. 

Fracture of the skull and ribs due direct contact with a surface, and fracture of spine due to
hyper flexion or extension may be seen.

Fracture of the limbs is common but apart from toes of the legs.

 In pedestrian accidents, the common cause of death is head injuries and fracture
dislocation of cervical spine.

Injuries to the chest and abdomen are minimal or absent.

http://www.forensicpathologyonline.com/E-Book/injuries/road-traffic-collisions

https://www.slideshare.net/KaleemKhan7/road-traffic-accidents-medicolegal-aspect

1. . INJURIES TO PEDESTRAINS Three patterns of injury are often seen. 1. Impact

Injuries- when vehicle strike the victim 2. Secondary Injuries- due to victim falling on
ground or striking any other stationary object 3. Run-over Injuries- d/t vehicle running
over some part of victim
2. 5. Impact Injuries • Primary Impact Injuries: d/t initial impact of vehicle Projections
of vehicle may cause specific injuries e.g. bumper fracture (# of tibia & fibula of one
or both the legs) Height of pedestrian often determines site of injury • Secondary
impact injuries: Subsequent impact with the same vehicle
3. 6. Secondary Injuries – Usually found on parts opposite to primary impact – Most
pronounced over the unclothed areas of the body Run-over Injuries – Severity of
injury will depend upon the part of body run over and weight of the vehicle. – E.g.
degloving injury, tyre marks, burns, avulsion etc.
4. 7. I. In Primary Impact injury:- • These are the injuries caused by vehicle when it first
struck and Hit the person whether crossing the road from one side to the other side
or walking with or against the traffic. • The importance of primary impact injury is that
 the body of victim may bear design / pattern of the part of vehicle in form of imprint
abrasion pattern bruised.
5. 8. Common parts of vehicle which may struck or hit a person includes.. 1. Bumper 2.
Wing 3. Grill 4. Head Light 5. Fender 6. Radiator 7. Door handle
6. 9. The body part which bears the injury depends upon the position of the person
such as 1. Was the pedestrian struck by front of Car/Vehicle? 2. Was the pedestrian
struck by side of Car/Vehicle? 3. Was the pedestrian standing on road? 4. Was the
pedestrian walking on road? 5. Was the pedestrian lying on road? • If the vehicle
was braking violently at the movement of impact, the font end of the vehicle dips
down an the legs get injured at a lower level.
7. 10. The injury comprises of damage to skin and fracture of bone (k/w as Bumper
fracture). • The Bumper fracture usually involves Tibia. The fracture is wedge shaped
with base of triangular fragment indicating the site of impact and apex pointing the
direction of vehicle. • Frequently Bumper injuries are at different level of the two legs
or absent on one leg, which suggest that the victim was walking or running when
Struck.
8. 11. • Frequently Bumper injuries are at different level of the two legs or absent on
one leg, which suggest that the victim was walking or running when Struck • In
children the bumper usually produces fracture of the femur. • If bumper injury are at
the same level on both legs then it means the person is standing. • The level of
bumper injury (i.e the height of injury from ground level) varies with height of bumper
of different vehicle. It means than the offending vehicle can be identified.
9. 12. • At impact against the headlamp or mudguard may result in fracture of the pelvis
or fracture dislocation of the sacroiliac joint. • The findings of primary impact injury
are important to find out the relative position of pedestrian and vehicle and kind of
vehicle involved in the Incident.
10. 13. II. In Secondary Impact Injury • After sustaining primary impact of injury, the
person may be lifted off the ground and thrown of the vehicle. • Thus these
secondary impact injuries are resulted from the impact of body of a person and the
vehicle for a second time. • Here the person strike to windshield or bonnet or placed
on the top of car/ vehicle.
11. 14. After the second impact injuries, the victim will be thrown on the ground. –
Extensive abrasions, bruises and laceration may be seen. – Some times pedestrians
are ‘run over’ if knocked down by the vehicle. – This will tend to occur if the
pedestrian’s center of gravity is lower then the impact side or scooped-up victim
being run over by other vehicle. – Injuries are variable, depending on the area of the
body involved.
12. 15. The weight of the vehicle and the surface area of the contact. There may be: 1.
Tyre trade marks marks over the unclothed or clothed areas on one surface of body
with graze like abrasions on the opposite side of body. 2. The head may be crushed
causing gross distortion and externalization of the brain and severe injuries my occur
to the chest, pelvis & abdomen.
13. 16. iii. Compression of the chest may result in multiple rib fractures, causing a ‘flail
chest ’ with rupture of internal organs along with the fracture of spine, sternum &
ribs. iv. Burning and singeing of skin and hair resulting from discharge of hot exhaust
14. 17. Flail Chest:-
15. 18. III. Secondary Injuries • These are the injuries that occur after second impact
injuries when the victim is thrown off the vehicle on the ground.
16. 19. • Here the victim sustain secondary injuries from the ground. Head injury is more
common though injuries to other part may occur. • Some times the victim may be run
over by the same vehicle and another vehicle. • Brain damage is frequent without
any associated skull fractures. • Fracture of the skull and ribs due direct contact with
a surface, and fracture of spine due to hyperflexion or extension may be seen.
17. 20. • Fracture of the limbs are common but apart from toes of the legs. • Usually it is
very difficult to classify the injuries as Primary impact, secondary impact or
secondary injuries. • In pedestrian accidents, the common cause of death is head
injuries and fracture dislocation of cervical spine. • Injuries to the chest and abdomen
are minimal or absent.