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Legal Medicine 9 (2007) 274–277 www.elsevier.

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Case Report

A two-rider motorcycle accident involving injuries around groin area in both the driver and the passenger
Yoko Ihama *, Chiaki Fuke, Tetsuji Miyazaki
Department of Legal Medicine, School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan Received 18 December 2006; received in revised form 23 March 2007; accepted 26 March 2007 Available online 11 June 2007

Abstract This paper presents a two-rider motorcycle accident in which both riders received injuries around the groin area. In medico-legal autopsies, injuries around the groin area in victims of motorcycle accidents are usually regarded as a ‘‘fuel tank injury.’’ Although fuel tank injuries are one of the most useful and important characteristics in determining injuries that have been found to be exclusive to the driver, our study reveals that passengers can also suffer from injuries around the groin area. To distinguish the driver from the passenger, we need to carefully consider each injury in both riders. In addition, we present bilateral traumatic testicular dislocation in the driver. We consider traumatic testicular dislocation as one of the important findings of fuel tank injuries in motorcycle accidents. Ó 2007 Elsevier Ireland Ltd. All rights reserved.
Keywords: Two-rider motorcycle accident; Injury around groin area; Fuel tank injury; Identification of the driver; Traumatic testicular dislocation

1. Introduction In two-rider motorcycle accidents, it is difficult to distinguish the driver from the passenger; however, being able to do so is important for medico-legal judgment [1]. The difficulty in the driver’s identification is that both riders are usually thrown from the vehicle and both have few characteristic injuries for each seated location. Injury around the groin area of the victim, known as ‘‘fuel tank injury,’’ is one of the few characteristic findings [2]. According to previous reports, injuries around the groin area, known as fuel tank injuries, were always related to the driver but never to the passenger [1,2]. We present a rare case of a two-rider motorcycle accident where both riders suffered injuries of the groin area. 2. Case report Two 17-year-old men were riding on European type motorcycle with a 400 cc engine (Kawasaki ZR400). The
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Corresponding author. Tel.: +81 98 895 1141; fax: +81 98 895 1413. E-mail address: makino@med.u-ryukyu.ac.jp (Y. Ihama).

motorcycle carrying the two riders ran straight into an intersection at the speed of ca. 60 km/h and collided with the left side of a right-turning car. Both riders were thrown from the motorcycle onto the roadway by the impact and consequently taken to a hospital. One rider (A) was unconscious immediately after the accident, and had neither spontaneous breathing nor response to the pain stimulus on arrival at the emergency department. He was nearly considered to be brain dead as a result of severe head trauma. Due to his medical condition, the prognosis was judged to be poor, and thus he did not receive aggressive head injury treatment. Rider (A) died from multiple organ failure secondary to brain damage due to head trauma three days after the accident. Meanwhile, the other rider (B) suffered head trauma with brain contusion and minor injuries on his body that took 6 weeks to completely heal. At the time of the collision, the car was taking a right turn at the speed of ca. 30 km/h on a right-turn light, when the motorcycle ran straight into the intersection against a red light. The motorcycle collided with the lower part of left front pillar of the car at impact angle of approximately 90°. Both riders were wearing half helmets; neither had a driver’s license. The driver of the car and both riders of

1344-6223/$ - see front matter Ó 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.legalmed.2007.03.003

Some abrasions with crustae were observed on both forearms and the inside of the thighs. Jaundice was found on the bulbar conjunctivae and skin. Left and right testes with parorchis weighed 15 g and 17 g. The severe hypoxia-induced damage to the brain resulted in edema and malacia. Ihama et al. There were comminuted mandibular parasymphyseal fractures separating the mandible into left and right fragments. The elastic soft masses were palpated in the superficial bilateral inguinal regions. medico-legal judgment of the identification of the driver must carefully consider all information before making any decision. 1. there were enough mature sperm in the testes. respectively. The pelvis was fractured at both sacroiliac joints. the front wheel and handlebar were pushed into the vehicle body and the fuel tank was crushed (Fig. and there was a contusion on the inferior surface of the frontal cortex. No injuries were found on the palms. 1). 1a).1. External examination revealed a lot of bruises and abrasions on the face. measuring 12 cm in length. The face was swollen. and the left side window and the front windshield were broken. and some bruising was found on the scrotum and perineum (Fig. Fig. The linear fracture. The body was 173 cm in length and weighed 74 kg. 3). flecks of fiber on the left side of the fuel tank had the same color and composition as the clothes that rider (A) was wearing at the time of the accident. The arrow indicates the tandem bar on the tail of the motorcycle was bent forward. There was no hernia protrusion of the peritoneum in the abdominal cavity. There was subcutaneous bleeding between the inguinal region and the inside of the thighs (Fig. including the scrotum. and black eyes were observed. The bilateral testes with each spermatic cord were located in the subcutaneous area of the inguinal region (Fig. In a two-rider motorcycle accident. chest. We concluded that he died as a result of brain damage due to head trauma from the accident. it is difficult to distinguish the driver from the passenger because both riders are thrown from the motorcycle at the time of collision and have few positional dependent injuries [1]. The decedent (A) was thrown from the motorcycle and banged his forehead against the front windshield of the car. Microscopically. Consequently. 2c). The tandem bar on the tail of the motorcycle was bent forward (Fig. (b) The fuel tank was crushed. and extremities. . were well developed and there was no observed injury on the surface (Fig. Postmortem hypostasis on the back was severe. 2. (a) The front wheel and handlebar of the motorcycle were pushed into the vehicle body. both riders had no previous history of cryptorchidism or inguinal herniation. Discussion It is always important in traffic accidents to distinguish between the driver and passenger because criminal and civil responsibilities usually fall on the driver. 2b). / Legal Medicine 9 (2007) 274–277 275 the motorcycle had not drunk alcohol before the accident. His external genital organs were well developed. The victim was able to respond although he was not fully conscious. 2. Diffuse subarachnoid hemorrhage was noted on almost the whole area of the brain. Autopsy findings for the decedent (A) The autopsy was performed 14 h post-mortem. neck. extended inferoposteriorly from the left frontal tuber into the right orbital roof to the tubercle saddle. Bilateral spermatic cords were 15 cm in length. and no injury was found on the organs in the thorax and abdomen. In addition. The scrotum was empty and subcutaneous hematoma was observed. 3. On the motorcycle. The car had a dent on the left side.2. The external genital organs.Y. External examination of the victim (B) The external examination was performed in the hospital five days after the accident. There were some contusions and lacerations on the forehead and the left palm. 2a). In addition. There were tissue and hair from rider (A) on the broken windshield.

the sudden deceleration of the motorcycle catapults the rider forward over the saddle. we believe the chain Fig. Fuel tank injury is comparatively rare in even drivers of motorcycle accidents because it may occur only from a head-on collision. To explain how the passenger (B) suffered injuries around the groin area.2]. In the present case. we discuss a traumatic testicular dislocation as one of the important findings of fuel tank injuries in motorcycle accidents. rider (A) (b) The subcutaneous bleeding around the inguinal region. / Legal Medicine 9 (2007) 274–277 Fig. our study reveals that passengers can also suffer from injuries that . is one of the most useful and important findings on the motorcycle driver [1. Thus. Injuries around the groin area in victims of motorcycle accidents are often regarded as a fuel tank injury. there were suggestive injuries in both riders. Most drivers try to dodge collision and topple over at the moment of the collision. and the victim with the fuel tank injury was always considered to be the driver [1. the victim with the injury around the groin area may be considered to be the driver. Ihama et al. as bilateral traumatic dislocated testes and pelvic fracture.1. both riders had some injuries around the groin area. The severity of injuries in both riders designated the rider (A) as the driver. However. 2. such as bruising around the scrotum and perineum. due to the nature and severity of injuries in both riders and based on scientific evidence. the passenger usually glides over the driver’s back and is launched unrestrained to impact. so he never suffers such an injury [2]. The fuel tank injury is exclusive to the driver who is sitting behind the fuel tank. known as a fuel tank injury. Some previous reports have concluded that the fuel tank injury was an evidence of the driver. but in fact. (c) The bilateral testicular dislocation. When a driver topples over before his groin area strikes the fuel tank. Meanwhile. in the present case of the motorcycle accident. it is relatively easy to identify rider (A) as the driver. the driver cannot suffer fuel tank injury. the passenger (B) had injuries around the scrotum and perineum. As most passengers glide over the driver’s back and are launched unrestrained to impact during an accident. known as a ‘‘fuel tank injury’’ A characteristic injury around the scrotum and perineum of the victim. while the other victim (B) had slight injury. In contrast. are usually only attributed to drivers. while the driver (A) had bilateral traumatic testicular dislocation. Bruises on the scrotum and perineum of the victim (B). they are thought to never suffer from injuries around the groin area [2]. On impact. The decedent (A) had severe injuries. 3.276 Y. Injury around groin area. 3. (a) The external genital organ and the injuries around the groin area on the corpse. The fuel tank injury results from gliding and striking of the scrotum and perineum of the rider on the fuel tank during the collision [3–7]. but it is extremely rare that the passenger can also suffer from injuries around the groin area.2]. Additionally.

(2) superficial dislocation where the testis is forced subcutaneously in inguinal. Injuries of motorcycle riders. Ann Emerg Med 2004. Traumatic testicular dislocation a review of 36 cases.16(12):1000–2. Matsuta Y. J Trauma 1982. In addition the passenger holding the bar might have struck his groin area on the void space of the fuel tank. [2] Kurihara K. . et al. [5] Tan PK. Am J Emerg Med 1991. Terada N. his straddling from backward presses his testes upwards. Salim A. Traumatic dislocation of the testes. Wong C. Choonhaklai V. Wu WJ. J Trauma 2003. Testicular dislocation following minor scrotal trauma. / Legal Medicine 9 (2007) 274–277 277 of events began with the passenger clutching the tandem bar on the tail of the motorcycle at the moment of the accident.54(5):1009–11. According to previous reports. 3. Kaohsiung J Med Sci 2002. preputial. [10] Bromberg W.31:275–9. [6] Ko SF. [12] Yoshimura K. Traumatic dislocation of the testes.2].5.Y. The testicular dislocation can be classified into two groups: (1) internal dislocation where the testis is forced through the external ring into the inguinal canal or to the abdominal cavity. Huang SP. resulting in the groin injuries. Matsubara K.18(2):95–8. J Urol 2002. See Fig. Identification of the driver in two-rider motorcycle accidents. pubic. Am J Forensic Med Pathol 1990.9. Ichioka K. Furthermore.167(2 Pt 1):649–50. Traumatic bilateral testicular dislocation. Inguinal contusion–laceration as an indication of the driver. Bilateral traumatic dislocation of testes. At the moment of the collision. as in the case of the decedent (A).5. Muangman V. Traumatic testicular dislocation Traumatic testicular dislocation is a rare complication of scrotal trauma [8]. Okubo K.83(2):208–12. Traumatic testicular dislocation usually results from highspeed motorcycle crashes [3.67(6):311–3. Res Pract Forens Med 1988. were always related to the driver but never to the passenger [1. Restoration of spermatogenesis by orchiopexy 13 years after bilateral traumatic testicular dislocation.2. Traumatic dislocation of the testis: addition of two cases with a changing etiology. or acetabular [3. he may not have been launched immediately and his groin area might have initially glided forward and struck the seat or the driver’s buttocks. is even rarer [3.43(3):371–5. [7] Goulding FJ. injuries around groin area. J Trauma 1976. Bilateral traumatic testicular dislocation – a case report.6. Sacchetti A. Wan YL. If the passenger held the tandem bar. Myrick S. with simultaneous crushing and squeezing actions forcing the testis to pop out of the scrotal sac [6]. [3] Tsai HN. Arai Y. [9] Wu CJ. Tanabe K. Akane A. J Med Assoc Thai 2000. Takahashi S.10]. crural. The differential diagnosis from cryptorchidism can be readily made because in cryptorchidism the scrotum is not well developed (Broakman’s sign) [4]. known as fuel tank injuries. the sharp edge of the fuel tank strikes the rider’s groin area from the front [3.9–11]. Yanagida J. Ng SH. Chang HC.9(1):40–2. Forensic pathologists have to identify the driver after due consideration of each injury on both riders. consequently.12].4.7.11]. The latter type is more common and frequently observed in young adults. and the victim had no previous history of inguinal hernia or cryptorchism. 1(a) as it shows that the tandem bar was bent forward. Ihama et al. References [1] Shiono H.11(3):190–2. Kuroda N. as in this case. We emphasize that there is a possibility that the passenger can also suffer from injuries around the groin area in the two-rider motorcycle accidents. [11] Pollen JJ. Kurek S. Tsai JL. J Chin Med Assoc 2004. [8] Feder M. Chue YC. Ann Acad Med Singapore 1998.27(2):269–71. Conclusion This paper presented a case of a two-rider motorcycle accident where both riders were found to have injuries around the groin area. [4] Kochakarn W. Hotrapawanond P. 4.6. forcibly displacing them in a lateral and superior direction [10]. (1) fuel tank injury. Tsai WF. The scrotum and testes were well developed in this case. et al. Testicular dislocation is usually caused by severe direct scrotal trauma.22(3):247–9. The traumatic testicular dislocation is one of the important findings of a fuel tank injury in motorcycle accidents. Lee YM. Funckes C. Additionally. perineal. penile. we consider traumatic testicular dislocation as one of the important findings of fuel tank injuries. and bilateral testicular dislocation. Testicular dislocation: an uncommon and easily overlooked complication of blunt abdominal trauma. Murai T.