Road Traffic Accident

Dr Zakir Hossain
Department of Forensic Medicine & Toxicology
 Road Traffic Accident

Fracture:

Fracture is a break in the surface of a bone either across its cortex

or its articular surface

Dislocation:

It is a complete and persistent displacement of a joint in which at

least part of the supporting joint capsule and some of its ligament
are disrupted
 Causes of Road traffic accident
A. Causes related to driver----

I. Lack of driving skill

II. Lack of knowledge of mechanism of vehicle
III. Alcoholism
IV. Drug abuse by the driver
V. Violation of traffic rules
VI. Defects in visual and auditory system
VII. Heart disease and epilepsy
VIII.Physical and mental exhaustion
 Contd

B. Causes related with vehicle ----

I. Sudden brake failure
II. Sudden tyre puncture
III. Large no. of old, poorly maintained vehicle

IV. Ignoring the necessity of periodic checkup

 Contd
C. Causes related with victim ----
i. Disease of the victim
ii. Drunkenness
iii.Ignore about seat belts

d. Causes related with authority: ----

i. Dishonesty of traffic central authority
ii. Issuing driving license to unskilled driver
iii.Giving road permit to an unfit vehicle
 Contd
e. Miscellaneous:
i. Bad road condition
ii. Poor street lighting
iii.Defective layout of cross road and speed breaker
iv.Bad weather
 Injuries of Pedestrians

1. Primary impact : Due to impact of the vehicle

2. Secondary impact: Further injuries result from vehicle.
victim is thrown forward & falls on vehicle & run over by
vehicle.

3. Secondary injury : Due to striking the ground or other

object. It is sometimes called tertiary injuries
Contd
When an adult hit by a car the front bumper
usually strikes first
I. At or below knee level
II. Radiator grille, lamps or bonnet (hood) --- causes
further primary injury on the thigh or hip
III. Contre-coup brain damage ---- due to moving head
suddenly stopped on impact
IV. Fracture of spine --- especially in cervical and
thoracic spine
V. Cord damage ---- paraplegia
VI. Fracture of femur or tibia
 Contd
viii. flail chest: When fracture of multiple ribs, bilaterally in the
front or sides of the thorax occur including sternum and thoracic
spine leading to the condition of severe or fatal embarrassment
as the expansion of the lung is prevented by bellows effect of the
thorax.

ix. flaying injury: When a mater wheel, specially of large vehicle

rotates against the body on the ground, large areas of skin and
subcutaneous tissue may be ripped off, this is called flaying injury
usually on leg and scalp.
 Contd
x: Running over injury:
When a wheel passes over the body Gross distortion of head,chest,
pelvis or abdomen Internal organ may be ruptured
xi. Scooping up injury:

When the pedestrian is knocked at his feet and rotated upon to the
bonnet or hood, only occur with cars not large trucks or buses. The
scooped up victim may throw violently against the wind screen
Run over injury Flaying injury
Scooping up injury Flial chest
When hit by large vehicle e.g. truck or bus---

1. Injuries at higher position on the chest, arms or head

20 km/h—the body can be thrown violently
2. 60-100 km/h --- victim may be projected up into air
and travel a considerable distance before striking
ground when projected body strikes the road way---
cause brush abrasions
 Small Vehicle

When the speed of car is more the victim may be flung across the
roof of the car and strike the road behind.
 Car Occupants

Most vehicle accidents are frontal --- 80%

The car strikes another vehicle or stationary object---

rapidly stops the vehicle--- severe deceleration to the car
and occupants
Vehicle is hit from behind 20%
 Contd
Injuries Occupant of Vehicle

i. In case of driver and front seat occupants ----

Forehead strikes glass screen
Chest strikes steering wheel
Reflexly straightened legs & sustain fracture of tibia or
calcaneum
Seat belt injury
May be thrown out from doors & sustain secondary injury or run
over by another vehicle
 Contd
2. Rear seat occupants
Forehead strikes back of front seat
Knees strikes back of body of front seat
May be thrown out from doors & secondary injuries or run over by
another vehicle
3. Common injuries
Collison( 1 - car to car, 2 car to occupants, 3 body
st nd rd

cavity to viscera)
Whiplash injury
Seat belt syndrome etc
 Seat belt
Functions of seat belt:

i. It holds the occupants back against the seat and prevent forward
movement against steering, wheel and wind shield and ejection
from the vehicle
ii. It spreads the deceleration forces over a considerable area of broad
strap against the body surface so that the passengers are inclined
forward
iii.The strap stretches appreciably during severe deceleration
iv.The belt prevent ejections into the road through brust doors, a
common cause of severe injury and death
 Seat belt syndrome
i. Externally abrasions, contusions and haematomas of lower
abdomen can occur as a direct result of seat belt trauma

ii. Internally small intestinal avulsions, intestinal, mesenteric

lacerations and intestinal perforations can occur due to acute
flexions over a lap strap. Rupture of the spleen, liver, pancreas,
caecum and bladder occur due to compression between belt
and vertebrae.
 Contd
iii. The abdominal aorta can be crushed. Transverse fracture of
lumber vertebrae (2nd or 3rd segment) can occur due to acute
hyper flexion over the belt.

The above mentioned all the injuries may occur due to seat belt
leading to the development of seat belt syndrome
 Identification of the driver
The driver can be identified by-
I. The presence of steering wheel impact type of injuries
II. Finding of point or glass from the door on the driver’s
side on the victim’s body or clothes
III. Finding of cloth fibers, hair and tissue from the suspected
driver on the driver panel, door or glass on the driver’s
side or on the steering wheel
 Contd
iv. The brake or acceleration pedal design is imprinted on the sole

of the drives shoe

v. Matching of the blood group of the driver with that of blood of the

driver’s side of the vehicle

vi. Finding of driving license, id card with pocket belongings

 Crush Syndrome

Crush Syndrome is related to road traffic accident where it occurs

after the victim receives crushing or avulsed laceration of the
skeletal muscles specially in the lower limbs

Here the patient dies at the end of a week in the hospital due to
the action of toxin & rhabdomyogloin causing renal failure.
 Whiplash injury
Fatal contusions or lacerations of spinal cord without fracture of
the vertebral column due to a state of acute hyperflexion or
hyperextension of the neck or combination of both.
Injury usually found at the level of C4-C6.
Cause :
RTA
Blow on neck
Fall from height
Lifting of heavy weight.
 Contd
Mechanism:
This is the injury of the spinal cord, without fracture of vertebral
column, sustained commonly by the occupants of the front seat
of a motor vehicle.
When the vehicle comes to a sudden stop, the forward thrust
produces a state of acute hyperflexion, but it is converted to
acute hyper extension as the forehead strikes the wind screen
which causes injury to cervical column. In such cases and also
due to sharp blow against the spinous process of upper cervical
vertebrae (rabbit punch) fatal contusion or laceration of the spinal
cord may occur without fracture of spine.
Diagnostic Criteria For RTA:

Different types of abrasion( brush burn) found on different parts

of body with different size & shape.

Opinion

In my opinion cause of death was shock ( hypovolemic/

Neurogenic) as a result of above mentioned injuries which was
ante mortem & consisting with RTA