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PATTERN OF INJURIES TO MOTORCYCLISTS IN
FATAL ROAD TRAFFIC ACCIDENTS
Dr. Srinivasulu Pothireddy*1, Dr. Naresh Karukutla 21. Associate Professor 2. Assistant Professor Dept of Forensic Medicine, Katuri medical college & hospital,
Guntur, Andhra pradesh. *E – Mail: [email protected]
ABSTRACT
Study of pattern of injuries in road traffic accidents helps us to know the measures to be taken at different levels to reduce suffering to human beings. Injuries to the limbs (96%) and head (95%) occurred in most of the cases followed by chest and abdomen. In head region, scalp contusion, fissured fracture of the skull and subdural hemorrhage were more commonly seen than other injuries. Lungs and liver suffered maximum among visceral organs. Contusions were more commonly seen in scalp and brain unlike that of abrasions present on chest, abdomen and limbs. Femur fracture (n=16) was more than other long bones. Head injury was the primary cause of death (69%) in most of the cases. Fatal motorcycle accidents are associated with a wide spectrum of injuries involving multiple anatomical regions.
Key words:
Road traffic accident, Motorcyclist,
Injury.
1.INTRODUCTION
Road traffic accidents are the world’s most serious health problem causing premature death and disability with increasing prevalence year by year. India accounts for about 10% of road accident fatalities world-wide.1
In 2010, 1,33,938 people died in India.2 Factors that increase the risk of road traffic accidents include poor road structure and maintenance, encroachments, traffic mix, non laying of roads compared to absolute increase in the motor vehicles, alcohol overuse, lack of driving awareness, ill control of children by parents, allowing domestic animals on to roads and usage of mobiles while driving.
Motorized two wheelers account for a significant number of cases in developing countries like India.3 Motorcyclists constitute a large number among vehicle
days, motorized two wheelers in India became a family vehicle where the number of riders are more than two because of habituation and family size.
2. MATERIALS AND METHODS
The study was conducted in modern mortuary, Andhra medical college, Vishakapatnam from 1st Jan 2007 to 31st Dec 2007. A total of 131 motorcyclists deaths were studied for the pattern of injuries using a standard proforma prospectively. Mechanical injuries of different anatomical regions of the body were studied externally along with the internal organs like brain, lungs, heart, liver, spleen, intestines etc.,As there was no stringent law implementation regarding the usage of helmet in motorcyclists, we could not study the affect of helmet. Pedestrians and bicyclers, who died as a result of hit with
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3. OBSERVATIONS AND
DISCUSSION
Out of all motorcyclists’ deaths, injuries to the limbs (96%) and head (95%) occurred in most of the cases followed by chest (61%) and abdomen (38%) correlating with Nilambar Jha etal study.4 The predominance of injuries to limbs can be attributed to the free mobility and reflex action of limbs, partial covering of lateral regions of chest and abdomen by upper limbs. High incidence of head injuries can be due to reception of maximum force because of restricted movement of the head. In the trunk, the predominance of injuries in chest can be explained by the fragile nature of bony cage sometimes even damaging the internal organs, while the abdomen is protected by its elasticity and rebound nature. The rolling nature of trunk during accidents makes it more susceptible to injuries.
In head, scalp injuries were present in 92% of cases among which contusions (75%) were more common than lacerations (43%) and abrasions (8%), consistent with other studies.4,5 The common area of contusion of scalp was right parietal region and least common was left frontal region. The predominance of contusions and lacerations in scalp can be explained by the heavy blunt force, loose areolar space available for blood accumulation beneath scalp, minimal musculature of the scalp and the velocity of victim at the time of fall on the ground. Skull was fractured more (69%), among which fissured fractures (65%) followed by comminuted (18%) and depressed fractures (12%) were observed, in consistent with Akhilesh Pathak’s study.6 Right Parietal part of skull was commonly involved (36%). Parietal (n=58) and temporal (n=50) bones
were fractured more commonly than frontal (n=33) and occipital bones (n=27). In Basal fractures, middle cranial fossa was commonly involved which was also observed in Harnam Singh’s study.7 More number of skull fractures observed in this study can be explained by restricted movement of the head receiving maximum force, more striking surface area of skull in all directions, least protection offered by the minimal scalp musculature when compared to limbs and other parts of the body.
Contusions (61%) were more prevalent than lacerations (14%) in all the lobes of brain. Frontal lobes (91%) suffered maximum injury followed by temporal (89%) and parietal lobes (84%). Less number of lacerated injuries were noted in parietal (39%) and occipital (28%) lobes of brain when compared to the frontal (78%) and temporal lobes (72%). Intracranial hemorrhages were present in 76% of cases, in which sub-dural and sub-arachnoid hemorrhages were dominant, consistent with Nilambar Jha etal 4, Akhilesh Pathk 6 and Sarkar etal 8 studies.
Extra-dural and intra-cerebral hemorrhages were noted only in few cases (3% each). Contusions were more because of effusion of blood in different layers of brain due to the rupture of blood vessels by blunt trauma. An impacting force to the head can produce distortion of skull, development of shear strains in brain tissue which can produce a contusion. The development of acceleration and deceleration forces may produce intracranial pressure gradients responsible for intracranial hemorrhages. Less number of lacerations in parietal and occipital areas can be explained by the smoothness of skull in the respective regions.
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TABLE 1
INCIDENCE OF MECHANICAL INJURIES IN DIFFERENT REGIONS OF BODY
TABLE : 2
PATTERN OF HEAD INJURIES
CHART 1
INCIDENCE OF REGIONAL INJURIES
95.41% 15.26% 61.06% 38.16% 9.92% 6.87% 96.18% head neck c hest abdomen pelvis genitals limbs REGION OF BODY
ABRASION CONTUSION LACERATION
Head 8.33% 87.78% 43.45% Neck 9.16% 3.81% 0.76% Chest 54.19% 14.5% 4.58% Abdomen 23.66% 8.39% 2.29% Upper limb 84% 21.37% 16.03% Lower limb 82.96% 19.84% 18.32% Scalp injuries Skull fractures Brain injuries
abrasions contusions laceration contusion laceration Intracranial hemorrhage
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CHART 2
INCIDENCE OF VISCERAL INJURIES (N); N= NUMBER OF CASES
CHART 3
INCIDENCE OF FRACTURES IN DIFFERENT BODY REGIONS (N); N= NUMBER OF CASES
32
6
20
16
13
8
6
7
lungs
heart
liver
spleen
kidneys
intestines
38 72 32 40 22 8 91 face trunk upper limbs lower limbs vertebra pelvis skullwww.jbstonline.com
In toto, scalp injuries were seen in 92% of cases, skull fractures were seen in 70% of cases, and brain injuries were seen in 76% of cases.
The incidence of injuries in different layers of the head explains the independency of each anatomical region i.e., more brain injuries can be observed with or without fracture of skull and vice versa.
Abrasions were the common injuries suffered by the neck (9%) followed by contusions (4%). Fractures of vertebral column were seen in 20 cases in which cervical vertebra suffered maximum (n = 12) followed by thoracic vertebra (n = 5), consistent with Sarkar etal’s study.8 The transmission of force from head to neck, instability of cervical vertebra due to neck movements, less support of musculature for neck may be the cause for causing more number of cervical vertebral fractures.
Abrasions were the most common injuries present on trunk. Abrasions (54%), contusions (15%) and lacerations (5%) were present on the chest wall in descending order of frequency. Fractures of clavicle were seen in 20 cases, sternum in 6 cases and ribs in 45 cases. Lung injuries were present in 32 cases and heart injuries were present in 6 cases, consistent with KY Tham etal study.9 High incidence of lung injuries can be explained by their anatomical position and more surface area covering antero-posteriorly, medially and laterally, while heart was injured only in few cases because of its anatomical position and the protection offered by lungs, layers of heart and blood.
Abrasions (24%), contusions (8%) and lacerations (2%) were present on the abdominal wall in descending order of
predominant laceration injuries can be explained by the solidity and close approximation with rib cage. Kidneys were injured in 13 cases, intestines in 8 cases with predominant contusion injury, can be explained by the anatomical position of kidneys and mobility of intestines. Injuries to bladder (n=6) and external genitals (n=7) were seen only in few cases. Fractures of pelvic bones were seen in 8 cases with pubis fractured in all cases whereas Ilium in 3 cases.
In this study, upper and lower limbs suffered maximum with abrasions as the predominant injuries (85%) followed by contusions (20%) and lacerations (17%). In upper limbs, humerus fractured in 10 cases followed by ulna and radius each in 9 cases. In lower limbs, femur was fractured in 16cases followed by tibia and fibula each in 11 cases. Lower limb long bones were comparatively at high risk than upper limb long bones, consistent with Nilambar Jha etal’s study.4 Higher risk of injuries to the lower limbs can be attributed to landing on the lower limbs receiving the first impact, weight of the motorcycle and dragging at the time of accident.
Out of 131 cases, 69% of the people died primarily of head injury associated either with fracture of skull or intracranial hemorrhages or brain injuries which were consistent with studies of Julian Stella etal 5 and Harnam singh 10.
4. CONCLUSIONS
1. Abrasions, contusions were the common injuries observed throughout the body. 2. Skull fracture was the most common
fracture.
3. Intracranial hemorrhages were observed more frequently among brain injuries. 4. Lungs, liver suffered more than other
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5. Limbs suffered maximum injuries when compared to other regions of the body. 6. Cause of death in majority of cases was
due to head injury associated with fracture of skull or intracranial hemorrhages or brain injury.
5. SUGGESTIONS
The study indicates cause of death is mainly due to head injury which necessitates the establishment of emergency trauma care centers with inclusion of neurology, radiology and orthopedic departments to reduce morbidity and mortality. The prevention of death of a bread winner in the family will help directly the family not to land in economic crisis and indirectly the country through prevention of crimes.
6. ACKNOWLEDGEMENT
Work attributed to Andhra medical college, Visakhapatnam, Andhra Pradesh.
7. REFERENCES
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[2]. National Crime Record Bureau. Ministry of Home Affairs, Govt. of India. Accidental Deaths In India, 2010. URL:
http://ncrb.nic.in/ADSI2010/accidental-deaths-10.pdf
[3]. B.R. Sharma. Motorized two – wheeler crash injuries and the role of helmet use in their prevention: an overview. JIAFM 2008; vol 30(4): 244-248.
[4]. Nilambar Jha, D.K. Srinivasa, Gautam Roy, S. Jagdish. Epidemiological study of road traffic accident cases: a study from South India. Indian Journal of Community Medicine Jan.-Mar 2004;Vol. XXIX No.1: 20 – 24.
[5]. Julian Stella, Peter Sprivulis, Clive Cooke. Head injury-related road crash mortality in rural Western Australia. ANZ Journal of Surgery November 2001; Volume 71:665–668.
[6]. Akhilesh Pathak, N L Desania, Rajesh Verma. Profile of road traffic accidents and head injury in Jaipur. JIAFM 2008; 30(1): 6-9.
[7]. Harnam Singh, S.K.Dhattarwal. Pattern and distribution of injuries in fatal road
[8]. Traffic accidents in Rohtak (Haryana). JIAFM 2004; 26(1): 20-23.
[9]. Sarkar, soumitra; Peek, Corinne; Kraus, Jess F. Fatal injuries in Motorcycle Riders According to Helmet Use. Journal of Trauma – Injury infection and Critical Care February 1995; 38(2):242 – 245.
[10]. Tham KY, Seow E, Lau G. Pattern of injuries in
helmeted motorcyclists in Singapore. Emerg Med J 2004; 21:478-482.
[11]. Harnam Singh , AD Aggarwal. Fatal road traffic accident in motorcyclists not wearing helmets. Journal of Punjab Academy of Forensic Medicine & Toxicology (Online) 2011; 11(1).