Overview
Transportation injuries encompass a wide range of incidents including injuries on roads (greatest contributor), railways, and aviation accidents. Forensic pathology plays a crucial role in investigating and understanding the causes and effects of injuries sustained in transportation-related incidents.
Road traffic injuries
WHO Road Safety Report 2015 states that there are 27.4 traffic deaths per 100,000 people every year in Uganda, 29.1 in Kenya, 32.1 in Rwanda, and 32.9 in Tanzania. Half of those dying on the roads are ‘vulnerable road users’, i.e. pedestrians, cyclists, and motorcyclists.
Postmortem examination in vehicular injuries
- The investigation of RTA cases is done for the following reasons:
- To identify the cause of the collision or incident
- To punish the offender if any offense is involved
- To allow adequate compensation to the victim or next of kin
- To come up with guidelines to prevent future accidents
- Importance of forensic medical examination of RTA injuries:
- To establish the cause, nature and mechanism of death
- To identify any predisposing factors to death
- To identify the victim (including if they were a driver, occupant, cyclist, or pedestrian)
Injuries to pedestrians
Pedestrians are the single largest group of victims of RTA.
Pattern of injuries to pedestrians
| Pattern of Trauma | Description |
|---|---|
| Primary impact injury (first impact) | Caused by the first impact of the vehicle on the victim. It is the first part of the body that is struck. The height of the primary impact injury on the body gives an idea about the height of the vehicle |
| Secondary impact injury | Results from impact between the body and the vehicle for a second time |
| Tertiary impact injury | Caused by subsequent contact of the victim with the ground |
- Primary impact injury
- Typically the victim is struck by the front of the vehicle i.e. bumper injury on the leg
- Trauma is severe with fractures of the tibia and femur and extensive soft tissue damage. The base of the triangular fragment indicates the site of impact, while the apex points in the direction in which the vehicle was traveling
- Secondary and tertiary impact injury
- The feet slide forward and the whole body falls backwards. The head and the trunk make a secondary impact with the windshield and hood.
- Secondary impact injuries vary in severity from abrasions to fractures. Direct impact to the thorax may rupture the aorta below the arch of the heart (due to sudden increased intravascular pressure)
- The body may be thrown into the air and strike the ground
- Running-over
- Running-over may also occur, leaving behind tread marks on the victim’s body – may occur before or after the victim dies by a secondary vehicle, and results in crushing injuries
- The rotary effect against a fixed limb strips off all tissue down to the bone. The resulting avulsed wound may be segmental or circumferential.
- Testes or intestines may be extruded if the scrotum or abdominal wall is injured.
- Complete amputation, decapitation, deep crushing of internal organs, and flattening deformities of the head, chest, or pelvis may occur
- Fractures may not be produced if a child is run over due to the elasticity of the partly cartilaginous skeleton
Injury to occupants of the vehicles
Tissue injury is caused by a change in the rate of movement – either acceleration or deceleration, measured in ‘gravities’ or ‘G-forces’. The occupant’s injuries depend on several factors, most importantly, their position in the vehicle (driver, front seat, rear seat) and whether or not they were restrained with a safety belt. The occupant may continue to move forward even when the vehicle has stopped.
Injuries commonly seen in road traffic accidents
60-80% of vehicular crashes are frontal causing violent deceleration, 6% are rear impacts causing acceleration, and the remainder are ‘sideswipes’ and ‘roll-overs’.
| Injuries | Examples |
|---|---|
| Head and Neck Injury | Facial and scalp lacerations, skull fractures, intracranial hemorrhage, varying degrees of brain damage, C-spine fractures and dislocations, atlanto-occipital joint dislocation |
| Chest injury | Rib and sternal fractures, lung contusions, aortic rupture, chest laceration, epicardial and myocardial bruising, heart avulsion, pneumothorax, hemothorax |
| Abdominal injury | Liver laceration, spleen rupture, damage to kidneys and intestines, bruising, lacerations |
| Extremity injury | Fractures, dislocations, and soft tissue injuries of both lower (more common) and upper limbs |
- Steering-wheel impact type of injuries
- Transverse fracture of the sternum
- Rib fractures
- Myocardial and lung contusion/laceration
- Transection of the aorta (distal to the origin of the left subclavian artery)
- Liver, spleen, and kidney contusion/laceration
- Throat compression (against the horn ring or the top of the steering wheel)
- Seatbelt injuries
- ‘Submarining’
- Garroting
- Bruising
- Rupture of the mesentery, intestines, full bladder
- Crushing of the abdominal aorta
- Compression fracture or dislocation of the lumbar spine
- Fractures of the clavicle and sternum
- Whiplash injury
- Due to violent acceleration or deceleration forces applied to the occupant of the vehicle. When the vehicle comes to a sudden stop the heavy head continues to move forward in flexion. When the body comes to rest there is a reactionary hyperextension.
- This violent extension-flexion movement causes dislocation of the upper cervical spine or fracture-dislocation of the lower spine (less common, at about C6-C7). Fatal contusion or laceration of the spinal cord may occur without fracture of the spine. Fracture dislocation can also occur in the upper dorsal spine around T10 or L4-5.
Injuries to motorcyclists
Motorcyclists are more prone to injuries than motor vehicle occupants – compromised stability, reduced visibility, less protection from the motorcycle, an inevitable fall to the ground
- Commonly seen injuries include:
- Head injury especially if driver was not wearing a helmet – skull fractures are common (e.g. hinge/motorcyclist’s fracture, ring fracture), cortical contusion and laceration, contrecoup and varying degrees of brain damage
- Extremity fractures, dislocations, lacerations and friction burns
- Other injuries less common but still seen – rib fractures, visceral damage
Injuries to pedal cyclists
Form a less severe counterpart of motorcycle injuries – same instability but far lower speeds
- Common injuries include:
- Head injury
- Injuries from primary impact of a striking vehicle – at thigh, hip or chest level
- Secondary injuries from striking the ground – friction grazes, extremity fractures and dislocations, entrapment of leg between wheel spokes with compression of calf soft tissues
Railway injuries
Gross mutilation is common in railway injuries
- Railway injuries may be sustained in the following ways:
- Walking along or crossing the railway track
- Train derailment
- Unconscious/dead/suicide victim laid or laying on the track
- Head or other body part extended out of door or window of running train
- Collison of trains
- Fire outbreak in train
- Passengers standing on the roof struck against overhead structure or electrocuted by high-tension live wire
Aviation injuries
Barring a few exceptions, aviation accidents are devastating, with no survivors.
The main problem is the identification of victims from grossly mutilated body parts of victims, commonly burned to a char, scattered over a wide area.
- Two main kinds of aircraft:
- Military aircraft, with fewer fatalities
- Civil aircraft with many more fatalities
- Some common causes of aviation injuries include:
- Mechanical aircraft defects
- Pilot physical and mental factors
- Weather challenges
