Injury Patterns in Motor Vehicle Accident Victims from a

167 Pages·2013·2.99 MB·English

Injury Patterns in Motor Vehicle Accident Victims from a
Sample Taken at the Southern Cluster Forensic Pathology
Services
Claire Lewis 0603513M

Supervisors
Guinevere Gordon (BSc, BSc Hons, MSc Wits, PhD Wits)
Associate Researcher, Division of Forensic Medicine, University of Witwatersrand
And
Professor Jeanine Vellema (MBBCh (Wits), FC For Path (SA))
Chief Specialist, Division of Forensic Medicine, University of Witwatersrand

A dissertation submitted to the Faculty of Health Sciences, University of the
Witwatersrand, in fulfilment of the requirements for the degree of MSc Med
Johannesburg
2012
DECLARATION
I declare that this thesis is my own unaided work. It is being submitted for the
degree of Masters of Sciences in Medicine, in Forensic Science at the University
of Witwatersrand, Johannesburg. It has not been submitted before for any degree
or any examination in any other University.

____________________________________

DATE
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Table of Contents
List of Figures ............................................................................................................ ix
Acknowledgements .................................................................................................. xi
Abstract ................................................................................................................... xii
1. Introduction .......................................................................................................... 1
1.1. Aim and Objectives ........................................................................................ 4
2. Literature Review .................................................................................................. 6
2.1. Physics of Motor Vehicle Collisions ............................................................... 7
2.2. Injuries in Motor Vehicle Accident Victims .................................................... 9
2.2.1. Soft Tissue Injuries and the Classification Thereof ........................................ 9
2.2.2. Skeletal Fractures and the Classification Thereof ....................................... 11
2.3. Types and Patterns of Injuries in Motor Vehicle Accident Victims ............. 12
2.3.1. Driver Injury Mechanisms ............................................................................ 12
2.3.2. Front- and Rear-Seat Passenger Injury Mechanisms ................................... 13
2.3.3. Frequent Injuries Noted in Various Body Regions ....................................... 14
2.3.3.1. Craniocerebral Injuries ........................................................................... 14
2.3.3.1.1. Skull Fractures ....................................................................................... 16
2.3.3.2. Cervical Spinal Injuries ........................................................................... 17
2.3.3.2.1 Atlantooccipital Fracture Dislocations .............................................. 20
2.3.3.3. Thoracic Cage and Visceral Thoracic Injuries ......................................... 20
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2.3.3.3.1. Thoracic Aortic Injuries ......................................................................... 21
2.3.3.4. Thoracic and Lumbar Spinal Column Injuries ......................................... 22
2.3.3.5. Abdominal Injuries ................................................................................. 24
2.3.3.6. Pelvic Injuries.......................................................................................... 25
2.3.3.7. Upper Extremity Injuries ........................................................................ 27
2.3.3.8. Lower Extremity Injuries ........................................................................ 28
2.3.3.9. Genital Injuries in Males ......................................................................... 29
2.4. Vehicle Type ................................................................................................. 29
2.5. Collision Type ............................................................................................... 32
2.5.1. Front-Impact versus Side-Impact Collisions................................................. 32
2.5.2. Rear-Impact Collisions ................................................................................. 33
2.5.3. Left-Sided, Right-Sided, Near-Sided and Far-Sided Impact Collisions and the
Influence on Injury Patterns ................................................................................... 33
2.5.4. Rollover Collisions ........................................................................................ 34
2.5.5. Ejection Collisions ........................................................................................ 35
2.5.6. Intrusion of the Occupant Compartment .................................................... 37
2.6. Safety Features ............................................................................................ 37
2.6.1. Seatbelts....................................................................................................... 38
2.6.2. Airbags ......................................................................................................... 39
2.7. South African Data on Motor Vehicle Accidents ......................................... 41
2.8. Injury Grading Scales .................................................................................... 42
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3. Methods and Materials ....................................................................................... 44
3.1. Inclusion and Exclusion Criteria ................................................................... 46
3.2. Estimation of Sample Size ............................................................................ 48
3.3. Data Collection ............................................................................................. 49
3.3.1. Autopsy Processes ....................................................................................... 49
3.3.1.1. X-Ray Protocol ........................................................................................ 50
3.3.1.2. Autopsy Procedure ................................................................................. 51
3.3.2. Police Data Collection .................................................................................. 53
3.4. Data Analysis ................................................................................................ 53
3.5. Ethical and Radiological Clearance and Permission .................................... 56
4. Results ................................................................................................................. 57
4.1. Data Exclusions ............................................................................................ 57
4.2. Overview and Demographic Trends ............................................................ 57
4.3. Seasonal Trends ........................................................................................... 59
4.4. Vehicle Type Trends ..................................................................................... 62
4.5. Collision Type Trends ................................................................................... 64
4.4.1. Trends in the Different Vehicle Type Pairings during Collisions .................. 65
4.6. Trends in the Position of Occupancy during a Collision .............................. 66
4.7. Safety Feature Trends .................................................................................. 66
4.8. Injuries ......................................................................................................... 66
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4.8.1. External and/or Soft Tissue Injuries ............................................................. 66
4.8.1.1. External Injuries of the Craniocerebral Region ...................................... 67
4.8.1.2. External Injuries of the Neck Region ...................................................... 68
4.8.1.3. External Injuries of the Thoracic Region ................................................ 69
4.8.1.4. External Injuries of the Abdominal Region ............................................ 69
4.8.1.5. External Injuries of the Pelvic Region ..................................................... 69
4.8.1.6. External Injuries of the Upper Extremities ............................................. 70
4.8.1.7. External Injuries of the Lower Extremities ............................................. 71
4.8.1.8. External Injuries of the Genital region in Males .................................... 72
4.7.1. Visceral Injuries ............................................................................................ 73
4.7.2. Skeletal Fractures ......................................................................................... 74
4.8. Comparisons of the Injury Patterns in Specific Types of Vehicles ............... 77
4.8.1. Comparisons of the External Injury Patterns in Specific Types of Vehicles . 78
4.8.2. Comparisons of the Visceral Injury Patterns in Specific Types of Vehicles . 79
4.8.3. Comparisons of the Skeletal Fracture Patterns in Specific Types of Vehicles
79
4.9. Comparisons of the Injury Patterns of Individuals with Regard to their
Position of Occupancy ............................................................................................ 80
4.9.1. Comparisons of the External Injury Patterns of Individuals with Regard to
their Position of Occupancy .................................................................................... 80
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4.9.2. Comparisons of the Visceral Injury Patterns of Individuals with Regard to
their Position of Occupancy .................................................................................... 81
4.9.3. Comparisons of the Skeletal Fracture Patterns of Individuals with Regard to
their Position of Occupancy .................................................................................... 81
4.10. Comparisons of the Injury Patterns of Drivers and Passengers in the same
Vehicle .................................................................................................................... 82
4.10.1. Comparisons of the External Injury Patterns of Drivers and Passengers in
the same Vehicle .................................................................................................... 82
4.10.2. Comparisons of the Visceral Injury Patterns of Drivers and Passengers in
the same Vehicle .................................................................................................... 82
4.10.3. Comparisons of the Skeletal Fracture Patterns of Drivers and Passengers in
the same Vehicle .................................................................................................... 83
5. Discussion ............................................................................................................ 83
5.1. Overview and Demographic Trends ............................................................ 86
5.2. Seasonal Trends ........................................................................................... 87
5.3. Vehicle Type Trends ..................................................................................... 90
5.4. Collision Type Trends ................................................................................... 92
5.4.1. Trends in the Different Vehicle Type Pairings during Collisions .................. 95
5.5. Trends in the Position of Occupancy during a Collision .............................. 95
5.6. Injuries ......................................................................................................... 96
5.6.1. External and/or Soft Tissue Injuries ............................................................. 96
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5.6.1.1. External Injuries of the Craniocerebral Region ...................................... 99
5.6.1.2. External Injuries of the Thoracic Region .............................................. 100
5.6.1.3. External Injuries of the Genital region in Males .................................. 101
5.6.2. Visceral Injuries .......................................................................................... 102
5.6.2.1. Injuries of the Cerebral Region ............................................................ 103
5.6.2.2. Injuries of the Thoracic Region ............................................................ 105
5.6.2.2.1. Injuries of the Thoracic Aortic Region ................................................ 106
5.6.2.3. Injuries of the Abdominal Viscera ........................................................ 107
5.6.3. Skeletal Fractures ....................................................................................... 107
5.6.3.1. Fractures of the Cranial Region ............................................................ 108
5.6.3.2. Fractures of the Thoracic Cage Region ................................................ 109
5.6.3.3. Fractures of the Spinal Column ............................................................ 110
5.6.3.3.1. Fractures of the Cervical Spinal Colum Region ................................... 110
5.6.3.3.2. Fractures of the Thoracic and Lumbar Spinal Regions ....................... 111
5.6.3.3.3. Fracture-Dislocations of the Atlantooccipital Joint ............................ 113
5.6.3.4. Fractures of the Pelvic Region .............................................................. 115
5.6.3.5. Fractures of the Upper Extremities ...................................................... 116
5.6.3.6. Fractures of the Lower Extremities ...................................................... 118
5.7. Comparisons of the Injury Patterns in Specific Types of Vehicles ............. 119
5.8. Comparisons of the Injury Patterns of Individuals with Regard to their
Position of Occupancy .......................................................................................... 121
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5.9. Comparisons of the Injury Patterns of Drivers and Passengers in the Same
Vehicle .................................................................................................................. 124
5.10. Study Limitations, Recommendations, and Further Research .................. 125
6. Conclusion ......................................................................................................... 131
7. References ........................................................................................................ 134
Appendix A ............................................................................................................. 144
Appendix B ............................................................................................................. 146
Appendix C ............................................................................................................. 147
Appendix D ............................................................................................................ 148
Appendix E ............................................................................................................. 153

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List of Figures Page
Figure 4.1: Pie Chart Demonstrating the Percentage Sex Distribution of the
Sample…………………………………………………………………………………..58
Figure 4.2: Pie Chart Demonstrating the Percentage Race Distribution of the
Sample…………………………………………………………………………………..59
Figure 4.3: Bar Graph Displaying the Age Range and Frequencies for
Individuals Involved in Fatal Motor Vehicle collisions…………………...................59
Figure 4.4: Bar Graph Displaying the Time of Day Distribution for Fatal Motor
Vehicle Collisions………………………………………………………..…………......60
Figure 4.5: Bar Graph Displaying the Day of the Week Distribution for Fatal
Motor Vehicle Collisions……………………………………….………………………61
Figure 4.6: Bar Graph Displaying the Time of Day Distribution for the Three
Most Common Days of the Week for Fatal Motor Vehicle Accidents to
Occur………………………………………………………………………………….…61
Figure 4.7: Bar Graph Displaying the Monthly Distribution for Fatal Motor
Vehicle Collisions………………………………………………………………………62
Figure 4.8: Pie Chart Displaying the Percentage Distributions of the Vehicle
Types Involved in Fatal Motor Vehicle Collisions…………………………..…........63
Figure 4.9: Pie Chart Displaying the Percentage Distribution of the Vehicle
Makes Involved in Fatal Motor Vehicle Collisions………………………………….63
Figure 4.10: Pie Chart Demonstrating the Percentage Distributions of the
Toyota Vehicles involved in Fatal Motor Vehicles Collisions……………………..64
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