Mechanism of injury | Additional considerations | Potential associated injuries |
|---|---|---|
Motor vehicle collisions | ||
Head-on collision | Facial injuries Lower extremity injuries Aortic injuries | |
Rear-end collision | Hyperextension injuries of cervical spine Cervical spine fractures Central cord syndrome | |
Lateral (T-bone) collision | Thoracic injuries Abdominal injuries: spleen, liver Pelvic injuries Clavicle, humerus, rib fractures | |
Rollover | Greater chance of ejection Amplified mechanism of injury | Crush injuries Compression fractures of spine |
Ejected from vehicle | Likely unrestrained Significant mortality | Spinal injuries |
Windshield damage | Likely unrestrained | Closed head injuries, coup and contrecoup injuries Facial fractures Skull fractures Cervical spine fractures |
Steering wheel damage | Likely unrestrained | Thoracic injuries such as:
|
Dashboard involvement/damage | Pelvic and acetabular injuries Dislocated hip | |
Restraint/seat belt use | ||
Proper three-point restraint | Decreased morbidity | Sternal and rib fractures, pulmonary contusions |
Lap belt only | Abdominal injuries, head and facial injuries/fractures | |
Shoulder belt only | Cervical spine injuries/fractures, “submarine” out of restraint devices (possible ejection) | |
Airbag deployment | Front-end collisions Less severe head/upper torso injuries Not effective for lateral impacts More severe injuries in children (improper front seat placement) | Upper extremity, soft tissue injuries/fractures, facial fractures/lacerations, eye injuries Lower extremity injuries/fractures |
Pedestrian versus automobile | ||
Low speed (braking automobile) | Tibia and fibula fractures, knee injuries | |
High speed | Waddle’s triad-tibia/fibula or femur fractures, truncal injuries, craniofacial injuries “Thrown” pedestrians at risk for multisystem injuries | |
Bicycle related | ||
Automobile related | Closed head injuries “Handlebar” injuries Spleen/liver lacerations Additional intra-abdominal injuries Consider penetrating injuries | |
Nonautomobile related | Extremity injuries “Handlebar” injuries | |
Falls: 36-60 feet (11-18 meters) | ||
Vertical impact | Calcaneal and lower extremity fractures Pelvic fractures Closed head injuries Cervical spine fractures Renal and renal vascular injuries | |
Horizontal impact | Craniofacial fractures Hand and wrist fractures Abdominal and thoracic visceral injuries Aortic injuries | |
Reproduced from Gross, E., & Martel, M. Multiple trauma. (2010). In J. A. Marx, R. S. Hockberger, & R. M. Walls, et al. (Eds.), Rosen’s emergency medicine: Concepts and clinical practice (7th ed.). Philadelphia, PA: Mosby Elsevier. |