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Table

TABLE 17-3 Mechanism of Injury

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:

  • Sternal and rib fractures, flail chest
  • Cardiac contusion
  • Aortic injuries
  • Hemo/pneumothoraces

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.