FORMING MECHANISM OF LONG BONE FRACTURES OF THE LOWER LIMBS AT A CAR INJURY
About the author:
Sokol V. K., Serbinenko I. Yu., Voitov Ye. A.
Type of article:
One of the main causes of mechanical injuries of the musculoskeletal system in the non-productive sphere is road traffic accidents, the frequency of which in Ukraine in 2019 reached 440 per day. As a result, 32,736 people were injured (90 people per day). At the same time, the structure of mechanical injuries of the lower extremities and their basic mechanisms in forensic science are not well understood. Purpose – to study the structure of fractures of long bones of the lower extremities in victims of mechanical trauma and the mechanisms of their formation in car accidents according to the results of the primary forensic medical examination. Object and methods. The research material – 130 reports of primary forensic medical examinations of victims with fractures of the femur and / or lower leg bones resulting from a non-lethal car accident. In all cases, an expert assessment of the nature of traumatic injuries was carried out at the Kharkiv Regional Bureau of Forensic Medical Examination (KRBFME) for a period not exceeding 1 month after an injury. Reports of primary forensic medical examinations were selected by random sampling for the period February – June 2018. Inclusion criteria – isolated fractures of the femur or lower leg bones; non-lethal polytrauma with fractures of long bones of the lower extremities as a leading injury received by drivers, passengers of vehicles, pedestrians as a result of a collision with a car. Exclusion criteria – non-lethal polytrauma, in which fractures of the long bones of the lower extremities were a concomitant injury; car accident in which the forensic medical examination was carried out in terms exceeding 1 month; fractures of long bones of the lower extremities obtained as a result of other mechanisms (except for car injury), fatal car injury. Research methods – retrospective analysis, descriptive statistics. The average age of the victims was 47.1 ± 26.6 years (10-81 years).Results. According to primary forensic examinations, the main type of mechanical injury to the long bones of the lower extremities was road traffic injury – 89.2% of cases. Falls from various heights (10%) were much less common, and, like medical casuistry, a gunshot fracture was detected during hunting (0.8%). Given the selection criteria for forensic medical examinations, the average speed of a collision between a car and a pedestrian and vehicles among themselves was about 40 km/h. Most often, frontal (41.4%) and frontside collisions (32.8%) occurred. By the nature of injuries in road accidents, polytrauma prevailed (87.9%) with a significant prevalence of combined injuries (71.6%). Among the victims of road traffic injuries pedestrians prevailed (78.4%), car drivers were 9.5%, car passengers – 6.1%. Pedestrians in the phase of impact with the front surface of the car formed bumper fractures of the leg bones (n = 57) and hips (n = 22), fractures of the pelvis (n = 4), proximal femur (n = 3), intraarticular fractures of the knee joint (n = 7). In the second phase of a person falling onto the hood, there were mainly concussions of the brain of mild or moderate severity (n = 15). In the third phase of casting the body onto an asphalt pave, fractures of the bones of the upper (n = 7) and lower (n = 10) limbs, ribs (n = 2) were formed. In an in-car injury during the phase of impact and compression by the internal parts of the car, the main injuries for the drivers were chest injuries (n = 6) with rib fractures (n = 2) and abdominal injuries (n = 4), fractures of the lower limbs (n = 8). Passengers in this phase as a result of an impact on the instrument panel formed shaft fractures of the hips (n = 7), as a result of an impact on the uprights and handrails of the passenger compartment, fractures of the shoulder (n = 1) and lower leg (n = 7). In the phase of elastic rebound due to the rapid rearward movement of the body of the driver and front seat passenger, a whiplash injury of the cervical spine occurred (n = 5 and n = 4, respectively). Conclusions. At an average collision speed of 40 km/h, the main mechanism of lower limb injuries for pedestrians is bumper fractures of the thigh and lower leg, for drivers and passengers – diaphyseal fractures due to shock and compression by the internal parts of the car.
fractures of long bones of the lower extremities, car accident, fracture formation mechanism, forensic medical examination.
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 (156), 2020 year, 374-379 pages, index UDK 340.6:616.718.4/.6-001.5:614.8:656.1