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©2013 UpToDate ® Print Email Blunt trauma mechanisms and associated injuries 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 Significant 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 countercoup injuries Facial fractures Skull fractures Cervical spine fractures Steering wheel damage Likely unrestrained Thoracic injuries 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 Chance fractures, 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 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 Automobile related Closed head injuries "Handlebar" injuries Spleen/liver lacerations Additional intra-abdominal injuries Consider penetrating injuries Nonautomobile related Extremity injuries "Handlebar" injuries Falls LD 50 36 - 60 ft 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

Nonautomobile related Extremity injuries "Handlebar" injuries Falls LD 50 36 - 60 ft 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 Gross, E, Martel, M. Multiple trauma. In: Rosen's Emergency Medicine: Concepts and Clinical Practice, 7th ed., Marx, JA, Hockberger, RS, Walls, RM, et al. (Eds), Mosby Elsevier, Philadelphia 2010. Illustration used with the permission of Elsevier Inc. All rights reserved.