Blunt Trauma

Blunt trauma is the most common mechanism of injury seen in the United States. The injury pattern is often diffuse; thus all parts of the abdomen are at risk for injury. The biomechanics of blunt injury involve a compression or crushing by energy transmission directly to the patient. If the compressive, sheering, or stretching forces exceed the tolerance limits of the tissue or organ, the tissues are disrupted. This may result in injury to solid viscera such as the liver or spleen or rupture of hollow viscera such as the gastrointestinal tract.

Injury also can result from the movement of organs within the body. Some organs are rigidly fixed, whereas others are more motile. Injury is particularly common in areas of transition where one part is fixed and the other is free to move with some velocity. Typical examples in the abdomen include mesenteric or small bowel injuries, particularly at the ligament of Treitz or at the junction of the distal small bowel and right colon.

Falls from a height produce a unique pattern of injury. The degree of injury is a function of the distance, the surface on which the victim lands, and whether the fall has been broken by objects. Interestingly, intraabdominal injuries are very uncommon in patients who have fallen from a height. When they occur, they usually involve hollow visceral rupture and almost never cause hypotension.1 Retroperitoneal injuries, however, are quite common because force is usually transmitted upward along the axial skeleton.

Pedestrians struck by cars may have unique patterns of injury because they are completely unprotected and all force is applied directly to the patient's body. Motorcyclists or bicyclists generally are poorly protected with the exception of a helmet. Their injuries are also compounded by the fact that motorcycles can travel at a great rate of speed.

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