Pedestrians who are lying on the road and run over by motor vehicles do not have bumper fractures. The exception is an individual who is hit initially while standing, then is run over repeatedly by other cars. Hip dislocation and pelvic injuries can be observed (665). Patterned injuries from the undersurface of the vehicle and pressure marks from clothing can be observed on the skin (Figs. 23 and 82; ref. 683). There may be considerable external trauma caused by the grinding from the road surface and the wheels. Clothes can be torn extensively (683,684). Markings from the car undersurface may transfer to clothing. Skin may separate from the subcutaneous fat, and amputation of limbs is possible (Fig. 83; ref. 665). Detachment of skin also occurs if an upright person is struck tangentially (665). Dragging and scraping may produce extensive "brush burning" (Fig. 2; refs. 683 and 685). Blackened abrasions may reflect thermal effects caused by friction (686). This is seen on bony protuberances (skull, joints, ribs [683,685]). Internal organs can be exposed (683,684). Bone grinding can occur (Fig. 83; ref. 683). Neck compression leads to fractures of the larynx and hyoid bone (Fig. 84; Chapter 3, Fig. 30; ref. 687). Ocular petechiae occur if there is chest compression. Severe compression results in tearing or avulsion injuries of viscera. Hemorrhage into the sites
injured by dragging indicates antemortem injury (683). Aspiration of dirt is another sign the individual was alive while being dragged (683). Ethanol intoxication is commonly present in recumbent pedestrians (664).
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