Soft Tissue Injuries

Pedestrian- or cyclist-to-car hits usually cause extensive bruises and the crushing of deeper tissues, which can be detected within the organ by ultrasound and on autopsy only after extensive removal of the skin of the back and the entire circumference of extremities and deep-muscle incisions. In many cases, the location of bruises allows the investigator to determine the direction of impact and in hit-and-run accidents may also help the investigator determine the type of vehicle responsible for the injuries on the basis of the level at which bumper injuries are observed (Fig. 9). The injuries are usually located lower than the bumper level because the front part of the vehicle dips on braking.

Forensic Radiography
Fig. 5. External injuries from a dashboard.
Fig. 6. Dust wipes on the bumper due to contact with both of the pedestrian's legs.
Fig. 7. Typical skin excoriations caused by being dragged along a rough road surface.
Fig. 8. Skin pierced by bone fragments on the side opposite to that on which the injury occurred (open fracture).

Moreover, heavy car loading and the height of the victim's shoes (especially important in women) may substantially lower the contact level. Injuries located only on one extremity may indicate that the victim was hit by the corner of the vehicle (4,5,9).

Moreover, the skin preparation enables investigators to detect the areas in which the skin is torn from the muscle fascia as a result of the turning wheel rolling across the extremity ("decollement"); this usually involves most of the circumferences of the extremity (Fig. 10). Deeper injuries are usually more extensive on the side of the

Decollement Haut

Fig. 9. Bruises in the muscles and subcutaneous tissue ("bumper injuries") revealed after skin preparation in the lower limbs.

Fig. 9. Bruises in the muscles and subcutaneous tissue ("bumper injuries") revealed after skin preparation in the lower limbs.

Decollement Trauma
Fig. 10. The mechanism of the decollement type of skin detachment.

extremity towards which the vehicle was moving, and skin ruptures may lie transversely to the direction of the car. In most cases, however, the skin is not ruptured and a "subcutaneous pocket" forms, filled with blood and crushed fatty tissues (3,5,9). Skin detachment is also likely to result from a tangential or oblique hit when the victim is in an erect position (when the corner or side of the vehicle only "brushes" the pedestrian's body) and occasionally by a perpendicular impact (especially in the elderly) as a result of the crushing of subcutaneous tissue, although in the latter case, they are usually much less extensive than in the cases involving being run over by the wheel (10).

Modern vehicles are constructed to reduce the degree of traumatic injury in pedestrians by distributing the energy of primary trauma over larger surface area and by partially absorbing the energy into car body elements (11). Therefore, in more and more cases typical "bumper injuries" cannot be detected or the "primary impact" injuries cannot be distinguished from secondary injuries occurring in subsequent phases of the accident. Such difficulties are even greater when the victim survives a relatively short time, because bruises tend to spread beyond their primary location within soft tissue; the infiltration of tissue with blood is particularly common around skeleton fractures, and bruises spread throughout (also due to gravity) loose connective tissue and interfascial spaces, especially when parenchymatous bleeding persists. In delayed postaccident deaths, which are increasingly common, the bruises undergo complete resorption before death.

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