This content is not included in
your SAE MOBILUS subscription, or you are not logged in.
Adult Occupant Injuries of the Lower Limb
Annotation ability available
Sector:
Language:
English
Abstract
Lower limb injuries among motor vehicle occupants are relatively common and are one of the principle causes of permanent disability. The author has reviewed the current literature and his own experience as an orthopaedic surgeon and research accident investigator concerning lower limb injuries among motor vehicle occupants. An unreported series of knee, thigh, hip, pelvis injuries with indepth accident investigation is reported.
Incidence rates for specific injury diagnoses are not available. Gross tabulations reveal that lower limb injury is second only to head injury in frequency among injured motor vehicle occupants. Lower limb injuries are possibly the commonest cause of permanent disability and impairment resulting from motor vehicle accidents.
Accident investigation studies have identified the mechanisms of the more common lower limb injuries which are as follows:
- 1) Intrapelvic fracture-dislocations of the hip are caused by lateral impacts selectively loading the greater trochanter of the proximal femur.
- 2) Pelvic rami fractures occur with lateral impacts in which the load is distributed to the iliac wing and pelvis as well as the greater trochanter by a padded or yielding surface.
- 3) Posterior hip dislocations are caused by axial loading of the femur through the knee with the hip in acute flexion. Similar loading and less flexion causes fractures of the posterior wall of the acetabulum (hip socket) followed by dislocation.
- 4) Femoral shaft fractures are caused by axial loading of the femur through the knee and the application of a bending moment to the thigh. Penetration of the knee into the clash, slipping below the lower dash, or impaction of the thigh against the steering wheel or steering column are the usual causes of the bending moment.
- 5) Supracondylar and comminuted shaft fractures occur in more severe accidents with increased energy transfer to the femur through the knee and without bending moment.
- 6) Patellar fractures occur because of load concentration on the patella. Knee contact with dash support structures or dash mounted accessories may provide such concentration, resulting in patellar fractures.
- 7) Knee ligament and other soft tissue and joint surface injuries are caused by knee impact with the lower dash and/or interaction between the knee, dash and foot, toepan and/or pedals.
- 8) Posterior cruciate ligament injury is caused by loading of the proximal tibia through the lower dash displacing the tibia posteriorly beneath the femoral condyles.
- 9) Tibial shaft fracture are caused by axial loading because of knee-dash fixation and upward and rearward movement of the toepan coupled with torsion and/or a bending moment.
- 10) Foot and ankle injuries are caused by upward and rearward displacement of the toepan after the knee has impacted and become fixed in the lower dash or by rolling off the brake pedal.
Treatment of lower limb fractures is necessarily prolonged because of the necessity for bone healing and rehabilitation of injured joints. Cast immobilization of 6 weeks to as much as a year may be necessary. Certain fractures are best treated by open reduction and internal fixation with plates and screws, intramedullary nails, circumferential wires and bands. Occasionally, immobilization in traction or external fixation with the use of trans-fixation pins extending trhough the skin into the bone, is necessary. Soft tissue damage and loss must be repaired or replaced by graft or substitution with an artificial implant. Minimum healing time is seldom less than 3 months, typically requires 6-12 months, and may extend as long as several years.
Permanent disability frequently results from lower extremity injuries. Fractures extending into major joints,' the hip, knee and ankle frequently cause traumatic (degenerative) arthritis. Total joint replacement of the hip and knee, and fusion of the ankle are ultimately often necessary to provide even partial relief from such disability. Ligamentous injuries of the knee may lead to long term instability and traumatic arthritis. Deformities due to bone loss, malunion and infection are also common sequelae of more severe fractures of the lower limb.
Recommended Content
Authors
Topic
Citation
States, J., "Adult Occupant Injuries of the Lower Limb," SAE Technical Paper 861927, 1986, https://doi.org/10.4271/861927.Also In
References
- Routson G. W. States J. D. “Causes and Consequences of Lower Extremity Injuries” 1 14 Proceedings of American Association for Automotive Medicine 1981
- Huelke D. F. O'Day J. States J. D. “Lower Extremity Injuries in Automobile Crashes” Accident Analysis and Prevention 14 95 106 1982
- Nahum A. M. Siegel A. W. Hight P. V. Brooks S. H. “Lower Extremity Injuries of Front Seat Occupants” SAE 680483
- Gogler G. Road Accidents 100 103 Chirurgica, Documenta Geigy Geigy (U.K.) Ltd. Manchester 23 U.K. 1965
- Kilberg J. K. “Multiplicity of Injury in Automobile Accidents” Impact Injury and Crash Protection Gurdjian E. S. Thomas C. C. Springfield Illinois 1970
- Peterson K. “Lower Extremity Injury Investigation” Oral presentation - Highway Safety Research Institute Ann Arbor, Michigan
- Malliaris A. C. Hitchcock R. Hedlund J. “A Search For Priorities in Crash Protection” SAE 820242 Crash Protection SB 513
- Naam N. H. Brown W. H. Hurd R. Burdge R. E. Kaminski D. L. “Major Pelvic Fractures” Archives of Surgery 118 610 616 1983
- Nerubay J. Glanz G. Nelson A. Katz “Fractures of the Acetabulum” Journal of Trauma 13 1050 1062 1973
- Rosenthal R. E. Coker W. L. “Posterior Fracture-Dislocation of Hip: An Epidemiologic Review” Journal of Trauma 19 572 581 1979
- Melton J. L. Ilstrup D. M. Riggs D. L. Beckenbaugh R. D. “Fifty Year Trend in Hip Fracture Incidence” Clinical Orthopaedics and Related Research 162 144 149 1982
- Waddell J. P. “Subtrochanteric Fractures of the Femur: A Review of 130 Patients” Journal of Trauma 19 582 592 1979
- Loomer R. L. Meek R. DeSommer D. “Plating of Femoral Shaft Fractures: The Vancouver Experience” Journal of Trauma 20 1038 1042 1980
- Kolmert L. Egund H. Persson R. N. “Internal Fixation of Supracondylar and Bicondylar Femoral Fractures Using a New Semi-Elastic Device” Clinical Orthopaedics and Related Research 181 204 219 1983
- Robinson S. E. States J. D. “Epidemiology and Treatment and Prevention of Patellar Fractures” 11 in Symposium on Reconstructive Surgery of the Knee C. V. Mosby Company St. Louis 1978
- Sarmiento A. Kinman P. B. Latta L. L. “Fractures of the Proximal Tibia and Tibial Condyles” Clinical Orthopaedics and Related Research 145 136 145 1979
- Johner R. Wruhs O. “Classification of Tibial Shaft Fractures and Correlation With Results After Rigid Internal Fixation” Clinical Orthopaedics and Related Research 178 7 25 1983
- Bourne R. B. Rorabeck C. H. MacNab J. “Intra-articular Fractures of the Distal Tibia: The Pilon Fracture” Journal of Trauma 23 591 596 1983
- Burrell H. N. Charnley A. D. “The Treatment of Displaced Fractures at the Ankle by Rigid Internal Fixation and Early Joint Movement” Journal of Bone and Joint Surgery 47B 634 660 1965
- Rowe C. R. Sakellarides H. T. Freeman D. A. Sorbie C. “Fractures of the Os Calcis” Journal of American Medical Association 184 920 923 1963
- Rockwood C. A. Green D. T. “Fractures in Adults” Second J. B. Lippincott Company Philadelphia, Pa. 1984
- Bunketorp O. Romanus B. “Cliinical Studies on Leg Injuries in Car Pedestrian Accidents” IRCOBI 1981 235 242
- Kruse T. “Disability Scaling and Accident Research” IRCOBI 1981
- Nielsen H. H. Nordentoft E. “Predicting Permanent Physical Disability Following Road Traffic Accident Trauma” IRCOBI 1981 20 25
- Mackenzie E. J. Shapiro S. Moody M. Smith R. “Predicting Post Trauma Functional Disability For Individuals Without Significant Brain Injury” 28th Proceedings of AAAM 173 188 1984
- Eastham J. N. “Construct Validity Analysis of the Abbreviated Injury Scale” 155 172
- Hirsh A. E. Eppinger R. H. “Impairment Scaling From The Abbreviated Injury Scale” 209 224
- Reidelbach W. Zeidler S. “Comparison of Injury Severity Assigned to Lower Extremity Skeletal Damages Versus Upper Body Lesion” 27th Proceedings of AAAM 141 158 1983
- States J. D. States D. J. “The Pathology and Pathogenesis of Injuries Caused by Lateral Impact Accidents” SAE 680773 23rd STAPP Car Crash Conference 1968
- States J. D. Williams J. S. Klug D. N. Balcerak J. C. “Obscure Injury Mechanisms in Automobile Accidents” Proceedings 15th Conference of AAAM 47 57 1972
- Funsten R. V. Kinser P. Frankel C. “Dashboard Dislocation of the Hip” Journal of Bone and Joint Surgery 20 124 132 1938
- Ritchey S. J. Schonholtz S. Thomson M. S. “The Dashboard Femoral Fracture” Journal of Bone and Joint Surgery 40A 1347 1358 1958
- States J. D. “Injuries of the Musculoskeletal System” SAE 700195
- Gratten E. Hobbs J. “Mechanisms of Serious Lower Limb Injuries To Motor Vehicle Occupants” Report LR201 Road Research Laboratory Ministry of Transport Crowthorne, Berkshire, U. K. 1968
- Haut R. C. “The Influence of Superficial Tissue on Response of the Primate Need to Posterior Tibial Drawer” Journal of Biomechanics 16 465 472 1983