Lower extremity injuries in automobile crashes

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Huelke, Donald F.¹; O'Day, James²; States, John D.³

Lower extremity injuries in automobile crashes

Accid Anal Prev. April 1982;12(2):95-106

Affiliations

¹Department of Anatomy and The Highway Safety Research Institute, The University of Michigan, Ann Arbor, MI 48109, U.S.A.

²Highway Safety Research Institute, The University of Michigan, Ann Arbor, MI 48109, U.S.A.

³Department of Orthopedics, University of Rochester, Rochester, NY 14627, U.S.A.
Abstract

The new United States National Crash Severity Study (NCSS) data on tow-away automobile crashes was reviewed to determine the details of the more severe injuries of the lower extremity. This review includes the frequency of injury by limb segments (pelvis, thigh, knee, leg and ankle/foot), the vehicle structure contacted to produce these injuries, and the injuries/contact differences among car occupants. Some of the finds are: of the various body regions having the more severe injuries, the lower extremity ranks second only to the thorax; lap-shoulder belted occupants hardly ever sustain the more severe lower extremity injuries; and severe lower extremity injuries occur primarily in frontal crashes. Extrapolation of the NCSS data for national estimates indicates that the more serious lower extremity injuries in car crash survivors approximately equals the total number of passenger car occupants who are killed annually (27,000).
Links

DOI: 10.1016/0001-4575(82)90076-8

WoS: A1982NH97600003
History

Received: 1980-12-01

Revised: 1981-03-09

Cited Works (14)

Year	Entry
1975	Marsh JC, Scott RE, Melvin JW. Injury patterns by restraint usage in 1973 and 1974 passenger cars. In: Proceedings of the 19th Stapp Car Crash Conference. November 17-19, 1975; San Diego, CA. Warrendale, PA: Society of Automotive Engineers:45-78. SAE 751143.
in press	Nahum AM, Siegel AW, Hight PV, Brooks SH. Lower extremity injuries of front seat occupants. SAE 680483.
1977	Danner JM. Accident and injury characteristics in side-collisions and protection criteria in respect of belted occupants. In: Proceedings of the 21st Stapp Car Crash Conference. October 19-21, 1977; New Orleans, LA. Warrendale, PA: Society of Automotive Engineers:153-211. SAE 770918.
1979	Jorgensen K, Kruse T, Somers RL, Weeth R. Description of 3225 victims of road-traffic-accident trauma according to type of accident, severity of injury, and nature of lesions sustained. In: Proceedings of the 1979 International IRCOBI Conference on the Biomechanics of Impact. September 5-7, 1979; Goeteborg, Sweden.13-23.
1973	Rubinstein E. An analysis of fatal car crashes in which the victim was wearing a seat belt. In: Proceedings of the 1973 International IRCOBI Conference on the Biomechanics of Impact. June 26-27, 1973; Amsterdam, The Netherlands.49-58.
1979	Gloyns PF, Hayes HRM, Rattenbury SJ, Thomas PD, Mills HC, Griffiths DK. Lower limb injuries to car occupants in frontal impacts. In: Proceedings of the 1979 International IRCOBI Conference on the Biomechanics of Impact. September 5-7, 1979; Goeteborg, Sweden.105-121.
1968	States JD, States DJ. The pathology and pathogenesis of injuries caused by lateral impact accidents. In: Proceedings of the 12th Stapp Car Crash Conference. October 22-23, 1968; Detroit, MI. Warrendale, PA: Society of Automotive Engineers:72-93. SAE 680773.
1972	Hight PV, Siegel AW, Nahum AM. Injury mechanisms in rollover collisions. In: Proceedings of the 16th Stapp Car Crash Conference. November 8-10, 1972; Detroit, MI. Warrendale, PA: Society of Automotive Engineers:204-227. SAE 720966.
1979	Rattenbury SJ, Gloyns PF, Hayes HRM, Griffiths DK. The biomechanical limits of seat belt protection. In: 23rd Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 4-6, 1979; Louisville, KY.162-176.
1971	States JD, Williams JS, Martin W. Korn a, Kluge DN, Balcerak JC. Obscure injury mechanisms in automobile accidents. In: 15th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 20-23, 1971; Colorado Springs, CO.47-57.
1975	Mackay GM, Gloyns PF, Hayes HRM, Griffiths DK, Rattenbury SJ. Serious trauma to car occupants wearing seat belts. In: Proceedings of the 1975 International IRCOBI Conference on the Biomechanics of Impact. September 9-11, 1975; Birmingham, UK.20-29.
1977	Nagel DA, States JD. Dashboard and bumper knee: will arthritis develop? In: 21st Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 15-17, 1977; Vancouver, BC.272-279.
1975	Melvin JW, Stalnaker RL, Alem NM, Benson JB, Mohan D. Impact response and tolerance of the lower extremities. In: Proceedings of the 19th Stapp Car Crash Conference. November 17-19, 1975; San Diego, CA. Warrendale, PA: Society of Automotive Engineers:543-559. SAE 751159.
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Cited By (22)

Year	Entry
1994	Dischinger PC, Burgess AR, Cushing BM, Pilkey WD, Crandall JR, Sieveka EM, Klopp GS. Lower extremity trauma in vehicular front-seat occupants. In: Proceedings of the 4th Injury Prevention Through Biomechanics Symposium. May 1994; Detroit, MI.
1991	Huelke DF, Compton TW, Compton CP. Lower extremity injuries in frontal crashes: injuries, locations, AIS and contacts. 1991. SAE 910811.
1986	States JD. Adult occupant injuries of the lower limb. In: Biomechanics and Medical Aspects of Lower Limb Injuries. Symposium on Biomechanics and Medical Aspects of Lower Limb Injuries; October 29-30, 1986; San Diego, CA. Warrendale, PA: Society of Automotive Engineering:97-107. SAE 861927.
1982	States JD, Hight PV. Tolerance of human femur derived from an accidental fall. In: 26th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 4-6, 1982; Ottawa, ON.37-51.
1992	Dischinger P, Cushing B, Kerns T. Lower extremity fractures in motor vehicle collisions: influence of direction of impact and seatbelt use. In: 36th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 5-7, 1992; Portland, OR.319-325.
1994	Dischinger PC, Kerns TJ, Kufera JA. Lower extremity fractures in motor vehicle collisions: the role of driver gender and height. In: 38th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 21-23, 1994; Lyon, France.335-342.
2002	Assal M, Huber P, Tencer AF, Rohr E, Mock C, Kaufman R. Are drivers more likely to injure their right or left foot in a frontal car crash: a crash and biomechanical investigation. In: 46th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 30–October 2, 2002; Tempe, AZ.
1994	Kippola WJ, Stando MJ. Emerging trends in safety design and technology. In: Proceedings of the 14th International Technical Conference on the Enhanced Safety of Vehicles (ESV). May 23-26, 1994; Munich, Germany.1535-1548.
1998	Jibril A, Prasad P, Prybylski J, Parekh I, Grush ES. Logistic regression analysis of lower limb injuries in frontal crashes. In: Proceedings of the 16th International Technical Conference on the Enhanced Safety of Vehicles (ESV). May 31–June 4, 1998; Windsor, Ontario, Canada.1473-1485.
1995	Fildes B, Lenard J, Lane J, Vulcan P, Seyer K. Lower limb injuries to passenger car occupants. In: Proceedings of the 1995 International IRCOBI Conference on the Biomechanics of Impact. September 13-15, 1995; Brunnen, Switzerland.47-58.
1994	Dischinger PC, Burgess AR, Cushing BM, O'Quinn TD, Schmidhauser CB, Ho SM, Juliano PJ, Bents FD. Lower extremity trauma in vehicular front-seat occupants: patients admitted to a level 1 trauma center. In: Proceedings of the SAE International Congress & Exposition. February 28–March 3, 1994; Detroit, MI. Warrendale, PA: Society of Automotive Engineers. SAE 940710.
1992	Lestina DC, Kuhlmann TP, Keats TE, Alley RM. Mechanisms of fracture in ankle and foot injuries to drivers in motor vehicle crashes. In: Proceedings of the 36th Stapp Car Crash Conference. November 2-4, 1992; Seattle, WA. Warrendale, PA: Society of Automotive Engineers:59-68. SAE 922515.
1997	Atkinson PJ, Garcia JJ, Altiero NJ, Haut RC. The influence of impact interface on human knee injury: implications for instrument panel design and the lower extremity injury criterion. In: Proceedings of the 41st Stapp Car Crash Conference. November 13-14, 1997; Lake Buena Vista, FL. Warrendale, PA: Society of Automotive Engineers:167-180. SAE 973327.
1995	Dischinger PC, Kerns TJ, Kufera JA. Lower extremity fractures in motor vehicle collisions: the role of driver gender and height. Accid Anal Prev. August 1995;27(4):601-606.
2017	Chakravarty AB, Martinez AA, Quenneville CE. The injury tolerance of the tibia under off-axis impact loading. Ann Biomed Eng. June 2017;45(6):1534-1542.
2020	Chirvi S, Pintar FA, Yoganandan N, Stemper B, Kleinberger M. Trabecular bone mineral density correlations using QCT: central and peripheral human skeleton. J Mech Behav Biomed Mater. December 2020;112:104076.
1989	Haut RC. Contact pressures in the patellofemoral joint during impact loading on the human flexed knee. J Orthop Res. March 1989;7(2):272-280.
1995	Burgess AR, Dischinger PC, O'Quinn TD, Schmidhauser CB. Lower extremity injuries in drivers of airbag-equipped automobiles: clinical and crash reconstruction correlations. J Trauma. April 1995;38(4):509-516.
2017	Quenneville CE, Fournier E, Shewchenko N. The effect of anthropomorphic test device lower leg surrogate selection on impact mitigating system evaluation in low- and high-rate loading conditions. Mil Med. September–October 2017;182(9-10):e1981-e1986.
2016	Chakravarty AB. The Effects of Off-Axis Loading on Fracture Risk in the Human Tibia [Master's thesis]. Hamilton, ON: McMaster University; September 2016.
1998	Atkinson PJ. A Stress-Based Damage Criterion to Predict Articular Joint Injury from Subfracture Insult [PhD thesis]. University of Michigan; 1998.
2006	Balasubramanian S. Posterior Cruciate Ligament (PCL) Injury and Repair: A Biomechanical Evaluation of the Human Knee Joint Under Dynamic Posterior Loading; Kinematics and Contact Pressure Measurements in Normal, PCL Deficient and PCL Reconstructed Knees [PhD thesis]. Detroit, MI: Wayne State University; 2006.