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Medico Macha
  • 6/21/2025
Transcript
00:00So hello friends, my next topic is road traffic accident injuries. Injuries caused during
00:07road traffic accident. In these we will discuss the motorcyclist injuries. If you are a motorcyclist
00:17and there is a fracture, this is known as motorcyclist injuries. Number two, pedestrian
00:25injuries. Pedestrian injuries. If you are walking and there is accident, these are known as pedestrian
00:35injuries or vehicles injuries. Vehicles injuries. These are common injuries in road traffic accident.
00:45Now my dear friend, these injuries depends. These injuries depends on two things. Number one,
00:55speed of the vehicle. Speed of the vehicle and second, the point of impact.
01:05The speed of the vehicle and point of impact. What is the speed of vehicle and point of impact? So these
01:12are two criteria. The injuries, the nature of injuries, the severity of injuries, all these
01:18depends. Now first I will discuss the motorcyclist injuries. Motorcyclist injuries. I told you in
01:26the regional injuries topic it can cause motorcyclist fracture. What is motorcyclist fracture? It is a
01:34fracture of base of skull. It is a fracture of base of skull and I classified motorcyclist fracture
01:42in few types but motorcyclist fracture is type 1 hinge fracture. It is a type 1 hinge fracture. Now you can see
01:54this is base of skull and my dear friend, I told you in the regional injury class, the motorcyclist fracture
02:01is the red line. It is the red line. Red line which is starting from the pitrus side, one side of the pitrus
02:08ridge. Then it is going to the cella tersica. Then it is going to the another side which is a pitrus
02:16race. So this is known as motorcyclist fracture, hinge type 1, hinge type 1. It divides skull in
02:25anterior half. This is the anterior half and this is posterior half, anterior half and posterior half. So this
02:33I discussed as a motorcyclist fracture. It is a hinge type 1 fracture. It is starting from the pitrus
02:38axis going to the cella tersica and going to another side of the pitrus axis. So it is a side by side
02:44fracture. It is a side by side fracture. It means force comes from one side and going to other side. It
02:54is known as side by side fracture. So motorcyclist fracture is a hinge type 1 fracture which divides
03:02base of the base of skull in anterior half and posterior half. This is known as motorcyclist fracture.
03:10Other fracture of the base of skull, I already told you. Other fracture of the base of skull, yes,
03:15it is type 2. Type 2 and this one, this one which is in coronal plane, it is type 3. But motorcyclist
03:24fracture is type 1 hinge fracture of the base of skull. It is type 1 fracture of the base of skull. Now,
03:32my dear friend, in motorcycle, those people who are riding motorcycle, sometimes what happens,
03:38there is a word which is known as tailgating. Friends, tailgating is also known as underrunning.
03:45As the name suggests, running, underrunning. It is running into, running into large vehicle
04:01or heavy vehicle. The backside of the large vehicle or heavy vehicle. So I am giving example. See,
04:11this is a truck. Yes, my dear friend. If any motorcycle or even you can write down car,
04:19that running into, that running into or running behind the large or heavy vehicle and crushed,
04:29and crushed. Rams, we can use the word Rams inside or behind this or crushed. So this is known as
04:37underrunning, tailgating. My dear friend, in underrunning, there are many injuries. The most common
04:43injury is head injury. The most common injury is head injury. The head is crushed. Head is
04:53crushed. And even sometime, it can lead decapitation. Even it can lead decapitation, removal of the head.
05:03It can lead the injury of the face. Yes, my dear friend. An injury of the front part of the body,
05:11face, chest, trauma. So it can be the injury of the face, chest, abdomen.
05:16One, these are the crushing injury where you are running behind the large or heavy vehicle. This is
05:27known as tailgating or it is also known as underrunning injuries. It is large or heavy vehicle
05:32so that you will crush. This is known as tailgating. So these are two common injuries which can be seen
05:38in motorcyclists. If they get the fracture, motorcyclist fracture and tailgating, you will crush
05:45underrunning injuries. So tailgating is also known as underrunning injuries. These are two things you
05:53have to remember. Motorcyclist fracture and tailgating. Now, I am coming to a very, very important
06:00topic. Pedestrian injury. What is pedestrian injury? You are walking or standing. Then you get accident.
06:07This is known as pedestrian injury. Very, very simple. Now, pedestrian injury, I can classify in
06:14three types of injury. Three types of injury. Number one, primary impact injury. Primary impact
06:22injury. It is the first contact as you can see in the diagram. Yes. As you can see in the diagram,
06:28this is the first impact. This is known as primary impact injury. The first impact of the vehicle to
06:34the body. This is the first contact. It is known as primary impact injury. The most common site
06:40affected is leg. Okay. Second. Second is secondary impact injury. Second is secondary impact injury.
06:49But, sir, secondary impact injury is the contact or hitting by same vehicle but it is second time,
06:56second contact. It is known as secondary impact. So what will happen, sir? As you can see,
07:00there will be injuries. As you can see, there will be the injuries and you are going over the vehicle.
07:06This is known as secondary impact. Second impact. Second contact. Now, I am coming to,
07:12now I am coming to tertiary impact injuries. Tertiary impact. Tertiary impact injuries are also known as
07:22secondary injuries. Tertiary impact injuries are known as secondary injuries. These are also known as
07:28secondary injury. Now, primary impact is the first contact. Second impact, same vehicle, second contact.
07:34Now, you are thrown on the road or any other object. So it is impact by any other object.
07:42This object could be road. This object could be the, like you can say, divider. Divider.
07:51This object could be a tree. And this object could be some other vehicle.
07:56This object could be some other vehicle. Like some truck is coming from other side. It can be this one
08:04also. So it is by some other object other than the same vehicle. First same vehicle. Second same vehicle.
08:12Tertiary impact is also known as secondary injuries. Tertiary impact is also known as secondary injuries.
08:23So if you are thrown and hitting the road, this is known as tertiary impact injury. As I told you,
08:28tertiary impact injuries are also known as secondary injury. Not secondary impact. Second impact.
08:33Injuries are tertiary impact. Now sir, we will discuss primary impact injury. As I told you, the first
08:43contact with the vehicle. Sir, mostly the bumper part of the vehicle produces this injury. That's why
08:51most common injuries are bumper injuries. Because bumper part hits your body. Now, what are the injuries
09:01on the body by bumper? What are the injuries on the body? Number one, it could be abrasion.
09:09Number two, it could be contusion. Number three, it could be some kind of laceration.
09:20And the last but not the least, very, very important, some fractures. These are bumper producing
09:25injury. Now, my dear friend, most of the time what happens? See, as I told you,
09:29what is the most common site? The most common site is leg. The most common site is leg. So if you are
09:37adult, my dear friend, there will be bumper fracture. What is the meaning of bumper fracture?
09:42Bumper producing fracture. This is known as bumper fracture. Bumper fracture is a fracture of tibia bone.
09:48Bumper fracture is a fracture of tibia bone. And it is the fracture of platu.
09:58Platu of the tibia. Tibia ki aage ki surface hoti the anterior surface. Platu of the tibia,
10:02mainly on the lateral side. So this is known as bumper fracture. So most of the time we have bumper
10:09fracture. Bumper fracture is a tibia fracture. It is wedge shape fracture or triangular fracture.
10:15The fracture may be some other fracture also. If it is not tibia, some other fracture may be also.
10:23So apart from tibia, there can be fracture of fibula. And sometime, very, very rarely,
10:30it could be femur. But most common fracture is bumper fracture, fracture of tibia bone. Tibia bone,
10:36lateral side, it is a bumper fracture. You can see this picture, sir. This is a
10:42wedge-shaped fracture. As you can see, this is a wedge-shaped fracture, the triangular fracture.
10:47This is known as bumper fracture. But, sir, most common side, it is this one.
10:53Tibial platu, tibial platu. And my dear friend, the base, the base and apex,
11:01the base is the point of impact. The base is the point of impact and the apex is direction.
11:14Apex is direction of, apex is direction of car or any vehicle. So this apex denotes the direction
11:27and base is the point of impact. This is known as bumper fracture. So mainly, it is a fracture of
11:32tibia bone. As I told you, the base, this is a triangular. The base, what is the base? It is,
11:41as I told you, it is impact. The point of impact, it is the base. And apex is the direction of vehicle,
11:50direction of moment. So this is bumper fracture. My dear friend, in adult, in adult, the most common
12:00site is leg without any doubt. So there will be the tibial fracture, bumper fracture, all fracture
12:06will be there. Femur, fibula, these fracture will be there. But in children, my dear friend,
12:11children are in short stature. Children are in short stature. So in short stature, there can be
12:18fracture of femur also. Femur also. So this is a primary impact injury, the first impact by vehicle.
12:26This is bumper fracture. Bumper fracture is a waist shape fracture of lateral plateau of tibia,
12:32lateral side. Now, my dear friend, if the bumper fracture is, or bumper injuries are on back of
12:41the leg. That means the vehicle is coming from behind. Vehicle is coming from behind. Now, my dear
12:50friend, vehicle movement. Now, sir, this is the situation. See, this is the back side. This is the
12:56back side. So I am talking about if the vehicle is coming from behind, the injury will be on the back
13:03of the leg. Now, if vehicle movement is from right to left, or vehicle movement is from left to
13:11right, bumper injury, where you will find the bumper injuries. If right to left, there will be the
13:19injuries, there will be injuries on the, on the lateral aspect of right side of leg.
13:28Lateral aspect of right side of the leg. It is right to left. Right to left. So it will, it is
13:41lateral aspect of right side. And if it is left to right, left to right, it is lateral aspect of,
13:51lateral aspect of left side leg. So again, I am revising my dear friend. If the vehicle is moving
14:00from right to left, it is lateral aspect of right leg. And if vehicle is moving from left to right,
14:07it is lateral aspect of left leg. So just keep this in mind. Yes, two important ones. Now,
14:15if the injuries are on the front of the leg, that means vehicle is coming from the front side.
14:24If the injuries, bumper injuries are on same level of the leg, same level on this leg, same level on
14:36this leg. That means the person or pedestrian was standing. But if it is different level of the leg,
14:46that means the person was either running or walking. Yes. So again, I am revising my dear friend, bumper injuries.
14:57Back of the leg, that means vehicle was coming from behind. Yes. And now vehicle is coming from behind.
15:03Okay. In this situation, vehicle is moving from right to left. It is on the right leg,
15:08lateral aspect. And vehicle is moving left to right. That means lateral aspect of the left leg. Very,
15:16very important. Front of the leg, it means the vehicle is coming from the front side, standing,
15:24same level of the leg, two injuries, different running or walking. Very, very important. Now,
15:29my dear friend, height of the injuries, most of the time, it can be same height. It means,
15:38same height means the height of the bumper and the injuries will be on same height. Same height.
15:44And yes or no, my dear friend. Now, if vehicle is accelerating,
15:50increasing, means the increasing in the speed, it can be a higher height compared to the normal.
16:00And if vehicle is using brakes, if it is brakes, it is banded down. So it can be a lower height bumper
16:11injuries. So by this, you can remember the speed, the sight, the right to left moment,
16:18the left to right moment, whether it is coming from front or behind. This is a very, very important
16:24topic, primary impact injuries. Bumper fracture is a waist-shaped fracture of anterior plate of
16:30tibia or lateral plate. Lateral. It is anterior. Now, the second injury, secondary injury or secondary
16:40impact injury, as I told you, it is caused by second impact. So as I told you, it is caused by
16:48second contact of the same vehicle. Second contact. Now, how would you get the second
16:54contact? Either you will go to the bonnet. Yes.
16:59Either you will hit the bonnet or you will hit the windshield. But my dear friend, you are hitting
17:07the bonnet or windshield. There will be multiple injuries. These injuries. The most common type
17:13of these injuries are head injuries. Head is hitting. Head injuries. Apart from head injury,
17:21there can be cervical injuries, cervical fracture or cervical injuries. Yes. And there can be
17:26skeletal fracture, skeletal injury. These all injuries are possible in second impact. So there can be
17:36abrasion, contusion or laceration. Most common type of injury is head injury. So this is,
17:41this is secondary impact. You are going over the vehicle. This is secondary impact. A very, very
17:48potential MCQ. So now I am coming to the third one, my dear friend. Tertiary impact. I already
17:54discussed my dear friend. Tertiary impact is also known as secondary injuries. It is hitting with
18:01some other object. This object could be road, ground. So probably you are hitting the road or ground.
18:09Yes. Or you are dragging. Your body is dragged. If your body is dragged, it is a tertiary impact injury.
18:20Dragging of the body or hitting the ground, it is a tertiary impact injury. So I told you,
18:25it is caused by either hitting the road or by dragging. My dear friend, what are the possible injuries in
18:34this? My dear friend, what are the possible injuries in this? Number one, it is head injury.
18:45Number two, skeletal fracture or skeletal injuries. Yes, skeletal fracture or skeletal injury. You can
18:52write down skeletal fracture. Yes. Now, my dear friend, you can get a question. Multiple grazed abrasion
19:00and laceration are very, very important. And here, it is due to, because you are being
19:07dragged on the road. If you are being dragged on the road, multiple abrasion and lacerations are
19:14possibility. So again, I am revising. These are produced by road, by dragging over the road. And
19:20most common type is head injury, skeletal injury. But sir, if you find multiple grazed abrasion or
19:26laceration, definitely it is because you are being dragged. So these are three possible injuries.
19:33Now, my dear friend, in tertiary impact injury, I can classify the injury in two categories. Number one,
19:40roll-on or roll-over injury. You can write down roll-on or roll-over injuries. And my dear friend,
19:46what is the meaning of roll-on? The body is rolled-on. It is seen
19:52by the vehicle which is having low chassis. It is seen by the vehicle which is low chassis. Example is like car.
20:05The small car has a low chassis. So your body will be rolled-on. Your body will be rolled-on. It is not
20:11a run-over. It is a rolled-on. Okay? So my dear friend, most characteristic will be grazed abrasion.
20:17Because while you are rolling-on, see, while you are rolling-on, there will be grazed abrasion,
20:24which is seen on circumference. Grazed abrasion, which is seen on circumference. Circumference means
20:32all circumference will show the grazed abrasion. Okay? Multiple grazed abrasion. Fractures of the bone.
20:39Very, very important, my dear friend. Fractures of the bone. Now, so grazed abrasion on the circumference
20:45of the body and the fracture of the bone. The chassis will form the pattern abrasion.
20:53The chassis will form the pattern abrasion. Okay? It is a low chassis car. Hot exhaust,
21:01because of the heat is exhausted, this will cause the burning of the skin. The burning of the skin can
21:07be seen. And the grease material on the body will form the grease stain. The grease material of the car
21:15that will form grease stain. So these are the common when it is a roll-over injury or roll-on injuries.
21:22It means it is not run-over. It is the body is rolled-on by the vehicle.
21:26Aisa vehicle, jiski chassis low. Chassis low. Okay? Now I am coming to the run-over injury. My dear friend,
21:36first question. Run-over injuries are caused by those vehicle, heavy vehicle, where chassis is high.
21:44Where chassis is high. Example, the heavy truck, lorry, heavy truck, lorry. These causes run-over injuries.
22:00Because the chassis is high, higher from the ground. Chassis is low, lower from the ground, higher from the
22:04ground. This will cause the run-over injury. Means the vehicle will run-over your body. Rolled-over,
22:10you are rolling-over, you are rolling-over, and the vehicle is rolling-over. Run-over,
22:16that vehicle is running-over your body. That is when the chassis is high. Like truck or lorry,
22:21heavy lorry. Now my dear friend, the most specific, the most specific mark are tire marks. Very,
22:30very potential. The tire marks are actually, I already discussed, these are the example of pattern abrasion.
22:40So my dear friend, there will be tire marks. Tire marks are example of pattern abrasion. Or because
22:49it is running over of the vehicle, because it is running over the vehicle, we can write down,
22:53it is an example of pattern bruise also. Intradermal bruise also. Because of heavy object.
23:00Grazed abrasion. Multiple, multiple grazed abrasion on the body.
23:05Multiple grazed abrasion on the body. Because of friction. The grazed abrasion, the mechanism is
23:14friction. The mechanism is friction. Now my dear friend, separation of the tissue, tearing off,
23:22separation of the tissue, this is known as evolution. That is shearing laceration.
23:29Searing laceration. Separation or tearing of the tissue. The tissue will be separated. There will be
23:37avulsen. Crushing injuries my dear friend. Crushing of the head, crushing of the body and crushing of the
23:46internal organ. This is known as crushing injuries. And my dear friend, the burning and blackening. Same
23:53method I told you. The burning and blackening is because of heat or exhausted heat that will cause
24:00burning and blackening. And grease stain. These can be possible. But sir, again I am telling you,
24:05this is a run over injury. First I told you rolled over or rolled on injuries. Again I am telling you,
24:11if you have the low chassis, chassis is low, your body will be rolled on. Body will be rolled on. Yes,
24:16this is rolled over. And if chassis is higher, your body will be run over. Run over injuries are by
24:26higher chassis. Okay? So just remember this one. So these are roll on injuries and run over injuries.
24:32Very, very important. Now my dear friend, I am coming to the next category. Car occupant injury.
24:37First of all, what are the injuries which are possible in car occupant? Sir, in car occupant,
24:44the first occupant is driver. The first occupant is driver. The second is front seat passenger.
24:57Front seat passenger. What are the injuries in the driver and what are the injuries in the front
25:02seat passenger? Now first I will discuss the car driver injuries. Car driver injuries. My dear friend,
25:09in car driver injury, the first is windshield injuries.
25:12Windshield, the glass. If the glass is broken. If the windshield glass is broken. Actually sir,
25:23after it is broken, it is a shattered glass. It is a shattered glass. The glass fragments or glass particle,
25:33glass particle, which can be spherical or cubical. Which can be spherical or cubical. So this glass is
25:45shattered glass. The glass particle, glass fragments are spherical and cubical. What happens sir? When I rams,
25:54I crushed in the glass. Means my body has been crushed in the glass. I am a front seat car driver and my body is
26:03crushed or my body is pushed in the glass. So it is, you are ramming in the glass. You are thrown in the glass.
26:11So what will happen sir? There will be sparrow feet mark by this glass particle. Sparrow feet mark by this glass
26:19particle. How does sparrow feet mark look like? It is just like a sparrow feet on the face.
26:26So sparrow feet mark. The most common sight is on the face. What is sparrow feet mark? It is multiple,
26:35multiple, small, superficial, multiple, small, superficial, multiple, small, superficial,
26:48punctate laceration. Puncted laceration.
26:54Puncted laceration. So again, I am telling you my dear friend. Because of the glass particle,
27:00because of the glass particle, when you are thrown in the glass, there will be windshield injury.
27:06And these injuries are sparrow feet mark. Sparrow feet mark. These are multiple, small,
27:14superficial, punctate laceration. And it is not common when you are wearing seat belt.
27:21So it is not common because most of the time, if you are wearing seat belt now,
27:26then it is not common. So my dear friend, what I discussed, I am discussing the car driver injuries.
27:32Yes, my dear friend. The first car driver injury is a windshield injury. It is by broken glass,
27:37which is a shattered glass. And you are thrown in the glass. Your face is thrown in the glass,
27:42ramming in the glass, crushing. So there will be multiple, small, superficial,
27:48punctate laceration on the face. This is known as sparrow feet mark. So first is sparrow feet mark.
27:54But this sparrow feet mark is not common because we are putting seat belt. That is why it is not common.
27:59Second, my dear friend, if this glass particle,
28:06if this glass particle are broken and hit your body, hitting your face or body,
28:15these injuries on face or your body, this is known as dicing injury. There are two things.
28:24First, you are crushing in the, you are thrown in the glass. Second, the glass particle coming on the face
28:30or the body. This is known as dicing injury. Both are different. Sparrow feet mark. Sparrow feet mark,
28:37when you ram inside the glass, that is small, multiple, superficial, punctate laceration. So first injury,
28:43because of the windshield I discussed. Second injury, my dear friend, neck injury. My dear friend,
28:50neck injury, number one, it could be V plus injury. Number two, it could be neck fracture. That is a
28:59cervical fracture. That is a cervical fracture. But sir, what is a V plus injury? My dear friend,
29:06it is not a fracture. It is a soft tissue injury. It is a soft tissue injury. That is a V plus injury.
29:16Soft tissue injury of the neck. Now, what happens, sir? Neck injury. There is a violent
29:21neck movement. So what is the reason of the neck injury, my dear friend? The reason of the neck
29:25injury is violent neck movement. Violent neck movement. Okay. Now, this violent neck movement
29:31produces V plus injuries. What is V plus injury? Number one, one type is acceleration. Number two
29:40type is deceleration. What is acceleration? When your speed is going up, then you hit someone,
29:48this is acceleration. What is deceleration? When your speed is already high, then your sudden stop,
29:55this is known as deceleration. Now, my dear friend, in acceleration, what happens?
30:01In acceleration, what happens? It is hyperextension of the neck. It is hyperextension of the neck
30:09followed by hyperflexion. Hyperextension of the neck followed by hyperflexion. This is acceleration
30:18injury. And what about the deceleration injury? It is hyperflexion of the neck followed
30:25by hyperextension. This is deceleration injury. So when you suddenly stop, what happens? First you
30:32go hyperflex, then hyperextension. This is deceleration. Now, my dear friend, more common
30:39and dangerous is hyperextension. If you get a question, which is more common and dangerous as the
30:47V plus injury? The answer is hyperextension. My dear friend, in the V plus injury, there will be
30:53there will be contusion of the soft tissue, contusion of the soft tissue of cervical spinal area.
31:06Cervical spinal area. And my dear friend, most common level is C5 to C6.
31:16Most common level. Soft tissue injury of cervical spinal area,
31:19a fatal contusion. Sometime, it becomes a very, very fatal contusion of the spinal cord. So my dear
31:27friend, this is an injury of spinal cord. This is soft tissue injury. And my dear friend, this is
31:33known as V plus injury. And which is more dangerous or more common? The answer is hyperextension. This is
31:39more common. A neck injury can cause some cervical fracture also. That is a different thing. But V plus injury.
31:45Now, sir, what is the most common side? Most common side is anterior longitudinal ligament.
31:54Anterior longitudinal ligament. That is very, very important. You can see this is mainly a
32:04mainly a hyperextension. Yes, my dear friend. It is torn anterior longitudinal ligament and torn
32:12knuckle ligament of cervical spinal area. This is known as V plus injury. And as I already told you,
32:19it's a soft tissue damage. In neck injury, there can be fracture of cervical vertebra. And most common
32:25side, most common side is C5, C6. The most common side is C5, C6. So I have discussed two injury
32:32of car drivers. Car driver number one injury was windshield. Car driver number one injuries was
32:39windshield. Number two injuries are neck injury. Now, I am coming to number three injury, my dear friend.
32:45Steering. Steering, aapke car driver ke paas ota. ST for steering, it is ST for it is a sternum fracture.
32:53Yes, my dear friend. RI, it is a ribs fracture. Sternum fracture and rib fracture are very, very common.
33:03Very, very important. So, what are the other sides? It can be fracture of, it can be fracture of elbow
33:14and your arm bones or forearm bones. Fracture of elbow and forearm bones, that is very common.
33:20Now, apart from this, this can involve other organ. But sir, a very, very important pattern bruise.
33:30Pattern bruise, what is the common side of the pattern bruise? Pattern bruise, the most common side,
33:37pattern bruise, the most common side is chest. So, the steering will form the pattern bruise on the
33:44chest. Organs involved are, a very, very potential word, organs involved are lung,
33:51heart, heart, and aorta. Lung, heart, and aorta. These are the common organs involved.
33:59So, ST, steering, sternum, re, ribs, it is a fracture of elbow, forearm, and wrist.
34:07Fracture of elbow, forearm, and wrist, steering. Pattern bruises on the chest and organs involved are
34:14lung, heart, and aorta. Very, very important. My dear friend, direct impact on aorta, this will cause
34:29torsion force. And my dear friend, this mechanism is torsion force. Which part of the aorta is involved?
34:37Because the steering is hitting the aorta. The part involved in aorta is isthmus.
34:44Isthmus. And my dear friend, very, very important. You can remember, sir, this is a ascending aorta.
34:52And this is a descending aorta. Yes. The isthmus is distal to, isthmus area is distal to
35:07subclavian artery. So, this area which is isthmus, which is distal to subclavian artery,
35:16this is involved. And it is descending aorta. This is ascending aorta. And there will be transverse
35:28fracture. There will be transverse fracture. So, another very, very important word, this will be
35:38transverse fracture. So, there will be transverse tear. So, correct this. So, isthmus is distal to,
35:55correct this. This isthmus is distal to subclavian artery. And there will be transverse tear.
36:02There will be transverse tear. Transverse tear in the intima of the isthmus.
36:16In the intima of the isthmus. And my dear friend, isthmus, this is known as
36:24ladder rung tear. This is just like a ladder pattern. This is known as ladder rung tear.
36:33It is isthmus is intima showing transverse tear. And my dear friend,
36:37this steering wheel, so there will be compression between,
36:43there will be compression between sternum because in front part of the aorta you have sternum
36:50and in the back you have thoracic vertebra.
36:55In the back you have thoracic vertebra. So, my dear friend, there is a compression between
37:02sternum and thoracic vertebra. This phenomena is known as osseous punch.
37:14This phenomena is known as osseous punch. But my dear friend, at least you have to remember
37:18the most common site is isthmus of the aorta. It is a transverse tear, horizontal tear in the intima of the
37:25blood vessels. Blood vessels, that is isthmus. Ladder rung tear and it is a compression between
37:30sternum and thoracic vertebra. It is osseous punch. And my dear friend, you have to remember
37:36ladder rung tear, most common site is isthmus of the aorta. It is isthmus of the aorta.
37:43Very, very potential. Deceleration injury to the aorta.
37:50Deceleration injury to the aorta, because first I told you the direct impact on the aorta,
37:55the second is deceleration injury to the aorta. This causes
38:02stretching.
38:03This causes stretching or straining of the aorta. The mechanism is stretching and straining of the aorta.
38:13Here, the main force in direct impact is torsion force. And in deceleration injury,
38:19it is stretching or straining of the vessels. That is aorta. So, there are two types of mechanisms we have.
38:26Now, my dear friend, so I have discussed three things, steering wheel injury, yes, neck injuries,
38:31and windshield or broken glass injury. Now, I am coming to the fourth one, seat belt injury.
38:40Seat belt injury, I can classify in three categories. Number one, number one, seat belt syndrome,
38:46it contains three things. So, my dear friend, seat belt injury, there is a seat belt syndrome.
38:52Seat belt syndrome has three things, seat belt sign, number two, intra abdominal traumatic injury,
38:59number three, number three, vertebral injuries. What is seat belt syndrome? My dear friend, this is
39:06seat belt syndrome, pattern bruise. So, pattern bruise, this is seat belt syndrome. And my dear friend,
39:14if I am a driver, if I am a driver, the most common sight is the right shoulder.
39:22It is starting from the right shoulder, if I am a driver. So, it is starting from the right shoulder,
39:30then it is going downwards to involve this. It is seat belt sign, a pattern bruise. My dear friend,
39:36intra-abdominal injuries, products of seat belt syndrome have three things. Number one, seat belt
39:42is the right shoulder, which is the right shoulder, which is the right shoulder, which is a pattern bruise.
39:50And driver, it is on right side. Intra-abdominal injury, it is by deceleration and compression mechanism.
39:58The intra-abdominal injury is by deceleration because suddenly the vehicle stops and compression.
40:02What are the common organ? The most common sight is misentry.
40:08The most common sight is misentry, then small intestine, then spleen, and then liver. These are
40:21the most common sight of intra-abdominal injury by seat belt. My dear friend, in small intestine,
40:28if you want to go in detail, the most common sight is
40:32diodyno-jejunal flexor. The most common sight is diodyno-jejunal flexor. The second is
40:45ileocecal junction. So, diodyno-jejunal flexor and ileocecal junction. Now, I am coming to, sir,
40:53vertebral injuries. Vertebral injury is caused by two mechanism, destruction and compression.
41:00If you are using lap belt, lap belt means the belt only over the lap belt, there is a hyperflexion of
41:15spine. Hyperflexion of spine and the most common sight is lumbar vertebra. Hyperflexion of the spine,
41:29most common sight is lumbar vertebra. Now, this is the first mechanism. Now, if you have distraction,
41:35due to distraction, distraction is like it is a loosening of the joint or you can say separation of
41:41the joint. It is a separation of the joint. So, distraction on the posterior side and compression
41:48on the anterior side, it causes posterior anterior fracture. Destruction on the posterior side of the
41:56vertebra and compression in the anterior side of the vertebra, it causes posterior anterior fracture.
42:00And my dear friend, this posterior anterior fracture of the lumbar vertebra, this is known as chance
42:08fracture or it is also known as fulcrum fracture. Destruction on the posterior side, compression on
42:17the anterior side, it causes posterior anterior fracture of the vertebral body. It is a fracture
42:23of vertebral body. It is known as chance fracture or fulcrum fracture. So, what are the seat belt
42:29syndrome number one? Seat belt sign, that is a pattern bruise. Intra-abdominal trauma, as I told you,
42:36misrential everything and vertebral injury. So, my dear friends, remember three things here. Seat belt
42:43syndrome, three things. Number one is seat belt sign, a pattern bruise. Number two, the intra-abdominal
42:49injury, the injury involved, the most common side is misrential. Other side are small intestine,
42:53spleen and liver. And the third foremost, it is a chance fracture, a hyperflexion of this. This is
42:58a transverse fracture. So, my dear friend, chance fracture is a posterior anterior fracture of the
43:03vertebral body. It is a transverse fracture. It is a transverse fracture. Transverse fracture line
43:12is a chance fracture. So, these three things combined are known as seat belt syndrome. Now, as you can see,
43:18it is bruise starting from the right shoulder, then it is in driver, it will be seen in the right
43:22shoulder. Okay, then it is going in this direction. Yes, we have already discussed this one. This is
43:27the pattern bruise, pattern bruise. Now, my dear friend, if you are not driver, you are front seat
43:34passenger. You will have all the injuries same which we have seen in the driver. There will be
43:40windshield injury, the sparrow footmark or I told you the dicing injuries. Second, there will be V-plus
43:46injury, the cervical injuries, the spinal cord injury, the soft tissue injury of the spinal cord.
43:52Yes, there will be seat belt injury. But my dear friend, in this, the only difference would be
43:57because you are a front seat passenger of a car. So, it will start from the left shoulder.
44:04The pattern bruise, the pattern bruise will start from the left shoulder. Very, very potential MCQ.
44:15It will start from the left shoulder. It will go in this manner. Other will be seen. Dashboard injury,
44:20I will discuss. It means that one injury is missing in the front seat passenger. Anyone who can tell me?
44:25Yes, steering injury is missing. No steering wheel injuries. No steering wheel injuries. Because there is
44:33no steering wheel. That's very, very important. Now, dashboard injury. What happens, sir? Let's see.
44:39You are sitting. This is your hip. You are sitting in this position. So, what is this position? Sir, knees are flexed.
44:47Knees are flexed and your hip is also flexed. So, where is the dashboard? In front of you. In front part
45:00of the leg. This is the dashboard. So, this dashboard hit the flexed knee. This dashboard hit the flexed knee.
45:07So, there are three P. Number one, patella fracture. Number two, posterior cruciate
45:17ligament injury. Patella fracture. Posterior cruciate ligament injury. And the third which is very,
45:24very important, sir. Posterior dislocation of hip. Posterior dislocation of hip. This is, these are
45:38three dashboard injuries. All three are P. Patella fracture. Posterior cruciate ligament injury.
45:42Posterior dislocation of hip. This is known as posterior dislocation of hip. This is also known as
45:48dashboard injury or dashboard dislocation. Very, very important. And most common nerve to be involved,
45:56it is sciatic nerve. It is sciatic nerve is the most common nerve to be involved in posterior
46:02dislocation of hip joint. Now, why most common injury is posterior cruciate ligament?
46:08Most common is posterior cruciate ligament. Why not anterior cruciate ligament? The reason is,
46:14in this position, anterior cruciate ligament is relaxed.
46:22And posterior cruciate ligament is taut. So, there are chances of posterior cruciate
46:26ligament injuries more. So, anterior cruciate ligament is relaxed. That's why the posterior
46:31cruciate ligament injuries are more common because it is taut. Because it is taut. So,
46:37just remember, 3P patella fracture. Sometime, femur fracture is also seen. But most common is patella.
46:44P, posterior cruciate ligament injury. P, posterior dislocation of the hip. That can injure the sciatic
46:49nerve. These are the common injury in the dashboard injury of the front seat passenger. Very, very important.
46:55Which injury is missing? It's a steering wheel injuries are not seen. Why anterior cruciate ligament
47:01injury is less? It is relaxed. Which is taut? Posterior cruciate ligament. And what is the
47:06dashboard injury? It's a PPP patella fracture. P, posterior cruciate ligament. P, posterior dislocation
47:12of hip. What is the most common nerve injury? It's a sciatic nerve. So, my dear friend, this is all
47:17about we discussed the injury of motorcyclist, the injury of pedestrian, injury of the car occupant,
47:23injury of the driver, injury of the front seat passenger. A very, very important topic. Just go
47:28through this. Good luck.