[hermantheshocker]

Case 1
A young male adult was driving at high speed, believed to be over 100 km/h (62 mph) when his car crossed into the opposite lane and collided with a B-Double, a prime mover which was pulling two semitrailers and was 26 m long (85 ft). The cause of death was multiple injuries sustained in the motor vehicle collision.

There were multiple abrasions and bruising over much of the body and significant trauma with gross deformity of both lower and upper limbs with multiple compound fractures (Fig.1). The trauma included a ruptured diaphragm, subcutaneous emphysema, pneumocephaly, and a pneumothorax. There was deformity of the face, which included a large laceration on the right side of the face extending from the right ear (pinna) to the bridge of the nose (Fig.2). There were visible underlying fractures and brain tissue within this laceration.

There was extensive compression of the compartment of the vehicle, which resulted in injuries to all surfaces of the body. The high energy involved in this collision has resulted in a multiplicity of skeletal injuries that include both the axial and appendicular skeleton.


Fig.1 Anterior view showing the gross deformity of both lower and upper limbs and the multiple abrasions and bruising over the entire body. VR image of the anterior post-cranial skeleton showing extensive trauma to the axial skeleton. NB: part of the left leg was unintentionally cut out of the CT scan.


Fig.2 Anterior view of the face showing the general deformity and large laceration on the right side.

Postmortem CT demonstrated grossly comminuted, depressed facial bone fractures with bilateral linear parietal skull vault fractures radiating posteriorly (Fig.3). There was also extensive trauma to the axial skeleton (Fig.1) including the pelvis, ribs, and upper and lower limbs indicating a high-impact force. There was a fracture-dislocation of the upper thoracic spine (Fig.4).


Fig.3 VR images of the six standard views of the skull showing grossly comminuted, depressed facial bone fractures with bilateral linear parietal skull vault fractures.


Fig.4 Clipped VR image of the anterior rib cage showing a fracture dislocation of the upper thoracic spine.

An axial scan through the chest showed multiple gas-filled defects in the lungs (Fig.5). These are known as traumatic pneumatoceles and are typically ovoid in shape, occurring in high-impact force to the chest and thought to have a shearing or tearing mechanism. They are best seen on CT rather than autopsy where the pathologist usually describes laceration to the lungs.


Fig.5 Axial reconstruction of the chest showing multiple gas-filled in the lungs (traumatic pneumatoceles) (white arrows).

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Case 2
A middle-aged male was driving a semi-tractor with an attached trailer in heavy fog. On approaching a sharp left bend in a 60 km/h (37 mph) zone, the trailer tipped and the truck flipped onto its right side. It appeared the vehicle entered the bend at approximately 100 km/h (62 mph). The individual was not wearing a seat belt. The cause of death was the severe head injury sustained in the incident.


Fig.1 Anterior view of the head showing extensive lacerations, comminuted skull, and facial fractures with extrusion of the brain.


Fig.2 Left view of the head showing extensive lacerations, comminuted skull, and facial fractures with extrusion of the brain.


Fig.3 Right view of the head showing extensive lacerations, comminuted skull, and facial fractures with extrusion of the brain.

There was marked disruption of the head with extensive abrasions, lacerations, and comminuted skull and facial fractures with extrusion of the brain. The left ear was completely avulsed (Fig.2). There was no evidence of any upper cervical spinal injury. There were minor abrasions, lacerations, and bruises all over the body. The ribs, pelvis, long bones, and vertebral column were grossly intact without evidence of fracture or deformity. The supporting musculature and soft tissues were normal.

The head trauma mostly likely occurred as a result of contact with the road through the driver’s window and may have involved compressive force between the vehicle and road surface. Postmortem CT showed grossly comminuted and depressed fractures of the skull and facial bones because of an extreme anterior compressive force (Fig.4).


Fig.4 VR images of the six standard views of the skull showing grossly comminuted and depressed fractures of the skull and facial bones due to an extreme anterior compressive force.


Fig.5 Comparison of photographs and VR images.


Fig.6 Comparison of photograph and VR image.

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This post is for educational purposes only and is nonprofit. Under Section 107 of the US Copyright Act of 1976; Allowance is made for "Fair Use" for purposes such as criticism, comment, news reporting, teaching, scholarship, and research. OP is not a medical expert. No copyright infringement intended. This post does not encourage or glorify violence/harassment. Images might have been upscaled and enhanced. Text might have been shortened and simplified/reorganized for online view. Original case report by Blau S., Ranson D., O'Donnel C. - Academic Press 2018.

[Karma]

Another excellent informative post. The skeleton shows the true depth of the trauma. Wow.

Thanks for sharing.

[imbok]

Those post mortem CT scans are positively spectacular. The amount of skeletal and cranio-facial damage in both cases is just horrendous. The CT scans bring it out in a detail that is unmatched. Bravo.

[Riddla]

Thats some serious skeletal distortion. That spine just snapped.

[William May]

Any pictures or video of the actual wreck?

[Izumi]

Im digging the CT scans!

[three_some]

Serious accidents. Major fracture-dislocation of the vertebral column.

[WonderMomma]

Yes the scans were very interesting. Not sure I've seen anything like that. Great post, as always!

[redrum217]

Great post! You're my new hero.

[thecollector]

That first guy is all sorts of fucked up. Imagine how painful that was for just a split second. Broke practically every bone in his body and severed his spinal cord.