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Description of road traffic related knee injuries in published investigations is very heterogeneous. The purpose of this study was to estimate the risk of knee injuries in real world car impacts in Germany focusing vulnerable road users (pedestrians, bicyclists and motorcyclists) and restrained car drivers. The accident research unit analyses technical and medical data collected shortly after the accident at scene. Two different periods (years 1985-1993 and 1995-2003) were compared focusing on knee injuries (Abbreviated Injury Scale (AISKnee) 2/3). In order to determine the influences type of collision, direction and speed as well as the injury pattern and different injury scores (AIS, MAIS, ISS) were examined. 1.794 pedestrians, 742 motorcyclists, 2.728 bicyclists and 1.116 car drivers were extracted. 2% had serious ligamentous or bony injuries in relation to all injured. The risk of injury is higher for twowheelers than for pedestrians, but knee injury severity is higher for the latter group. Overall the current knee injury risk is low and significant reduced comparing both time periods (27%, p<0,0001). Severe injuries (AISKnee 2/3) were below 1%). Improved aerodynamic design of car fronts reduced the risk for severe knee injuries significantly (p=0,0015). Highest risk of injury is for motorcycle followed by pedestrians, respectively. Knee protectors could prevent injuries by reducing local forces. The classically described dashboard injury was rarely identified. The overall injury risk for knee injuries in road traffic is lower than estimated and reduced comparing both periods. The aerodynamic shape of current cars compared to older types reduced the incidence and severity of knee injuries. Further modification and optimization of the interior and exterior design could be a proper measurement. Classic described injury mechanisms were rarely identified. It seems that the AIS is still underestimating extremity injuries and their long term results.
The incidence and treatment of sternal fractures among traffic accidents are of increasing importance to ensure best possible outcomes. Analysis of technical indicators of the collision, preclinical and clinical data of patients with sterna fractures from 1985-2004 among 42,055 injured patients were assessed by an Accident Research Unit. Two time groups were categorized: 1985-1994 (A) vs. 1995-2004 (B). 267/42,055 patients (0.64%) suffered a sterna fracture. Regarding the vehicle type, the majority occurred after car accidents in 0.81% (251/31,183 pts), followed by 0.19% (5/2,633pts) driving motorbike, and 0.11% (4/3,258pts) driving a truck. 91% wore a safety belt. Only 13% of all passengers suffering a sternal fracture had an airbag on board (33/255 car/trucks), with an airbag malfunction in 18%. The steering column was deformed in 39%, the steering wheel in 36%. Cars in the recent years were significantly older (7.67-±5 years (B) vs. 5.88-±5 years (A), p=0.003). Cervical spine injuries are frequent (23% vs. 22%), followed by multiple rib fractures (14% vs. 12%) and lung injuries (12% vs. 11%). We found 9/146 (6%) and 3/121 patients (3%) with heart contusion among the 267 sternal fractures. MAIS was 2.56-±1.3 vs. 2.62-±1.3 (A vs. B, p=0.349). 18% of patients were polytraumatized, with 11.2% dying at the scene, 2.3% in the hospital. Sternal fractures occur most often in old cars to seat-belted drivers often without any airbag. Severe multiple rib fractures and lung contusion are concomitant injuries in more than 10% each indicating the severity of the crash. Over a twentyyear period, the injury severity encountered was not different with 18% polytrauma patients suffering sternal fractures.
Since the compulsory use of child restraints for children up to 5 years of age was introduced in 2000, restraint use among younger children has increased significantly. However, the observed rate of child restraint use plateaus at around 50%, and apparently little spillover effect has been found for older children who are not covered by the law. This report examines the restraint use patterns for children who were injured in cars in relation to driver and child passenger characteristics. Univariate and multivariate analyses were conducted to describe the association between the outcome measure (the proper use of restraints for children) and relevant variables. Better ways for parents and caregivers to improve the use of restraints for children are also discussed.
The use of proper child restraint systems (CRS) is mandatory for children travelling in cars in most countries of the world. The analysis of the quantity of restrained children shows that more than 90% of the children in Germany are restrained. Looking at the quality of the protection, a large discrepancy between restrained and well protected children can be seen. Two out of three children in Germany are not properly restrained. In addition, considerable difference exists with respect to the technical performance of CRS. For that reason investigations and optimisations on two different topics are necessary: The technical improvement of CRS and the ease of use of CRS. Consideration of the knowledge gained by the comparison of different CRS in crash tests would lead to some improvements of the CRS. But improvement of child safety is not only a technical issue. People should use CRS in the correct way. Misuse and incorrect handling could lead to less safety than correct usage of a poor CRS. For that reason new technical issues are necessary to improve the child safety AND the ease of use. Only the combination of both parts can significantly increase child safety. For the assessment of the safety level of common CRS, frontal and lateral sled tests simulating different severity levels were conducted comparing pairs of CRS which were felt to be good and CRS which were felt to be poor. The safety of some CRS is currently at a high level. All well known products were not damaged in the performed tests. The performance of non-branded CRS was mostly worse than that of the well known products. Although the branded child restraint systems already show a high safety level it is still possible to further improve their technical performance as demonstrated with a baby shell and a harness type CRS.