Injury severity of e.g. pedestrians or bikers after crashes with cars that are reversing is almost unknown. However, crash victims of these injuries can frequently be seen in emergency departments and account for a large amount of patients every year. The objective of this study is to analyze injury severity of patients that were crashed into by reversing cars. The Hannover Medical School local accident research unit prospectively documented 43,000 road traffic accidents including 234 crashes involving reversing cars. Injury severity including the abbreviated injury scale (AIS) and the maximum abbreviated injury scale (MAIS) was analyzed as well as the location of the accident. As a result 234 accidents were included into this study. Pedestrians were injured in 141 crashes followed by 70 accidents involving bikers. The mean age of all crash victims was 57 -± 23 years. Most injuries took place on straight stretches (n = 81) as well as parking areas (n = 59), entries (n = 36) or crossroads (n = 24). The AIS of the lower extremities was highest followed by the upper extremities. The AIS of the neck was lowest. The mean MAIS was 1.3 -± 0.6. The paper concludes that the lower extremities show the highest risk to become injured during accidents with reversing cars. However, the risk of severe injuries is likely low.

Still correlated with high mortality rates in traffic accidents traumatic aortic ruptures were frequently detected in unprotected car occupants in the early years. This biomechanical analysis investigates the different kinds of injury mechanisms leading to traumatic aortic injuries in todays traffic accidents and how the way of traffic participation affects the frequency of those injuries over the years. Based on GIDAS reported traffic accidents from 1973 to 2014 are analyzed. Results show that traumatic aortic injuries are mainly observed in high-speed accidents with high body deceleration and direct load force to the chest. Mostly chest compression is responsible for the load direction to the cardiac vessels. The main observed load vector is from caudal-ventral and from ventral solely, but also force impact from left and right side and in roll-over events with chest compression lead to traumatic aortic injuries. Classically, the injury appeares at the junction between the well-fixed aortic arch and the pars decendens following a kind of a scoop mechanism, a few cases with a hyperflexion mechanism are also described. In our analysis the deceleration effect alone never led to an aortic rupture. Comparing the past 40 years aortic injuries shift from unprotected car occupants to today's unprotected vulnerable road users like pedestrians, cyclists and motorcyclists. Still the accident characteristics are linked with chest compression force under high speed impact, no seatbelt and direct body impact.

Introduction: The incidence of trauma-related cervical-spine fractures is 19-88 / 100.000. In contrast, the incidence of cervical spine injuries is as high as 19% - 51% of all spinal trauma. Cervical spine injuries in non-polytrauma patients are rare. However, due to the potential damage to the spinal cord these traumata are feared and mustn't be missed. Cervical spine injuries represent the highest reported early mortality rate of all spinal trauma. The rate of functional impairment afterwards is high and the rate of reintegration into work is low compared to other organ systems. In the past, trauma surgeons often did x-rays of the cervical spine with low inhibition threshold and often without strong clinical suggestion for vertebral or discoligamental injuries. This practice was queried by the Canadian C-Spine rule and extensively discussed in the past. Therefore we did a retrospective study whether non-polytrauma patients benefit from cervical spine x-rays.