Common Fractures after a Motor Vehicle Accident
Common Fractures occur in Motor vehicle accidents with high-velocity impacts. There can be fractures to many different bones throughout the body. Often, fractures can be found from head to toe, depending on where the impact was and where the individual was located in the vehicle. Those passengers or the driver with an airbag tend to suffer less from head, neck, and chest fractures but they are still possible, especially if the individual isn’t seat-belted properly.
Skull fractures can happen if the automobile is crushed from the top, crushing those within the vehicle. They are also possible if the individual is ejected from the vehicle and lands on their head some distance away from the car.
Skull fractures can involve just about any part of the skull and can be depressed, with bony fragments pushing on the brain tissue. When there is a documented skull fracture, there is a likelihood of brain injury . Rarely do the fractures themselves require surgical intervention unless there is a depressed skull fracture.
Management of the brain injury takes priority over the skull fracture in the vast majority of cases.
Spinal fractures can be present from the base of the skull to the sacral area of the spine. The biggest danger with spinal fractures is that they can swell and/or dislocate, leading to disruption of the spinal cord, which is normally protected by the various vertebrae of the spine. When the fracture is in the cervical area and results in damage or transection of the spinal cord, the patient sufferers from quadriplegia, which is paralysis and lack of feeling of every part of their body below the neck and/or shoulders. Fractures and cord problems at C1 and C2 of the spine can mean the individual has no control over their breathing so they need continual ventilator support. Spinal cord injury is catastrophic.
Fractures of the thoracic spine with transection or other damage to the spinal cord will yield a patient who is paraplegic with paralysis and lack of sensation below the level of the injury. Bowel and bladder function are disturbed as well.
Fractures of the lumbar spine can yield lesser degrees of paralysis of the legs with bowel and bladder dysfunction in most cases.
Motor vehicle occupants can have fractures of their nose, orbit, cheekbones, midface or mandible. Midface fractures are particular worrisome not because the fractures themselves are so bad but because midface fractures are harbingers of severe injuries elsewhere in the body. Most facial fractures require the assistance of a maxillofacial surgeon who can surgically repair the fracture. Even with good surgical repair, there can be persistent deformities of the face that are life-long.
Rib fractures are common after a significant motor vehicle accident, even in persons who are seat-belted properly. Rib fractures that are not displaced are simply painful and do not pose a threat to the victim; however, displaced rib fractures can puncture the lung, leading to a pneumothorax. If there is a penetrating wound or simply certain kinds of injuries to the lungs, the pneumothorax can be a tension pneumothorax in which the air leaves the lungs into the parietal space but does not exit. This causes compression of the lungs in the chest cavity that increases with each breath.
This can be life threatening if not treated by allowing the air to escape from the parietal space, relieving the compression on the collapsed lung. Rib fractures do not need any special treatment if there is no collapsed lung. Pain medications are given in order to allow the person to take deeper breaths and the patient can be taught how to splint the affected area with pillows during coughing. The greatest risk of a rib fracture besides a pneumothorax is pneumonia from under-breathing and failing to cough well enough to get rid of lung secretions.
Upper Extremity Fractures
People who anticipate a crash and put out their hand or hands to brace themselves can face a variety of upper extremity fractures, depending on where the force of the impact is most felt at. For example, the force on the outstretched arm can be transmitted to the humerus, leading to a proximal humeral fracture or dislocated shoulder. These may need surgical intervention or, in older individuals, the arm is simply reduced and kept in a sling until it heals. The fracture can also happen anywhere along the humerus including the distal humerus in the elbow. These may need pinning or other surgical intervention.
Fractures of the wrist are common when an individual braces themselves for a motor vehicle crash. These can be treated with closed reduction and casting if they are closed fractures. Open fractures require IV antibiotics and possible surgery to bring the fracture fragments into proper positioning for healing. Fractures of any of the fingers or part of the hand are also possible. These are generally treated using closed reduction and casting or splinting, depending on the location of the fracture.
Fractures of the pelvis can happen in a motor vehicle accident, especially if the victim is ejected from the car. Fractures of the pelvis can be stable and require nothing more than pain control because the fracture fragments are in proper alignment and need only time to heal. If the fracture is unstable, surgical intervention may be necessary in order to secure the stability of the pelvis to allow for proper healing over a six week period of time.
Lower Extremity Fractures
An individual in a motor vehicle accident, particularly the driver, may brace themselves with their foot at the time of impact. This can lead to a variety of lower extremity fractures, depending on the degree of force involved in the collision and the exact positioning of the leg at the time of impact. Hip fractures are possible if the forces travel from the foot to the pelvic area and the part of the body that gives out and breaks is the proximal femur, or the hip.
This can be greatly displaced, depending on the amount of force placed on the fractured area. Midshaft femur fractures can happen from side crashes and fractures about the knee can happen if the force of the impact lands on the area of the knee. Knee fractures can involve the distal femur or the proximal tibia and fibula. These are usually treated by orthopedists in the operating room, particularly if there is a great deal of displacement of the bony fracture.
Ankle and foot fractures are also common in motor vehicle accidents. The ankle can be forcibly crushed, everted or inverted, yielding open or closed lateral malleolar, bimalleolar or trimalleolar fractures. Simple distal fibular fractures can be treated with casting and limited ambulation. If the fracture is complex, leaving the ankle unstable, it is treated in the operating room with open repair. Foot fractures are usually quite stable and can be treated with casting, splinting or the wearing of a firm supportive shoe and crutches with minimal weight bearing until the fracture or fractures heal.
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