Patterns of skeletal trauma resulting from motor vehicle collisions: a scoping literature review

As a leading cause of fatality, motor vehicle collisions comprise a significant proportion of medico-legal cases worldwide. During death investigations into such events, forensic practitioners may be asked to make inferences about the relationship between traumatic injuries and the circumstances of the collision. These interpretations require a thorough understanding of the hard and soft tissue blunt force trauma that results from vehicle collisions. This scoping literature review aimed to assess what is currently known about skeletal fracture patterns in occupants of fatal motor vehicle collisions and how contextual variables influence those fractures. Upon screening the search results from several databases based on a set of pre-defined inclusion criteria, 133 articles were identified including case reports, case series and large empirical studies. Most studies investigated car occupants, followed by motorcyclists, with very few focusing on heavy vehicle occupants. Fractures patterns observed comprised a high prevalence of rib, lower limb, and skull fractures in motorcyclists and a high frequency of skull, vertebral and rib fractures in car occupants, whilst pectoral girdle fractures were rare in both occupant types. The level of contextual detail about the collision varied between studies, with most failing to consider the influence of occupant and crash-related variables on resulting fractures. Further, there was a strong focus on soft tissue trauma and a lack of differentiation between fractures in deceased adult vehicle occupants and other groups. The minimal fracture data available in these studies provides limited assistance to forensic practitioners interpreting motor vehicle collision trauma. Additional research on fracture patterns in the context of the variables that influence trauma is recommended.