Under-reporting bicycle accidents to police in the COST TU1101 international survey: Cross-country comparisons and associated factors.

Police crash reports are often the main source for official data in many countries. However, with the exception of fatal crashes, crashes are often underreported in a biased manner. Consequently, the countermeasures adopted according to them may be inefficient. In the case of bicycle crashes, this bias is most acute and it probably varies across countries, with some of them being more prone to reporting accidents to police than others. Assessing if this bias occurs and the size of it can be of great importance for evaluating the risks associated with bicycling. This study utilized data collected in the COST TU1101 action "Towards safer bicycling through optimization of bicycle helmets and usage". The data came from an online survey that included questions related to bicyclists' attitudes, behaviour, cycling habits, accidents, and patterns of use of helmets. The survey was filled by 8655 bicyclists from 30 different countries. After applying various exclusion factors, 7015 questionnaires filled by adult cyclists from 17 countries, each with at least 100 valid responses, remained in our sample. The results showed that across all countries, an average of only 10% of all crashes were reported to the police, with a wide range among countries: from a minimum of 0.0% (Israel) and 2.6% (Croatia) to a maximum of a 35.0% (Germany). Some factors associated with the reporting levels were type of crash, type of vehicle involved, and injury severity. No relation was found between the likelihood of reporting and the cyclist's gender, age, educational level, marital status, being a parent, use of helmet, and type of bicycle. The significant under-reporting - including injury crashes that do not lead to hospitalization - justifies the use of self-report survey data for assessment of bicycling crash patterns as they relate to (1) crash risk issues such as location, infrastructure, cyclists' characteristics, and use of helmet and (2) strategic approaches to bicycle crash prevention and injury reduction.

Synaptic and cellular changes induced by the schizophrenia susceptibility gene G72 are rescued by N-acetylcysteine treatment.

Genetic studies have linked the primate-specific gene locus G72 to the development of schizophrenia and bipolar disorder. Transgenic mice carrying the entire gene locus express G72 mRNA in dentate gyrus (DG) and entorhinal cortex, causing altered electrophysiological properties of their connections. These transgenic mice exhibit behavioral alterations related to psychiatric diseases, including cognitive deficits that can be reversed by treatment with N-acetylcysteine, which was also found to be effective in human patients. Here, we show that G72 transgenic mice have larger excitatory synapses with an increased amount of N-methyl-d-aspartate (NMDA) receptors in the molecular layer of DG, compared with wild-type littermates. Furthermore, transgenic animals have lower number of dentate granule cells with a parallel, but an even stronger decrease in the number of excitatory synapses in the molecular layer. Importantly, we also show that treatment with N-acetylcysteine can effectively normalize all these changes in transgenic animals, resulting in a state similar to wild-type mice. Our results show that G72 transcripts induce robust alterations in the glutamatergic system at the synaptic level that can be rescued with N-acetylcysteine treatment.

[Prevention of bicycle accidents]. / Prävention von Fahrradfahrerunfällen.

For a very precise analysis of all injured bicyclists in Germany it would be important to have definitions for "severely injured", "seriously injured" and "critically injured". By this, e.g., two-thirds of surgically treated bicyclists who are not registered by the police could become available for a general analysis. Elderly bicyclists (> 60 years) are a minority (10 %) but represent a majority (50 %) of all fatalities. They profit most by wearing a helmet and would be less injured by using special bicycle bags, switching on their hearing aids and following all traffic rules. E-bikes are used more and more (145 % more in 2012 vs. 2011) with 600,000 at the end of 2011 and are increasingly involved in accidents but still have a lack of legislation. So even for pedelecs 45 with 500 W and a possible speed of 45 km/h there is still no legislative demand for the use of a protecting helmet. 96 % of all injured cyclists in Germany had more than 0.5 ‰ alcohol in their blood, 86 % more than 1.1 ‰ and 59 % more than 1.7 ‰. Fatalities are seen in 24.2 % of cases without any collision partner. Therefore the ADFC calls for a limit of 1.1 ‰. Some virtual studies conclude that integrated sensors in bicycle helmets which would interact with sensors in cars could prevent collisions or reduce the severity of injury by stopping the cars automatically. Integrated sensors in cars with opening angles of 180° enable about 93 % of all bicyclists to be detected leading to a high rate of injury avoidance and/or mitigation. Hanging lamps reduce with 35 % significantly bicycle accidents for children, traffic education for children and special trainings for elderly bicyclists are also recommended as prevention tools. As long as helmet use for bicyclists in Germany rates only 9 % on average and legislative orders for using a helmet will not be in force in the near future, coming up campaigns seem to be necessary to be promoted by the Deutscher Verkehrssicherheitsrat as, e.g., "Helmets are cool". Also, spots in TV should be broadcasted like "The 7th sense" or "Traffic compass", which were warning car drivers many years ago of moments of danger but now they could be used to warn bicyclists of life-threatening situations in traffic.

Chronic nicotine improves short-term memory selectively in a G72 mouse model of schizophrenia.

BACKGROUND AND PURPOSE: The prevalence of smoking in schizophrenia patients is exceptionally high; it is not known why but many researchers suggest that smoking constitutes a form of self-medication. Among the symptoms of schizophrenia that may be improved by nicotine are cognitive deficits. Hence, we studied the effects of long-term nicotine administration on cognition in a genetic animal model of schizophrenia susceptibility, G72-transgenic (G72Tg) mice. EXPERIMENTAL APPROACH: The effect of long-term nicotine or saline, administered by osmotic minipumps, on different cognitive domains was assessed in G72Tg mice and controls using a battery of behavioural tests. To investigate the mechanism underlying phenotypic differences, quantitative autoradiographic mapping of nACh receptor subtypes was performed in forebrain structures to explore effects of chronic nicotine exposure on nACh receptor density in wild-type (WT) and G72Tg mice. KEY RESULTS: Genotype significantly affected the cognitive effects of chronic nicotine administration. Whereas chronic nicotine disrupted cognitive performance in WT mice, it was effective at restoring impaired prepulse inhibition, working memory and social recognition in G72Tg mice. However, long-term spatial learning was further impaired by nicotine in transgenic animals. In contrast, associative learning was protected by G72-expression against the adverse nicotine effects seen in WT animals. G72-expression did not decisively influence nicotine-induced up-regulation of the α4ß2*subtype, whereas α7nACh receptor density was differentially altered by genotype or by a genotype·treatment interaction in specific brain areas, most notably hippocampal subregions. CONCLUSIONS AND IMPLICATIONS: Our data support the hypothesis that nicotine self-medication of schizophrenics improves cognitive symptoms, possibly by facilitating nicotine-induced α7nACh receptor activation in the hippocampus.

Mechanisms of motor vehicle crashes related to burns--an analysis of the German In depth Accident Study (GIDAS) database.

BACKGROUND: Patients of motor vehicle crashes (MVCs) suffering burns are challenging for the rescue team and the admitting hospital. These patients often face worse outcomes than crash patients with trauma only. Our analysis of the German In-depth Accident Study (GIDAS) database researches the detailed crash mechanisms to identify potential prevention measures. METHODS: We analyzed the 2011 GIDAS database comprising 14,072 MVC patients and compared individuals with (Burns) and without (NoBurns) burns. Only complete data sets were included. Patients with burns obviously resulting of air bag deployment only were not included in the Burns group. Data acquisition by an on call team of medical and technical researchers starts at the crash scene immediately after the crash and comprises technical data as well as medical information until discharge from the hospital. Statistical analysis was done by Mann-Whitney-U-test. Level of significance was p < 0.05. RESULTS: 14,072 MVC patients with complete data sets were included in the analysis. 99 individuals suffered burns (0.7%; group "Burns"). Demographic data and injury severity showed no statistical significant difference between the two groups of Burns and NoBurns. Injury severity was measured using the Injury Severity Score (ISS). Direct frontal impact (Burns: 48.5% vs. NoBurns: 33%; p < 0.05) and high-energy impacts as represented by delta-v (m/s) (Burns: 33.5 ± 21.4 vs. NoBurns: 25.2 ± 15.9; p < 0.05) were significantly different between groups as was mortality (Burns: 12.5% vs. NoBurns: 2.1%; p < 0.05). Type of patients' motor vehicles and type of crash opponent showed no differences. CONCLUSIONS: Our results show, that frontal and high-energy impacts are associated with a frequency of burns. This may serve automobile construction companies to improve the burn safety to prevent flames spreading from the motor compartment to the passenger compartment. Communities may impose speed limits in local crash hot spots.

Motorcycle riders' perception of helmet use: complaints and dissatisfaction.

In accidents which involve two-wheeled vehicles the helmet plays a life-saving role, but very little is known about the motorcycle rider's perception of the helmet. We evaluated the relationships between having been involved in an accident and dissatisfaction with the helmet, and between the perception of motorcycle riders and the objective features of the helmet. This was a case-control study: riders of motorized two-wheelers who had been involved in accidents (accident cases) were compared against a similarly interviewed sample of riders that had not been in accidents (control cases). Information about the driver, the vehicle and the helmet was collected in all interviews. To evaluate the relationships, logistic regressions were carried out. The majority of drivers were dissatisfied with their helmets, but no evidence was found to link this dissatisfaction with having been involved in an accident. The two most common complaints related to noisiness, followed by the helmet visor. Complaints did not seem to be statistically associated with physical features of the helmet.

[Prevention of road accidents involving non-motorized traffic participants (pedestrians and cyclists) in Germany]. / Prävention von Verkehrsunfällen äußerer Verkehrsteilnehmer (Fußgänger und Fahrradfahrer) in Deutschland.

During a 1-day workshop organized by the German Society of Orthopaedics and Traumatology (DGOU) 15 German accident researchers used different approaches to improve the effectiveness of accident prevention for pedestrians and bicyclists on German roads. The main results of this analysis show: Fatal injuries of pedestrians have been significantly reduced by 82% between 1970 (n=6.056) and 2007 (n=695). Similarly, fatalities of bicyclists have been reduced during the same time period from 1,835 to 425 which amount to almost 80%. However, the total number of injured cyclists increased almost twice, i.e. from 40,531 (in 1979) to 78,579 (in 2007) a fact that needs to be analyzed in more detail. Although scientifically proven to provide protection against severe head injuries, helmets are worn less frequently by adolescents and women as compared to younger children and men. Fatalities of bicyclists might be reduced by using Dobli mirrors which allow the truck driver to see the bicyclist when turning right. Recently developed sensors are able to detect pedestrians walking closely (<2.5 m) and warn the truck driver acoustically. Bicycle lanes should be planned for one direction only, separated from the pedestrian way and large enough (2.0 m are safer than 1.6 m). Traffic education for school beginners and younger children should be repeated to be effective. Training for elderly bicyclists in cities with heavy traffic would also be reasonable. Active security systems in cars like ESP (electronic stability program), BAS (brake assist system), special light systems for curves, and night vision utilities are most effective to prevent collision with pedestrians and bicyclists. TV spots for bicyclists could help to point out dangerous situations and the proven benefits of wearing a helmet in the same way as previous campaigns, e.g."The 7th Sense" for car drivers.

[Quad driving--life-endangering fun? A medical and technical analysis]. / Quad-Fahren--ein lebensgefährlicher Spaß? Eine medizinische und technische Unfallanalyse.

AIM: Quads or all-terrain vehicles do not seem to play a major role either in traffic accidents or in hospital admissions in Germany. However, reports about spectacular quad crashes in the press are not that infrequent. In contrast, no scientific survey or study regarding the issue of quad crashes in Germany has been published so far. Thus, this study aims to evaluate the present incidence of quad crashes, accident circumstances and resulting injury patterns, and to discuss possible consequences. METHOD: At a level I trauma centre, data from accident and hospital records of quad drivers were analysed focusing on the following parameters: injury type, localisation and mechanism, treatment details, abbreviated injury scale (AIS) score, maximum AIS (MAIS) score, delta-v, collision speed, and other technical parameters. Comparisons to motorcycle accidents were performed. RESULT During a five-year period from 2005 to 2009, there were ten admissions of quad drivers out of around 11 000 emergency trauma patients (0.1 %). Five accidents had happened off-road, four were traffic accidents. Eight patients were male; the mean age was 30 years. The mean total hospital stay was 15 days; there was a mean of 1.5 stays per patients with 2.0 surgical procedures needed. One patient died, only two recovered fully. The accident research data bank revealed 14 cases of quad accidents out of 18 990 (0.1 %). The mean impact velocity was 35 km/h (motorcyclists 40.0 km/h). The most frequent injury mechanism was a collision with a car. The upper extremity was the predominant injured region (AIS 0.7), while it was the lower extremity for motorcyclists (AIS0.91). The maximum AIS were 1.4 in quad drivers and 1.49 in motorcyclists. CONCLUSIONS: Although the absolute incidence of quad accidents in Germany is low, they pose a relatively high risk for severe injuries. Possible reasons are the comparatively low active and passive safety of quads as well as limited experience with quad driving and the "fun" aspect which might provoke risky driving behaviour. Larger series from the US report a high incidence of drug abuse among quad casualties as well as very limited use of helmets. In Germany, helmet usage has been mandatory since 2006. Possible additional measures to prevent a rise in quad accidents could be the total prohibition of alcohol consumption for quad drivers as well as special courses or driving licenses or an increase of the legal age for driving quads.

[The Abbreviated Injury Scale (AIS). Options and problems in application]. / Die Abbreviated Injury Scale (AIS). Potenzial und Probleme bei der Anwendung.

The new AIS (Abbreviated Injury Scale) was released with an update by the AAAM (Association for the Advancement of Automotive Medicine) in 2008. It is a universal scoring system in the field of trauma applicable in clinic and research. In engineering it is used as a classification system for vehicle safety. The AIS can therefore be considered as an international, interdisciplinary and universal code of injury severity. This review focuses on a historical overview, potential applications and new coding options in the current version and also outlines the associated problems.

[Injury situation of novice drivers in road traffic--a medical and technical analysis]. / Verletzungssituation von Fahranfängern im Strassenverkehr - eine medizinische und technische Unfallanalyse.

AIM: Novice drivers are at high risk for crash involvement. We performed an analysis of causations, injury patterns and distributions of novice drivers in cars and on motorcycles in road traffic as a basis for proper measurements. METHOD: Data of accident and hospital records of novice drivers (licence < 2 years) were analysed focusing on the following parameters: injury type, localisation and mechanism, abbreviated injury scale (AIS), maximum AIS (MAIS), delta-v, collision speed and other technical parameters and compared with those of experienced drivers. RESULTS: In 18 352 accidents in the area of Hannover (years 1985-2004), 2602 novice drivers and 18 214 experienced drivers were recorded as having an accident. Novice car drivers were more often and more severely injured whereas on motorcycles the experienced drivers were at higher risk. Novice drivers of both groups sustained more often extremity injuries. 4.5 % of the novice car drivers were not restrained by seatbelts as compared to 3.7 % of the experienced drivers and 6.1 % of the novice motorcycle drivers did not wear a proper helmet (versus 6.5 %). Severe injuries were sustained in 20 % at collision speeds below 30 km/h and in 80 % at collision speeds above 50 km/h. Novice car drivers drove significantly older cars. The risk profile of novice drivers is similar to that of drivers older than 65. CONCLUSION: Structural protection and special lectures like skidding courses could be proper measurements next to harder punishment of violations.

[Trauma and accident documentation in Germany compared with elsewhere in Europe]. / Trauma- und Unfalldokumentation in Deutschland. Eine Standortbestimmung im europäischen Vergleich.

BACKGROUND: The role of trauma documentation has grown continuously since the 1970s. Prevention and management of injuries were adapted according to the results of many analyses. Since 1993 there have been two different trauma databases in Germany: the German trauma registry (TR) and the database of the Accident Research Unit (UFO). Modern computer applications improved the data processing. Our study analysed the pros and cons of each system and compared them with those of our European neighbours. METHODS: We compared the TR and the UFO databases with respect to aims and goals, advantages and disadvantages, and current status. Results were reported as means +/- standard errors of the mean. The level of significance was set at P<0.05. RESULTS: There were differences between the two databases concerning number and types of items, aims and goals, and demographics. The TR documents care for severely injured patients and the clinical course of different types of accidents. The UFO describes traffic accidents, accident conditions, and interrelations. The German and British systems are similar, and the French system shows interesting differences. DISCUSSION: The German trauma documentation systems focus on different points. Therefore both can be used for substantiated analyses of different hypotheses. Certain intersections of both databases may help to answer very special questions in the future.

Sternal fractures are frequent among polytraumatised patients following high deceleration velocities in a severe vehicle crash.

INTRODUCTION: Sternal fractures are a rare entity. We hypothesised that a sternal fracture is an indicator of injury severity following traffic accidents. METHODS: Analysis of technical indicators of the collision, preclinical and clinical data of patients with sternal fractures from 1985 to 2004 among 42,055 injured patients assessed by an Accident Research Unit. RESULTS: Only 267/42,055 patients (0.64%) suffered a sternal fracture within the 20-year period. Soft tissue bruises are most often concomitant injuries (55%), followed by cervical spine injuries (23%), multiple rib fractures (14%) and lung injuries (12%). Eighteen percent of patients were polytraumatised, with 11.2% dying at the scene, 2.3% in hospital. Deceleration velocity (DeltaV) was significantly correlated with injury severity score (ISS, r2=0.92, y=0.408x-4.1573) as with maximal abbreviated injury scale (MAIS, r2=0.81). Patients suffering a sternal fracture being polytraumatised had significantly higher deceleration velocity (60+/-17km/h versus 37+/-16km/h [37.3+/-10.6mph versus 23+/-9.9mph], p=0.0001). Patients dying with a sternal fracture had a significant higher deceleration velocity (61km/h, 37.9mph) versus those surviving (38km/h, 23.6mph, p=0.0001). Regarding the vehicle type, the majority occurred after car accidents in 0.81% (251/31,183 patients), followed by 0.19% (5/2633 patients) driving motorbikes, and 0.11% (4/3258 patients) driving a truck. Only 13% of all passengers suffering a sternal fracture had an airbag on board (33/255 car/trucks), with an airbag malfunction in 18%. 22% were not admitted to hospital, 28% were admitted to a trauma ICU with a sternal fracture. CONCLUSION: In 1/5 of cases sternal fractures encountered in polytraumatised patients following significantly higher deceleration velocities during the crash. Typically car drivers without a functioning airbag suffer a sternal fracture.

[Motor vehicle accidents with entrapment. A medical and technical investigation of crash mechanism, injury pattern and severity of entrapment of motor vehicle occupants between 1983 and 2003]. / "Einklemmungstrauma" im Strassenverkehr. Unfallanalyse, Verletzungsschwere und -verteilung eingeklemmter PKW- und LKW-Insassen der Jahre 1983-2003.

AIM: Crash mechanisms, injury patterns, and severity of injury of entrapped motor vehicle occupants were analysed by the Accident Research Unit's scientific teams between 1983 and 2003. RESULTS: Of the 1281 vehicle passenger entrapments in our study, 18.3% happened on highways, 25.6% on federal roads, 35.9% on country roads, and 18.3% on city roads. Of those involved, 69.9% were drivers, 19.4% were front passengers, and 8.5% were rear passengers. Coinvolved objects in car collisions were: other cars 30.9%, trucks 50.2%, objects 18.6%, and motorbikes 0.3%. Coinvolved objects in truck collisions were: other trucks 61.8% and objects 38.2%. The mean Delta-V was 42 km/h (cars 46.2, trucks 32.2). Maximum AIS levels were 31% I, 25.2% II, 19.4% III, 7.8% IV, 7.8% V, and 8.6% VI. Of injuries, 68.7% were to the head, 23.5% to the neck, 50.8% to the chest, 43.6% to upper extremities, 15.4% to the abdomen, 16.4% to the pelvis, and 52.9% to lower extremities. The incidence of multiple injuries (ISS>16) was 23.7%, and mortality was 15.9%. CONCLUSION: Car drivers are more at risk of accidents with entrapment on rural streets, and truck drivers are more at risk on highways. In most cases car occupants crash with trucks or other cars, and truck drivers collide more frequently with other trucks or objects. Besides a high degree of severe single injuries, there is also a high incidence of multiple injury victims and high mortality. Of the fatalities, 74.5% occur during the preclinical course and 24.5% during the clinical course.

Characteristics on fractures of tibia and fibula in car impacts to pedestrians and bicyclists - influences of car bumper height and shape.

This study deals with the analysis of lower leg fractures in pedestrians and bicyclists after collisions with passenger cars and examines to what extent the shape and location of the fractures in the lower leg changed, following alterations in the shape of bumpers. It can be assumed that that the bumpers changed in shape and effective impact height, not least due to the realization of the developments of vehicle safety tests as in the context of the European Union Directive 2003/102/EC on pedestrian protection. In addition, consumer protection tests, EuroNCAP, accomplished a change of the injury situation. All of these are mainly focused on pedestrian protection measurements but adopt the bicyclists also in their goal. For the study, traffic accidents from GIDAS (German in-Depth-Accident Study) were selected, which had been documented in the years 1995 to 2004 by scientific teams in Hannover and Dresden (Germany) and for which there is detailed information regarding injury patterns and collision speeds. The accident documentations can be regarded as representative and constitute a random sample with statistic weighing of the data. Altogether 143 cases of lower leg fractures (Tibia/ Fibula) with x-rays of pedestrians and 79 cases of bicyclists were differentiated according to new and old vehicles (year of manufacture before/after 1995). The bumper shapes were divided into classical types (protruding pronouncedly/ protruding integrated /integrated rounded). Besides the injuries to the lower leg, those to thighs and feet were also regarded, and the injury conditions involving the head and trunk were included in the kinematic analytics.

[Knee injuries of vulnerable road users in road traffic]. / Kniegelenkverletzungen des ungeschützten Verkehrsteilnehmers im Strassenverkehr.

BACKGROUND: The purpose of this study was to assess the risk of knee injuries among vulnerable road users, such as pedestrians, bicyclists and motorcyclists. METHODS: Two different periods (years 1985-1993 and 1995-2003) were compared. Inclusion criteria were furthermore Abbreviated Injury Scale knee 2-3 (AIS(knee)). Technical analysis assessed the type of collision, direction and speed as well as the injury pattern, and different injury scores (AIS, ISS) were examined documented by the accident research unit, which analyses technical and medical data collected shortly after the accident at the scene. This study included 2,580 pedestrians, 2,279 motorcyclists and 4,322 bicyclists from a total number of 22,794 victims in 17,382 accidents. RESULTS: Among vulnerable road users, 2% (196/9181 patients) had serious ligamentous or bony injuries of the knee. The risk of injury was higher for motorcyclists and bicyclists than for pedestrians. Knee injury severity was higher for pedestrians. Over the course of 18 years, the knee injury risk was significantly reduced in more recent times (35%>28%, p<0.0001). Improved aerodynamic design of car fronts reduced the risk for severe knee injuries significantly (p=0.0015). CONCLUSIONS: The highest risk for knee injuries among vulnerable road users is encountered by motorcyclists followed by bicyclists and pedestrians. Over time, the knee injury risk for pedestrians could be significantly reduced due to aerodynamic changes of current car fronts. Further modification of the exterior car design might decrease the risk for knee injuries among vulnerable road users.

Correlation of clinical findings, collision parameters, and psychological factors in the outcome of whiplash associated disorders.

OBJECTIVE: To determine prognostic factors for the duration and severity of acute symptoms in subjects with grade 1 or 2 whiplash injuries. METHODS: Collision victims presenting to a trauma centre with spinal pain or stiffness were assessed clinically (including a visual analogue scale (VAS)), radiologically, and psychologically (short form 36 (SF36), everyday life quality (EDLQ), pain control questionnaire (FSR)). Collision type and estimated DeltaV (change in velocity of the occupant's vehicle) were also assessed. Assessment at six months involved VAS symptom rating, SF36, EDLQ, depression scale (CES-D), and impact of event scale (IES). RESULTS: 43 consecutive collision victims (22 male, 21 female; mean age 29 years (range 19 to 72) with grade 1 or 2 whiplash associated disorders were assessed. Mean DeltaV, available for 36 of 43 collisions, was 13.9 (5 to 30) km/h. Thirty two (74%) of the subjects were available for follow up at six months. The mean duration of symptoms was 28 (1 to 180) days in this group. No correlation was found between severity and duration of symptoms and the DeltaV of collision or other collision parameters. Patients with initial pain VAS >5 or with duration of symptoms more than 28 days had significant changes in SF36, EDLQ, CES-D, and IES scores at six months, and had initial scores that were predictive of these outcomes. CONCLUSIONS: Psychological factors were found to be more relevant than collision severity in predicting the duration and severity of symptoms in collision victims with grade 1 or 2 whiplash associated disorders.

[Changes in the injury pattern of polytraumatized patients over the last 30 years]. / Anderung des Verletzungsmusters Polytraumatisierter in den zurückliegenden 30 Jahren.

This study aims at describing the changes in injury patterns in traffic accidents in Germany that have taken place over a 30 year period. The basis for the analysis is the in-depth investigations by the scientific research team at the Trauma Department of the Hanover Medical School. Real accidents were investigated based on an on site random selection process. The study includes 1,235 accidents from 1973 to 1978 and 5,608 accidents from the years 1994 to 1999. A reduction in number of fatalities, as well as a change in the injury pattern and the time of death in fatalities was observed. In the earlier years, 54.2% of the fatalities occurred during hospital treatment, whereas in the currant years 78.8% of the fatalities occurred directly at the accident scene and were mainly caused by much higher impact levels. In the earlier group, the polytraumatised patients suffered injuries of AIS 3+ to nearly all body regions (head 69.6%, thorax 69.2%, abdomen 51.9%, pelvis 33.1% and lower extremities 51.9%), whereas today only the head and chest are dominant injury locations for life-threatening trauma. Analysis of the collision configuration showed that nowadays the impact of cars against structures with a low profile such as poles and trees is responsible for the majority of severe, life-threatening injuries, whereas other injury patterns are of minor importance. For pedestrians and cyclists, the impact of the body on the windscreen of the car is the major reason for severe injuries. We conclude that the currently used safety methods have led to a change in the injury pattern of polytraumatised victims. Injuries with much higher energy levels can nowadays be survived, but when the safety limits are exceeded immediate death at the scene is more common.

Possibilities for load reductions using garment leg protectors for motorcyclists -- a technical, medical and biomechanical approach.

This study has considered demands placed on protective clothes for motorcyclists together with observed benefits and limitations for absorbing loads and preventing injuries. In this study, 1933 accidents involving injured motorcyclists, collected by an in-depth investigation team at ARU-MUH, were analysed to find the detailed injury patterns comparing persons with and without protective clothes. The parameters influencing the force reduction are discussed comparing impact speed, elasticity coefficient and thickness of the materials used in special protectors. Additionally, post mortem human tests were carried out to find the effectiveness of such protector devices for load reductions in the lower leg. This study showed that loads, and the subsequent risk of fractures, can be reduced efficiently by foam-plate systems. Benefits were established for using a laminate of hard and soft materials for protection against soft tissue injuries both in the accident analysis and experimental tests.

Plantar impact causing midfoot fractures result in higher forces in Chopart's joint than in the ankle joint.

PURPOSE: Force effect (impact, extent of foot compartment deformation) and result (fracture pattern) for midfoot fractures in car occupants is known. An analysis of the processes in the foot was intended to improve car safety. MATERIALS AND METHODS: Eleven fresh, unfrozen, unpreserved intact human cadavers (age: 36.8 (16-61) years, gender: male, race: Caucasian) were studied 24-72 h after death. In 3 cadavers (5 feet) the experimental design was established: entire cadaver fixed on a special tray in supine position, pendulum with bar impactor hitting the foot plantar to Lisfranc's joint. A custom-made pressure sensor was inserted in the ankle (A), talonavicular (TN) and calcaneocuboid (CC) joints (resolution: 1 cm2, sampling rate: 500/s). RESULTS: Sixteen feet were measured: midfoot fractures were induced in 11 feet. The maximum pressure amounted to 1.22-2.55 MPa (2.04+/-0.412) at 0.005 0.195 s (0.067+/-0.059) after impact. The maximum pressure occurred in 8 (50%) cases in the ankle, in 7 (44%) of the TN and 1 (6%) of the CC joints. A comparison of the first 200 pressure samples after impact of all sensor fields resulted in higher forces in Chopart's joint than in the ankle (t-test: p < 0.001). These force differences were higher in cases with midfoot fractures (mixed model analysis of variance: p = 0.003). CONCLUSION: Due to considerable forces in Chopart's joint we recommend a modification of the actual crash test dummy lower extremity model with an additional load cell that detects forces in the longitudinal direction of the foot axis.

Head injury mechanisms in helmet-protected motorcyclists: prospective multicenter study.

BACKGROUND: In a prospective study, three research groups at Hannover (H) and Munich (M) in Germany and Glasgow (G) in the United Kingdom collected data from motorcycle crashes between July 1996 and July 1998 to investigate head injury mechanisms in helmet-protected motorcyclists. METHODS: The head lesions of motorcyclists with Abbreviated Injury Score-Head (AISHead) 2+ injuries and/or helmet impact were classified into direct force effect (DFE) and indirect force effect (IFE) lesions. The effecting forces and the force consequences were analyzed in detail. RESULTS: Two-hundred twenty-six motorcyclists (H, n = 115; M, n = 56; and G, n = 55) were included. Collision opponents were cars (57.8%), trucks (8.0%), pedestrians (2.3%), bicycles (1.4%), two-wheel motor vehicles (0.8%), and others (4.2%). In 25.4% no other moving object was involved. The mean impact speed was 55 km/h (range, 0-120 km/h) and correlated with AISHead. Seventy-six (33%) motorcyclists had no head injury, 21% (n = 48) AISHead 1, and 46% (n = 103) AISHead 2+. Four hundred nine head lesions were further classified: 36.9% DFE and 63.1% IFE. Lesions included 20.5% bone, 51.3% brain, and 28.1% skin. The most frequent brain lesions were subdural hematomas (22.4%, n = 47) and subarachnoid hematomas (25.2%, n = 53). Lesions of skin or bone were mainly DFE lesions, whereas brain lesions were mostly IFE lesions. CONCLUSION: A modification of the design of the helmet shell may have a preventative effect on DFE lesions, which are caused by a high amount of direct force transfer. Acceleration or deceleration forces induce IFE lesions, particularly rotation, which is an important and underestimated factor. The reduction of the effecting forces and the kinetic consequences should be a goal for future motorcycle helmet generations.