Book Review: Motor Vehicle Collision Injuries

Some topics are so vast we cannot hope to cover them in this journal. Occasionally we come across a book of note in the medical/legal field and will use this opportunity to notify you of such discoveries.

Motor Vehicle Collision Injuries by Lawrence S. Nordhoff, Jr. (Aspen Publishers, Inc., 1996) is a resource which provides extensive useful information in the medical/legal context. It was brought to our attention by a local medical doctor.

This book seeks to fill a void by focusing on the latest studies of the minor, non-fatal injuries, which Occur in over 90% of auto collisions and account for over one-half the associated costs. The mulch-disciplinary panel of contributors (including seven medical doctors, six doctors of chiropractic medicine, an engineer and an attorney) covers diagnosis, management strategies, prognosis, and mechanisms of injuries.

Not surprisingly, spinal injuries are the primary concern. Chapters are devoted to: diagnosis of common crash injuries; radiological evaluation of cervical spine trauma; imaging of hyper-extension injuries to the spine; neurodiagnosis for neck injuries: soft tissue healing/repair and clinical methods to objectively document soft tissue abnormality and recovery; rehabilitation of cervical-thoracic injuries; post-MVA disabilities and prognoses; medicolegal reports; going to court; collision dynamics of vehicles and occupants; and cost-effective management of car crash injuries, headaches and low back pain, among others.

Another purpose of the book is to dispel myths, misconceptions and erroneous judgments about these types of injuries, Such as “drunks don’t get injured as much”; “the amount of injury is directly proportionate to the amount of damage to the car”; and “few residual spinal problems result from MVA injuries.”

We found the chapter on collision dynamics of vehicles and occupants enlightening and would like to pass along some of the findings documented there:

“The assumption that injuries relate to the amount of external vehicle damage has no scientific basis.” In fact, there can be a very strong inverse correlation between visible vehicle damage and injury levels. Designing vehicles not only to protect occupants but also to reduce repair costs in low-speed collisions creates an inherent conflict. As the vehicle becomes stiffer, damage costs are reduced, but the occupant experiences a more violent “ride down,” increasing the potential for injury.

There is little correlation, for example, between neck injury and vehicle damage in low-speed rear-end collisions. Neck strains can occur from very minor crashes even where there is almost no vehicle damage. There are a number of factors, ranging from the speed and vector of the crash and the construction of the vehicle to the head restraint positioning and the victim’s awareness of the impending crash.

Contrary to the “relaxed drunk” theory, at low collision velocities, bracing for a crash can reduce injury. One study showed that occupants who were aware of the impending rear-end crash had less severe injuries and were considerably less at risk for persisting symptoms.

Recently more research has focused on the low-speed rear-end crash. Studies have shown not only the rapid extension and flexion of the neck with the accelerating and decelerating motion of the head – which we call “whiplash” – but also the elastic rebound properties of seat backs, head restraints and bumper systems contribute to occupant motion and increase the potential for injury.

Studies of low velocity rear-end crashes under 8 mph where head restraints are low or absent show the occupant’s head extending beyond anatomic limits and the tolerance of soft tissues. Even collisions at speeds as low as 1.6 mph may be potentially dangerous.

Several studies have also shown that use of seat belts actually increases the risk of neck injuries.

All these findings are thoroughly documented by numerous scientific studies including simulations, reconstructions, medical case studies and low impact studies utilizing live human volunteers. There are 173 footnotes in the chapter on collision dynamics alone!

Amply illustrated with photographs, drawings, graphs and charts, Dr. Nordhoff’s comprehensive text seems to us to be a resource you could refer to time and again, whether you are treating, diagnosing and managing the care of your accident-victim patient or preparing to testify for your patient’s personal injury claim.

This article was prepared by Dennis H. Black