Motorcycle Accidents

There is a classic line that goes, "Buy your son a motorcycle for his last birthday." This, in a way, summarizes motorcycle accidents. The motorcycle, by its design, is intrinsically dangerous. An accident that might result in minor injuries with an automobile can result in death with a motorcycle. Approximately 6% of all traffic fatalities involve motorcycles.12 In accidents involving automobiles, the most dangerous thing that can happen to an individual is to be ejected from the vehicle. Motorcycles involved in accidents always eject their operators or passengers. Individuals dying in motorcycle accidents typically die of either head or neck injuries, with the former more common. There are usually extensive skull fractures, predominantly basal. The injuries occur from impacting the ground or another object, e.g., a curb or a lamppost. If the individuals are not wearing protective clothing, and even when they are, there can be extensive confluent scrape-like abrasions as they slide across the pavement. An incision into this area typically reveals no underlying subcutaneous hemorrhage, because these injuries are very superficial and limited to the skin (Figure 4.1). Passengers falling off the backs of moving motorcycles typically have lacerations of the back of the head, fractures of the posterior fossa, contrecoup contusions of the frontal lobes of the brain, and abrasions of the back and elbows. If the person tumbles forward, there will be abrasions of the face. While motorcycle helmets reduce the incidence of head trauma in low-speed accidents, at moderate and high speeds their sole function is to prevent brain matter from being spread over the highway.

The most common causes of motorcycle accidents are alcohol or drugs, environmental factors (oil slicks, bumps or potholes in the road,), reckless driving, and failure of drivers of cars to see the motorcycle. The most common cause of a motorcycle fatality is running off the road. Approximately 28% of motorcycle operators involved in fatal crashes have a blood alcohol level of 0.10 g/dl or greater.12

The authors have seen a number of motorcycle operators beheaded or having arms avulsed due to cables or wires stretched across roads or used as supports to poles or towers (Figure 9.13). Injury occurs when the operator does not see the cable or wire. Examination of the amputated heads and extremities shows the edges of the wounds to be sharp, almost as if they had been produced with a knife. If one found such a head and body without knowing the individual had been on a motorcycle and beheaded by a wire, one would think that the head had been cut off with a sharp, edged instrument, so sharp are the edges of the wound.

Occasionally, a motorcycle rider, seeing a car stop abruptly in front of him and knowing he will not be able to stop in time, will drop his motorcycle on its side and skid toward the vehicle in an attempt to prevent impacting it. The authors have seen a number of cases in which this was effective in

Figure 9.13 (continued) (A) Complete avulsion of right arm by guy wire. Note sharp margins.
Figure 9.13 (continued) (B) Incomplete beheading due to wire. (C) Sharp margins to wound, almost as if neck had been cut with a knife.

preventing any serious damage to the motorcyclist. Unfortunately, in one case, the operator skidded beneath the car, hooking his chin on the bumper and dislocating his neck at the atlanto-occipital juction.

As mentioned previously, operators of automobiles often do not see motorcyclists, either because of their low profile, or because auto drivers are not attuned to looking for motorcycles. Automobiles will turn in front of a motorcycle and the motorcycles will crash into the car. Automobiles going through an intersection will crash into a motorcycle, failing to see it. Most experienced motorcyclists assume that individuals driving cars do not see them.

The aforementioned discussion of motorcycles also applies to a degree to off-the-road, all-terrain vehicles (ATVs). These are now all four-wheeled vehicles. Three-wheeled vehicles are no longer sold in the U.S. because they are believed to be unsafe. Fatal injuries tend to involve the head and neck, with occasionally the ATV's turning over and landing on top of the operator. The operators who are killed often are young children, too young to legally operate motor vehicles or motorcycles.

Mention at this time can also be made of snowmobiles. One of the more common causes of death with these vehicles is drowning. This occurs when a driver attempts to cross a frozen lake and does not realize that the ice is not thick enough to support the vehicle.

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