Was the pedestrian hit in an erect position before being run over?

Ifa pedestrian was run over by a car, the question can arise whether there was a preceding collision while the pedestrian was in an erect position, Fr om a total of 53 selected autopsy reports, the findings associated with acc idents known to involve running over in isolation (n = 32) were compared to findings associated with a combined mechanism of a primary impact in an er ect position and subsequent running over (n = 21). Findings exclusively pre sent in the combined group were wedge-shaped bone fractures ("Messerer"-wrd ges. 38%). glass fragment injuries (24%). traumatic amputations (10%), trac es of car paint on the lower extremities (50%) and abrasions of the shoe so les (17%). These findings can be considered specific for a primary impact i n an erect position, Fractures of the cervical and lumbar spine were presen t in the combined group in 33 and 17%, respectively. In contrast, in the ru n over group, there was only one case of fracture of the cervical and one o f the lumbar spine and both cases involved direct contact with a car wheel. Fractures of the cervical and lumbar spine are, therefore. very indicative for a. primary impact. "Bumper injuries", sacroiliac dislocations and frac tures of the thoracic spine were approximately 2.5 times more common in the combined group than in the run over group. In the vast majority of cases, a clear differentiation between the two groups is. therefore, possible on t he basis of the autopsy findings. This is especially relevant if an inspect ion of the car cannot be pet-formed after a hit-and-run accident, which occ urred in 26% of the cases in this study. In addition, the blood alcohol lev els were higher in the run over group (mean = 2.14 g/l) as compared to the combined group (mean = 1.53 g/l). (C) 2001 Elsevier Science Ireland Ltd. Al l rights reserved.