The classic. Review article: Traffic accidents. 1966.

This Classic Article is a translation of the original work by Prof. Harald Tscherne, Der Straßenunfall [Traffic Accidents]. An accompanying biographical sketch of Prof. Tscherne is available at DOI 10.1007/s11999-013-3011-x . An online version of the original German article is available as supplemental material. The Classic Article is reproduced with permission from Brüder Hollinek & Co. GesmbH, Purkersdorf, Austria. The original article was published in Wien Med Wochenschr. 1966;116:105-108. (Translated by Dr. Roman Pfeifer.).

Use of an injectable calcium phosphate bone cement in the treatment of tibial plateau fractures: a prospective study of twenty-six cases with twenty-month mean follow-up.

OBJECTIVE: To evaluate the potential benefit of a new injectable mineral bone cement (Norian SRS, Cupertino, CA, USA) for the treatment of tibial plateau fractures OTA types 41.B2-B3 and C3. DESIGN: Prospective study with established protocol. SETTING: University hospital; university teaching hospital. PATIENTS: Twenty-six patients gave informed consent to participate in this study and were available for follow-up examinations. All patients had sustained intraarticular tibial plateau fracture types OTA B2-B3 and C3. All cases were followed with a mean follow-up time of 19.7 months (6 to 36 months, median eighteen months). INTERVENTION: Twenty-five cases were treated with open reduction, osteosynthesis with screws or plate, and injection of Norian SRS in the subchondral bone defect. One case had closed reduction, screw osteosynthesis, and percutaneous cement injection. MAIN OUTCOME MEASUREMENTS: Radiographs in two planes were evaluated prospectively at six, twelve, and twenty-six weeks postoperatively and at last follow-up using Rasmussen's radiologic score. Clinical parameters were measured at the same time intervals using Lysholm's and Tegner's knee scores. RESULTS: Two cases required early wound revisions because of sterile drainage. Two cases developed partial loss of reduction of the fracture between four and eight weeks after surgery, requiring revision surgery in one case (total complication rate 15.3 percent). No other patients had complications, and all other fractures healed without any displacement. The high mechanical strength of the cement allowed early weight bearing after a mean postoperative period of 4.5 weeks (1 to 6 weeks). CONCLUSIONS: An injectable mineral bone cement with high initial mechanical strength was used to fill bone defects in unstable tibial plateau fractures with good success. This material offers new perspectives in the treatment of tibial plateau fractures.

[Current situation of traffic accidents in children and adolescents. A medical and technical analysis]. / Problematik der Verletzungen von Kindern und Jugendlichen im Strassenverkehr. Eine medizinische und technische Unfallanalyse.

HYPOTHESIS: Analysis of the current injury situation in road users not exceeding 14 years of age involved in road traffic accidents to allow conclusions regarding future prophylaxis. METHODS: Traffic accident reports and medical records from children (< 15 years of age) were analyzed for the following parameters: Type, location and mechanism of injury, Abbreviated Injury Scale (AIS), Maximum AIS (MAIS), Injury Severity Score (ISS), Delta-v, collision speed, type and duration of treatment. RESULTS: In 12,309 traffic accidents occurring in the area of Hannover, Germany between 1985 and 1998, 7.5% (n = 2,317) of the involved persons and 10.5% (n = 1,734) of the injured road users were children and adolescents. 70% sustained MAIS 1 injuries, 28% MAIS 2-4 and 1.5% MAIS 5/6 injuries. The mean ISS was 3.38. 30.3% of the injured children were car occupants, 32.1% bicyclists, 33.3% pedestrians. 30.3% of the children were unrestrained car occupants, 42.1% used safety belts designed for adults, 36% used special devices. Half of the children in cars remained uninjured, whereas only 8% of the bicyclists and 2% of the pedestrians were not injured. Severe injuries occurred in 20% of bicyclists and pedestrians at a collision speed less than 30 km/h and in 80% at more than 50 km/h. Half of those crashes could have been avoided, if the colliding vehicle would had driven about 15 km/h slower. CONCLUSION: Children have an especially high risk of injury if they are involved in accidents as pedestrians, bicyclists and unrestrained car occupants. Besides of improvements of the inner and outer car design, the use of adjusted restraining systems and bicycle helmets is likely to prevent from severe injuries. Speed reduction is a considerable factor. According to our data, the injury severity for bicyclists and pedestrians increases progressively when the collision speed exceeds 50 km/h.

[Hannover Fracture Scale '98--reevaluation and new prospects for an established score system]. / Hannover Fracture Scale '98--Neuevaluierung und neue Perspektiven eines etablierten Scoresystems.

UNLABELLED: The Hannover Fracture Scale (HFS) was first introduced in 1983. As the treatment of open fractures has improved over the years, mainly due to new implants, the prognosis of open fractures has also changed. Thus a reevaluation of this limb salvage score has become necessary. DESIGN: Retrospectively all parameters of the HFS were evaluated in 182 open fractures of the upper and lower extremity treated in our institution between June '94 and June '96. Statistical means included the multivariant analysis, ROC analysis, calculation of sensitivity, specify and accuracy for the criterion of primary amputation. Finally the HFS'98 was established, which is characterized by eight domains (bone loss, skin injury, muscle injury, wound contamination, neurology, periost stripping, local and systemic circulation), a total score range from 0-22 points and a cut off point (amputation recommended) at a score of > or = 11. This score was then prospectively applied on another 87 open long bone fractures, treated in our institution between July '96 and Dec. '97. RESULTS: This validation of the HFS'98 revealed a sensitivity of 0.82 and a specify of 0.99. In comparison the NISSSA and the MESS presented a sensitivity and specify of 0.71, 0.99 and 0.82, 0.99 respectively based on data of the prospective study group. In addition the Gustilo classification for open fractures has been defined by certain score ranges of the HFS'98. CONCLUSION: In conclusion the HFS'98 has become a reliable extremity salvage score with a fairly high positive predictive value of 0.99, which is applicable for all open long bone fractures regardless of their location.

[Perthes syndrome. The classical symptom triad as a rarity in trauma surgery practice]. / Das Perthes-Syndrom. Die klassische Symptomtrias als Rarität in der unfallchirurgischen Praxis.

Perthes syndrome or traumatic asphyxia is a condition characterised by subconjunctival hemorrhage, cervicofacial petechiae and cyanosis caused by severe compression of the chest. Diagnosis is made by history and clinical examination. Associated injuries such as intrathoracic or abdominal lesions can be life-threatening and must be strictly assessed. This report demonstrates an illustrative case of this rare injury.

[Pronation and supination of the forearm. With special reference to the humero-ulnar articulation]. / Die Pro- und Supination des Unterarms. Unter besonderer Berücksichtigung der Articulatio humeroulnaris.

The development of a kinematic model of the pro- and supination, that can be used to predict the influence of angulations of ulna and radius on the pronation and supination is based on the precise knowledge of the pronation and supination movement. We performed two parallel studies for examining the pronation and supination motion of the human forearm. The first experiment dealt with MRI-studies on 18 probands (36 examined forearms). As a result we observed an evasive movement of the ulna during the rotation of 7, 14 degrees medial. In order to prove whether the evasive movement was caused by a rotation of the humerus or by an evasion in the articulatio humeroulnaris, we carried out a second experiment, using 30 preparations. The measurement of the pro- and supination motion with a fixed humerus was expedited using a special experimental setup which guaranteed that the ulna could move freely. In all cases we found the same magnitude of the evasive motion of the ulna. Therefore we demonstrated, that the ulna performs an evasive motion during the pro- and supination motion of the forearm that influences the kinematic behavior of the pro- and supination motion significantly.

Foot fractures in restrained front seat car occupants: a long-term study over twenty-three years.

OBJECTIVES: To analyze the mechanism of injury for foot and ankle fractures resulting from automobile accidents to create a basis for developing an improved design for protection. DESIGN: Retrospective. SETTING: Level I trauma center with accident research unit. PATIENTS: Automobile accident reports and medical records of individuals injured in the accidents. MAIN OUTCOME MEASUREMENTS: Technical indicators (collision type, impulse angle, deltav, and extent of vehicle deformation) and clinical data (injury location and severity [abbreviated injury scale and injury severity score] and long-term outcome). RESULTS: From 1973 to 1996, 15,559 car accidents were analyzed. Two hundred sixty-one front seat occupants sustained fractures of the foot and ankle (ankle, 41 percent; forefoot, 29 percent; midfoot, 20 percent; and hindfoot, 10 percent). Seventy-five percent of the fractures were classified abbreviated injury scale(foot) 2. The incidence, location, and abbreviated injury scale(foot) category of fractures were similar between driver (n = 210) and front seat passenger (n = 51). Fifty percent of the fractures occurred in head-on collisions and 34 percent occurred in accidents with multiple collisions. The deltav ranged in 82 percent of car crashes between fifteen and sixty kilometers per hour. The deltav and extent of foot compartment deformation correlated with the abbreviated injury scale. During our investigation, deltav increased; the injury severity score decreased; and the extent of deformation did not differ significantly. CONCLUSIONS: Although overall car passenger safety has improved, the relative incidence of foot and ankle fractures has increased. Comparing drivers and front seat passengers, the foot pedals, steering wheel, or the asymmetric design of the dashboard did not influence injury incidence, mechanism, or severity. Foot fractures are mainly caused by the foot compartment deformation in head-on collisions, and therefore improvements in foot compartments are essential for fracture prevention.

Hannover Fracture Scale '98--re-evaluation and new perspectives of an established extremity salvage score.

OBJECTIVE: as the treatment of open fractures has improved over the years, the prognosis of open fractures has also changed. Thus, a re-evaluation of the Hannover Fracture Score (HFS), first introduced in 1983, has become necessary. DESIGN: retrospectively all parameters of the HFS were evaluated in 182 open fractures of the upper and lower extremity treated in our institution between June 1994 and 1996. Statistical means included multivariant analysis, ROC analysis, calculation of sensitivity, specificity and accuracy. Finally the HFS 98 was established, which is characterised by eight domains with a total score range from 0 to 22 points and a cut off point (amputation recommended) at a score > or =11. This score was then prospectively applied on another 87 open long bone fractures, treated during July 1996 and December 1997. RESULTS: this validation of the HFS '98 revealed a sensitivity of 0.82 and a specificity of 0.99. In comparison the NISSSA and the MESS presented a lower sensitivity and same specificity based on the same study group. CONCLUSION: in conclusion the HFS '98 has become a reliable extremity salvage score with a fairly high positive predictive value of 0.99, which is applicable for all the open long bone fractures regardless of their location.

Dehydroepiandrosterone decreases mortality rate and improves cellular immune function during polymicrobial sepsis.

OBJECTIVE: Sepsis is associated with a marked depression of cellular immune function. The steroid hormone dehydroepiandrosterone (DHEA) is proposed to have immunoenhancing activities. We, therefore, investigated the effect of DHEA on the mortality rate and cellular immune functions in an experimental model of sepsis. DESIGN: Randomized animal study. SETTING: Level I trauma center, university research laboratory. SUBJECTS: Male NMRI mice. INTERVENTIONS: Mice were subjected to laparotomy (sham) or cecal ligation and puncture (CLP). Mice were treated with (sham/DHEA; CLP/DHEA) or without (sham; CLP) the steroid hormone DHEA (30 mg/kg sc). Animals were killed 48 hrs after the onset of sepsis. MEASUREMENTS AND MAIN RESULTS: The survival rate of septic mice was determined 24 and 48 hrs after onset of sepsis. Forty-eight hours after the septic challenge, a white blood cell count was performed and serum tumor necrosis factor (TNF)-alpha and interleukin (IL)-1beta concentrations were monitored using ELISA. Furthermore, the delayed type of hypersensitivity (DTH) reaction was evaluated on the basis of ear pinna swelling after dinitrofluorobenzene (DNFB) administration, and clinical variables (body weight, temperature, heart rate, fluid input/output, food intake) were monitored using metabolic cages. DHEA administration improved the survival rate (87% vs. 53% after 48 hrs; p <.001). This was accompanied by a restoration of the depressed DTH reaction and a reduction in TNF-alpha serum concentrations (20.7 +/- 1.4 pg/mL vs. 32.4 +/- 6.6 pg/mL). CONCLUSIONS: These results demonstrate that DHEA administration leads to an increased survival following a septic challenge. The immunoenhancing effect of DHEA is accompanied by a reduction of TNF-alpha release and an improved activity of T-cellular immunity. DHEA administration may, therefore, be beneficial in systemic inflammation.

Biochemical changes after trauma and skeletal surgery of the lower extremity: quantification of the operative burden.

OBJECTIVE: To quantify changes in variables of inflammation, coagulation, and fibrinolysis in blunt trauma patients with lower extremity fractures who underwent different types of surgical procedures. DESIGN: Prospective, cohort study. SETTING: Level I university trauma center. PATIENTS: We allocated 83 blunt trauma patients in stable condition and 22 patients eligible for elective hip replacement to four treatment groups. INTERVENTIONS: In 34 multiply traumatized patients with femoral fracture (group PTFF) and in 28 patients with an isolated femoral fracture (group IFF), primary unreamed intramedullary nailing for stabilization of the femoral shaft fracture was performed. In 22 patients, an elective uncemented total hip arthroplasty (group THA) was inserted for osteoarthritis, and in 21 control patients, an isolated ankle fracture (group AF) was acutely stabilized. MEASUREMENTS AND MAIN RESULTS: From serially sampled central venous blood, the perioperative concentrations of interleukin (IL)-6, of tumor necrosis factor-alpha, of prothrombin fragments 1 + 2, and of D-dimer cross-linked fibrin degradation products were evaluated. Intramedullary instrumentation for an isolated femur fracture caused a significant perioperative increase in the concentrations of IL-6 (preoperative IL-6, 52 +/- 12 pg/mL; IL-6 30 mins postinsertion, 78 +/- 14 pg/mL; p = .02). This increase was comparable with group THA (preoperative IL-6, 46 +/- 16 pg/mL; IL-6 30 mins postinsertion, 67 +/- 11 pg/mL; p = .03). A positive correlation occurred between both groups (r = .83, p < .0004). Multiple trauma patients demonstrated significantly (p = .0002) higher IL-6 concentrations than all other groups throughout the study period and showed a significant increase after femoral nailing (preoperative IL-6, 570 +/- 21 pg/mL; IL-6 30 mins postinsertion, 690 +/- 24 pg/mL; p = .003), whereas no perioperative change was seen in group AF. The highest IL-6 increases were associated with a longer ventilation time (group PTFF) and a longer period of positive fluid balances (groups PTFF, IFF, THA). The coagulatory variables demonstrated similar perioperative increases in groups IFF and THA, but not in groups PTFF and AF. The IL-6 concentrations and the prothrombin fragments 1 + 2 concentrations correlated between groups THA and IFF at 30 mins and at 1 hr after surgery (r2 = .64, p < .02). In all patients the clinical variables were stable perioperatively. CONCLUSIONS: Major surgery of the lower extremity causes changes to the inflammatory, fibrinolytic, and coagulatory cascades in patients with stable cardiopulmonary function. The inflammatory response induced by femoral nailing is biochemically comparable to that induced by uncemented total hip arthroplasty. In multiple trauma patients, increases, which occurred in addition to those induced by the initial trauma, were measured. Definitive primary femoral stabilization by intramedullary nailing imposes an additional burden to the patient with blunt trauma. A careful preoperative investigation is required to evaluate whether primary definitive stabilization can be performed safely.

[Classification, staging, urgency and indications in pelvic injuries]. / Klassifikation, Einstufung, Dringlichkeit und Indikation bei Beckenverletzungen.

For primary evaluation, classification and indication of pelvic ring injuries the exact knowledge of the injury mechanism and the clinical and radiological signs is mandatory. Clear injury definitions are proved for prognostical reasons and for the timing of the specific treatment. The simple classification of stable A-type injuries, rotational B-type injuries and translationally stable C-type injuries is the basis for further treatment. Whereas A-type fractures normally need no surgical stabilization, except in severely displaced fractures or possible organ injuries due to fracture fragments, in B-type injuries solely stabilization of the anterior pelvic ring provides sufficient stability for early ambulation with partial weight bearing. In C-type injuries a combined posterior and anterior stabilization is required for anatomical reduction and early ambulation. With this concept the pelvic girdle can be reconstructed anatomically in the majority of cases.

Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making.

BACKGROUND: Current techniques for assessment of chest trauma rely on clinical diagnoses or scoring systems. However, there is no generally accepted standard for early judgement of the severity of these injuries, especially in regards to related complications. This drawback may have a significant impact on the management of skeletal injuries, which are frequently associated with chest trauma. However, no convincing conclusions can be determined until standardization of the degrees of chest trauma is achieved. We investigated the role of early clinical and radiologic assessment techniques on outcome in patients with blunt multiple trauma and thoracic injuries and developed a new scoring system for early evaluation of chest trauma. METHODS: A retrospective investigation was performed on the basis of 4,571 blunt polytrauma (Injury Severity Score [ISS] > or = 18) patients admitted to our unit. Inclusion criteria were treatment of thoracic injury that required intensive care therapy, initial Glasgow Coma Scale score greater than 8 points, and no local or systemic infection. Patients with thoracic trauma and multiple associated injuries (ISS > or = 18) were included. In all patients, the association between various parameters of the thoracic injuries and subsequent mortality and morbidity was investigated. RESULTS: A total of 1,495 patients fulfilled the inclusion criteria. Patients' medical records and chest radiographs were reevaluated between May 1, 1998, and June 1, 1999. The association between rib fractures and chest-related death was low (> three ribs unilateral, mortality 17.3%, odds ratio 1.01) unless bilateral involvement was present (> three ribs bilateral, mortality 40.9%, odds ratio 3.43). Injuries to the lung parenchyma, as determined by plain radiography, were associated with chest-related death, especially if the injuries were bilateral or associated with hemopneumothorax (lung contusion unilateral, mortality 25.2%, odds ratio 1.82; lung contusion bilateral + hemopneumothorax, mortality 53.3%, odds ratio 5.1). When plain anteroposterior chest radiographs were used, the diagnostic rate of rib fractures (< or = three ribs) increased slightly, from 77.1% to 97.3% during the first 24 hours of admission. In contrast, pulmonary contusions were often not diagnosed until 24 hours after admission (47.3% at admission, 92.4% at 24 h, p = 0.002). A new composite scoring system (thoracic trauma severity score) was developed that combines several variables: injuries to the chest wall, intrathoracic lesions, injuries involving the pleura, admission PaO2/FIO2 ratio, and patient age. The receiver operating characteristic curve demonstrated an adequate discrimination, as demonstrated by a value of 0.924 for the development set and 0.916 for the validation set. The score was also superior to the ISS (0.881) or the thorax Abbreviated Injury Score (0.693). CONCLUSION: Radiographically determined injuries to the lung parenchyma have a closer association with adverse outcome than chest-wall injuries but are often not diagnosed until 24 hours after injury. Therefore, clinical decision making, such as about the choice of surgery for long bone fractures, may be flawed if this information is used alone. A new thoracic trauma severity score may serve as an additional tool to improve the accuracy of the prediction of thoracic trauma-related complications.

Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament: a prospective, longitudinal study.

We assessed proprioception in the knee using the angle reproduction test in 20 healthy volunteers, ten patients with acute anterior instability and 20 patients with chronic anterior instability after reconstruction of the anterior cruciate ligament (ACL). In addition, the Lysholm-knee score, ligament laxity and patient satisfaction were determined. Acute trauma causes extensive damage to proprioception which is not restored by rehabilitation alone. Three months after operation, there remained a slight decrease in proprioception compared with the preoperative recordings, but six months after reconstruction, restoration of proprioception was seen near full extension and full flexion. In the mid-range position, proprioception was not restored. At follow-up, 3.7 +/- 0.3 years after reconstruction, there was further improvement of proprioception in the mid-range position. There was no difference between open and arthroscopic techniques. The highest correlation was found between proprioception and patient satisfaction. After reconstruction of the ACL reduced proprioception may explain the poor functional outcome in some patients, despite restoration of mechanical stability.

[Distal fractures of the femur]. / Distale Femurfrakturen.

Supracondylar femoral fractures still present a challenge to the treating surgeon. The incidence of delayed and non-unions is reduced due to the minimally invasive plating techniques, but establishing a correct axis and good function is still a problem. During the last few years new implants have been developed to allow less difficult operative techniques in minimally invasive surgery. The Less Invasive Stabilization System (LISS) is a percutaneous plating system with monocortical self-drilling screws. The screws are inserted with an aiming guide and form a stable angle with the plate. The distal femoral nail allows placement of a spiral blade in the nail, thereby enhancing the interlocking stability.

[Fractures of the upper extremity in restrained automobile front seat passengers. Injury pattern and incidence in relation to accident mechanism]. / Frakturen der oberen Extremität bei gurtgeschützten PKW-Frontinsassen. Verletzungsart und -häufigkeit in Abhängigkeit vom Unfallmechanismus.

During 1985 and 1995, 3,260 restrained car drivers (1,228 front seat passengers) were injured in 9,380 crashes involving cars. 179 (5.5%) (front seat passengers: 53, 4.3%) of those sustained fractures, of the arm. Among the 384 single fractures the hand (25%), wrist (23%) and forearm (23%) were affected most often, elbow (9%), upper arm (10%) and shoulder (10%) rather seldom. Half of the evaluated fractures of the long tubular bones were type A-fractures due to the AO classification and the other two quarters, respectively type B- and C-injuries in each case. 16% were open fractures. No considerable differences of the injury mechanism were found comparing drivers and front seat passengers. Since over half of all fractures resulted from a direct impact to the hand and/or arm, modifications are necessary in order to improve the energy absorption by means of padding the dashboard and the inner door. The use of side- and front-airbags could serve as an additional auxiliary equipment, as long as it doesn't induce a supplemental stress, through unfolding of the airbag.

Pelvic fractures in pregnant multiple trauma patients.

OBJECTIVE: To study the outcome of pelvic fractures and fetuses in pregnant patients involved in blunt multiple trauma. DESIGN: Retrospective follow-up study. SETTING: Level I trauma center. PATIENTS: Pregnant multiple trauma patients with pelvic fractures between 1974 and 1998. INTERVENTIONS: Conservative and operative treatment of pelvic fractures adapted to the clinical status of the mother. MAIN OUTCOME MEASURES: Clinical, functional, and social outcomes were evaluated. RESULTS: Out of 4,196 patients with blunt multiple trauma treated between 1974 and June 1998, seven demonstrated the combination of blunt multiple trauma, pregnancy, and pelvic fractures. These patients had a mean Injury Severity Score of 29.9 points. Five mothers and three fetuses survived their injuries. All dead fetuses died on the scene. One surviving fetus was found to have hydrocephalus unrelated to the injury; the remaining fetuses had an uneventful delivery and were healthy. In two of the three patients whose fetuses survived, the treatment of the pelvic fracture was modified for the sake of fetal well-being. In all of these patients, acceptable outcome was achieved. CONCLUSION: Modification of the treatment of the pelvic fracture in pregnant women with multiple trauma may be necessary to minimize the risk of fetal injury. In our experience with these rare cases, this modified treatment did not severely alter the clinical outcome of the mother's pelvic fracture.

Biomechanics of femoral interlocking nails.

Today there is a variety of different interlocking intramedullary nail designs available for the femur. We compared different nail types in the bone implant complex (BIC) of four unreamed solid nails and a slotted reamed nail with simulated comminuted mid shaft fractures to see if there are major differences in stiffness for axial load, bending and torsion. The fractures were simulated by a 2 cm defect osteotomy in paired human cadaver femora. Each bone was tested intact in a universal testing machine, osteotomy and osteosynthesis were performed, and the BIC was tested. Relative stiffness was calculated. In torque testing the unslotted solid nail showed significantly more stiffness (0.6-1.8 Nm/degrees) compared to the slotted nail (0.2 Nm/degrees). Compared to intact bone (6.9 Nm/degrees), both groups of nails were significantly less stiff (relative stiffness 2-20%). In axial load and bending testing the large diameter unreamed nail showed significantly higher stiffness (32-68%). This study shows that stiffness of bone implant complex in interlocking femoral nails is more dependent on nail profile than on the pressfit of nails in the medullary canal.

[Mechanism of pelvic girdle injuries in street traffic. Medical-technical accident analysis]. / Die Entstehung von Beckenringverletzungen im Strassenverkehr. Medizinisch-technische Unfallanalyse.

During 1985 and 1993, 7,410 persons were injured in traffic accidents in the area of Hanover. Of these, 306 (4.1%) sustained a pelvic girdle injury. In 139 cases (45%), the pelvic girdle injuries were further classified (Pennal and Tile) and a technical reconstruction of the accident situation was performed. 52% were type A, 27% type B and 21% type C injuries. Some 47% of the casualties were vehicle occupants, 31% pedestrians, 12% motorcyclists and 10% cyclists. In restrained vehicle occupants pelvic girdle injuries occurred mostly in accidents with a delta-v of more than 30 km/h, whereas in unrestrained vehicle occupants, pedestrians and cyclists they also occurred with lower delta-v or collision speed. The percentage of type B and C injuries increased with higher velocities. In addition to further improvements in passive safety, lower collision speed or delta-v is necessary to reduce or prevent pelvic girdle injuries. The reconstruction of pelvic girdle injury mechanism in traffic accidents is possible, when both technical and medical parameters are considered.