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Abstract
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Injury producing road accidents involving occupants of 4-wheel motor vehicles symbolize the first traumatic epidemic in the history of surgery both in number and magnitude. Efforts toward its control, which embrace a large part of our physical and intellectual life-including the highest questions of ethics-are converging upon the prevention of injury in unavoidable accidents as a supplement to primary accident prevention. A growing body of clinical, epidemiological, laboratory and field crash experimental data have been accumulated in support of this basic biophysical concept (1). Attention has been drawn to the importance of orienting injuries of the major body linkages to the pathogenetic factors which governed their production (2). A more specific investigation along this line in regard to injuries of the femur followed (3). The present study was undertaken in order to more fully mesh crash femoral injuries with those of its conjoined articulations (hip and knee joints). This kind of consideration demands a certain degree of categorization and comparison in relation to the problem as a whole. The subject of my topic is the connection between these specific injuries of the hip, femoral shaft and knee and the current endeavor to attain a more reasonable degree of crash safety through improved standards of automotive design and engineering. Data will be presented in two parts in which both clinical and accident aspects will be summarized with respect to 145 patients who had incurred the lesions in question.
The present specific consideration of fractures and dislocations of the femoral linkages disclosed the extraordinary vulnerability of every element of this major body segment under crash energy (force) conditions; regardless of the various kinds of accident configurations. The clinical impact of these casualties was magnified by the morbid variety of the specific lesions in question; and further intensified by the multiplicity of their related and associated injuries. Moreover, orientation of these patients as clinical entities (Fig. 16) to the automotive environments which influenced and/or governed their production, clearly indicated the major injury potentials of the latter. In other words, both the clinical results and the mode of their development place these lesions in a category apart from trauma of mechanical origin in general. From this frame of reference, it was not difficult to entertain and formulate a philosophy of crash safety which aims at the reduction of our entropy through improved standards of automotive design and engineering.
The achievement of this goal calls for the highest sort of leadership by the medical and engineering professions; and, the disciplines which are closely related to them. The reluctance of individual doctors and engineers to assume this leadership is puzzling since this need is an important aspect of public health. There are no simple explanations of causation in regard to this phenomenon. The same thing applies to the automotive industry whose voracious appetite for causative data cannot be satisfied. Certainly, there are no villains in this piece, and no maligning of motives in the continuing lag between progress in basic researches and developmental uptake. One simply reports what has happened and registers uneasiness lest it continues and fades the public image of both doctor and engineer.
It is possible that these reluctant elements are ignorant of this potential feedback, first on the individual and ultimately on the society. On the other hand, perhaps, some of us who are on the positive side of the fence have now oversimplified the matter that this one condition can solve the whole problem; i.e., by a magical control over the automotive environment. Yet, man is the only creature who fights and often wins over the concept of the survival of the fittest. Be that as it may, there is no gainsaying the vast amount of empirically verifiable material to support the conclusion that improved standards of crash safety design and engineering is a factor of high potency in the prevention and/or amelioration of crash injury. |