Broken into two – unusual internal injuries due to a road traffic accident

Abstract

We present a case of a motorcyclist involved in a multi-vehicle motor vehicle accident (MVA), where he was rear-ended by a motorcar, collided head-on into a second motorcar and was subsequently flung off his motorcycle. There was no suggestion of a runover. At autopsy, the torso showed extensive brush abrasions with no open wounds. Internally, there were devastating injuries, with complete separation of the thoracic and abdominal viscera. Although the road traffic situation in Singapore has been improving with declining incidence of MVAs, motorcyclists continue to make up a disproportionate majority of injuries and fatalities. The spectrum of injuries encountered is vast, with injuries to the head and extremities most commonly described. Thoracic and intra-abdominal injuries can also occur, typically consisting of rib fractures and injuries to solid organs. This case highlights an unusual pattern of injury sustained in an MVA without runover and is postulated to be a result of rapid deceleration.