Biokinetics of Traumatic Aortic Rupture in a Pedestrian: Insights from an Autopsy Case Report
DOI:
https://doi.org/10.48165/jfmt.2026.43.03.27Keywords:
Traffic accidents, Pedestrian injuries, Traumatic aortic rupture, BiokineticsAbstract
Traumatic Aortic Rupture (TAR) is one of the leading causes of death, next to traumatic brain injury in occupants of vehicles, traditionally linked to high-velocity impacts. TAR among pedestrians is increasing due to a rise in encounters with over speeding and high-speed vehicle. Understanding the risk factors and trauma kinetics will help in the prevention of fatalities. This is a case of a 66-year-old male, a pedestrian, who was hit by an over speeding car from his side. Autopsy findings revealed a transverse rupture of the ascending aorta with minimal external injuries and traumatic brain injury. The aorta rupture is likely to result from a combination of compression forces, shearing stress, and the water hammer effect. The presence of head injuries and aortic rupture highlights the unpredictable injury patterns in such collisions and underscores the potential role of biomechanical susceptibilities. Clinically, this case stresses the importance of vigilance for internal thoracic injuries in survivors of pedestrian against vehicular accidents, even when external trauma appears negligible. TAR remains a complex, multifactorial injury and requires continued interdisciplinary research to comprehend its mechanisms.
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Pearson, R., Philips, N., Hancock, R., Hashim, S., Field, M., Richens, D., et al. (2008). Regional wall mechanics and blunt traumatic aortic rupture at the isthmus. European Journal of Cardio-Thoracic Surgery, 34(3), 616–622. https://doi.org/10.1016/j.ejcts.2008.03.069
Smith, R. S., & Chang, F. C. (1986). Traumatic rupture of the aorta: Still a lethal injury. The American Journal of Surgery, 152(6), 660–663. https://doi.org/10.1016/0002-9610(86)90444-7
Neschis, D. G., Scalea, T. M., Flinn, W. R., & Griffith, B. P. (2008). Blunt aortic injury. The New England Journal of Medicine, 359(16), 1708–1716. https://doi.org/10.1056/NEJMra0706159
Greendyke, R. M. (1966). Traumatic rupture of aorta: Special reference to automobile accidents. JAMA, 195(7), 527–530. https://doi.org/10.1001/jama.1966.03100070071021
Otte, D., Facius, T., & Brand, S. (2017). Injury mechanisms of aortic ruptures to vehicle occupants and vulnerable road users—An in-depth investigation over time. Journal of Forensic Biomechanics, 8(1), 132. https://doi.org/10.4172/2090-2697.1000132
Azizzadeh, A., Keyhani, K., Miller, C. C., III, Coogan, S. M., Safi, H. J., & Estrera, A. L. (2009). Blunt traumatic aortic injury: Initial experience with endovascular repair. Journal of Vascular Surgery, 49(6), 1403–1408. https://doi.org/10.1016/j.jvs.2009.02.234
Fattori, R., & Pierangeli, A. (1999). Aortic trauma. In A. Haverich & D. C. Miller (Eds.), Diagnosis and treatment of aortic diseases (pp. 161–200). Springer.
Chiara, O., Cimbanassi, S., & Zoia, R. (2009). Injury to the thoracic aorta following fatal blunt trauma: An autopsy study. European Journal of Trauma and Emergency Surgery, 35, 305–310. https://doi.org/10.1007/s00068-008-8187-5
Ben-Menachem, Y. (1993). Rupture of the thoracic aorta by broadside impacts in road traffic and other collisions: Further angiographic observations and preliminary autopsy findings. Journal of Trauma and Acute Care Surgery, 35(3), 363–367. https://doi.org/10.1097/00005373-199309000-00006
Pauka, D., Poór, V. S., Maróti, P., Told, R., Tóth, D., Tornóczky, T., et al. (2023). Biomechanical study on the effect of atherosclerosis on the vulnerability of thoracic aorta, and its role in the development of traumatic aorta injury. PLoS ONE, 18(9), e0287652. https://doi.org/10.1371/journal.pone.0287652
Crass, J. R., Cohen, A. M., Motta, A. O., Tomashefski, J. F., Jr., & Wiesen, E. J. (1990). A proposed new mechanism of traumatic aortic rupture: The osseous pinch. Radiology, 176(3), 645–649. https://doi.org/10.1148/radiology.176.3.2389022
Lesbo, M., Andersen, G., Nielsen, P. H., Pilegaard, H. K., & Hjortdal, V. E. (2011). Osseous pinch mechanism in traumatic rupture of the aorta and the left main bronchus. Grand Rounds, 11, 1–4. https://doi.org/10.1102/1470-5206.2011.0001
Shah, C. S., Yang, K. H., Hardy, W., Wang, H. K., & King, A. I. (2001). Development of a computer model to predict aortic rupture due to impact loading. Stapp Car Crash Journal, 45, 161–182. https://doi.org/10.4271/2001-22-0007
Lundevall, J. (1964). The mechanism of traumatic rupture of the aorta. Acta Pathologica et Microbiologica Scandinavica, 62(1), 34–46. https://doi.org/10.1111/apm.1964.62.1.34
Siegel, J. H., Yang, K. H., Smith, J. A., Siddiqi, S. Q., Shah, C., Maddali, M., et al. (2006). Computer simulation and validation of the Archimedes Lever hypothesis as a mechanism for aortic isthmus disruption in a case of lateral impact motor vehicle crash: A Crash Injury Research Engineering Network (CIREN) study. Journal of Trauma and Acute Care Surgery, 60(2), 379–390. https://doi.org/10.1097/01.ta.0000203542.38532.02
Horton, T. G., Cohn, S. M., Heid, M. P., Augenstein, J. S., Bowen, J. C., McKenney, M. G., et al. (2000). Identification of trauma patients at risk of thoracic aortic tear by mechanism of injury. Journal of Trauma and Acute Care Surgery, 48(6), 1008–1014. https://doi.org/10.1097/00005373-200006000-00003

