The pattern of fractures in road traffic crashes; findings from the National Trauma Registry in Iran

The pattern of fractures in road traffic crashes; findings from the National Trauma Registry in Iran | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The pattern of fractures in road traffic crashes; findings from the National Trauma Registry in Iran Mahgol Sadat Hassan Zadeh Tabatabaei, Mohammad Soleimani, Seyyed Hossein Shafiei, and 20 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4132019/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: Fractures constitute a significant concern in low- and middle-income countries, primarily due to road traffic crashes (RTCs), a leading cause of such injuries. This study aimed to analyze fracture patterns resulting from RTCs in Iran. Methods: A registry-based study was conducted using data from the National Trauma Registry of Iran (NTRI) spanning 2016 to 2023. The study included 10,114 trauma patients involved in RTCs, encompassing car and motorcycle crashes with at least one fracture. International Classification of Diseases (ICD-10) codes were used for data analysis, considering both orthopedic and non-orthopedic admissions related to RTCs. Fracture incidence was compared among pedestrians, drivers/riders, and passengers/pillions. Results: Males constituted a significant majority in cars (90.1% drivers, 72.1% pedestrians, 47.0% passengers) and motorcycle crashes (99.6% riders, 77.0% pedestrians, 65.3% pillions) (p < 0.001). Drivers showed the highest frequency of head injuries (26.9%) (p <0.01), while pedestrians had the highest frequency of upper extremity injuries (73.1%) (p<0.001). Drivers also demonstrated a higher frequency of vertebral fractures compared to passengers (C3-C7: 3.2% vs. 1.4%, p < 0.05). Riders (33.5%) displayed a higher frequency of head and face fractures compared to pillions (24.8%) and pedestrians (17.4%) (p < 0.05). Pedestrians (3.7%) demonstrated a higher frequency of peritrochanteric fractures compared to passengers/pillions (1.9%) and drivers/riders (1.7%) (p < 0.01). Fractures of the tibia were significantly more frequent in pedestrians (20.9%) compared to drivers/riders (22.5%) and passengers/pillions (15.4%) (p < 0.01). Conclusion: The study provided valuable information on the fracture patterns associated with RTCs among road user groups. Accidents Traffic Wounds and Injuries Fractures Bone Pedestrians 1. Introduction Road traffic crashes (RTCs), ranking as the ninth leading cause of death globally (and second in Iran), constitute a significant public health concern [ 1 ]. The World Health Organization's global road safety report indicated that Iran recorded a substantial 22,918 fatalities related to RTCs in a year [ 2 ]. Beyond the loss of life, these incidents result in a staggering 20–50 million non-fatal injuries annually, many of which lead to disabilities and account for 1.06% of all years lived with disability (YLDs) and 5.63% of Disability-Adjusted Life Years (DALY) among the Iranian population [ 3 , 4 ]. In low-income countries, RTCs are a leading cause of fractures, with survivors and their families facing significant social, physical, and psychological challenges [ 5 ]. Families often struggle with ongoing medical costs and the financial support needed for disabled individuals. Furthermore, injuries can lead to temporary unemployment or early retirement, creating a burden on both insurance companies and society [ 6 ]. While numerous epidemiological studies conducted in Iran have focused on various aspects of RTCs, such as injury patterns, mortality rates, demographic characteristics of patients, and associated costs, less attention has been given to the patterns of fractures in RTC patients [ 7 – 11 ]. Furthermore, insufficient information exists regarding variations in fracture patterns based on the occupant's seating position and road participation [ 12 ]. Understanding the patterns of RTC-related fractures is paramount for policymakers and strategic planners. This can significantly benefit public emergency services, healthcare facilities, and rehabilitation centers by helping them prioritize and implement preventive measures and improve their quality of care [ 13 ]. Moreover, detailed data on fracture patterns occurring in different car seat locations can draw attention to specific safety requirements and propose enhancements for safety features in those particular areas of the vehicle [ 12 ]. This study aimed to determine the pattern of RTC-associated fractures in drivers, riders, passengers, pillions, and pedestrians involved in car and motorcycle crashes for eight years in Iran. 2. Methods 2.1. Study design and participants: We conducted a registry-based study among trauma patients associated with the National Trauma Registry of Iran (NTRI) between September 17, 2016, and February 01, 2023. This registry is a collaborative initiative involving multiple major trauma centers across the country and was initially established at Sina Hospital in Tehran, Iran, in 2015 by the Sina Trauma and Surgery Research Center. Previous articles have provided detailed information about the NTRI's registration process, a minimal dataset, and data quality assurance [ 14 , 15 ]. Our study encompassed all trauma patients involved in RTCs, including car and motorcycle crashes, who presented with at least one fracture site and met the NTRI's inclusion criteria. These criteria included hospitalization for more than 24 hours, fatal injuries on the first day of admission, or transfer from other hospitals' intensive care units (ICUs). All RTCs involving bicycles, pick-up trucks or vans, buses, and heavy transport vehicles were excluded from the study. 2.2. NTRI Data collection: The registration process occurs in multiple stages. Initially, the hospital information system (HIS) identifies suitable patients using specific criteria. Subsequently, three trained nurses gathered patient information through face-to-face interviews or retrieved data from companions or hospital records if necessary. The interview questionnaire comprises 99 variables organized into eight sections, with specifics detailed in prior publications. Once the data is compiled, skilled registrars input it into the NTRI database portal. Finally, a qualified physician meticulously reviews and validates the accuracy and comprehensiveness of the gathered data. Previous articles extensively addressed the data collection process during the NTRI pilot phase. 2.3. Variables: The data analysis was conducted using the International Classification of Diseases and Causes of Death (ICD-10) codes for orthopedic and non-orthopedic admissions associated with RTCs. Fractures were classified according to the location of the injury, encompassing skull and facial bone fractures (S02), neck fractures (S12), rib, sternum, and thoracic spine fractures (S22), lumbar spine and pelvis fractures (S32), shoulder and upper arm fractures (S42), forearm fractures (S52), wrist and hand fractures (S62), femur fractures (S72), lower leg (including ankle) fractures (S82), and foot (except ankle) fractures (S92). We analyzed variables including gender, age group, transport to hospital, type of accident, number of fractures, body region of fractures, and fracture sites. The transport to the hospital was divided into three groups: ambulance, private vehicle, and others (i.e., police, public transportation, and on foot). The number of registered fractures pertained to the total number of fracture lines, regardless of whether a single line affected two or more bones. When a single bone exhibited two distinct fracture lines, each line was tallied individually based on the number of fracture lines observed. Comminuted fractures were grouped with multiple fractures. 2.4. Statistical analysis and ethical statement: Number and percent, and percent were used for describing nominal and categorical variables. The proportion of nominal and categorical variables among pedestrians, drivers/riders, and passengers/pillions were compared using the chi-square test. Also, the Chi-square test was used to compare the types of fractures among pedestrians, drivers/riders, and passengers/pillions. The Bonferroni approach was used for correcting multiple comparisons. Logistic regression models and "margins" command were employed to estimate the adjusted fracture frequency by three groups. A p-value less than 0.05 was considered statistically significant. Stata software version 14.0 (Stata Corporation, College Station, TX) was employed for data analysis. This study was approved by the ethics committee of Sina Hospital, Tehran University of Medical Sciences (Approval ID: IR.TUMS.SINAHOSPITAL.REC.1399.090). 3. Results We evaluated 10,114 cases of trauma patients associated with RTCs, comprising 4,755 (47.0%) car crashes and 5,359 (53.0%) motorcycle crashes. The average age of individuals involved in car crashes was 37.3 ± 19.3 years, while for motorcycle crashes, it was 33.7 ± 16.8 years (p-value < 0.001). In car crashes, 796 (47.0%) car passengers were male. Male individuals constituted 1,243 (72.1%) pedestrians struck by cars and 1,205 (90.1%) drivers (p-values < 0.001). Notably, 483 (28.0%) pedestrians and 240 (18.0%) drivers in car crashes were transported to the hospital by private cars (p-values < 0.001). Approximately 583 (43.6%) drivers had multiple or comminuted fractures, significantly more than 413 (24.0%) pedestrians injured in car crashes, and 651 (38.4%) car passengers (p-values < 0.001). Male individuals constituted 396 (77.0%) pedestrians struck by motorcycles, 4,193 (99.6%) riders, and 416 (65.3%) motorcycle pillions (p-values < 0.001). Almost 773 (18.4%) riders and 230 (36.2%) pillions were children under the age of 18 in motorcycle crashes (p-values < 0.001). Pedestrians over the age of 64 demonstrated a significantly higher crash rate (17.1%) compared to riders (4.6%) and pillions (3.3%) in the same age group in motorcycle crashes (p-values < 0.001). Collison crashes involved 3,350 (80.6%) riders and 433 (70.0%) motorcycle pillions, while rollovers accounted for 807 (19.4%) riders and 186 (30.0) motorcycle pillions (p-values < 0.001). In motorcycle crashes, more riders (28.9%) experienced multiple and comminuted fractures compared to pedestrians struck by motorcycles (18.5%) (P-value < 0.001). Additional demographic characteristics and crash-related details of RTC patients are illustrated in Table 1 . Table 1 Demographic and crash-related characteristics of road traffic crash patients by road participation. Car crashes Motorcycle crashes Pedestrian (N = 1724) Driver (N = 1337) Passenger (N = 1694) p-value Pedestrian (N = 514) Rider (N = 4208) Pillion (N = 637) p-value Gender Male 1243 (72.1) 1205 (90.1) 796 (47.0) < 0.001 396 (77.0) 4193 (99.6) 416 (65.3) < 0.001 Female 481 (27.9) 132 (9.9) 898 (53.0) 118 (23.0) 15 (0.4) 221 (34.7) Age group ≤ 18 382 (22.2) 33 (2.5) 368 (21.7) < 0.001 103 (20.0) 773 (18.4) 230 (36.2) < 0.001 19–64 1057 (61.3) 1247 (93.3) 1203 (71.0) 323 (62.8) 3239 (77.0) 384 (60.4) ≥ 65 285 (16.5) 57 (4.3) 123 (7.3) 88 (17.1) 192 (4.6) 22 (3.5) Transport to hospital Ambulance 1232 (71.5) 1078 (80.6) 1370 (80.9) < 0.001 431 (84.0) 3530 (84.0) 529 (83.2) 0.979 Private vehicle 483 (28.0) 240 (18.0) 293 (17.3) 80 (15.6) 662 (15.7) 105 (16.5) Others 8 (0.5) 19 (1.4) 30 (1.8) 2 (0.4) 12 (0.3) 2 (0.3) Type of accident Collision NA 788 (59.1) 972 (57.7) 0.432 NA 3350 (80.6) 433 (70.0) < 0.001 Rollover NA 546 (40.9) 714 (42.3) NA 807 (19.4) 186 (30.0) Number of fractures Isolated fractures 1311 (76.0) 754 (56.4) 1043 (61.6) < 0.001 419 (81.5) 2991 (71.1) 475 (74.6) < 0.001 Multiple/ Comminuted fractures 413 (24.0) 583 (43.6) 651 (38.4) 95 (18.5) 1217 (28.9) 162 (25.4) In car crashes, both drivers and passengers exhibited a heightened frequency of fractures in various body regions, including the face, pelvis, spine, and lower extremities, in comparison to pedestrians (p-values < 0.001). Notably, drivers had the highest frequency of head injuries (26.9%), followed by car passengers (21.2%) and pedestrians struck by cars (12.1%) (p-values < 0.01). Neck injuries were less common, with 1.8% of drivers and 1.6% of car passengers experiencing them, while only 0.6% of pedestrians struck by cars suffered from neck injuries (p-values = 0.01). Thorax injuries were most frequent in drivers (17.1%), followed by car passengers (12.6%), and pedestrians involved in car crashes (3.6%) (p-values < 0.01). Upper extremity injuries were significantly more frequent in pedestrians struck by cars (73.1%) compared to drivers (43.5%) and car passengers (43.0%) (p-values < 0.001). Shifting to motorcycle crashes, riders (20.9%) displayed a significantly higher frequency of head fractures compared to pillions (15.5%) and pedestrians (10.9%) (Pedestrian vs. rider, p-value < 0.001; pedestrian vs. pillion, p-value = 0.1; rider vs. pillion, p-value < 0.01). Additionally, 12.6% of riders, 9.3% of pillions, and 6.5% of pedestrians struck by motorcycles experienced face fractures (pedestrian vs. rider, p-value < 0.001; pedestrian vs. pillion, p-value < 0.001; rider vs. pillion, p-value = 0.03). Thorax injuries were more frequent in riders (4.8%) and motorcycle pillions (4.0%) compared to pedestrians struck by motorcycles (1.1%) (P-values < 0.01). Moreover, spine traumas were significantly higher in riders (5.6%) and motorcycle pillions (5.6%) than in pedestrians struck by motorcycles (1.2%) (P-values < 0.001). Upper extremity injuries were also significantly higher in pedestrians struck by motorcycles (67.1%) than in riders (61.9%) (P-value = 0.03). Table 2 details the distribution of fractures across various body regions among individuals involved in RTCs adjusted for age, gender, and safety device. Table 2 Body region in fractures of road traffic crash patients by road participation adjusted for age, gender, and safety device. Car crashes Motorcycle crashes Pedestrian Driver Passenger Pairwise comparison Pedestrian Rider Pillion Pairwise comparison Head 12.1 (10.6 to 13.7) 26.9 (24.2 to 29.6) 21.2 (19.1 to 23.2) B > C > A 10.9 (8.3 to 13.5) 20.9 (19.6 to 22.2) 15.5 (12.5 to 18.6) B > C > A Face 6.9 (5.7 to 8.1) 17.4 (15.2 to 19.6) 15.8 (14.0 to 17.7) B > A C > A 6.5 (4.3 to 8.6) 12.6 (11.6 to 13.7) 9.3 (6.9 to 11.7) B > C > A Neck 0.6 (0.2 to 1.0) 1.8 (0.9 to 2.7) 1.6 (1.0 to 2.1) B > A C > A 0.5 (-0.1 to 1.1) 1.1 (0.7 to 1.4) 1.0 (0.2 to 1.7) - Thorax 3.6 (2.7 to 4.5) 17.1 (14.8 to 19.4) 12.6 (10.9 to 14.3) B > C > A 1.1 (0.3 to 2.0) 4.8 (4.1 to 5.5) 4.0 (2.2 to 5.7) B > A C > A Pelvis 1.8 (1.2 to 2.4) 5.2 (3.8 to 6.7) 4.3 (3.3 to 5.3) B > A C > A 1.7 (0.5 to 3.0) 1.6 (1.2 to 2.0) 1.6 (0.6 to 2.7) - Spine 4.5 (3.6 to 5.5) 20.2 (17.7 to 22.7) 14.6 (12.8 to 16.4) B > C > A 1.2 (4.8 to 6.4) 5.6 (4.8 to 6.4) 5.6 (3.6 to 7.5) B > A C > A Upper extremity 73.1 (70.8 to 75.3) 43.5 (40.6 to 46.4) 43.0 (40.5 to 45.5) A > B A > C 67.1 (62.9 to 71.3) 61.9 (60.4 to 63.5) 64.4 (60.3 to 68.5) A > B Lower extremity 29.9 (27.6 to 32.2) 43.2 (40.3 to 46.1) 46.5 (44.0 to 49.0) B > A C > A 32.9 (28.7 to 37.1) 35.4 (33.9 to 36.9) 33.8 (29.7 to 37.8) - Multiple trauma 22.9 (20.9 to 24.9) 45.9 (42.9 to 48.8) 38.2 (35.8 to 40.6) B > C > A 16.6 (13.5 to 19.8) 29.4 (28.0 to 30.9) 24.6 (21.0 to 28.2) B > C > A A: pedestrian, B: driver/rider, C: passenger/pillion. In car crashes, the need for open reduction was observed in 47.5% of pedestrians struck by cars, with slightly lower percentages for car passengers (42.5%) and drivers (39.6%) (p-values < 0.01). The frequency of spinal repair exhibited a similar trend, being highest among drivers (5.6%), followed by car passengers (3.6%), and pedestrians involved in car crashes (1.0%) (pedestrian vs. driver, p-value < 0.001; pedestrian vs. passenger, p-value < 0.001; driver vs. passenger, p-value = 0.03). In motorcycle crashes, a parallel pattern emerged concerning spinal repair. Riders displayed the highest rate of spinal repair (1.7%), surpassing pillions (0.4%) and pedestrians (0.2%) (pedestrian vs. rider, p-value = 0.01; rider vs. pillion, p-value = 0.03). Table 3 displays a comprehensive overview of clinical management and outcomes in RTC-related trauma patients adjusted for age, gender, and safety device. Table 3 Clinical management and outcomes of road traffic crash patients by road participation adjusted for age, gender, and safety device. Car crashes Motorcycle crashes Pedestrian Driver Passenger Pairwise comparison Pedestrian Rider Pillion Pairwise comparison Craniotomy 0.7 (0.3 to 1.1) 2.1 (1.2 to 3.0) 1.1 (0.6 to 1.7) B > A 0.3 (-0.1 to 0.8) 1.2 (0.9 to 1.6) 2.2 (0.9 to 3.6) C > A Plaster/splints 40.4 (37.9 to 42.9) 33.8 (31.0 to 36.6) 32.6 (30.3 to 34.9) A > B A > C 50.2 (45.7 to 54.7) 49.8 (48.3 to 51.4) 45.6 (41.4 to 49.9) - Traction 2.2 (1.5 to 2.9) 4.4 (3.1 to 5.6) 3.9 (2.9 to 4.9) B > A C > A 3.0 (1.5 to 4.6) 2.7 (2.2 to 3.2) 1.6 (0.6 to 2.7) - Fracture immobilization 39.8 (37.4 to 42.2) 42.5 (39.6 to 45.4) 38.1 (35.7 to 40.6) B > C 54.1 (49.7 to 58.5) 46.0 (44.5 to 47.6) 46.6 (42.3 to 50.8) A > B A > C Closed reduction 38.7 (36.2 to 41.2) 30.4 (27.8 to 33.1) 36.7 (34.3 to 39.1) A > B C > B 40.2 (35.7 to 44.6) 33.2 (31.7 to 44.6) 31.5 (27.5 to 35.4) A > B A > C Open reduction 47.5 (45.0 to 50.0) 39.6 (36.8 to 42.5) 42.5 (40.0 to 44.9) A > B A > C 47.3 (42.8 to 51.8) 48.0 (46.4 to 49.6) 50.3 (46.0 to 54.6) - Amputation 0.1 (-0.1 to 0.2) - 0.2 (-0.2 to 0.5) - - 0.3 (0.1 to 0.4) 0.2 (-0.2 to 0.7) - Spinal repair 1.0 (0.5 to 1.4) 5.6 (4.1 to 7.1) 3.6 (2.7 to 4.6) B > C > A 0.2 (-0.1 to 0.6) 1.7 (1.0 to 2.4) 0.4 (0.0 to 0.9) B > A B > C Mechanical ventilation 3.6 (2.7 to 4.4) 7.9 (6.3 to 9.4) 7.1 (5.8 to 8.5) B > A C > A 1.8 (0.7 to 2.9) 3.9 (3.3 to 4.5) 3.3 (1.7 to 4.9) B > A ICU admission 11.3 (9.8 to 12.8) 20.3 (17.9 to 22.7) 18.4 (16.4 to 20.3) B > A C > A 7.4 (5.2 to 9.5) 10.4 (9.4 to 11.4) 10.0 (7.3 to 12.7) B > A Death 1.2 (0.7 to 1.7) 1.8 (1.0 to 2.6) 2.0 (1.2 to 2.8) - 0.4 (-0.1 to 0.8) 0.9 (0.6 to 1.3) 0.9 (-.0.1 to 1.9) - A: pedestrian, B: driver/rider, C: passenger/pillion. Table 4 presents the frequency of extremities and pelvis fractures in car and motorcycle crashes, adjusted for age, gender, Injury Severity Score (ISS), safety device, and vehicle type. Notably, pedestrians (0.6%) exhibited a significantly higher frequency of ilium fractures compared to drivers/riders (0.2%) (p-value = 0.01). Pubis fractures were more frequent in pedestrians (3.4%) than in drivers/riders (1.9%) (p-value < 0.01). When adjusting for age, gender, ISS, safety device, and type of vehicle, 3.3% of pedestrians experienced fractures in the proximal humerus, and 1.8% had fractures in the shaft of the ulna. Both frequencies were higher than those observed in drivers/riders (2.3% and 1.1%, respectively) (p-values: 0.04 and 0.02, respectively). Furthermore, the frequency of peritrochanteric fractures in pedestrians was 3.7%, significantly surpassing the frequency of 1.9% among passengers/pillions and 1.7% among drivers/riders (p-values < 0.01). Additionally, fractures in the proximal tibia and shaft of the tibia were observed in 10.0% and 15.8% of pedestrians, respectively, which were significantly higher than the frequencies among drivers/riders and passengers/pillions when adjusting for age, gender, ISS, safety device, and type of vehicle (p-values < 0.001). In pedestrians, the frequency of distal tibia fractures was 5.1%, significantly exceeding 3.6% among drivers/riders and 2.7% among passengers/pillions (p-values < 0.01). Table 4 Specific fractures (extremities and pelvis) in car and motorcycle accidents adjusted for age, gender, ISS, safety device, and type of vehicle. Pedestrian Driver/rider Passenger/pillion Pairwise comparison S32.3 - Fracture of ilium 0.6 (0.3 to 1.0) 0.2 (0.1 to 0.4) 0.6 (0.2 to 0.9) A > B, C > B S32.4 - Fracture of acetabulum 2.4 (1.7 to 3.1) 3.2 (2.7 to 3.7) 4.1 (3.3 to 5.0) C > A S32.5 - Fracture of pubis 3.4 (2.6 to 4.1) 1.9 (1.5 to 2.3) 2.5 (1.9 to 3.1) A > B S42.2 - Fracture of proximal humerus 3.3 (2.5 to 4.0) 2.3 (1.9 to 2.8) 4.3 (3.5 to 5.2) A > B, C > B S42.3 - Fracture of shaft of humerus 1.4 (0.9 to 1.9) 2.6 (2.1 to 3.1) 4.8 (3.9 to 5.7) C > B > A S42.4 - Fracture of distal humerus 1.5 (1.0 to 2.0) 1.3 (1.0 to 1.7) 2.7 (2.1 to 3.4) C > A, C > B S52 - Fracture of forearm 0.1 (-0.0 to 0.3) 0.1 (0.0 to 0.2) 0.2 (-0.0 to 0.3) - S52.0 - Fracture of proximal of ulna 1.1 (0.6 to 1.5) 1.3 (0.9 to 1.6) 1.3 (0.8 to 1.8) - S52.1 - Fracture of proximal radius 0.5 (0.2 to 0.8) 0.7 (0.5 to 0.9) 0.7 (0.3 to 1.1) - S52.2 - Fracture of shaft of ulna 1.8 (1.2 to 2.4) 1.1 (0.8 to 1.4) 2.0 (1.4 to 2.7) A > B, C > B S52.3 - Fracture of shaft of radius 0.9 (0.5 to 1.3) 1.5 (1.2 to 1.9) 1.7 (1.2 to 2.3) C > A S52.4 - Fracture of shafts of both ulna and radius 0.4 (0.1 to 0.6) 0.5 (0.3 to 0.6) 0.6 (0.3 to 1.0) - S52.5 - Fracture of distal radius 7.2 (6.1 to 8.3) 7.3 (6.6 to 8.1) 6.6 (5.5 to 7.7) - S52.6 - Fracture of the distal of both ulna and radius 0.9 (0.5 to 1.3) 1.6 (1.2 to 2.0) 1.3 (0.8 to 1.7) B > A S52.7 - Multiple fractures of the forearm 2.1 (1.5 to 2.8) 1.2 (0.9 to 1.5) 2.2 (1.5 to 2.8) A > B, C > B S72 - Fracture of femur 0.1 (-0.0 to 0.3) 0.5 (0.3 to 0.7) 0.5 (0.2 to 0.8) - S72.0 - Fracture of neck of femur 2.7 (2.0 to 3.4) 2.0 (1.6 to 2.4) 2.1 (1.5 to 2.7) - S72.1 – Peritrochanteric fracture 3.7 (2.9 to 4.5) 1.7 (1.3 to 2.0) 1.9 (1.3 to 2.5) A > B, A > C S72.2 - Subtrochanteric fracture 1.3 (0.7 to 1.8) 0.9 (0.7 to 1.2) 1.1 (0.7 to 1.6) - S72.3 - Fracture of shaft of femur 4.6 (3.7 to 5.6) 6.0 (5.4 to 6.6) 6.2 (5.2 to 7.1) B > A, C > A S72.4 - Fracture of distal femur 2.4 (1.7 to 3.0) 2.9 (2.4 to 3.4) 2.2 (1.6 to 2.9) - S72.7 - Multiple fractures of the femur 0.1 (-0.0 to 0.2) 0.3 (0.2 to 0.4) 0.4 (0.1 to 0.7) - S82 - Fracture of the lower leg, including ankle 0.4 (0.2 to 0.7) 0.4 (0.2 to 0.5) 0.2 (-0.0 to 0.4) - S82.0 - Fracture of patella 2.0 (1.3 to 2.6) 3.1 (2.6 to 3.5) 2.3 (1.6 to 2.9) B > A S82.1 - Fracture of proximal tibia 10.0 (8.7 to 11.3) 7.1 (6.4 to 7.8) 4.1 (3.2 to 5.0) A > B > C S82.2 - Fracture of shaft of tibia 15.8 (14.3 to 17.4) 11.8 (10.9 to 12.6) 8.6 (7.3 to 9.8) A > B > C S82.3 - Fracture of distal tibia 5.1 (4.1 to 6.0) 3.6 (3.0 to 4.1) 2.7 (2.0 to 3.3) A > B, A > C S82.4 - Fracture of fibula alone 2.8 (2.1 to 3.5) 2.2 (1.8 to 2.6) 1.1 (0.6 to 1.5) A > C, B > C S82.5 - Fracture of medial malleolus 3.2 (2.4 to 3.9) 2.7 (2.3 to 3.1) 1.8 (1.2 to 2.4) A > C, B > C S82.6 - Fracture of lateral malleolus 2.2 (1.5 to 2.8) 2.0 (1.6 to 2.4) 1.4 (0.9 to 1.9) - S82.7 - Multiple fractures of the lower leg 1.3 (0.7 to 2.0) 0.3 (0.2 to 0.4) 0.8 (0.4 to 1.2) A > B, C > B A: pedestrian, B: driver/rider, C: passenger/pillion. ISS: Injury Severity Score. Approximately 1.6% of drivers/riders suffered from distal radius and ulna fractures, surpassing the 0.9% observed in pedestrians (p-value = 0.03). Among drivers/riders, 6.0% exhibited femur shaft fractures, while 4.6% of pedestrians had this type of fracture (p-value = 0.03). Additionally, 3.1% of drivers/riders experienced patella fractures, a statistically significant increase compared to the 2.0% observed in pedestrians (p-value = 0.02). Fibula fractures were observed in 2.2% of drivers/riders, significantly higher than the 1.1% followed in passengers/pillions (p-value < 0.01). Furthermore, drivers/riders displayed a significantly higher frequency of fractures in the medial malleolus (2.7%) compared to the 1.8% observed in passengers/pillions (p-value = 0.04). Fractures of the ilium were more frequent in passengers/pillions (0.6%) compared to drivers/riders (0.2%) (p-value = 0.04). Among fractures of the shaft of the humerus, passengers/pillions had the highest frequency (4.8%), followed by drivers/riders (2.6%) and pedestrians (1.4%) (p-values < 0.01). Additionally, fractures in the proximal humerus (4.3%), distal humerus (2.7%), and shaft of the ulna (2.0%) were significantly more common in passengers/pillions compared to 3.3%, 1.5%, and 1.8% in drivers/riders, respectively (p-values < 0.01). Table 5 outlines the frequency of neck and spine fractures in car crashes, adjusted for age, gender, safety device, and type of accident. Fractures in the cervical vertebra C3-C7, thoracic vertebra, and lumbar vertebra were more frequent in drivers (3.2%, 7.0%, 8.3%) compared to car passengers (1.4%, 4.9%, 5.6%, respectively) (p-values: <0.01, 0.04, and 0.01, respectively). Table 5 Specific fractures (neck and spine) in car accidents adjusted for age, gender, safety device, and type of accident. Driver Passenger p-value S12.0- Fracture of first cervical vertebra (C1 fracture) 0.6 (0.1 to 1.1) 0.5 (0.2 to 0.9) 0.758 S12.1- Fracture of second cervical vertebra (C2 fracture) 0.8 (0.3 to 1.2) 1.1 (0.5 to 1.7) 0.389 S12.2- Fracture of other specified cervical vertebra 3.2 (2.0 to 4.3) 1.4 (0.8 to 2.0) 0.006 S12.7- Multiple fractures of the cervical spine 0.5 (0.1 to 0.9) 0.6 (0.2 to 1.0) 0.714 S22.0- Fracture of thoracic vertebra 7.0 (5.4 to 8.5) 4.9 (3.9 to 6.0) 0.042 S22.1- Multiple fractures of the thoracic spine 0.9 (0.4 to 1.5) 0.7 (0.2 to 1.1) 0.458 S32.0- Fracture of lumbar vertebra 8.3 (6.6 to 10.0) 5.6 (4.5 to 6.7) 0.012 S32.1- Fracture of sacrum 1.6 (0.8 to 2.5) 1.5 (0.9 to 2.1) 0.845 S32.2- Fracture of coccyx 0.2 (-0.1 to 0.5) 0.1 (-0.0 to 0.2) 0.603 Bold indicates column proportions that differ significantly at the 0.05 level. Table 6 describes the frequency of head and face fractures in motorcycle crashes, adjusted for age, gender, safety device, and type of accident. There were no significant differences in head and face fractures between riders and motorcycle pillions. Table 6 Specific fractures (head and face) in motorcycle accidents adjusted for age, gender, safety device, and type of accident. Rider Pillion p-value S02 - Fracture of skull and facial bones 0.6 (0.3 to 0.8) 0.5 (-0.2 to 1.3) 0.923 S02.0 - Fracture of vault of skull 1.7 (1.3 to 2.1) 2.0 (0.7 to 3.2) 0.706 S02.1 - Fracture of the base of the skull 3.8 (3.1 to 4.4) 2.9 (1.4 to 4.3) 0.328 S02.2 - Fracture of nasal bones 3.7 (3.1 to 4.3) 3.1 (1.6 to 4.6) 0.502 S02.3 - Fracture of orbital floor 0.8 (0.6 to 1.1) 1.0 (0.1 to 2.0) 0.661 S02.4 - Fracture of malar and maxillary bones 4.2 (3.6 to 4.8) 2.9 (1.3 to 4.4) 0.175 S02.6 - Fracture of mandible 2.1 (1.7 to 2.5) 1.5 (0.5 to 2.6) 0.402 S02.7 - Multiple fractures involving skull and facial bones 2.1 (1.5 to 2.6) 1.0 (0.1 to 1.9) 0.160 Tables 1 and 2 found in the supplementary materials display the distribution of fracture sites in both car and motorcycle crashes. 4. Discussion In both car and motorcycle crashes, males were more commonly involved compared to females. Different patterns of injuries were observed among drivers, passengers, pedestrians, riders, and pillions, with varying frequencies of head injuries, upper and lower extremity injuries, vertebral fractures, and other types of fractures depending on the role in the crash. The majority of the RTC-related injured individuals were motorcyclists, with approximately 81.6% being male and 18.7% under the age of 18. This demographic distribution underscores the vulnerability of young male motorcyclists in RTC-related trauma. Batista et al. conducted a parallel study on 3,528 motorcycle crash victims over seven years, with a significant male predominance constituting 88.86% of all victims [ 16 ]. Furthermore, Brockamp et al.'s investigation of 24,373 road accident trauma victims from the German trauma registry underscored a heightened frequency of severe and fatal injuries among the younger population [ 17 ]. Fractures were predominantly observed in the lower extremities, with the tibia emerging as the most frequently fractured bone, followed by the femur in our study. The upper extremities, particularly the radius and humerus, ranked second in common fractures. This aligns with findings from other studies [ 16 , 18 , 19 ]. A retrospective hospital-based study conducted in Kashan, Iran, illustrated these trends, emphasizing a more significant occurrence of fractures in the lower extremities, with the tibia and fibula taking precedence, followed by the femur [ 11 ]. In our study, a significant pattern emerged as head fractures exhibited a higher frequency among drivers than car passengers and pedestrians struck by cars. While the pervasiveness of traffic accidents continues to be a leading cause of facial fractures, our study emphasized an intriguing distinction between drivers and pedestrians struck by cars as well as between riders and motorcycle pillions and pedestrians involved in motorcycle crashes. Drivers might face increased vulnerability due to their proximity to the steering wheel. Fonseca et al. revealed that drivers not wearing seat belts experienced 6.33 fractures per patient, whereas those wearing seat belts had 5.54 fractures per patient [ 20 ]. Modern safety features, mainly steering wheel protection measures like airbags, may contribute to a reduction in facial fractures. This implies that while drivers are exposed to potential injuries due to their position, advanced safety technologies in vehicles, especially those protecting the steering wheel, might effectively mitigate them [ 20 ]. The prevalence of such safety features is emphasized, especially in Europe and North America [ 21 , 22 ]. Our study revealed no cases involving airbag-equipped vehicles, possibly due to their low prevalence in our region or the effective prevention of facial fractures when airbags were activated. To further understand the discrepancies noted in injuries between drivers, car passengers, and pedestrians struck by cars, it is essential to consider additional factors such as airbag deployment and the presence or absence of side impact protection systems. Modern vehicles equipped with steering wheel protection measures, including airbags, may contribute significantly to the protection of drivers. Conversely, the absence of a steering wheel in passenger positions may expose them to increased forward momentum, potentially concentrating force on areas of restraint, particularly the chest and abdomen [ 23 ]. Our study uncovered a contrasting result, showing a higher frequency of thorax injuries in drivers compared to car passengers, which could be attributed to the inadequate use of airbags in our region. Additionally, we observed a higher frequency of spine fractures in drivers compared to car passengers, which could be due to the increased flexion and extension of the spine associated with these types of injuries in drivers. A study conducted by Pigolkin et al. on traffic accident victims found that the driver's most common fatal injuries consist of fractures in the cervical, thoracic, and lumbar vertebrae, which were much less frequent in passengers seated in the front and right back seats [ 24 ]. Pedestrians struck by cars demonstrated a higher frequency of proximal tibia, shaft of tibia, and distal tibia fractures in our study, aligning with the notion that the knee joint is one of the most vulnerable body parts in car-to-pedestrian collisions [ 25 ]. The impact, concentrated mainly in the knee joint or just below it, is attributed to the low bumper height in passenger cars [ 26 ]. Similar findings were noted by Otte et al., who studied lower leg fractures in pedestrians and bicyclists after collisions, revealing a higher prevalence of proximal tibia fractures in pedestrians than in cyclists [ 27 ]. A retrospective study spanning three years further pointed out a significant prevalence of ligamentous knee injuries in pedestrians struck by motor vehicles [ 28 ]. In our study, when adjusted for age, gender, ISS, safety device, and type of vehicle, ilium and humerus fractures were more commonplace in passengers/pillions compared to drivers/riders, consistent with findings from other studies. A retrospective study involving 191 patients injured in motor vehicle collisions underscored a higher occurrence of lower limb and pelvic fractures in males, rear seat passengers, and occupants of smaller vehicles [ 29 ]. Notably, pelvis ring fractures were frequently observed when a component of the door or side of the car intruded into the passenger compartment, compressing the pelvis laterally [ 30 ]. In our study, we found that only 1.8% of drivers and 1.6% of car passengers experienced neck injuries, a significantly lower rate compared to what is typically reported in the literature. This discrepancy raises questions about potential factors contributing to our findings, such as the possibility of underdiagnosed injuries or a failure to recognize certain symptoms, which could have resulted in incomplete data in the NTRI dataset. According to previous studies, there's a generally accepted "safe threshold" for rear-end impacts, which suggests that velocities between 10 and 15 km/h shouldn't cause harm [ 31 ]. Individuals involved in rear-end collisions, particularly drivers, face a significantly higher risk of suffering whiplash injuries and factors such as age and gender seem to play a less significant role [ 32 ]. To ensure the accuracy of our results, we adjusted for variables like age, gender, and safety device usage. However, unfortunately, we lacked specific information about factors such as vehicle speed or the nature of the collision (e.g., car-to-car or car-to-wall). Our study's strength is exemplified by its large sample size, allowing for a thorough exploration of distinct fracture types in the Iranian population and providing distinctive insights not present in other studies. The combination of large sample size, a unique focus on different fracture types, and detailed categorization strengthens our study's overall impact and relevance, marking it as a valuable addition to the field. Acknowledging the limitations of our study is crucial. Including children may influence results due to distinct injury patterns in this population, mainly since they likely constitute a significant proportion of those seated in the rear seats. Moreover, we didn’t have access to the data on the passenger seats, such as the front, center, and outboard seats, which may influence patient injury risks. Additionally, the lack of information in our national trauma registry regarding different vehicle types, their weight, and speed introduces potential bias into the study, affecting injury patterns. We also didn’t have access to the data of trauma victims who succumbed at the scene. 5. Conclusion When adjusting for factors such as age, gender, and the use of safety devices, a distinct pattern emerges in the types of injuries sustained by individuals involved in different kinds of motor vehicle accidents. Drivers, after adjustments, displayed a heightened frequency of experiencing fractures in the head, spine, and multiple areas, often necessitating spinal repairs. On the other hand, pedestrians struck by cars exhibited a higher frequency of upper extremity fractures, commonly treated with casts, splints, and open reduction methods, compared to drivers and car passengers. In motorcycle crashes, riders faced a higher frequency of head and facial fractures, as well as multiple traumas, leading to a greater prevalence of spinal repairs. Conversely, pedestrians struck by motorcycles more frequently underwent fracture immobilization and closed reduction procedures compared to riders and motorcycle pillions. Further adjustments for age, gender, safety device usage, and vehicle type revealed additional nuances. Even when factoring in these variables, pedestrians demonstrated a heightened frequency of peritrochanteric, proximal, shaft, and distal tibia fractures. Meanwhile, passengers/pillions, under similar adjustments, were more prone to shaft and distal humerus fractures. Abbreviations RTCs: Road traffic crashes YLDs: Years lived with disability DALYs: Disability-Adjusted Life Years NTRI: National Trauma Registry of Iran ICUs: Intensive care units ICD: International Classification of Diseases and Causes of Death Declarations Author Contribution Conceptualization: P.S., SH.Sh, and M.H.Data curation: S.M., S.P., SM.P, M.S., M.Sh, and M.KFormal analysis: M.H and V.B.Funding acquisition: M.Z.Investigation: SH.Sh, E.F., SH.SB,V.H., H.SB, R.FR, F.S., M.NE., V.R, and A.GhMethodology: V.B.Project administration: P.S. and M.Z. Resources: M.Z. Software: Kh.N. Supervision: V.R., P.S., SH,Sh, E.F., SH.SB,V.H., H.SB, R.FR, F.S., M.NE., V.R, and A.GhValidation: V.R., S.P., and SM.P.Visualization: M.H., S.M., M.S., M.Sh, and M.K.Writing–original draft: M.H., M.S.Writing–review editing: A.Kh., S.P., and SM.P. References Soroush D et al. 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Castro W et al. Do whiplash injuries occur in low-speed rear impacts? European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 1997. 6(6): p. 366–75. Berglund A, et al. Occupant-and crash-related factors associated with the risk of whiplash injury. Ann Epidemiol. 2003;13(1):66–72. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Sciences","correspondingAuthor":false,"prefix":"","firstName":"Vahid","middleName":"","lastName":"Rahmanian","suffix":""},{"id":281672378,"identity":"96e26d51-2a2c-4e5d-8ce6-ab2803dd8819","order_by":14,"name":"Amir Ghadiphasha","email":"","orcid":"","institution":"Shahid Modarres Hospital, Saveh University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Amir","middleName":"","lastName":"Ghadiphasha","suffix":""},{"id":281672379,"identity":"69a12740-39af-458c-8740-d6b93267edab","order_by":15,"name":"Mohammad Shahidi","email":"","orcid":"","institution":"Qom University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Shahidi","suffix":""},{"id":281672380,"identity":"bcf8636f-fe24-4bf2-9398-f22598f29203","order_by":16,"name":"Mohamad Kogani","email":"","orcid":"","institution":"Abadan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohamad","middleName":"","lastName":"Kogani","suffix":""},{"id":281672381,"identity":"f9a378b0-c13a-4481-8e25-88e819867d6b","order_by":17,"name":"Sobhan Pourmasjedi","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Sobhan","middleName":"","lastName":"Pourmasjedi","suffix":""},{"id":281672382,"identity":"ae2bdda2-4d59-43b0-aa4b-fd3fdc8282bd","order_by":18,"name":"Seyed Mohammad Piri","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Seyed","middleName":"Mohammad","lastName":"Piri","suffix":""},{"id":281672383,"identity":"8c0aa718-a501-43ec-91f4-8f12973e8b14","order_by":19,"name":"Sara Mirzamohamadi","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Sara","middleName":"","lastName":"Mirzamohamadi","suffix":""},{"id":281672384,"identity":"eede9ca1-c2a9-4720-b174-a67f45191555","order_by":20,"name":"Armin Khavandegar","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Armin","middleName":"","lastName":"Khavandegar","suffix":""},{"id":281672385,"identity":"4332fee2-66fb-4b3c-b236-843271e1b67f","order_by":21,"name":"Khatereh Naghdi","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Khatereh","middleName":"","lastName":"Naghdi","suffix":""},{"id":281672386,"identity":"07fd0c25-4d49-468c-a2c9-d5e19ce94681","order_by":22,"name":"Payman Salamati","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYFAC5gYQycPADqINLIjRwghWysPAcwBESxCvhYFBIgHEI0KLfPvBxk83av7ImEs+v7rhR4EEA397dwJeLQZnEpulc44Z8FjOzim72QN0mMSZsxvwa2FIbJDOYTPgMbidk3aDB6jFQCIXvxb5/ofNv3P+AbXcPJN28w8xWhhuJLZJ57YBtdxgP3abKFsMbjxss87tM+ax7Mlhuy1jIMFD0C/y/cmHb+d8k7M3Zz/+7OabPzZy/O29BBwGt46BxwBE8xCnHKKF/QHxqkfBKBgFo2BEAQBAa0aIyJFHTwAAAABJRU5ErkJggg==","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Payman","middleName":"","lastName":"Salamati","suffix":""}],"badges":[],"createdAt":"2024-03-19 16:50:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4132019/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4132019/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58406982,"identity":"c6e65571-7c44-45be-b7c1-38f731b5bb7b","added_by":"auto","created_at":"2024-06-15 07:34:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1095700,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4132019/v1/d346b0c2-61bc-4069-ab71-ba337bb2dd2d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The pattern of fractures in road traffic crashes; findings from the National Trauma Registry in Iran","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eRoad traffic crashes (RTCs), ranking as the ninth leading cause of death globally (and second in Iran), constitute a significant public health concern [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The World Health Organization's global road safety report indicated that Iran recorded a substantial 22,918 fatalities related to RTCs in a year [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Beyond the loss of life, these incidents result in a staggering 20\u0026ndash;50\u0026nbsp;million non-fatal injuries annually, many of which lead to disabilities and account for 1.06% of all years lived with disability (YLDs) and 5.63% of Disability-Adjusted Life Years (DALY) among the Iranian population [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn low-income countries, RTCs are a leading cause of fractures, with survivors and their families facing significant social, physical, and psychological challenges [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Families often struggle with ongoing medical costs and the financial support needed for disabled individuals. Furthermore, injuries can lead to temporary unemployment or early retirement, creating a burden on both insurance companies and society [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile numerous epidemiological studies conducted in Iran have focused on various aspects of RTCs, such as injury patterns, mortality rates, demographic characteristics of patients, and associated costs, less attention has been given to the patterns of fractures in RTC patients [\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Furthermore, insufficient information exists regarding variations in fracture patterns based on the occupant's seating position and road participation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Understanding the patterns of RTC-related fractures is paramount for policymakers and strategic planners. This can significantly benefit public emergency services, healthcare facilities, and rehabilitation centers by helping them prioritize and implement preventive measures and improve their quality of care [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Moreover, detailed data on fracture patterns occurring in different car seat locations can draw attention to specific safety requirements and propose enhancements for safety features in those particular areas of the vehicle [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aimed to determine the pattern of RTC-associated fractures in drivers, riders, passengers, pillions, and pedestrians involved in car and motorcycle crashes for eight years in Iran.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study design and participants:\u003c/h2\u003e \u003cp\u003eWe conducted a registry-based study among trauma patients associated with the National Trauma Registry of Iran (NTRI) between September 17, 2016, and February 01, 2023. This registry is a collaborative initiative involving multiple major trauma centers across the country and was initially established at Sina Hospital in Tehran, Iran, in 2015 by the Sina Trauma and Surgery Research Center. Previous articles have provided detailed information about the NTRI's registration process, a minimal dataset, and data quality assurance [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Our study encompassed all trauma patients involved in RTCs, including car and motorcycle crashes, who presented with at least one fracture site and met the NTRI's inclusion criteria. These criteria included hospitalization for more than 24 hours, fatal injuries on the first day of admission, or transfer from other hospitals' intensive care units (ICUs). All RTCs involving bicycles, pick-up trucks or vans, buses, and heavy transport vehicles were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. NTRI Data collection:\u003c/h2\u003e \u003cp\u003eThe registration process occurs in multiple stages. Initially, the hospital information system (HIS) identifies suitable patients using specific criteria. Subsequently, three trained nurses gathered patient information through face-to-face interviews or retrieved data from companions or hospital records if necessary. The interview questionnaire comprises 99 variables organized into eight sections, with specifics detailed in prior publications. Once the data is compiled, skilled registrars input it into the NTRI database portal. Finally, a qualified physician meticulously reviews and validates the accuracy and comprehensiveness of the gathered data. Previous articles extensively addressed the data collection process during the NTRI pilot phase.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Variables:\u003c/h2\u003e \u003cp\u003eThe data analysis was conducted using the International Classification of Diseases and Causes of Death (ICD-10) codes for orthopedic and non-orthopedic admissions associated with RTCs. Fractures were classified according to the location of the injury, encompassing skull and facial bone fractures (S02), neck fractures (S12), rib, sternum, and thoracic spine fractures (S22), lumbar spine and pelvis fractures (S32), shoulder and upper arm fractures (S42), forearm fractures (S52), wrist and hand fractures (S62), femur fractures (S72), lower leg (including ankle) fractures (S82), and foot (except ankle) fractures (S92). We analyzed variables including gender, age group, transport to hospital, type of accident, number of fractures, body region of fractures, and fracture sites. The transport to the hospital was divided into three groups: ambulance, private vehicle, and others (i.e., police, public transportation, and on foot). The number of registered fractures pertained to the total number of fracture lines, regardless of whether a single line affected two or more bones. When a single bone exhibited two distinct fracture lines, each line was tallied individually based on the number of fracture lines observed. Comminuted fractures were grouped with multiple fractures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Statistical analysis and ethical statement:\u003c/h2\u003e \u003cp\u003eNumber and percent, and percent were used for describing nominal and categorical variables. The proportion of nominal and categorical variables among pedestrians, drivers/riders, and passengers/pillions were compared using the chi-square test. Also, the Chi-square test was used to compare the types of fractures among pedestrians, drivers/riders, and passengers/pillions. The Bonferroni approach was used for correcting multiple comparisons.\u003c/p\u003e \u003cp\u003eLogistic regression models and \"margins\" command were employed to estimate the adjusted fracture frequency by three groups. A p-value less than 0.05 was considered statistically significant. Stata software version 14.0 (Stata Corporation, College Station, TX) was employed for data analysis.\u003c/p\u003e \u003cp\u003eThis study was approved by the ethics committee of Sina Hospital, Tehran University of Medical Sciences (Approval ID: IR.TUMS.SINAHOSPITAL.REC.1399.090).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eWe evaluated 10,114 cases of trauma patients associated with RTCs, comprising 4,755 (47.0%) car crashes and 5,359 (53.0%) motorcycle crashes. The average age of individuals involved in car crashes was 37.3\u0026thinsp;\u0026plusmn;\u0026thinsp;19.3 years, while for motorcycle crashes, it was 33.7\u0026thinsp;\u0026plusmn;\u0026thinsp;16.8 years (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eIn car crashes, 796 (47.0%) car passengers were male. Male individuals constituted 1,243 (72.1%) pedestrians struck by cars and 1,205 (90.1%) drivers (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Notably, 483 (28.0%) pedestrians and 240 (18.0%) drivers in car crashes were transported to the hospital by private cars (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Approximately 583 (43.6%) drivers had multiple or comminuted fractures, significantly more than 413 (24.0%) pedestrians injured in car crashes, and 651 (38.4%) car passengers (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eMale individuals constituted 396 (77.0%) pedestrians struck by motorcycles, 4,193 (99.6%) riders, and 416 (65.3%) motorcycle pillions (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Almost 773 (18.4%) riders and 230 (36.2%) pillions were children under the age of 18 in motorcycle crashes (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Pedestrians over the age of 64 demonstrated a significantly higher crash rate (17.1%) compared to riders (4.6%) and pillions (3.3%) in the same age group in motorcycle crashes (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Collison crashes involved 3,350 (80.6%) riders and 433 (70.0%) motorcycle pillions, while rollovers accounted for 807 (19.4%) riders and 186 (30.0) motorcycle pillions (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In motorcycle crashes, more riders (28.9%) experienced multiple and comminuted fractures compared to pedestrians struck by motorcycles (18.5%) (P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additional demographic characteristics and crash-related details of RTC patients are illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and crash-related characteristics of road traffic crash patients by road participation.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eCar crashes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eMotorcycle crashes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePedestrian\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1724)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDriver\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1337)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePassenger\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1694)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePedestrian\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;514)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRider\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;4208)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePillion\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;637)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1243 (72.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1205 (90.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e796 (47.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e396 (77.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4193 (99.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e416 (65.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e481 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e132 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e898 (53.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e118 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e15 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e221 (34.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e382 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e368 (21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e103 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e773 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e230 (36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1057 (61.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1247 (93.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1203 (71.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e323 (62.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3239 (77.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e384 (60.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e285 (16.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e123 (7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e88 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e192 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e22 (3.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransport to hospital\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmbulance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1232 (71.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1078 (80.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1370 (80.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e431 (84.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3530 (84.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e529 (83.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.979\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate vehicle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e483 (28.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e240 (18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e293 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e80 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e662 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e105 (16.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e12 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2 (0.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of accident\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e788 (59.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e972 (57.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3350 (80.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e433 (70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRollover\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e546 (40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e714 (42.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e807 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e186 (30.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of fractures\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated fractures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1311 (76.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e754 (56.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1043 (61.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e419 (81.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2991 (71.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e475 (74.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple/ Comminuted fractures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e413 (24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e583 (43.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e651 (38.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95 (18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1217 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e162 (25.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn car crashes, both drivers and passengers exhibited a heightened frequency of fractures in various body regions, including the face, pelvis, spine, and lower extremities, in comparison to pedestrians (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Notably, drivers had the highest frequency of head injuries (26.9%), followed by car passengers (21.2%) and pedestrians struck by cars (12.1%) (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Neck injuries were less common, with 1.8% of drivers and 1.6% of car passengers experiencing them, while only 0.6% of pedestrians struck by cars suffered from neck injuries (p-values\u0026thinsp;=\u0026thinsp;0.01). Thorax injuries were most frequent in drivers (17.1%), followed by car passengers (12.6%), and pedestrians involved in car crashes (3.6%) (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Upper extremity injuries were significantly more frequent in pedestrians struck by cars (73.1%) compared to drivers (43.5%) and car passengers (43.0%) (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eShifting to motorcycle crashes, riders (20.9%) displayed a significantly higher frequency of head fractures compared to pillions (15.5%) and pedestrians (10.9%) (Pedestrian vs. rider, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001; pedestrian vs. pillion, p-value\u0026thinsp;=\u0026thinsp;0.1; rider vs. pillion, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Additionally, 12.6% of riders, 9.3% of pillions, and 6.5% of pedestrians struck by motorcycles experienced face fractures (pedestrian vs. rider, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001; pedestrian vs. pillion, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001; rider vs. pillion, p-value\u0026thinsp;=\u0026thinsp;0.03). Thorax injuries were more frequent in riders (4.8%) and motorcycle pillions (4.0%) compared to pedestrians struck by motorcycles (1.1%) (P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Moreover, spine traumas were significantly higher in riders (5.6%) and motorcycle pillions (5.6%) than in pedestrians struck by motorcycles (1.2%) (P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Upper extremity injuries were also significantly higher in pedestrians struck by motorcycles (67.1%) than in riders (61.9%) (P-value\u0026thinsp;=\u0026thinsp;0.03). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e details the distribution of fractures across various body regions among individuals involved in RTCs adjusted for age, gender, and safety device.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBody region in fractures of road traffic crash patients by road participation adjusted for age, gender, and safety device.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eCar crashes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eMotorcycle crashes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePedestrian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDriver\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePassenger\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePairwise\u003c/p\u003e \u003cp\u003ecomparison\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePedestrian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRider\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePillion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePairwise\u003c/p\u003e \u003cp\u003ecomparison\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003cp\u003e(10.6 to 13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.9\u003c/p\u003e \u003cp\u003e(24.2 to 29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003cp\u003e(19.1 to 23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;C\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003cp\u003e(8.3 to 13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.9\u003c/p\u003e \u003cp\u003e(19.6 to 22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15.5\u003c/p\u003e \u003cp\u003e(12.5 to 18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;C\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003cp\u003e(5.7 to 8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.4\u003c/p\u003e \u003cp\u003e(15.2 to 19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003cp\u003e(14.0 to 17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003cp\u003eC\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003cp\u003e(4.3 to 8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003cp\u003e(11.6 to 13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003cp\u003e(6.9 to 11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;C\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003cp\u003e(0.2 to 1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003cp\u003e(0.9 to 2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003cp\u003e(1.0 to 2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003cp\u003eC\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003cp\u003e(-0.1 to 1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003cp\u003e(0.7 to 1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003cp\u003e(0.2 to 1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThorax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003cp\u003e(2.7 to 4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.1\u003c/p\u003e \u003cp\u003e(14.8 to 19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003cp\u003e(10.9 to 14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;C\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003cp\u003e(0.3 to 2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003cp\u003e(4.1 to 5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003cp\u003e(2.2 to 5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003cp\u003eC\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePelvis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003cp\u003e(1.2 to 2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003cp\u003e(3.8 to 6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003cp\u003e(3.3 to 5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003cp\u003eC\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003cp\u003e(0.5 to 3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003cp\u003e(1.2 to 2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003cp\u003e(0.6 to 2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003cp\u003e(3.6 to 5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003cp\u003e(17.7 to 22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.6\u003c/p\u003e \u003cp\u003e(12.8 to 16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;C\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003cp\u003e(4.8 to 6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003cp\u003e(4.8 to 6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003cp\u003e(3.6 to 7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003cp\u003eC\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper extremity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.1\u003c/p\u003e \u003cp\u003e(70.8 to 75.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.5\u003c/p\u003e \u003cp\u003e(40.6 to 46.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.0\u003c/p\u003e \u003cp\u003e(40.5 to 45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B\u003c/p\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67.1\u003c/p\u003e \u003cp\u003e(62.9 to 71.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e61.9\u003c/p\u003e \u003cp\u003e(60.4 to 63.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e64.4\u003c/p\u003e \u003cp\u003e(60.3 to 68.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower extremity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.9\u003c/p\u003e \u003cp\u003e(27.6 to 32.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.2\u003c/p\u003e \u003cp\u003e(40.3 to 46.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.5\u003c/p\u003e \u003cp\u003e(44.0 to 49.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003cp\u003eC\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.9\u003c/p\u003e \u003cp\u003e(28.7 to 37.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e35.4\u003c/p\u003e \u003cp\u003e(33.9 to 36.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003cp\u003e(29.7 to 37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.9\u003c/p\u003e \u003cp\u003e(20.9 to 24.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.9\u003c/p\u003e \u003cp\u003e(42.9 to 48.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.2\u003c/p\u003e \u003cp\u003e(35.8 to 40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;C\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.6\u003c/p\u003e \u003cp\u003e(13.5 to 19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29.4\u003c/p\u003e \u003cp\u003e(28.0 to 30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24.6\u003c/p\u003e \u003cp\u003e(21.0 to 28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;C\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eA: pedestrian, B: driver/rider, C: passenger/pillion.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn car crashes, the need for open reduction was observed in 47.5% of pedestrians struck by cars, with slightly lower percentages for car passengers (42.5%) and drivers (39.6%) (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The frequency of spinal repair exhibited a similar trend, being highest among drivers (5.6%), followed by car passengers (3.6%), and pedestrians involved in car crashes (1.0%) (pedestrian vs. driver, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001; pedestrian vs. passenger, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001; driver vs. passenger, p-value\u0026thinsp;=\u0026thinsp;0.03). In motorcycle crashes, a parallel pattern emerged concerning spinal repair. Riders displayed the highest rate of spinal repair (1.7%), surpassing pillions (0.4%) and pedestrians (0.2%) (pedestrian vs. rider, p-value\u0026thinsp;=\u0026thinsp;0.01; rider vs. pillion, p-value\u0026thinsp;=\u0026thinsp;0.03). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e displays a comprehensive overview of clinical management and outcomes in RTC-related trauma patients adjusted for age, gender, and safety device.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical management and outcomes of road traffic crash patients by road participation adjusted for age, gender, and safety device.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eCar crashes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eMotorcycle crashes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePedestrian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDriver\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePassenger\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePairwise\u003c/p\u003e \u003cp\u003ecomparison\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePedestrian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRider\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePillion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePairwise\u003c/p\u003e \u003cp\u003ecomparison\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCraniotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003cp\u003e(0.3 to 1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003cp\u003e(1.2 to 3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003cp\u003e(0.6 to 1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003cp\u003e(-0.1 to 0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003cp\u003e(0.9 to 1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003cp\u003e(0.9 to 3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eC\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlaster/splints\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.4\u003c/p\u003e \u003cp\u003e(37.9 to 42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003cp\u003e(31.0 to 36.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.6\u003c/p\u003e \u003cp\u003e(30.3 to 34.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B A\u0026thinsp;\u0026gt;\u0026thinsp;C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50.2\u003c/p\u003e \u003cp\u003e(45.7 to 54.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e49.8\u003c/p\u003e \u003cp\u003e(48.3 to 51.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e45.6\u003c/p\u003e \u003cp\u003e(41.4 to 49.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003cp\u003e(1.5 to 2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003cp\u003e(3.1 to 5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003cp\u003e(2.9 to 4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A C\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003cp\u003e(1.5 to 4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003cp\u003e(2.2 to 3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003cp\u003e(0.6 to 2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFracture immobilization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.8\u003c/p\u003e \u003cp\u003e(37.4 to 42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.5\u003c/p\u003e \u003cp\u003e(39.6 to 45.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.1\u003c/p\u003e \u003cp\u003e(35.7 to 40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e54.1\u003c/p\u003e \u003cp\u003e(49.7 to 58.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e46.0\u003c/p\u003e \u003cp\u003e(44.5 to 47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e46.6\u003c/p\u003e \u003cp\u003e(42.3 to 50.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B\u003c/p\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;C\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClosed reduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.7\u003c/p\u003e \u003cp\u003e(36.2 to 41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.4\u003c/p\u003e \u003cp\u003e(27.8 to 33.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.7\u003c/p\u003e \u003cp\u003e(34.3 to 39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B C\u0026thinsp;\u0026gt;\u0026thinsp;B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.2\u003c/p\u003e \u003cp\u003e(35.7 to 44.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33.2\u003c/p\u003e \u003cp\u003e(31.7 to 44.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003cp\u003e(27.5 to 35.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B\u003c/p\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;C\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen reduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.5\u003c/p\u003e \u003cp\u003e(45.0 to 50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.6\u003c/p\u003e \u003cp\u003e(36.8 to 42.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.5\u003c/p\u003e \u003cp\u003e(40.0 to 44.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B\u003c/p\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47.3\u003c/p\u003e \u003cp\u003e(42.8 to 51.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e48.0\u003c/p\u003e \u003cp\u003e(46.4 to 49.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e50.3\u003c/p\u003e \u003cp\u003e(46.0 to 54.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003cp\u003e(-0.1 to 0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003cp\u003e(-0.2 to 0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003cp\u003e(0.1 to 0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003cp\u003e(-0.2 to 0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpinal repair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003cp\u003e(0.5 to 1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003cp\u003e(4.1 to 7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003cp\u003e(2.7 to 4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;C\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003cp\u003e(-0.1 to 0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003cp\u003e(1.0 to 2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003cp\u003e(0.0 to 0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A B\u0026thinsp;\u0026gt;\u0026thinsp;C\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMechanical ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003cp\u003e(2.7 to 4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003cp\u003e(6.3 to 9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003cp\u003e(5.8 to 8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A C\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003cp\u003e(0.7 to 2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003cp\u003e(3.3 to 4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003cp\u003e(1.7 to 4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003cp\u003e(9.8 to 12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003cp\u003e(17.9 to 22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003cp\u003e(16.4 to 20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A C\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003cp\u003e(5.2 to 9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.4\u003c/p\u003e \u003cp\u003e(9.4 to 11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003cp\u003e(7.3 to 12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003cp\u003e(0.7 to 1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003cp\u003e(1.0 to 2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003cp\u003e(1.2 to 2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003cp\u003e(-0.1 to 0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003cp\u003e(0.6 to 1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003cp\u003e(-.0.1 to 1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eA: pedestrian, B: driver/rider, C: passenger/pillion.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the frequency of extremities and pelvis fractures in car and motorcycle crashes, adjusted for age, gender, Injury Severity Score (ISS), safety device, and vehicle type. Notably, pedestrians (0.6%) exhibited a significantly higher frequency of ilium fractures compared to drivers/riders (0.2%) (p-value\u0026thinsp;=\u0026thinsp;0.01). Pubis fractures were more frequent in pedestrians (3.4%) than in drivers/riders (1.9%) (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.01). When adjusting for age, gender, ISS, safety device, and type of vehicle, 3.3% of pedestrians experienced fractures in the proximal humerus, and 1.8% had fractures in the shaft of the ulna. Both frequencies were higher than those observed in drivers/riders (2.3% and 1.1%, respectively) (p-values: 0.04 and 0.02, respectively). Furthermore, the frequency of peritrochanteric fractures in pedestrians was 3.7%, significantly surpassing the frequency of 1.9% among passengers/pillions and 1.7% among drivers/riders (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Additionally, fractures in the proximal tibia and shaft of the tibia were observed in 10.0% and 15.8% of pedestrians, respectively, which were significantly higher than the frequencies among drivers/riders and passengers/pillions when adjusting for age, gender, ISS, safety device, and type of vehicle (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In pedestrians, the frequency of distal tibia fractures was 5.1%, significantly exceeding 3.6% among drivers/riders and 2.7% among passengers/pillions (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpecific fractures (extremities and pelvis) in car and motorcycle accidents adjusted for age, gender, ISS, safety device, and type of vehicle.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePedestrian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDriver/rider\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePassenger/pillion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePairwise comparison\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS32.3 - Fracture of ilium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003cp\u003e(0.3 to 1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003cp\u003e(0.1 to 0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003cp\u003e(0.2 to 0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B, C\u0026thinsp;\u0026gt;\u0026thinsp;B\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS32.4 - Fracture of acetabulum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003cp\u003e(1.7 to 3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003cp\u003e(2.7 to 3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003cp\u003e(3.3 to 5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eC\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS32.5 - Fracture of pubis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003cp\u003e(2.6 to 4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003cp\u003e(1.5 to 2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003cp\u003e(1.9 to 3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS42.2 - Fracture of proximal humerus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003cp\u003e(2.5 to 4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003cp\u003e(1.9 to 2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003cp\u003e(3.5 to 5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B, C\u0026thinsp;\u0026gt;\u0026thinsp;B\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS42.3 - Fracture of shaft of humerus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003cp\u003e(0.9 to 1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003cp\u003e(2.1 to 3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003cp\u003e(3.9 to 5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eC\u0026thinsp;\u0026gt;\u0026thinsp;B\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS42.4 - Fracture of distal humerus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003cp\u003e(1.0 to 2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003cp\u003e(1.0 to 1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003cp\u003e(2.1 to 3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eC\u0026thinsp;\u0026gt;\u0026thinsp;A, C\u0026thinsp;\u0026gt;\u0026thinsp;B\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS52 - Fracture of forearm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003cp\u003e(-0.0 to 0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003cp\u003e(0.0 to 0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003cp\u003e(-0.0 to 0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS52.0 - Fracture of proximal of ulna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003cp\u003e(0.6 to 1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003cp\u003e(0.9 to 1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003cp\u003e(0.8 to 1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS52.1 - Fracture of proximal radius\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003cp\u003e(0.2 to 0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003cp\u003e(0.5 to 0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003cp\u003e(0.3 to 1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS52.2 - Fracture of shaft of ulna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003cp\u003e(1.2 to 2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003cp\u003e(0.8 to 1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003cp\u003e(1.4 to 2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B, C\u0026thinsp;\u0026gt;\u0026thinsp;B\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS52.3 - Fracture of shaft of radius\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003cp\u003e(0.5 to 1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003cp\u003e(1.2 to 1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003cp\u003e(1.2 to 2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eC\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS52.4 - Fracture of shafts of both ulna and radius\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003cp\u003e(0.1 to 0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003cp\u003e(0.3 to 0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003cp\u003e(0.3 to 1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS52.5 - Fracture of distal radius\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.2\u003c/p\u003e \u003cp\u003e(6.1 to 8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003cp\u003e(6.6 to 8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003cp\u003e(5.5 to 7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS52.6 - Fracture of the distal of both ulna and radius\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003cp\u003e(0.5 to 1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003cp\u003e(1.2 to 2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003cp\u003e(0.8 to 1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS52.7 - Multiple fractures of the forearm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003cp\u003e(1.5 to 2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003cp\u003e(0.9 to 1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003cp\u003e(1.5 to 2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B, C\u0026thinsp;\u0026gt;\u0026thinsp;B\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS72 - Fracture of femur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003cp\u003e(-0.0 to 0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003cp\u003e(0.3 to 0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003cp\u003e(0.2 to 0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS72.0 - Fracture of neck of femur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003cp\u003e(2.0 to 3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003cp\u003e(1.6 to 2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003cp\u003e(1.5 to 2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS72.1 \u0026ndash; Peritrochanteric fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003cp\u003e(2.9 to 4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003cp\u003e(1.3 to 2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003cp\u003e(1.3 to 2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B, A\u0026thinsp;\u0026gt;\u0026thinsp;C\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS72.2 - Subtrochanteric fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003cp\u003e(0.7 to 1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003cp\u003e(0.7 to 1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003cp\u003e(0.7 to 1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS72.3 - Fracture of shaft of femur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003cp\u003e(3.7 to 5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003cp\u003e(5.4 to 6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003cp\u003e(5.2 to 7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A, C\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS72.4 - Fracture of distal femur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003cp\u003e(1.7 to 3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003cp\u003e(2.4 to 3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003cp\u003e(1.6 to 2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS72.7 - Multiple fractures of the femur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003cp\u003e(-0.0 to 0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003cp\u003e(0.2 to 0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003cp\u003e(0.1 to 0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS82 - Fracture of the lower leg, including ankle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003cp\u003e(0.2 to 0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003cp\u003e(0.2 to 0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003cp\u003e(-0.0 to 0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS82.0 - Fracture of patella\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003cp\u003e(1.3 to 2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003cp\u003e(2.6 to 3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003cp\u003e(1.6 to 2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u0026thinsp;\u0026gt;\u0026thinsp;A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS82.1 - Fracture of proximal tibia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003cp\u003e(8.7 to 11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003cp\u003e(6.4 to 7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003cp\u003e(3.2 to 5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B\u0026thinsp;\u0026gt;\u0026thinsp;C\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS82.2 - Fracture of shaft of tibia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003cp\u003e(14.3 to 17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.8\u003c/p\u003e \u003cp\u003e(10.9 to 12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003cp\u003e(7.3 to 9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B\u0026thinsp;\u0026gt;\u0026thinsp;C\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS82.3 - Fracture of distal tibia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003cp\u003e(4.1 to 6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003cp\u003e(3.0 to 4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003cp\u003e(2.0 to 3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B, A\u0026thinsp;\u0026gt;\u0026thinsp;C\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS82.4 - Fracture of fibula alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003cp\u003e(2.1 to 3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003cp\u003e(1.8 to 2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003cp\u003e(0.6 to 1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;C, B\u0026thinsp;\u0026gt;\u0026thinsp;C\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS82.5 - Fracture of medial malleolus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003cp\u003e(2.4 to 3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003cp\u003e(2.3 to 3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003cp\u003e(1.2 to 2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;C, B\u0026thinsp;\u0026gt;\u0026thinsp;C\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS82.6 - Fracture of lateral malleolus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003cp\u003e(1.5 to 2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003cp\u003e(1.6 to 2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003cp\u003e(0.9 to 1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS82.7 - Multiple fractures of the lower leg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003cp\u003e(0.7 to 2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003cp\u003e(0.2 to 0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003cp\u003e(0.4 to 1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA\u0026thinsp;\u0026gt;\u0026thinsp;B, C\u0026thinsp;\u0026gt;\u0026thinsp;B\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eA: pedestrian, B: driver/rider, C: passenger/pillion. ISS: Injury Severity Score.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eApproximately 1.6% of drivers/riders suffered from distal radius and ulna fractures, surpassing the 0.9% observed in pedestrians (p-value\u0026thinsp;=\u0026thinsp;0.03). Among drivers/riders, 6.0% exhibited femur shaft fractures, while 4.6% of pedestrians had this type of fracture (p-value\u0026thinsp;=\u0026thinsp;0.03). Additionally, 3.1% of drivers/riders experienced patella fractures, a statistically significant increase compared to the 2.0% observed in pedestrians (p-value\u0026thinsp;=\u0026thinsp;0.02).\u003c/p\u003e \u003cp\u003eFibula fractures were observed in 2.2% of drivers/riders, significantly higher than the 1.1% followed in passengers/pillions (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Furthermore, drivers/riders displayed a significantly higher frequency of fractures in the medial malleolus (2.7%) compared to the 1.8% observed in passengers/pillions (p-value\u0026thinsp;=\u0026thinsp;0.04).\u003c/p\u003e \u003cp\u003eFractures of the ilium were more frequent in passengers/pillions (0.6%) compared to drivers/riders (0.2%) (p-value\u0026thinsp;=\u0026thinsp;0.04). Among fractures of the shaft of the humerus, passengers/pillions had the highest frequency (4.8%), followed by drivers/riders (2.6%) and pedestrians (1.4%) (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Additionally, fractures in the proximal humerus (4.3%), distal humerus (2.7%), and shaft of the ulna (2.0%) were significantly more common in passengers/pillions compared to 3.3%, 1.5%, and 1.8% in drivers/riders, respectively (p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e outlines the frequency of neck and spine fractures in car crashes, adjusted for age, gender, safety device, and type of accident. Fractures in the cervical vertebra C3-C7, thoracic vertebra, and lumbar vertebra were more frequent in drivers (3.2%, 7.0%, 8.3%) compared to car passengers (1.4%, 4.9%, 5.6%, respectively) (p-values: \u0026lt;0.01, 0.04, and 0.01, respectively).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpecific fractures (neck and spine) in car accidents adjusted for age, gender, safety device, and type of accident.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDriver\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePassenger\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS12.0- Fracture of first cervical vertebra (C1 fracture)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003cp\u003e(0.1 to 1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003cp\u003e(0.2 to 0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.758\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS12.1- Fracture of second cervical vertebra (C2 fracture)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003cp\u003e(0.3 to 1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003cp\u003e(0.5 to 1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.389\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS12.2- Fracture of other specified cervical vertebra\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3.2\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(2.0 to 4.3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.4\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(0.8 to 2.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS12.7- Multiple fractures of the cervical spine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003cp\u003e(0.1 to 0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003cp\u003e(0.2 to 1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS22.0- Fracture of thoracic vertebra\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e7.0\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(5.4 to 8.5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4.9\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(3.9 to 6.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS22.1- Multiple fractures of the thoracic spine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003cp\u003e(0.4 to 1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003cp\u003e(0.2 to 1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.458\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS32.0- Fracture of lumbar vertebra\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e8.3\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(6.6 to 10.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5.6\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(4.5 to 6.7)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS32.1- Fracture of sacrum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003cp\u003e(0.8 to 2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003cp\u003e(0.9 to 2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.845\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS32.2- Fracture of coccyx\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003cp\u003e(-0.1 to 0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003cp\u003e(-0.0 to 0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eBold indicates column proportions that differ significantly at the 0.05 level.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e describes the frequency of head and face fractures in motorcycle crashes, adjusted for age, gender, safety device, and type of accident. There were no significant differences in head and face fractures between riders and motorcycle pillions.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpecific fractures (head and face) in motorcycle accidents adjusted for age, gender, safety device, and type of accident.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRider\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePillion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS02 - Fracture of skull and facial bones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003cp\u003e(0.3 to 0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003cp\u003e(-0.2 to 1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.923\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS02.0 - Fracture of vault of skull\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003cp\u003e(1.3 to 2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003cp\u003e(0.7 to 3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.706\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS02.1 - Fracture of the base of the skull\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003cp\u003e(3.1 to 4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003cp\u003e(1.4 to 4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.328\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS02.2 - Fracture of nasal bones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003cp\u003e(3.1 to 4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003cp\u003e(1.6 to 4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.502\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS02.3 - Fracture of orbital floor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003cp\u003e(0.6 to 1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003cp\u003e(0.1 to 2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.661\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS02.4 - Fracture of malar and maxillary bones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003cp\u003e(3.6 to 4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003cp\u003e(1.3 to 4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS02.6 - Fracture of mandible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003cp\u003e(1.7 to 2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003cp\u003e(0.5 to 2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.402\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS02.7 - Multiple fractures involving skull and facial bones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003cp\u003e(1.5 to 2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003cp\u003e(0.1 to 1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e found in the supplementary materials display the distribution of fracture sites in both car and motorcycle crashes.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn both car and motorcycle crashes, males were more commonly involved compared to females. Different patterns of injuries were observed among drivers, passengers, pedestrians, riders, and pillions, with varying frequencies of head injuries, upper and lower extremity injuries, vertebral fractures, and other types of fractures depending on the role in the crash.\u003c/p\u003e \u003cp\u003eThe majority of the RTC-related injured individuals were motorcyclists, with approximately 81.6% being male and 18.7% under the age of 18. This demographic distribution underscores the vulnerability of young male motorcyclists in RTC-related trauma. Batista et al. conducted a parallel study on 3,528 motorcycle crash victims over seven years, with a significant male predominance constituting 88.86% of all victims [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Furthermore, Brockamp et al.'s investigation of 24,373 road accident trauma victims from the German trauma registry underscored a heightened frequency of severe and fatal injuries among the younger population [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFractures were predominantly observed in the lower extremities, with the tibia emerging as the most frequently fractured bone, followed by the femur in our study. The upper extremities, particularly the radius and humerus, ranked second in common fractures. This aligns with findings from other studies [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. A retrospective hospital-based study conducted in Kashan, Iran, illustrated these trends, emphasizing a more significant occurrence of fractures in the lower extremities, with the tibia and fibula taking precedence, followed by the femur [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, a significant pattern emerged as head fractures exhibited a higher frequency among drivers than car passengers and pedestrians struck by cars. While the pervasiveness of traffic accidents continues to be a leading cause of facial fractures, our study emphasized an intriguing distinction between drivers and pedestrians struck by cars as well as between riders and motorcycle pillions and pedestrians involved in motorcycle crashes. Drivers might face increased vulnerability due to their proximity to the steering wheel. Fonseca et al. revealed that drivers not wearing seat belts experienced 6.33 fractures per patient, whereas those wearing seat belts had 5.54 fractures per patient [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Modern safety features, mainly steering wheel protection measures like airbags, may contribute to a reduction in facial fractures. This implies that while drivers are exposed to potential injuries due to their position, advanced safety technologies in vehicles, especially those protecting the steering wheel, might effectively mitigate them [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The prevalence of such safety features is emphasized, especially in Europe and North America [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Our study revealed no cases involving airbag-equipped vehicles, possibly due to their low prevalence in our region or the effective prevention of facial fractures when airbags were activated.\u003c/p\u003e \u003cp\u003eTo further understand the discrepancies noted in injuries between drivers, car passengers, and pedestrians struck by cars, it is essential to consider additional factors such as airbag deployment and the presence or absence of side impact protection systems. Modern vehicles equipped with steering wheel protection measures, including airbags, may contribute significantly to the protection of drivers. Conversely, the absence of a steering wheel in passenger positions may expose them to increased forward momentum, potentially concentrating force on areas of restraint, particularly the chest and abdomen [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Our study uncovered a contrasting result, showing a higher frequency of thorax injuries in drivers compared to car passengers, which could be attributed to the inadequate use of airbags in our region. Additionally, we observed a higher frequency of spine fractures in drivers compared to car passengers, which could be due to the increased flexion and extension of the spine associated with these types of injuries in drivers. A study conducted by Pigolkin et al. on traffic accident victims found that the driver's most common fatal injuries consist of fractures in the cervical, thoracic, and lumbar vertebrae, which were much less frequent in passengers seated in the front and right back seats [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePedestrians struck by cars demonstrated a higher frequency of proximal tibia, shaft of tibia, and distal tibia fractures in our study, aligning with the notion that the knee joint is one of the most vulnerable body parts in car-to-pedestrian collisions [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The impact, concentrated mainly in the knee joint or just below it, is attributed to the low bumper height in passenger cars [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSimilar findings were noted by Otte et al., who studied lower leg fractures in pedestrians and bicyclists after collisions, revealing a higher prevalence of proximal tibia fractures in pedestrians than in cyclists [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. A retrospective study spanning three years further pointed out a significant prevalence of ligamentous knee injuries in pedestrians struck by motor vehicles [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, when adjusted for age, gender, ISS, safety device, and type of vehicle, ilium and humerus fractures were more commonplace in passengers/pillions compared to drivers/riders, consistent with findings from other studies. A retrospective study involving 191 patients injured in motor vehicle collisions underscored a higher occurrence of lower limb and pelvic fractures in males, rear seat passengers, and occupants of smaller vehicles [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Notably, pelvis ring fractures were frequently observed when a component of the door or side of the car intruded into the passenger compartment, compressing the pelvis laterally [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, we found that only 1.8% of drivers and 1.6% of car passengers experienced neck injuries, a significantly lower rate compared to what is typically reported in the literature. This discrepancy raises questions about potential factors contributing to our findings, such as the possibility of underdiagnosed injuries or a failure to recognize certain symptoms, which could have resulted in incomplete data in the NTRI dataset. According to previous studies, there's a generally accepted \"safe threshold\" for rear-end impacts, which suggests that velocities between 10 and 15 km/h shouldn't cause harm [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Individuals involved in rear-end collisions, particularly drivers, face a significantly higher risk of suffering whiplash injuries and factors such as age and gender seem to play a less significant role [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. To ensure the accuracy of our results, we adjusted for variables like age, gender, and safety device usage. However, unfortunately, we lacked specific information about factors such as vehicle speed or the nature of the collision (e.g., car-to-car or car-to-wall).\u003c/p\u003e \u003cp\u003eOur study's strength is exemplified by its large sample size, allowing for a thorough exploration of distinct fracture types in the Iranian population and providing distinctive insights not present in other studies. The combination of large sample size, a unique focus on different fracture types, and detailed categorization strengthens our study's overall impact and relevance, marking it as a valuable addition to the field.\u003c/p\u003e \u003cp\u003eAcknowledging the limitations of our study is crucial. Including children may influence results due to distinct injury patterns in this population, mainly since they likely constitute a significant proportion of those seated in the rear seats. Moreover, we didn\u0026rsquo;t have access to the data on the passenger seats, such as the front, center, and outboard seats, which may influence patient injury risks. Additionally, the lack of information in our national trauma registry regarding different vehicle types, their weight, and speed introduces potential bias into the study, affecting injury patterns. We also didn\u0026rsquo;t have access to the data of trauma victims who succumbed at the scene.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eWhen adjusting for factors such as age, gender, and the use of safety devices, a distinct pattern emerges in the types of injuries sustained by individuals involved in different kinds of motor vehicle accidents. Drivers, after adjustments, displayed a heightened frequency of experiencing fractures in the head, spine, and multiple areas, often necessitating spinal repairs. On the other hand, pedestrians struck by cars exhibited a higher frequency of upper extremity fractures, commonly treated with casts, splints, and open reduction methods, compared to drivers and car passengers. In motorcycle crashes, riders faced a higher frequency of head and facial fractures, as well as multiple traumas, leading to a greater prevalence of spinal repairs. Conversely, pedestrians struck by motorcycles more frequently underwent fracture immobilization and closed reduction procedures compared to riders and motorcycle pillions. Further adjustments for age, gender, safety device usage, and vehicle type revealed additional nuances. Even when factoring in these variables, pedestrians demonstrated a heightened frequency of peritrochanteric, proximal, shaft, and distal tibia fractures. Meanwhile, passengers/pillions, under similar adjustments, were more prone to shaft and distal humerus fractures.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eRTCs: Road traffic crashes\u003c/p\u003e\n\u003cp\u003eYLDs: Years lived with disability\u003c/p\u003e\n\u003cp\u003eDALYs:\u0026nbsp;Disability-Adjusted Life Years\u003c/p\u003e\n\u003cp\u003eNTRI:\u0026nbsp;National Trauma Registry of Iran\u003c/p\u003e\n\u003cp\u003eICUs: Intensive care units\u003c/p\u003e\n\u003cp\u003eICD: International Classification of Diseases and Causes of Death\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: P.S., SH.Sh, and M.H.Data curation: S.M., S.P., SM.P, M.S., M.Sh, and M.KFormal analysis: M.H and V.B.Funding acquisition: M.Z.Investigation: SH.Sh, E.F., SH.SB,V.H., H.SB, R.FR, F.S., M.NE., V.R, and A.GhMethodology: V.B.Project administration: P.S. and M.Z. Resources: M.Z. Software: Kh.N. Supervision: V.R., P.S., SH,Sh, E.F., SH.SB,V.H., H.SB, R.FR, F.S., M.NE., V.R, and A.GhValidation: V.R., S.P., and SM.P.Visualization: M.H., S.M., M.S., M.Sh, and M.K.Writing\u0026ndash;original draft: M.H., M.S.Writing\u0026ndash;review editing: A.Kh., S.P., and SM.P.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSoroush D et al. \u003cem\u003eCharacteristics of road traffic injuries in the second largest city of Iran.\u003c/em\u003e 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization WH. \u003cem\u003eGlobal status report on road safety 2018 [Internet]\u003c/em\u003e. 2018; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.afro.who.int/publications/global-status-report-road-safety-time-action\u003c/span\u003e\u003cspan address=\"https://www.afro.who.int/publications/global-status-report-road-safety-time-action\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003cem\u003eGlobal Burden of Diseases, compare [Internet]\u003c/em\u003e. 2019; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://vizhub.healthdata.org/gbd-compare/\u003c/span\u003e\u003cspan address=\"https://vizhub.healthdata.org/gbd-compare/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization WH. 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Ann Epidemiol. 2003;13(1):66\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Accidents, Traffic, Wounds and Injuries, Fractures, Bone, Pedestrians","lastPublishedDoi":"10.21203/rs.3.rs-4132019/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4132019/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e Fractures constitute a significant concern in low- and middle-income countries, primarily due to road traffic crashes (RTCs), a leading cause of such injuries. This study aimed to analyze fracture patterns resulting from RTCs in Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A registry-based study was conducted using data from the National Trauma Registry of Iran (NTRI) spanning 2016 to 2023. The study included 10,114 trauma patients involved in RTCs, encompassing car and motorcycle crashes with at least one fracture. International Classification of Diseases (ICD-10) codes were used for data analysis, considering both orthopedic and non-orthopedic admissions related to RTCs. Fracture incidence was compared among pedestrians, drivers/riders, and passengers/pillions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Males constituted a significant majority in cars (90.1% drivers, 72.1% pedestrians, 47.0% passengers) and motorcycle crashes (99.6% riders, 77.0% pedestrians, 65.3% pillions) (p \u0026lt; 0.001). Drivers showed the highest frequency of head injuries (26.9%) (p \u0026lt;0.01), while pedestrians had the highest frequency of upper extremity injuries (73.1%) (p\u0026lt;0.001). Drivers also demonstrated a higher frequency of vertebral fractures compared to passengers (C3-C7: 3.2% vs. 1.4%, p \u0026lt; 0.05). Riders (33.5%) displayed a higher frequency of head and face fractures compared to pillions (24.8%) and pedestrians (17.4%) (p \u0026lt; 0.05). Pedestrians (3.7%) demonstrated a higher frequency of peritrochanteric fractures compared to passengers/pillions (1.9%) and drivers/riders (1.7%) (p \u0026lt; 0.01). Fractures of the tibia were significantly more frequent in pedestrians (20.9%) compared to drivers/riders (22.5%) and passengers/pillions (15.4%) (p \u0026lt; 0.01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe study provided valuable information on the fracture patterns associated with RTCs among road user groups.\u003c/p\u003e","manuscriptTitle":"The pattern of fractures in road traffic crashes; findings from the National Trauma Registry in Iran","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-22 12:34:36","doi":"10.21203/rs.3.rs-4132019/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"831a4bf3-a679-4203-91e6-fe540e2de59b","owner":[],"postedDate":"March 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-15T07:26:31+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-22 12:34:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4132019","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4132019","identity":"rs-4132019","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}