Pattern and Distribution of Skull Fractures in Fatal Road Traffic Accidents: A Descriptive Study

Abstract

Background: Road traffic accidents (RTAs) are a primary global health concern, causing about 1.3 million deaths annually, with low- and middle-income countries bearing most of the burden. Head injuries, particularly skull fractures, are a leading cause of death in RTAs, reflecting the force and mechanism of impact. Fracture patterns vary by accident type, victim role, and protective gear use, with the cranial vault, especially the frontal and parietal bones, most frequently affected. Basal fractures, often involving the middle cranial fossa, are linked to high-energy impacts. Understanding fracture distribution through autopsy studies aids forensic analysis, clinical management, and the development of targeted injury prevention strategies. Aim of the study: The present study aims to analyze the pattern and distribution of skull fractures in fatal road traffic accidents based on medico-legal autopsies. Methods: This retrospective descriptive study was conducted in the Department of Forensic Medicine, North Bengal Medical College, Sirajganj, Bangladesh, analyzing 115 medico-legal autopsy cases of fatal road traffic accident victims over 12 months. Inclusion criteria comprised all RTA victims who died from head injuries with complete autopsy records, while cases with incomplete records, decomposition, or non-RTA deaths were excluded. Data on demographics, accident details, and skull fracture characteristics, including anatomical site, specific bones, cranial fossae involvement, and fracture type, were extracted from autopsy reports and related documents. Skull examinations followed standard medico-legal protocols. Data were analyzed using SPSS 26.0, with results expressed as frequencies and percentages. Results: Among 115 fatal RTA cases, most victims were young adults aged 21–30 years (33.91%), predominantly male (86.09%). Two-wheeler accidents were the leading cause (73.91%), with drivers comprising the majority of victims (53.04%). Skull fractures most commonly involved the cranial vault (65.22%), particularly the frontal bone (32.43%), followed by multiple bones (21.62%) and temporal bone fractures (16.22%). Basal skull fractures primarily affected the middle cranial fossa (61.54%). Linear fractures were the most frequent type (61.74%), followed by combination (19.13%) and comminuted fractures (13.91%), highlighting the severity and distribution of cranial injuries in fatal RTAs. Conclusion: In fatal RTAs, young adult males are most affected, with two-wheeler collisions predominating. The cranial vault, particularly the frontal bone, and the middle cranial fossa in basal fractures are most commonly involved. Linear fractures are predominant, underscoring the need for improved road safety, helmet use, and trauma care.