As the automobile has evolved over its first 100 years, many changes have improved its safety and have resulted in lower fatality rates. To a great extent, physicians have provided the thrust for these improvements. Now, as more people survive automobile accidents, injuries to the musculoskeletal system take on importance as causes of individual disability and social cost. The patterns of automobile-induced orthopedic injuries continue to change. This article reviews the first 100 years of these injury patterns and relates their occurrence to specific automobile design features and oversights. Because any one automobile accident is likely to injury only a few people at most, trends and patterns are much more difficult to ascertain than for mass transit vehicular accidents. For this reason, physician awareness of contemporary injury patterns is the first step toward safer automobile design.