Severe thoracic intra-abdominal and vertebral injury occurring in combination in a patient wearing a seat belt

Pediatric seatbelt injuries: diagnosis and treatment of lumbar flexion-distraction injuries

Motor vehicle accidents are the major cause of flexion-distraction injuries of the thoracolumbar spine. In a retrospective review, we present the results of operative treatment for six pediatric patients who sustained such injuries while wearing seatbelts. There were three purely ligamentous injuries, two bony injuries (Chance fractures), and one combination injury. There were also concomitant neurological and intra-abdominal injuries. Of note is that two patients had either their spinal or abdominal injury missed on initial evaluation. All patients were treated surgically with open reduction and internal fixation. At average follow up of 2 years, all patients had a full range of motion with no back pain. Five had returned to their preinjury activity levels, while the sixth patient was paraplegic from his injury but was able to ambulate at home with crutches and knee-ankle-foot orthoses. We recommend operative reduction and two-level fusion of these injuries when (1) instability is apparent in either a purely ligamentous injury or an overtly unstable fracture-pattern, (2) significant kyphosis is present which cannot be reduced or maintained in a cast, or (3) there is associated neurological or intra-abdominal injury.

Fracture of the body of the sternum associated with the use of static seat belts

Four cases of fracture of the body of the sternum associated with the use of a static type of seat belt are reported. We wish to draw attention to an easily missed fracture in patients surviving a road traffic accident.

Chest wall injuries and the seat belt syndrome

A 3-year prospective study of road traffic accidents in which injuries of the chest wall were accurately recorded and related to the use of seat belts was performed in Oxfordshire by a combined team of surgeons and engineers. An increased incidence of soft tissue injuries was noted in restrained front seat occupants though this was not the case for fractures of the clavicle or sternum. The overall incidence of broken ribs in front seat passengers was not affected by the wearing of belts but the incidence of those with four or more broken ribs was considerably reduced by wearing belts.

Duodenal transection and vertebral injury occurring in combination in a patient wearing a seat belt

A case is described of complete transection of the first part of the duodenum combined with a vertebral injury in a patient wearing a lap-diagonal seat belt when involved in a head-on collision. A review of the literature is presented, the mechanism of injury discussed and attention drawn to the delay in diagnosis.