An unusual seat belt injury: case report

Autopenetrating hernia: a novel form of traumatic abdominal wall hernia--case report and review of the literature

Traumatic abdominal wall hernias remain relatively rare entities despite the increased incidence of blunt trauma. Mechanisms reported in the literature include a combination of a sudden increase in intra-abdominal pressure and powerful shear forces applied to the abdominal wall. These hernias are noteworthy in that they may be associated with significant intra-abdominal injuries. We describe a novel form of traumatic hernia with a unique mechanism. A blunt force leads to the fracture of a rib and penetration of the abdominal wall by the jagged costal remnant, creating a hernia defect. This autopenetrating hernia is presented in the context of a classification scheme for traumatic abdominal wall hernias.

Seatbelt effectiveness and cost of noncompliance among drivers admitted to a trauma center

Enactment of seatbelt legislation in Maryland presented the opportunity to compare seatbelt compliance among seriously injured drivers admitted to a Level I trauma center and to establish levels of severity, length of stay, and hospital cost differences among the study population. Fifty-five randomly selected drivers were examined from a total surgical population of 689. Seatbelt compliance rate was 41.8%, reflecting the rate in the community. Seatbelts reduced the total number of injuries by 34%, major injuries by 57%, and minor injuries by 20%. No deaths occurred among the belted group. The unbelted group had a mean Injury Severity Score two times as great as the belted group and were hospitalized 1.6 times longer at double the cost. Major injuries to the face, chest, and pelvic regions were prevented by the seatbelt. Among the belted group, severe injuries did occur to the head, neck, and abdominal regions. It is recommended that both air bags and automatic restraining devices be required for all drivers if the trauma occurring daily on highways is to be eliminated and acute hospital cost minimized.

Late presentation of a traumatic abdominal hernia associated with constipation

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