Letter: Seat belt syndrome

The aetiology of maxillofacial injuries and the seat belt law

Between the period 1 February 1981 and 31 January 1985, 678 patients with maxillofacial injuries were referred to the Department of Oral and Maxillofacial Surgery, at Southampton General Hospital. The commonest two aetiological factors in this group of patients were alleged assaults and road traffic accidents. Seat belt legislation in the United Kingdom was introduced on 1 February 1983. The compliance with seat belt usage rose to 90-95% for all front seat occupants after the legislation. The incidence of maxillofacial trauma cases arising in the front seat occupant group of patients dropped from 20.9% (78 patients) in the 2 years before the legislation to 5.9% (18 patients) in the 2 years after the legislation. The difference is statistically significant (p less than 0.001).

The effect of seat belt legislation on a district general hospital

The introduction of legislation making the use of seat belts compulsory was associated with a marked reduction in the number of patients coming to the Accident and Emergency Department of a district general hospital as a result of road traffic accidents. Those patients who were not wearing seat belts required hospital admission twice as often as restrained car occupants. The only deaths occurring during the period of study occurred in those not using seat belts. Rear seat passengers were found to suffer from more severe and more numerous injuries than restrained car occupants. Injuries caused by seat belts were seen, usually causing bruising of the chest wall or minor fractures, and, excluding the chest, those wearing seat belt were less likely to suffer an injury to any part of the body than those not protected by a belt.

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.