Abstract
Between 1981 and 1989, 541 children were admitted with abdominal injuries sustained as passengers in motor vehicle accidents. Twenty-nine of them had seat belt injuries of the abdomen. From 1981 to 1984, 1 child was admitted each year with such injuries and 21% of the abdominal injuries were due to seat belts. The number of cases had increased to 8 in 1989 and 78% of abdominal injuries were due to seat belts. These changes coincided with increased compliance with seat belt legislation in the State of Victoria. Restraint of children under 8 years of age in the front seat was legislated in 1976 and in the rear seat in 1981. In 1985, drivers were also held responsible for the restraint of children 8–17 years of age. Most of the children with seat belt injuries of the abdomen used lap belts or poorly fitting lap/sash belts. Twenty of the children had other non-abdominal injuries including 11 head, 7 thoracic, and 12 limb injuries. Eight children had spinal injuries including 7 Chance flexion-distraction fractures of the spine and 1 spinal cord injury without radiological abnormality. Chance fractures were only detected in one-half of the children on admission and in only 1 of the 9 children who had a laparotomy. Seventy-five per cent of children with spinal injuries had a laparotomy; 67% of those with abdominal injuries had spinal injuries, while only 7% of those not undergoing laparotomy had spinal injuries. These findings indicate that all children with seat belt injuries of the abdomen need careful clinical and radiographic assessment of the thoracolumbar spine. Prevention of seat belt injuries of the abdomen and spine requires legislation that ensures that all children use effective restraints that are appropriate for their age, size, and position within the vehicle.
Similar content being viewed by others
References
Agran P, Dunkle DE, Winn DG (1985) Motor vehicle accident trauma and restraint usage patterns in children less than 4 years of age. Pediatrics 76: 382–386
American Association for Automotive Medicine (1985) The abbreviated injury scale. Arlington Heights, III
Asbun HJ, Irani H, Roe EJ, Bloch JH (1990) Intra-abdominal seatbelt injury. J Trauma 30: 189–193
Beldekos A, Korres DS, Nikolakakos G (1981) A Chance's fracture in a double level fracture of the spine. Injury 13: 34–36
Blasier RD, LaMont RL (1985) Chance fracture in a child: a case report with nonoperative treatment. J Pediatr Orthop 5: 92–93
Carragher AM, Cranley B (1987) Seat-belt stomach transection in association with ‘Chance’ vertebral fracture. Br J Surg 74: 397–399
Chance GQ (1948) Note on a type of flexion fracture of the spine. Br J Radiol 21: 452–453
Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal fractures. Spine 8: 817–831
Fletcher BD, Brogdon BG (1967) Seat belt fractures of the spine and sternum. JAMA 200: 167–168
Gallagher DJ, Heinrich SD (1990) Case report: paediatric Chance fracture. J Orthop Trauma 4: 183–187
Garrett JW, Braunstein PW (1962) The seat belt syndrome. J Trauma 2: 220–238
Gertzbein SD, Court-Brown CM (1988) Flexion-distraction injuries of the lumbar spine. Clin Orthop 227: 52–60
Reference deleted
Gumley G, Taylor TKF, Ryan MD (1982) Distraction fractures of the lumbar spine. J Bone Joint Surg [BR] 64: 520–525
Haddad GH, Zickel RE (1967) Intestinal perforation and fracture of lumbar vertebra caused by lap-type seat belts. N Y State J Med 67: 930–932
Hoffman MA, Spence LJ, Wesson DE, Armstrong PF, Williams JI, Filler RM (1987) The paediatric passenger: trends in seatbelt use and injury patterns. J Trauma 27: 974–976
Hope PG, Houghton GR (1986) Spinal and abdominal injury in an infant due to the incorrect use of a car seat belt. Injury 17: 368–369
Howland WJ, Curry JL, Buffington CB (1965) Fulcrum fractures of the lumbar spine. JAMA 193: 240–241
Hudson I, Kavanagh TG (1984) Duodenal transection and vertebral injury occurring in a patient wearing a seat belt. Injury 15: 6–9
LeGay DA, Petrie DP, Alexander DI (1990) Flexion-distraction injuries of the lumbar spine and associated abdominal trauma. J Trauma 30: 436–444
Moskowitz A (1989) Lumbar seatbelt injury in a child: case report. J Trauma 29: 1279–1282
Reid AB, Letts RM, Black GB (1990) Paediatric Chance fractures: association with intra-abdominal injuries and seatbelt use. J Trauma 30: 384–391
Reid DC, Henderson R, Saboe L, Miller JDR (1987) Etiology and course of missed spinal fractures. J Trauma 27: 980–986
Rennie W, Mitchell N (1973) Flexion distraction fractures of the thoracolumbar spine. J Bone Joint Surg [AM] 55: 386–390
Ritchie WP Jr, Ersek RA, Bunch WL, Simmons RL (1970) Combined visceral and vertebral injuries from lap type seat belts. Surg Gynecol Obstet 131: 431–435
Rogers LF (1971) The roentgenographic appearance of transverse of Chance fractures of the spine: the seat belt fracture. AJR Am J Roentgenol 111: 844–849
Royal Automobile Club of Victoria (1991) Monthly bulletin statistical data from internatal survey.
Smith WS, Kaufer H (1969) Patterns and mechanisms of lumbar injuries associated with lap seat belts. J Bone Joint Surg [AM] 51: 239–254
Taylor GA, Eggli KD (1988) Lap belt injuries of the lumbar spine in children: a pitfall in CT diagnosis. AJR Am J Roentgenol 150: 1355–1358
Taylor TKF, Henderson JJ, Trinca GW (1990) Seat-belt injuries of the spine in children and young adolescents — an increasing cause for concern. Med J Aust 152: 447–448
Tingvall C (1987) Children in cars. Acta Paediatr Scand Suppl 339: 1–104
Trinca GW, Dooley BJ (1975) The effects of mandatory seat belt wearing on the mortality and pattern of injury of car occupants involved in motor vehicle crashes in Victoria. Med J Aust 1: 675–678
Yngve DA, Harris WP, Herndon WA, Sullivan JA, Gross RH (1988) Spinal cord injury without osseous spine fracture. J Pediatr Orthop 8: 153–159
Author information
Authors and Affiliations
Additional information
Correspondence to: W. G. Cole
Rights and permissions
About this article
Cite this article
Hoy, G.A., Cole, W.G. Concurrent paediatric seat belt injuries of the abdomen and spine. Pediatr Surg Int 7, 376–379 (1992). https://doi.org/10.1007/BF00176598
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00176598