title: Injuries of the thoracolumbar spine associated with restraint use in head-on motor vehicle accidents.
abstract: Many authors have described spinal and bodily injuries associated with seat belt use. However, most reports have focused primarily on lap seat belts and resultant flexion-distraction injuries. This retrospective chart review studies the relation between the specific type of restraint or air bag and the resultant thoracolumbar spinal injury subtype and associated bodily injuries. The charts of 221 patients who had sustained thoracolumbar fractures in motor vehicle accidents during a 10-year period were reviewed, and 37 patients were identified whose accidents were clearly described as a frontal collision and whose specific form of restraint was recorded. Among the 15 patients who used a shoulder strap and lap belt device (three-point restraint), 12 patients sustained burst fractures (80%) compared with 4 of the 14 patients (28.6%) restrained with lap seat belts alone. Life-threatening intraabdominal injuries occurred in 57.1% of lap-belted victims and in 26.7% of patients who used three-point restraints, and the character of these injuries also differed. No patients in an automobile in which an air bag deployed sustained major associated bodily injuries. Among restrained occupants of head-on motor vehicle accidents who have sustained a thoracolumbar fracture, patients using lap belts are more likely to sustain the classic flexion-distraction injury patterns, whereas patients using three-point restraints may sustain a higher incidence of burst fractures. In addition, three-point restraints are associated with a decreased risk of intraabdominal injury compared with lap seat belts.
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: S T
authors.initials: ST
authors.lastname: Ball
authors.forename: A R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: T J
authors.initials: TJ
authors.lastname: Albert
authors.forename: J M
authors.initials: JM
authors.lastname: Cotler
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D017278:Air Bags / Q000009:adverse effects; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012622:Seat Belts / Q000009:adverse effects; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000209:etiology*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*