Upper extremity fracture patterns following motor vehicle crashes differ for drivers and passengers.
OBJECTIVE
Injury patterns of occupants in motor vehicle crashes are changing, with upper extremity injury becoming more common in patients treated at trauma centres. Although not life threatening, upper extremity injuries may result in long-term disability, including chronic deformity, neurovascular compromise and degenerative arthritis. The purpose of this study was to compare upper extremity injury in drivers and passengers using the Crash Injury Research Engineering Network (CIREN) database.


METHODS
CIREN data were used to compare upper extremity skeletal injury patterns and sources for drivers and passengers in frontal and side impacts. Occupant variables (age, gender, co-morbidity, avoidance maneuvers and restraint use) and crash variables (direction of impact, delta V and vehicle crush) were considered in the analysis.


RESULTS
Only 24.8% of all occupants in the CIREN database had upper extremity injuries. One-half of upper extremity injuries to drivers were forearm fractures compared to one-third for passengers. Occupants in side impacts were more likely (OR=5.05) to have clavicle fractures, even while controlling for driver versus passenger status and safety belt use. Air bags were more likely to be a source of forearm fracture (OR=2.31) when controlling for driver versus passenger status, direction of force, sex and age compared to other sources. Only 10% of driver fractures with air bag deployment in frontal impacts were associated with air bag fling.


CONCLUSIONS
This study found that drivers and passengers have different upper extremity injury patterns but the direction of impact also plays an important role.
Conroy
Carol
C
Department of Surgery, University of California, San Diego, CA 92120, United States. carol.conroy@sdcounty.ca.gov <carol.conroy@sdcounty.ca.gov>
Schwartz
Alexandra
A
Hoyt
David B
DB
Brent Eastman
A
A
Pacyna
Sharon
S
Holbrook
Troy Lisa
TL
Vaughan
Teresa
T
Sise
Michael
M
Kennedy
Frank
F
Velky
Tom
T
Erwin
Steve
S
D015998:Abbreviated Injury Scale; D000063:Accidents, Traffic; D000328:Adult; D017278:Air Bags / Q000009:adverse effects; D001134:Arm Injuries / Q000209:etiology*; D001334:Automobile Driving; D004551:Elbow Joint / Q000473:pathology; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D006801:Humans; D006810:Humeral Fractures / Q000209:etiology; D004204:Joint Dislocations / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011885:Radius Fractures / Q000209:etiology; D012307:Risk Factors; D012622:Seat Belts / Q000009:adverse effects; D012783:Shoulder Dislocation / Q000209:etiology; D014458:Ulna Fractures / Q000209:etiology; D014954:Wrist Injuries / Q000209:etiology