title: Upper extremity fracture patterns following motor vehicle crashes differ for drivers and passengers.
abstract: 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.
authors.affiliation: Department of Surgery, University of California, San Diego, CA 92120, United States. carol.conroy@sdcounty.ca.gov <carol.conroy@sdcounty.ca.gov>
authors.forename: Carol
authors.initials: C
authors.lastname: Conroy
authors.forename: Alexandra
authors.initials: A
authors.lastname: Schwartz
authors.forename: David B
authors.initials: DB
authors.lastname: Hoyt
authors.forename: A
authors.initials: A
authors.lastname: Brent Eastman
authors.forename: Sharon
authors.initials: S
authors.lastname: Pacyna
authors.forename: Troy Lisa
authors.initials: TL
authors.lastname: Holbrook
authors.forename: Teresa
authors.initials: T
authors.lastname: Vaughan
authors.forename: Michael
authors.initials: M
authors.lastname: Sise
authors.forename: Frank
authors.initials: F
authors.lastname: Kennedy
authors.forename: Tom
authors.initials: T
authors.lastname: Velky
authors.forename: Steve
authors.initials: S
authors.lastname: Erwin
mesh_terms: 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