title: Real-World Rib Fracture Patterns in Frontal Crashes in Different Restraint Conditions.
abstract: OBJECTIVE
  The purpose of this study was to use the detailed medical injury information in the Crash Injury Research and Engineering Network (CIREN) to evaluate patterns of rib fractures in real-world crash occupants in both belted and unbelted restraint conditions. Fracture patterns binned into rib regional levels were examined to determine normative trends associated with belt use and other possible contributing factors.
  
  
  METHODS
  Front row adult occupants with Abbreviated Injury Scale (AIS) 3+ rib fractures, in frontal crashes with a deployed frontal airbag, were selected from the CIREN database. The circumferential location of each rib fracture (with respect to the sternum) was documented using a previously published method (Ritchie et al. 2006) and digital computed tomography scans. Fracture patterns for different crash and occupant parameters (restraint use, involved physical component, occupant kinematics, crash principal direction of force, and occupant age) were compared qualitatively and quantitatively.
  
  
  RESULTS
  There were 158 belted and 44 unbelted occupants included in this study. For belted occupants, fractures were mainly located near the path of the shoulder belt, with the majority of fractures occurring on the inboard (with respect to the vehicle) side of the thorax. For unbelted occupants, fractures were approximately symmetric and distributed across both sides of the thorax. There were negligible differences in fracture patterns between occupants with frontal (0°) and near side (330° to 350° for drivers; 10° to 30° for passengers) crash principal directions of force but substantial differences between groups when occupant kinematics (and contacts within the vehicle) were considered. Age also affected fracture pattern, with fractures tending to occur more anteriorly in older occupants and more laterally in younger occupants (both belted and unbelted).
  
  
  CONCLUSIONS
  Results of this study confirmed with real-world data that rib fracture patterns in unbelted occupants were more distributed and symmetric across the thorax compared to belted occupants in crashes with a deployed frontal airbag. Other factors, such as occupant kinematics and occupant age, also produced differing patterns of fractures. Normative data on rib fracture patterns in real-world occupants can contribute to understanding injury mechanisms and the role of different causation factors, which can ultimately help prevent fractures and improve vehicle safety.
authors.affiliation: a National Highway Traffic Safety Administration (NHTSA), Human Injury Research Division , Washington , DC.
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Lee
authors.affiliation: a National Highway Traffic Safety Administration (NHTSA), Human Injury Research Division , Washington , DC.
authors.forename: Matthew
authors.initials: M
authors.lastname: Craig
authors.affiliation: a National Highway Traffic Safety Administration (NHTSA), Human Injury Research Division , Washington , DC.
authors.forename: Mark
authors.initials: M
authors.lastname: Scarboro
mesh_terms: D015998:Abbreviated Injury Scale; D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012253:Rib Fractures / Q000000981:diagnostic imaging / Q000209:etiology*; D012272:Ribs / Q000502:physiology; D012622:Seat Belts / Q000706:statistics & numerical data*; D013249:Sternum / Q000502:physiology; D013909:Thorax / Q000502:physiology; D014057:Tomography, X-Ray Computed
keywords: biomechanics; injury mechanism; restraints; rib fractures