Seat belt-related injury to the common iliac artery: case report and review of the literature

Blunt trauma to the common iliac artery is a rare phenomenon. Although seat belt injuries to the abdominal aorta and the carotid artery have been reported, there is only one previous report in the literature of seat belt injury to the common iliac artery. We report a case of common iliac arterial injury directly related to use of the lap belt and not associated with pelvic or lumbar fractures. The literature related to blunt trauma of the common iliac artery is reviewed.     

Internal carotid artery occlusion related to seat belt shoulder strap: report of two cases

Two cases of traumatic internal carotid artery occlusion probably related to the seat belt shoulder strap are reported. Case 1. A 20-year-old woman was driving and was struck on the right front side of her car by another car. There were neither bruises, abrasions on her neck, nor weakness in her extremities. About 4 hours later, she developed left hemiplegia, and CT scan taken on the following day revealed low density areas in the capsulostriatal area on the right. The right carotid angiography revealed occlusion of the internal carotid artery about 3 cm distal to the bifurcation. Case 2. A 43-year-old man was driving and was struck on the front of his car by a hard iron railing. He sustained a sternum fracture, but there was no disturbance of consciousness or paresis of the extremities. His neck was unremarkable externally. About 50 days later, he developed left hemiplegia. CT scan and MRI revealed a massive infarction in the distribution of the right middle cerebral artery territories. The carotid angiography revealed occlusion of the right internal carotid artery about 3 cm distal to the bifurcation. In each cases, the driver was wearing a three-point shoulder seatbelt when the car was struck on the front or on the right front. Previous experimental studies have revealed in these situations the neck is flexed right anteriorly, and then quickly overextended left posteriorly. The overextension of the neck probably injured the intima of the internal carotid artery ipsilateral to the shoulder fixed in the seatbelt, resulting in the subsequent occlusion by a thrombus.     

Injuries in restrained motor vehicle accident victims

Passenger restraints reduce fatalities and serious injuries. Restraint systems alter the distribution of injuries seen in accident victims, and they cause a number of injuries. The distribution of injuries is dependent on the type of restraint. Automatic motorized shoulder belts are being used without the accompanying manual lap belt. This greatly reduces the effectiveness of the system and is equal to the two-point shoulder belt of the 1960s. Airbag injuries include abrasions to the face, neck, and chest; minor burns to the upper extremities; and chemical keratitis. Airbags have been shown to reduce injuries overall, especially when used in conjunction with a lap and shoulder belt. Elderly patients incur more rib and sternal fractures due to seat belts than do younger patients. Nevertheless, restraint systems are effective at reducing serious internal injuries in this population. Children who are too large for child safety seats but too small for adult seat belts are at increased risk for injury. Improvement in restraint systems for children in this age range is recommended. All pregnant women should be encouraged to wear seat belts because they reduce maternal injuries, and there is no evidence that they increase the risk of fetal loss. In view of the injury reduction associated with passenger restraint systems, emergency physicians should emphasize to their patients the importance of wearing seat belts.     

Nonsanction seat belt law enforcement: a modern day tale of two cities

This paper describes the implementation and evaluation of a nonsanction seat belt law enforcement program in two experimental communities of contrasting size in a state with a mandatory belt law. The main ingredients of the program were seat belt "salutes," public information and education, and limited use of inexpensive economic incentives. Driver shoulder belt use data collected before, during, and after the experimental programs, compared to similar data collected in a comparison community, showed the approach to be effective. While standard seat belt enforcement activities without incentives have been shown to be effective, many police departments, especially in smaller communities, are reluctant to make wholesale increases in seat belt citations. Although requiring some additional level of manpower and resources, a nonsanction approach to seat belt law enforcement can provide an alternate way of increasing belt use in these communities.     

Seat belts: Changing usage by changing beliefs.

Tested a model to predict seat belt use, based on a linear combination of (a) beliefs about discomfort when wearing a seat belt and (b) beliefs about injury reducing effects of seat belts. 154 employees of a large steel company, nonusers of seat belts, were randomly assigned to 1 of 6 groups receiving one or a combination of the following treatments: (a) verbal information stressing the role of seat belts in reducing injury, (b) nonverbal practice in seat belt use, (c) verbal information irrelevant to seat belt use, or (d) no treatment. Groups receiving seat belt information had the most favorable posttest beliefs and displayed the greatest increase in seat belt usage, although the effects generally decreased over time. The Discomfort (D) factor and the model (D * E) were equally predictive, while the Effect (E) factor was predictive only at low values. A multiplicative model is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gallbladder rupture, an isolated seat belt injury

This report describes a patient who suffered free intraperitoneal perforation of a previously normal gallbladder as an isolated abdominal injury from seat belt compression. It is postulated that a prerequisite for such an injury is distension of the gallbladder with bile. Alcohol ingestion in the fasting state is likely to produce such a situation.     

Cocaine augments contractility of the pregnant human uterus by both adrenergic and nonadrenergic mechanisms

Airbag injuries have resulted in the deaths of several infants and small children, and such deaths are generally associated with rearward-facing infant seats or unrestrained children in front passenger seats of cars equipped with airbags. An airbag can also cause death in a small child wearing a shoulder/lap belt, however, as this case report illustrates. A two-year-old female was involved in a low-speed collision while riding in the front passenger seat of a dual-airbag-equipped automobile. Secondary impact with the airbag caused catastrophic occipitoatlantoaxial disarticulation with traumatic spinal cord separation, thermal injury and abrasions of the right forearm and distinctive patterned abrasions of the face. The possibility of airbag injury should be considered in all low-speed traffic fatalities, and the confirmatory injuries sought at postmortem examination.     

Acute abdomen. When to operate immediately and when to observe

BACKGROUND: Seat belt type injury of thoracolumbar spine is an uncommon injury characterized by disruption of the posterior elements of the spine. The fracture has long been treated conservatively, but progressive kyphotic deformity developed frequently. METHODS: From January, 1991 through December, 1992, 10 cases of seat belt type injury of the thoracolumbar spine were encountered at our hospital with an incidence of 8% in overall spinal fractures. Of these patients, eight patients were male and two were female, average age 30.7 years old. The causes included motor-vehicle accident in five patients, fall from height in four, and stricken by a falling electric pole in one. None of the victims of motor vehicle accidents wore seat belt. All of them received open reduction, posterior internal fixation and posterior fusion. RESULTS: After follow-up for an average of 42.2 months, the average kyphotic angulation was 5.7 degrees. Back pain and function of these patients were all rated good. None of them suffered from neurologic deficit. One patient with breakage of transpedicular screws was encountered during follow-up, but there was no complaint. CONCLUSIONS: In treating seat belt type injuries of spinal column, benefits of operation outweigh the risks. Besides, the clinical result is satisfactory and more aggressive surgical approach should be encouraged.     

Air bags influence the pattern of injury in severe thoracic trauma

Severe intrathoracic cardiovascular injuries were found in three patients who were drivers of cars involved in head on collisions causing air bags to be released. A 32 year old male had not worn a seat belt, while a 39 year old female was restrained by a seat belt. The male patient suffered an intimal lesion of the brachiocephalic artery. Extensive soft tissue haematomas were seen subcutaneously and retrosternally. The female suffered a rupture of the aortic isthmus and a dislocated pelvic fracture. Vascular repair was performed in both patients. The female died after two months without having regained consciousness. The third patient, a 47 year old male, had not worn a seat belt. He lost his pulse within minutes. Midline emergency thoracotomy showed a complete rupture of the right atrium. An air bag protects against injuries caused by hitting internal parts of the vehicle. It does not necessarily protect against deceleration trauma in high speed collisions.     

Patterns of injury in belted and unbelted individuals presenting to a trauma center after motor vehicle crash: seat belt syndrome revisited

STUDY OBJECTIVE: Investigators have described a "seat belt syndrome" consisting variously of injuries to the lumbar or cervical spine, abdominal contents, or all 3. In this study we sought to identify these and any other patterns of injury associated with seat belt use in patients who presented to a trauma center after a motor vehicle crash. METHODS: The charts of all patients involved in motor vehicle crashes who presented as trauma alerts to the study institution between January 1, 1991, and December 31, 1993, were retrospectively reviewed for data regarding belt use and 35 specific injuries in 7 body regions. We calculated the positive likelihood ratio of injury between belted and unbelted patients, along with 95% confidence intervals. RESULTS: We identified 1,124 patients involved in motor vehicle crashes. Of these subjects, 376 were belted and 544 unbelted; in 204 belt status was unknown. Belted patients were more likely to have sustained sternal fracture than were unbelted patients (4% versus .7%; positive likelihood ratio, 1.97; 95% confidence interval, 1.09 to 3.29) but were less likely to have sustained head injury (30.6% versus 46.0%; positive likelihood ratio, .67; 95% confidence interval, .53 to .83). We noted no statistically significant differences in the rates of other specific injuries, including cervical and lumbar fractures and the need for abdominal surgery. CONCLUSION: Severe injuries of all types occur in both belted and unbelted individuals involved in motor vehicle crashes who present to a typical trauma center. With the exception of sternal fractures, injuries previously associated with the seat belt syndrome occurred in similar proportions of belted and unbelted patients. Head injuries were less frequent. Seat belt use cannot serve as a discriminator for specific injury. A diligent search of all body regions is indicated in both belted and unbelted patients.     

Legislation and the prediction of reported seat belt use.

Examined differences between jurisdictions with seat belt use laws and jurisdictions without such laws in the relative importance of factors that influence reported seat belt use. 2,047 Canadians, aged 16 yrs and older, were interviewed personally about their attitudes toward and use of seat belts. Multiple regression analyses performed separately for Ss in the 2 types of jurisdiction revealed that, for both groups, the major predictors of reported seat belt use (past and intended) were attitudes toward seat belt use, normative pressure from friends and family to wear belts, and favorability toward seat belt use laws. Up to 53% of the variance in reported seat belt use was accounted for by these factors and the presence of a seat belt law. Implications for public education programs to promote seat belt use are discussed. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Accidents with sharp instruments in nurses in a university hospital in Campinas, Sao Paolo

To investigate the role of the sympathetic nervous system in angiotensin II (AngII)-stimulated medial and neointimal smooth muscle cell (SMC) replication, we sympathectomized rats with 6-hydroxydopamine (6-OHDA) in which the left carotid artery was injured by a balloon catheter. Balloon injury is associated with a loss of specific [3H]-prazosin binding. AngII (250 ng/kg/min), infused 2 weeks after balloon injury of the rat left carotid artery, increased systolic blood pressure by approximately 70 mm Hg. There was no effect of 6-OHDA on this pressor response. AngII increased the cumulative 5-bromo-2'-deoxyuridine (BrdU) labeling fraction (LF) in the uninjured right carotid media and the injured left carotid neointima as compared to controls (5.7+/-1.6% vs. 0.4+/-0.1%, p<0.05; 10.6+/-0.9% vs. 5.0+/-0.8%, p<0.05, respectively). 6-OHDA decreased the AngII-induced increase in LF in the media of the uninjured right carotid artery (AngII/6-OHDA 0.9+/-0.2% vs. AngII 5.7+/-1.6%, p < 0.05). 6-OHDA did not decrease the AngII-induced increase in LF in both the injured left carotid media and neointima at 4 weeks after balloon injury. The effects of chemical sympathectomy were comparable with those obtained 12 weeks after balloon injury. Thus, the data show that the sympathetic nervous system mediates the AngII-induced increase in SMC DNA synthesis, but only in the uninjured carotid media. This indicates a differential regulation of AngII-induced SMC replication in injured and uninjured vessels.     

Basal skull fracture with traumatic polycranial neuropathy and occluded left carotid artery: significance of fractures along the course of the carotid artery

A patient who survived with traumatic multiple cranial nerve palsies and occluded internal carotid artery associated with a basal skull fracture that involved the carotid canal is described. A literature review indicates that a wide variety of injuries can occur to the carotid artery as it passes through a fractured skull base. Basal fractures involving the course of the carotid artery reflect a significant risk of carotid injury.     

Reading level, learning presentation preference, and desire for information among cancer patients

Protease inhibitors such as aprotinin and urinastatin inhibited vascular endothelial cell injury induced by PMA-stimulated leukocytes, although their inhibitors did not suppress the production of active oxygen species released from leukocytes. On the other hand, in the presence of pancreas elastase (10 micrograms/ml), hydrogen peroxide (50 microM) caused severe injury of endothelial cells isolated from the bovine carotid artery (% specific 51Cr release, % SR = 42.9 +/- 3.3%), although the % SR elicited by elastase or hydrogen peroxide alone, respectively, was below 1%. Elastase and hydrogen peroxide acted synergistically on the injury of endothelial cells from the bovine carotid artery similarly to that in the endothelial cells isolated from the bovine coronary artery and human umbilical vein. Furthermore, elastase derived from both pancreas and leukocyte induced this synergistic action on endothelial cell injury. To clarify the mechanism of vascular endothelial cell injury induced by the combination of elastase and hydrogen peroxide, we examined the effects of various radical scavengers and protease inhibitors. Deferoxamine mesylate completely inhibited the endothelial cell injury, while protease inhibitors such as antitrypsin and macroglobulin had a protective effect. Pretreatment of endothelial cells with deferoxamine mesylate also protected against this cytotoxicity. These findings suggested that the synergistic effect of elastase and hydrogen peroxide on the endothelial cell injury is due to the production of hydroxylradical in the endothelium and that this synergistic action might be partially involved in the endothelial cell injury induced by activated leukocytes.     

Rupture of the bowel due to road trauma: the emergence of the "seat belt syndrome"

Seat belts have proved to be life saving for drivers and passengers involved in motor-car collisions. The number of severe head, face and trunk injuries has been significantly reduced. However, the wearing of belts has been responsible for an increased incidence of bowel rupture, in itself a potentially lethal injury if not diagnosed and treated early. There is still much to be done in improving seat belt design.     

Assay for phenoloxidase activity in Amblyomma americanum, Dermacentor variabilis, and Ixodes scapularis

The rare complication of complete uterine prolapse can occur after a motor vehicle accident. One could speculate that a sudden increase in intra-abdominal pressure related to the trauma and seat belt position lead to this condition.     

Injury pattern and severity in lateral motor vehicle collisions: a Canadian experience

OBJECTIVE: To determine the pattern and severity of injury and the outcome of front seat motor vehicle occupants after lateral impact crashes. DESIGN: Retrospective review undertaken in a Regional Trauma Unit (Sunnybrook Health Science Centre). MATERIALS AND METHODS: Review of seriously injured front seat motor vehicle occupants admitted to a Regional Trauma Unit over a 46-month period (September 15, 1989, to July 15, 1993) for whom vehicle crash information and occupant seat belt use were known. MEASUREMENTS AND MAIN RESULTS: Three hundred forty-eight front seat vehicle occupants were available for study; one hundred forty-one (41%) were involved in a lateral impact motor vehicle crash. Driver side lateral crashes (57%) were more common than passenger side impacts. Victims of lateral impact crashes had a significantly higher mean Injury Severity Score (25 compared with 20 for nonlateral crashes: p < 0.05), and the direction of impact was strongly associated with injury severity (p < 0.05). Lateral impact crashes resulted in substantially more significant chest (p < 0.01) and intra-abdominal (p < 0.0001) injuries. Type of injury was significantly different between the lateral and nonlateral impact groups for facial, chest, abdominal, and musculoskeletal injuries. CONCLUSIONS: The direction of impact in motor vehicle crashes is strongly associated with the pattern and severity of organ injuries. Further attention to automobile safety design is necessary to better protect occupants involved in lateral impact crashes.     

Seat belts and pregnancy

The best safety for the mother and her unborn child while driving a car is the proper use of a seat belt. Only a correctly constructed and fitted lap-shoulder safety harness should be used. The instruction to wear a seat belt and to wear it correctly should be part of the pregnancy-care-program for each physician.     

Obstructive intestinal herniation due to improper use of a seat belt: a case report

The term "seat belt syndrome" has been used to describe injuries to the abdominal viscera caused by seat belts during car accidents. These injuries are usually sustained as a result of the rapid deceleration that occurs in front-end collisions, with the consequent compression of the abdominal viscera. The spectrum of injuries includes intestinal perforation or stenosis, mesenteric disruption, and lumbar fracture-dislocation. We present an uncommon case of obstructive herniation in a 2-year-old girl which we believe was due to improper use of a seat belt.     

The effect of 12 months'' treatment with eicosapentaenoic acid in five children with cystic fibrosis

BACKGROUND: The use and indications for laparoscopy have been increasing. As part of this trend, a new algorithm may emerge for pediatric trauma in which laparoscopic techniques are used in hemodynamically stable patients with suspected hollow viscus perforation. CASE REPORT: We present a case in which laparoscopy was successfully used in a pediatric trauma patient as a diagnostic and therapeutic modality. A 4-year-old boy was a back-seat passenger in a head-on collision motor vehicle accident. He was restrained by a lap seat belt. He sustained a concussion, a large forehead laceration and a seat belt abdominal injury. On admission, he complained of abdominal pain. Physical examination revealed a soft, non-distended abdomen with moderate diffuse tenderness. He was hemodynamically stable. Computerized tomography of the abdomen revealed free fluid in the pelvis. No abnormalities were detected in the liver or spleen. Because of clinical deterioration and suspected intestinal perforation, diagnostic laparoscopy was utilized instead of proceeding directly to celiotomy. At laparoscopy a jejunal perforation was found and successfully repaired laparoscopically. Large hematomas were seen in the mesentery, as well as an unsuspected splenic laceration. No active bleeding was found. The patient recovered uneventfully and was discharged 5 days following the surgical procedure. CONCLUSION: This case illustrates the efficacy of using early laparoscopy in children with abdominal trauma when diagnosis is difficult and hollow viscus injury is suspected.