Abstract
Rally driving is an inherently hazardous motor sport yet the risk of serious injury is minimised through rigorous safety regulations required by its governing body. We describe the management of a deceleration injury resulting in scrotal trauma, sustained despite the use of a competition six point seat harness. Blunt trauma to the scrotum can cause injury ranging from scrotal haematoma to testicular rupture (found in approximately 50% of blunt traumas to the scrotum). Deceleration injury to the external genitalia may result in traumatic dislocation of the testes to an inguinal, pubic or abdominal location. Internal dislocation is usually associated with blunt abdominal trauma and can be overlooked, one study reporting a mean of 19 days delay in diagnosis. Scrotal laceration as seen here usually occurs as a result of traumatic avulsion from entanglement of the skin in machinery or clothing. Whilst the harness used here spared the occupant more severe injuries, it is of concern that this type of injury occurred despite the harness and the three layer suit. The minimum safety standard for harnesses in cross country racing is two shoulder straps and one lap belt, although most drivers prefer a minimum of a four point harness involving straps coming over either shoulder and up from the waist to join in a central quick-release coupling. In this case a six point harness was used: a greater number of points of harness contact should equate with greater restraint. The added crotch strap, fixed at points under the seat, connects to the coupling at a single point . The crotch strap has the advantage of preventing the occupant sliding under the belt ('submarining') and spreads the force of impact more evenly over the body in the event of a crash. For a harness to work it must be done up very tightly, to the point of being uncomfortable. It is possible that in the case described the belt was not as tight as recommended and permitted the occupant to be transported forward after impact into the straps, resulting in the degloving-type injury.
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