Seat Belt Trauma Research Articles

Urgent endovascular aorta repair for a rupture of a traumatic infrarenal aortic dissection: Case report and review of literature

Traumatic aortic injury is a life-threatening condition usually followed by blunt trauma with damage at the thoracic aorta. Abdominal aortic injuries are rare and usually seen with seatbelt trauma. Timing and approach of treatment are associated with significant morbidity and mortality. This case concerns a 66-year-old man with a high impact trauma after a fall from height. Upon presentation in our level two trauma center, he was conscious but hemodynamically unstable. Computer Tomography scan revealed multiple rib, spine and pelvic fractures with bilateral lung contusions warranting a transfer to a level one trauma center. However, an infrarenal aortic dissection with a retroperitoneal rupture and active bleeding necessitated acute surgical intervention. He was treated endovascularly with an off-the-shelf aortic stent graft which is meant for aortic aneurysm repair. Surgery was performed percutaneously under local anesthetic. Other fractures were treated conservatively. Postoperatively, the patient made a swift recovery without any complications in follow-up. As this case demonstrates, urgent endovascular repair of a traumatic infrarenal aortic injury can be done quickly with a minimally invasive approach with conventional stent graft systems thereby reducing the high morbidity and mortality rates associated with this life-threatening condition.

A Case of Delayed Cecal Perforation After Abdominal (Seat Belt) Injury

Seatbelts have reduced the number of fatal head, facial, and chest injuries. They have, however, introduced a set of injuries comprising abdominal wall bruising, Intra-abdominal injuries, and lumbar spine fractures collectively termed the seat belt syndrome. Surgical repair is the treatment for encountered bowel injuries. We present a case of delayed bowel perforation following presentation with signs of seat belt trauma identifying a decisional dilemma in the surgical management of serosal tears with no apparent signs of perforation.

Hemorrhagic Shock Caused by Mesenteric Injury - Ski Pediatric Blunt Abdominal Trauma case report

Trauma is the leading cause of pediatric mortality and abdominal injury is a significant contributor to morbidity. Abdominal trauma in the population of injured children, is the third leading cause of death in this population, after head and thoracic injuries. It is the most common cause of death owing to unrecognized injury. They most often occur in traffic accidents, games and sports. The clinical presentation depends on the severity of the injury, the injured organ and the associated injuries. Mesenteric injury from blunt abdominal trauma is uncommon and can be difficult to diagnose. It is known that seatbelt trauma from motor vehicle accidents is the most common mechanism of mesenteric injury and that the mesentery of the small bowel is injured more frequently than that of the colon. We present an unusual case, a seven-year-old boy who was injured while skiing. The patient was in a state of hemorrhagic shock and underwent emergency surgery after an urgent diagnosis. During the operation, the leading trauma and the reason for the hemorrhagic shock were found to be a mesenteric injury, and bleeding from the branches of the superior mesenteric artery. Early transport, monitoring and diagnostics significantly contribute to reducing morbidity and mortality. The standard in surgery is non-operative treatment of injured parenchymal organs. A multidisciplinary approach that includes doctors of various specialties (pediatric surgeons, pediatricians, neurosurgeons, anesthesiologists and radiologists) who contribute to the diagnosis and treatment of injured children through diagnostic and therapeutic procedures has a key role. At the end, the decision regarding surgical treatment is responsibility of pediatric surgeon.

PLACENTALABRUPTION AND FETAL DEATH FOLLOWING VEHICLE COLLISION: A CASE REPORT AND LITERATURE REVIEW

AIM: We present a case of placental abruption and fetal death following a motor vehicle accident, associated with air bag activation, and a short literature review of this important issue. Case report:A27-year-old women at 32nd gestational week presented after a head-on motor vehicle collision. Patient was restrained and air-bag deployed. Upon admission patient had stable vital signs, no visible major physical injuries, but was complaining of lower abdominal and the right leg pain. Physical examination revealed ecchymosis of the lower abdomen consistent with seatbelt trauma. Initial obstetric ultrasound examination showed no fetal cardiac activity, and the retro placental hematoma was identied. The labor was induced. Massive hemorrhage occurred after delivery of the placenta. Uterus atonia could not be managed conservatively with uterotonic agents or surgically, so hysterectomy had to be performed. The patient recovered and was discharged on the night postoperative day. Pathologic examination conrmed placental abruption. CONCLUSION:In conclusion all pregnant women who had a vehicle accident should be sent to the medical center with the possibility to take care of both trauma patients - the pregnant woman and fetus. Utmost attention should be paused to such patients as even the slightest trauma can have grave consequences on both the mother and fetus.

シートベルトにより生じた鈍的腹部大動脈損傷の2例(Prevalent sites and conditions of blunt abdominal aortic injury caused by seat belt: Case series)

要旨 シートベルトによる鈍的腹部大動脈損傷（BAAI）は死亡率が高く，また，見逃されやすい。今回，シートベルトにより生じたと考えられるBAAIを2例経験した。症例1：30才男性，ガードレールに衝突し受傷した。シートベルト痕，腸間膜損傷，第2腰椎骨折，BAAIを認め，腸間膜損傷に対し開腹止血術を施行，BAAIについては第9病日にステントグラフト内挿術を施行した。症例2：77才女性，ガードレールに衝突し受傷した。シートベルト痕，肝損傷，膵損傷，小腸損傷，腰椎骨折，BAAIを認めた。ガーゼパッキングと小腸穿孔部の縫合を行い，BAAIは保存的に管理した。いずれの症例もCTでシートベルト痕と思われる皮下組織の濃度上昇，腹腔内臓器損傷，腰椎骨折を認め，ともに第2/3腰椎椎間板高位でのBAAIを認めた。シートベルト痕，腸管・腸間膜損傷，腰椎骨折を3徴とするシートベルト症候群ではBAAIを考慮した画像評価を行う必要があること，シートベルトによるBAAIは第2–3腰椎高位が好発部位であることが示唆された。

Delayed manifestation of internal carotid artery dissection secondary to seat belt trauma successfully treated with endovascular surgery: a case report

Delayed manifestation of internal carotid artery dissection secondary to seat belt trauma successfully treated with endovascular surgery: a case report

Breast Injuries In Female Collegiate Athletes

In 2015-2016, over 214,000 female athletes competed at the collegiate level in the U.S. The NCAA collects injury data; however, breast related injuries do not have a specific reporting category. The exact sequelae of breast injury is unknown; however, a relationship between breast injury and fat necrosis, which mimics breast carcinoma, is documented outside of sport participation. Breast injuries related to motor vehicle collisions, seatbelt trauma, and blunt trauma have been reported. For these reasons, it is important to investigate female breast injuries in collegiate sports. PURPOSE: The objectives of this study are to report the prevalence of self-reported breast injuries in female collegiate athletes, explore injury type and treatment, and investigate breast injury reporting and impact on sports participation. METHODS: A cross-sectional study of female collegiate athletes at four U.S. Universities participating in basketball, soccer, softball, or volleyball. The main outcome measure was a questionnaire regarding breast injuries during sport participation. RESULTS: Almost half of the 194 participants (47.9%) reported a breast injury during their collegiate career, less than 10% reported their injury to health personnel with 2.1% receiving treatment. Breast injuries reported by sport include softball (59.5%), basketball (48.8%), soccer (46.7%), and volleyball (34.6%). CONCLUSION: The long-term effects and sequelae of breast injuries reported by female collegiate athletes during sport play is unknown. Nearly 50% of participants had a breast injury during sport. Although 18.2% indicated that breast injury affected sport participation, only 9.6% of the injuries were reported to medical personnel with 2.1% receiving treatment. From a clinical perspective, this information can be used to heighten the awareness related to female breast injuries and encourage health professionals to create an environment that encourages disclosure of injures that may be perceived as personal or embarrassing to discuss. Supported by an Internal Grant - University of Michigan-Flint Physical Therapy Department

Breast Injuries in Female Collegiate Basketball, Soccer, Softball and Volleyball Athletes: Prevalence, Type and Impact on Sports Participation.

In 2015-2016, over 214,000 female athletes competed at the collegiate level in the United States (U.S.). The National Collegiate Athletic Association (NCAA) collects injury data; however, breast-related injuries do not have a specific reporting category. The exact sequelae of breast injury are unknown; however, a relationship between breast injury and fat necrosis, which mimics breast carcinoma, is documented outside of sports participation. Breast injuries related to motor vehicle collisions, seatbelt trauma, and blunt trauma have been reported. For these reasons, it is important to investigate female breast injuries in collegiate sports. The objectives of this study are to report the prevalence of self-reported breast injuries in female collegiate athletes, explore injury types and treatments, and investigate breast injury reporting and impact on sports participation. A cross-sectional study of female collegiate athletes at four U.S. universities participating in basketball, soccer, softball, or volleyball. Main outcome measure was a questionnaire regarding breast injuries during sports participation. Almost half of the 194 participants (47.9%) reported a breast injury during their collegiate career, less than 10% reported their injury to health personnel with 2.1% receiving treatment. Breast injuries reported by breast injuries reported by sport include softball (59.5%), basketball (48.8%), soccer (46.7%), and volleyball (34.6%). The long-term effects and sequelae of breast injuries reported by female collegiate athletes during sport play are unknown. Nearly 50% of participants had a breast injury during sports activities. Although 18.2% indicated that breast injury affected sports participation, only 9.6% of the injuries were reported to medical personnel with 2.1% receiving treatment.

Occult Perforation with Circumferential Ischaemic Injury of the Sigmoid Colon following Seat-Belt Trauma: A Case Report

Seat-belt syndrome is defined as the presence of a seat-belt sign predominantly involving thoracolumbar vertebral fractures and intra-abdominal organ injury following the use of a seat belt during a traffic collision. Isolated sigmoid colon perforation occurring as part of seat-belt syndrome is rare. We report a 34-year-old patient who presented seat-belt sign after his car collided with a guardrail. The patient was initially haemodynamically stable and complained lower abdomen pain. Serial clinical examination with abdominal computed tomography (CT) scans illustrated sigmoid colon with ischaemic change without perforation. Exploratory laparotomy was performed and isolated sigmoid colon perforation was diagnosed. Therefore, in cases of persistent abdominal pain or tenderness despite an initially negative CT scan, repeated examinations of the abdomen with following abdominal CT are recommended because of the high risk of seat-belt sign and the possibility that the peritoneal symptoms can be hidden, such as in the retroperitoneal duodenum or sigmoid colon. Thus, we recommend using repeat abdominal CT as an adjunct to secondary survey for clarifying the haemodynamic status of patients with seat-belt trauma.

A Chance fracture and accompanying injuries secondary to seat belt trauma in childhood

A Chance fracture and accompanying injuries secondary to seat belt trauma in childhood

A Case of Ischemic Ileal Obstruction Secondary to Seat Belt Trauma

A Case of Ischemic Ileal Obstruction Secondary to Seat Belt Trauma

Seat-belt trauma of the breast in a pregnant woman causing milk-duct injury: a case report and review of the literature

Injury to the milk-duct following a road traffic accident has not been reported in the literature. This case report describes a 25-year-old postpartum lady with massive swelling of the breast due to milk-duct injury and collection of milk within the breast. We describe the possible mechanism of milk-duct injury, its presentation and management, and also review the literature on seat-belt injury to the breast.

Subacromial impingement in patients with whiplash injury to the cervical spine.

BackgroundImpingement syndrome and shoulder pain have been reported to occur in a proportion of patients following whiplash injuries to the neck. In this study we aim to examine these findings to establish the association between subacromial impingement and whiplash injuries to the cervical spine.Methods and resultsWe examined 220 patients who had presented to the senior author for a medico-legal report following a whiplash injury to the neck. All patients were assessed for clinical evidence of subacromial impingement. 56/220 patients (26%) had developed shoulder pain following the injury; of these, 11/220 (5%) had clinical evidence of impingement syndrome. Only 3/11 patients (27%) had the diagnosis made prior to evaluation for their medico-legal report. In the majority, other clinicians had overlooked the diagnosis. The seatbelt shoulder was involved in 83% of cases (p < 0.03).ConclusionAfter a neck injury a significant proportion of patients present with shoulder pain, some of whom have treatable shoulder pathology such as impingement syndrome. The diagnosis is, however, frequently overlooked and shoulder pain is attributed to pain radiating from the neck resulting in long delays before treatment. It is important that this is appreciated and patients are specifically examined for signs of subacromial impingement after whiplash injuries to the neck. Direct seatbelt trauma to the shoulder is one possible explanation for its aetiology.

Seat belt associated central line fracture—A previously unreported complication in cystic fibrosis

Totally implantable venous access devices (TIVAD) are used widely in the management of cystic fibrosis (CF) [Standards of Care: Standards for the clinical care of children and adults with cystic fibrosis in the UK. The Cystic Fibrosis Trust's Clinical Standards and Accreditation Group. Cystic Fibrosis Trust, London, UK, 2001]. They have been shown to be safe and advantageous in the long term administration of intravenous antibiotics [A-Rahman A, Spencer D. Totally implantable vascular access devices for cystic fibrosis. Cochrane Database Syst Rev 2003(3)]. However, TIVADs are not without short and long term complications including infections, thrombosis and mechanical failure [Munck A, Malbezin S, Bloch J. Follow up of 452 totally implantable vascular devices in cystic fibrosis patients. Eur Respir J 2004;23:430–4; Aitkin ML, Tonelli ML. Complications of indwelling catheters in cystic fibrosis: a 10-year review. Chest 2000;118:1598–602; Deerojanawong J, Sawyer SM, Fink AM, Stokes KB, Robertson CF. Totally implantable venous access devices in children with cystic fibrosis. Thorax 1998;53:285–89; Rodgers HC, Liddle K, Nixon SJ, Innes JA, Greening AP. Totally implantable venous access devices in cystic fibrosis: complications and patients' opinions. Eur Respir J 1998;12:217–20; Yung B, Campbell IA, Elborn JS, Harvey JS, Shale DJ. Totally implantable venous access devices in adult patients with cystic fibrosis. Respir Med 1996;90:353–56; Kariyawasam HH, Pepper JR, Hodson ME, Geddes DM. Experience of totally implantable venous access devices (TIV Ads) in adults with cystic fibrosis over a 13-year period. Respir Med 2000;94:1161–5]. Patients should be counselled prior to TIVAD insertion regarding the risks and instructed on post-operative care of the device to minimise the risks. However it is not routine practice to advise on seating position within the car in relationship to the seatbelt placement over the anterior chest wall. Line failure due to direct pressure from a seatbelt worn to prevent injury in the sudden deceleration involved during a motor vehicle accident (MVA) has not been described previously in the CF literature We report the case of an 8 year old child who fractured her Vascuport® line secondary to seatbelt trauma following a road traffic accident (RTA). Children and adults with CF should be advised to sit in the car on the side that places the shoulder strap of the seatbelt on the opposite side to the TIVAD line.

Seat Belt Trauma: Pectoralis Muscle Rupture and Delayed Mesh Repair

To our knowledge, this is the first reported case of a seat belt-related rupture of the pectoralis major muscle and its successful delayed repair using mesh. We report a case of a 34-year-old white man who sustained a right pectoralis major muscle rupture from a seat belt during a motor vehicle crash. The patient presented to us 2 years after the injury. We introduce a technique using mesh that results in a successful repair of a cosmetically disfiguring chest wall defect.

Complete Fetal Transection After a Motor Vehicle Collision

Motor vehicle collisions are the leading cause of fetal death related to maternal trauma, with rupture of the gravid uterus being one potential grave outcome. We present a case of a woman at 22 weeks of gestation who presented to the emergency department after a "high-speed" motor vehicle collision. On initial presentation, she was hemodynamically stable, and the examination was significant for midabdominal transverse ecchymosis from seatbelt trauma. A computed tomography scan identified a probable uterine rupture. Laparotomy revealed a 1,500-mL hemoperitoneum and a completely ruptured uterus requiring hysterectomy. The fetus was completely transected at the level of the midabdomen. Uterine rupture is possible for gravid women involved in motor vehicle collisions.

An Unusual Late Complication of Axillobifemoral Bypass Graft: A Case Report

Axillobifemoral bypass is a well-established surgical procedure performed in conditions that preclude direct arterial reconstruction due to aortic sepsis, aortoenteric fistula, or other hostile abdominal pathology or prohibitive surgical risk. The choice of prosthetic graft used is either knitted Dacron(R) or polytetrafluoroethylene, with equally good results. Although externally supported grafts reportedly yielded improvement in primary patency compared to historical controls, no consensus exists as to which demonstrates superiority over the other despite several retrospective studies. Complications are usually limited to the perioperative period, although late anastomotic disruption, graft thrombosis, axillary thromboembolism, pseudoaneurysm formation due to seat belt trauma, and hemorrhage or graft rupture have all been described. In addition to the above complications responsible for graft failure, perigraft infection, intimal hyperplasia, poor distal runoff, anastomotic fibrosis, and comorbid conditions may contribute to graft failure. We describe an unusual late complication of an axillobifemoral bypass graft whereby an organized thrombus within the layers of the bypass graft led to luminal compromise and, hence, attenuation of flow and resultant "failing graft."

TREATMENT OF THORACIC AND LUMBAR SPINE AND SPINAL CORD INJURY IN CHILDREN

Objective. To assess results of surgical treatment and to develop an optimal management regiment of patients with spine and spinal cord injury. Material and methods. Twenty patients, age 9 to 17 years, with complicated unstable spinal injuries were operated on. Out of them 13patients had severe Frankel grades A, B, C neurological disorders, 7 patients – grades D and Er. Seventeen patients had burst fractures, one – seat-belt injury, and two – fracture-dislocations. Surgery was performed in the first hours following the trauma in 9 patients, within two weeks – in 9, and after 15 days – in two. Burst fractures with grades A, B, C were treated by simultaneous posterior reposition and fixation of the injured segment, and anterior decompression and fusion. Grade D and Er was treated initially by indirect posterior reduction and fixation of the involved segment. If neurological disorders still remained decompression and body fusion were performed. Posterior-lateral decompression and instrumental fixation were performed in cases of seat-belt injuries. Fracture-dislocation was treated by decompression laminoplasty, spinal canal revision, followed by posterior reposition and fixation. Results. Two patients with burst fractures and grade A neurological disorders have shown a regression to the grade D. Dynamics of neurological restoration to grades B and C was observed in 4patients. The patient with grade B has not shown any regression. A positive dynamics with motor function improvement was observed in 4 patients with grade C. Seven patients (6 with burst fractures, 1 with seat-belt trauma) with grade D and Er were operated on within first hours and day after the trauma. First stage of surgical treatment provided elimination of neurological deficit in 5 cases. Two patients with grade D required the second stage. Regression of neurological deficit was not achieved in patients with fracture-dislocations. Conclusion. Surgical treatment of patients with complicated spine and spinal cord injury should be performed within first 6–8 hours after the trauma.

Sigmoid Endometriosis Presenting with Colonic Obstruction after Seat Belt Trauma

Sigmoid Endometriosis Presenting with Colonic Obstruction after Seat Belt Trauma

Neck Injuries Caused by Automatic Two-point Seat Belts: An Analysis of Four Cases

Although seat belts significantly reduce the extent and severity of injuries sustained by motor vehicle occupants, seat belts are known to be associated with chest and abdominal trauma. Less commonly understood are severe neck injuries caused by the use of two-point automatic shoulder harnesses without concurrent use of a manual lap belt. Such injuries may include cervical spine fractures, craniocervical dislocations and rarely decapitation. Recognizing patterned injuries caused by seat belts and the ability to correlate autopsy findings with the circumstances surrounding the death will allow for correct interpretation of seat-belt related trauma. The four cases described detail fatal neck injuries as a result of improper seat belt use in which an automatic two-point shoulder harness was used without a manual lap restraint. In two of the cases, the victims were decapitated.