AIR BAG AND SEAT BELT: FRIEND OR FOE?

Abstract

Background: Prior studies identified that crash severity (Delta V), occupant position, and restraint systems as reliable predictors of crash injuries.1–5 Others have noted that correlation between the biomedical thresholds (age, gender, height, weight) and injury pattern to the lower extremity but very little have been written on the subject of upper extremity.

METHOD: This is a retrospective analysis of CIREN database in a level trauma center focusing on upper extremity injuries. The aim was to investigate the relationship between of the ‘crash’ and ‘occupant’ factors on the pattern and severity of upper extremity injuries following a frontal impact collision. results &

Discussion:Majority of the injuries were soft tissues type. (67.6% soft tissue vs. 32.4% fractures). There were 144 fractures to the upper extremity, 12.5% were ‘open’ fractures. 66% of cases of fractures required operative intervention. 74.5% of the fractures sustained in the upper extremity occurred distal to the elbow, whereas soft tissue injuries predominated in the humerus. 21.5% of distal radius fractures were attributed to airbag deployment and all of the clavicle fractures were related to compression from seat belt. Occupants who sustained fractures had a significantly higher ISS scores (mean score 21.88 vs. 17.68, p < 0.05). Using logistic binary regression model, the ISS continued to be a significant predictor for fracture, overriding weight as a co-founding variable. Of the 144 fractures, 66% of cases required operative intervention.

Conclusion:. To advance occupant protection, it is important to understand the differences in individual variability in affecting injury tolerance in high-energy trauma. One could argue that current modern restraint systems are not designed to protect these vulnerable areas; therefore it may not come as a surprise to observe such an emerging trend of injuries to the upper extremities. There is no doubt that modern restraint systems have contributed to the overall decrease in mortality over the years. However, there are case series reported on the effect of airbag-related injuries to upper extremities as a consequence of its primary effectiveness. Our study reinforce the debate for a more ‘depowered’ airbag capable of saving lives yet simultaneously protecting the upper extremities from serious injuries.