PMID- 18606276
OWN - NLM
STAT- MEDLINE
DCOM- 20081010
LR  - 20181201
IS  - 0001-4575 (Print)
IS  - 0001-4575 (Linking)
VI  - 40
IP  - 4
DP  - 2008 Jul
TI  - Pediatric lumbar Chance fractures in British Columbia: chart review and analysis 
      of the use of shoulder restraints in MVAs.
PG  - 1424-9
LID - 10.1016/j.aap.2008.03.007 [doi]
AB  - Chance fractures of the skeletally immature spine classically occur in frontal 
      motor vehicle accidents (MVAs) when the occupants are restrained by a lap belt 
      only and undergo traumatic hyperflexion of the torso during the impact. We 
      retrospectively examined all MVA-related Chance fractures at British Columbia's 
      Children's Hospital since 1986, by collecting injury and seat-belt use 
      information from chart data and imaging studies. Twenty-six patients were 
      included in the study, 14 wore a lap belt only, seven wore a three-point 
      restraint properly, and five were reportedly misusing the shoulder portion of a 
      three-point restraint. The subjects ranged in age from 3 to 16 with a mean age of 
      10.6 years. Eleven of the 26 (42%) patients sustained abdominal viscera injuries, 
      seven of the 26 patients suffered neurologic injury (spinal cord and/or spinal 
      nerve injury) associated with their spinal fracture, with two cases of complete 
      paralysis, and there was a 38% incidence of head injury. Concomitant injuries 
      (i.e. to the head, abdomen and abdominal contents) tended to be mitigated by the 
      presence of a properly worn shoulder restraint. This leads to the conclusion that 
      Chance fractures can be sustained even when the occupant is using a shoulder belt 
      to restrain their torso. The mechanism responsible for this is unknown. This may 
      indicate that Chance fractures can be caused by a lesser degree of torso 
      hyperflexion than previously thought. Alternatively, we also speculate that 
      Chance fractures can occur while the torso is restrained by the shoulder belt if 
      the hips submarine beneath the lap belt and the torso experiences hyperflexion 
      secondary to forward excursion of the pelvis and legs during the collision. 
      Future work is necessary to confirm these mechanisms and to find ways to prevent 
      them. These studies will need to use computational or experimental child 
      surrogates that can sit in a slouched posture and submarine during a collision.
FAU - Louman-Gardiner, Katherine
AU  - Louman-Gardiner K
AD  - Injury Biomechanics Laboratory and Division of Orthopedic Engineering Research, 
      Departments of Mechanical Engineering and Orthopedics, University of British 
      Columbia, Vancouver, BC, Canada.
FAU - Mulpuri, Kishore
AU  - Mulpuri K
FAU - Perdios, Angeliki
AU  - Perdios A
FAU - Tredwell, Stephen
AU  - Tredwell S
FAU - Cripton, Peter A
AU  - Cripton PA
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20080414
PL  - England
TA  - Accid Anal Prev
JT  - Accident; analysis and prevention
JID - 1254476
SB  - IM
MH  - *Accidents, Traffic
MH  - Adolescent
MH  - British Columbia
MH  - Child
MH  - Child, Preschool
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Lumbar Vertebrae/*injuries
MH  - Male
MH  - Multiple Trauma/complications
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Seat Belts/adverse effects/*statistics & numerical data
MH  - Shoulder
MH  - Spinal Fractures/diagnosis/*etiology/therapy
EDAT- 2008/07/09 09:00
MHDA- 2008/10/11 09:00
CRDT- 2008/07/09 09:00
PHST- 2007/07/17 00:00 [received]
PHST- 2008/03/10 00:00 [revised]
PHST- 2008/03/14 00:00 [accepted]
PHST- 2008/07/09 09:00 [pubmed]
PHST- 2008/10/11 09:00 [medline]
PHST- 2008/07/09 09:00 [entrez]
AID - S0001-4575(08)00046-8 [pii]
AID - 10.1016/j.aap.2008.03.007 [doi]
PST - ppublish
SO  - Accid Anal Prev. 2008 Jul;40(4):1424-9. doi: 10.1016/j.aap.2008.03.007. Epub 2008 
      Apr 14.