Chest and Abdominal Injuries Caused By Seat Belt Wearing

J. L. Greingor, MD; S. Lazarus, MD

Disclosures

South Med J. 2006;99(4):534-535. 

In This Article

Discussion

The increase in road traffic accidents and the seat belt compliance rate contribute to higher rates of injuries resulting from seat belt use. Chest and/or abdominal abrasion at the site of seat belt contact are commonly seen, and with the exception of subcutaneous bruising, the sternal fracture is the most common seat belt injury.

Sternal fractures are seen with increasing frequency in motor vehicle accidents, especially since the introduction of seat belt legislation. Since that time, the incidence of sternal fractures has increased threefold.[4]

Clinical manifestations include pain and tenderness over the sternum. In the setting of a sternal fracture, myocardial contusion is strongly feared, but fortunately, rare. Conductance or excitability disturbance must lead to monitoring in the intensive care unit. Usual associated injuries are spinal trauma and rib fractures.[2,3] The association of sternal fracture with bowel injury has not been frequently reported in the literature.

There has, however, been a significant increase in the incidence of intestinal injuries among seat belt users. Early clinical manifestation of injuries of the bowel and mesentery may be poor.[5] Signs of peritonitis and abdominal pain may be absent on initial evaluation,[5] especially since the physician may be distracted by the pain of extra-abdominal injuries, such as sternal fracture, as in our case. Association of blunt bowel trauma with sternal fracture is uncommon. Frick et al[6] reported no sternal fracture associated with blunt bowel injury in a study of 70 cases. The presence of a seat belt abrasion across the abdomen is an argument for high suspicion, but may not be necessarily indicative of intestinal injury.[7] Chandler et al[7] reported the presence of an abdominal seat belt sign in 14/117 cases. Of these 14, two-thirds had an abdominal injury. In addition, the seat belt sign may be found in victims without occult injuries. Conversely, its absence cannot exclude underlying visceral injury. According to some authors, the presence of a seat belt sign requires admission of the patient and serial examination. Increasing abdominal tenderness is the most frequent change after the initial evaluation which leads to surgical intervention.[6] Delayed diagnosis of bowel injuries could result in higher mortality and morbidity.[8]

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