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Children Who Do Not Wear 3-Point Restraint Properly May Sustain Severe Abdominal Injuries in Motor Vehicle Accidents
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Posted on: 12/10/2009
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Chance fractures are fractures of the lumbar (lower) and thoracic (mid-upper) spine and are most often seen in adults who have been in a motor vehicle accident and who were wearing only lap belts as restraints. Chance fractures in children are not common because of the safety restraints used in cars these days, but they do happen. When children do sustain Chance fractures, there is a slight risk of neurological (nerve) issues that result but, usually, doctors find it more common for the children to sustain serious injuries in the abdomen instead, intra-abdominal injuries.
Children who sustain Chance fractures do so usually because they were using lap belts in cars rather than the three-point restraints that hold the chest back, preventing them from bending forward at the waist. The authors of this article write about a family who was in a motor vehicle accident at a high speed. Three of the four siblings (aged 15, 13 and 12 years) were not wearing their three-point restraints properly because they had removed the chest strap during the drive. The children had been reclined in their seats, sleeping in their minivan at the time of the accident. The three sustained Chance fractures and two of the three also developed serious intra-abdominal injuries.
The 15-year-old, a girl, had severe face and head injuries, although she was conscious when she arrived in the emergency room. She also complained of abdominal pain, where there was an obvious seatbelt mark. Her neurological tests were normal but a computed tomography scan (CT scan) of her abdomen and pelvis showed that her colon had been perforated and there was a Chance fracture at the L3 level of her lower back.
Her surgery included repairing the intestine, removing food and fluid from the abdominal cavity and repairing any other internal tears. Two days later, she underwent surgery again to repair facial fractures and when she was physically ready, she was placed in a Risser castto stabilize her back. She has since healed from the spinal fracture and abdominal injuries, but she continues to need several procedures to repair the damage to her face, jaws and teeth.
The 13-year-old sibling, a boy, was also conscious on arrival at the emergency room and also complained of facial pain, back pain and mild abdominal pain. He, too, had a visible seatbelt mark on his abdomen. The boy's neurological examination was normal and, for the most part, his CT scan was normal, except for some fluid in his pelvis. The spine had sustained a Chance fracture at the L2 and L3 level of the lower back.
Surgery was done immediately to repair his complex facial injuries and surgeons also took a look inside the boy's abdomen, but did not find any injuries. He was also placed in a Risser cast, but earlier than his sister, only six days after the accident. The boy has since healed and returned to his normal pre-accident activities.
The third sibling was a 12-year-old boy. He was also conscious on arrival at the emergency room, complaining of significant back pain and severe abdominal pain. He, too, had a large seatbelt mark on his abdomen. His neurological signs were normal, despite the complaints of back pain. His abdominal injuries, as seen by CT scan, showed a right-sided pneumothorax, air in the chest that has collapsed the lung. He also had internal bruising and there was fluid in the pelvis. When surgery was performed that night, the surgeons found a tear in the common bile duct (part that exits the liver) and they repaired this and they also inserted a chest tube to treat the pneumothorax. No other abdominal injuries were found. It was only the next day, with another CT scan, that the doctors found that this sibling had also sustained a Chance fracture, this time in the lower level of the mid-upper spine. He was also placed in a Risser cast after this chest tube was removed.
The authors used these cases to show the importance of proper restraints in a motor vehicle. The incidence of Chance fractures have gone down with the wider spread use of three-point restraints, but as shown by this case, they still do happen, usually when the three-point restraints are not being used properly. The authors also pointed out that "up to two-thirds of Chance fractures have associated intra-abdominal injuries, with 25 percent to 58 percent of these injuries requiring surgical treatment."
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References:
Zachary L. Gordon, MD, et al. Three Siblings With Chance Fractures: The Importance of 3-Point Restraints. In Journal of Pediatric Orthopedics. Dec. 2009. Vol. 29. No. 8. Pp. 856 to 859.
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