310
Injury, 7, 310-312
An unusual seat-belt injury in a doctor Christopher D. Jefferiss Princess Elizabeth Orthopaedic Hospital, Exeter Summary The personal experience of a general practitioner who sustained a fracture-dislocation of the atlanto-axial joint is recorded. The inefficient application of an unyielding (non-inertial) lap and diagonal seat belt permitted this injury, although one does not know what other injuries might have occurred had the belt not been worn.
INTRODUCTION CERVICAL spine injuries o f gross degree are frequently seen in busy a c c i d e n t services as a result o f r o a d traffic accidents. These injuries c a n be missed initially with dire effect u p o n the patient. C e r t a i n injuries to wearers o f seat belts are n o w recognized, particularly t h o s e due to p o o r a p p l i c a t i o n o f a n unyielding belt. A case r e p o r t o f a G P w h o p r o b a b l y flexed his n e c k at the limit o f seat-belt r e s t r a i n t is presented in his o w n words.
a hard day the neck sometimes feels a bit stiff and then I will take a couple of paracetamol tablets to settle for the night.
MANAGEMENT This 69-year-old G P was driving to the district h o s p i t a l to visit his sick wife. H e h a d b e e n e x a m i n e d by a senior casualty officer a n d the n e c k was f o u n d to b e slightly stiff a n d osteoa r t h r i t i s was diagnosed. As the sternal f r a c t u r e (Fig. 1) was painful, h e was admitted. T h e f r a c t u r e - d i s l o c a t i o n o f the atlanto-axial j o i n t was diagnosed on repeat radiographs and reduced
CASE REPORT I was driving on a wet road to the hospital when I suddenly and unexpectedly skidded. 1 went into the off-side ditch and was thrown on to the steering wheel, cracking my breastbone. I could not get an inertia belt for my model of car, so was wearing the static lap and diagonal belt, but it was only done up loosely for comfort. The belt then held me and my head went forward but didn't hit anything. I had a severe pain in my chest but noticed no other pain. I got out of the car and some people kindly drove me into the hospital. When I arrived I felt rather shaky so [ reported to casualty where a fractured sternum was diagnosed and I was admitted to the ward. My neck felt increasingly stiff on the right hand side and after a few hours was very painful indeed. A fracture of the odontoid was diagnosed and I was put on skull traction, which relieved the pain immediately and completely. Now, a year later, rotation to the right is slightly limited but otherwise movement is full. At the end of
Fig. 1. Fracture of the sternum.
Jefferiss: Unusual Seat-belt Injury
immediately with traction on Crutchfield tongs (Fig. 2). After 4 weeks a plaster collar was applied and he went home a week later. The joint was stable at 12 weeks but a polythene collar was worn for another 3 months (Fig. 3).
311
extension forces. This patient had a flexion injury caused by inefficient application of an unyielding seat belt and was diagnosed with the difficulty recorded by Durbin (1957) at t h i s / e v e / a n d was treated in the manner he recommended. This
Fig. 2. Anteroposterior and lateral view at diagnosis.
Fig. 3. Lateral views at 12 weeks.
DISCUSSION Gissane and Bull (1968) drew our attention to seat-belt injuries, and London (1975) has recently emphasized the efficacy of proper restraint. Voight (i975), in the same review, reports injuries o f the upper cervical spine due to
patient has recovered the good mobility that Horlyck and Rahbek (1974) found usual in high cervical spine injuries that had no neurological involvement. Any symptom in the neck demands good quality radiographs with an anteroposterior view,
312
Injury : the British Journal of Accident Surgery Vol. 7/No. 4
o p e n - m o u t h view a n d laterals w i t h the n e c k flexed a n d extended. T h e presence o f fracture o f t h e s t e r n u m ( p r o b a b l y due to t h e steering wheel) w h e n a seat belt was w o r n m a y be a p o i n t e r to a n o t h e r m o r e serious injury.
Acknowledgements I a m grateful to the general p r a c t i o n e r for his enthusiastic c o - o p e r a t i o n a n d to M r F. C. D u r b i n u n d e r w h o s e care h e was treated.
REFERENCES
DURBIN F. C. (1957) Fracture-dislocations of the cervical spine. J. Bone Joint Surg. 39B, 23. GISSANE W. and BULL J. P. (1968) Seat-belt injuries. Br. Med. J. 4, 641. HORLVCI~ E. and RAnBEK M. (1974) Cervical spine injuries. Acta Orthop. Scand. 45, 845. LONDON P. S. (1975) Clinical aspects of the disruptive effects of road traffic accidents on the h u m a n body. Acta Orthop. Scand. 46, 460. V o l a n t G. E. (1975) Injury patterns in traffic accidents and suggested preventive measures. Acta Orthop. Scand. 46, 475.
Requestsfor reprintsshouldbe addressedto:C. D. Jefferiss, Senior Registrar, Princess Elizabeth Orthopaedic Hospital, Wonford Road, Exeter, EX2 4UE.
ERRATUM
We regret that in the article by K. C. Chong, P. B. Chacha and B. T. Lee, 'Fractures of the neck of the femur in childhood and adolescence', Injury, 7, 111-19, Figs. 6a and 6b were transposed.
Injury, 7, 310-312
An unusual seat-belt injury in a doctor Christopher D. Jefferiss Princess Elizabeth Orthopaedic Hospital, Exeter Summary The personal experience of a general practitioner who sustained a fracture-dislocation of the atlanto-axial joint is recorded. The inefficient application of an unyielding (non-inertial) lap and diagonal seat belt permitted this injury, although one does not know what other injuries might have occurred had the belt not been worn.
INTRODUCTION CERVICAL spine injuries o f gross degree are frequently seen in busy a c c i d e n t services as a result o f r o a d traffic accidents. These injuries c a n be missed initially with dire effect u p o n the patient. C e r t a i n injuries to wearers o f seat belts are n o w recognized, particularly t h o s e due to p o o r a p p l i c a t i o n o f a n unyielding belt. A case r e p o r t o f a G P w h o p r o b a b l y flexed his n e c k at the limit o f seat-belt r e s t r a i n t is presented in his o w n words.
a hard day the neck sometimes feels a bit stiff and then I will take a couple of paracetamol tablets to settle for the night.
MANAGEMENT This 69-year-old G P was driving to the district h o s p i t a l to visit his sick wife. H e h a d b e e n e x a m i n e d by a senior casualty officer a n d the n e c k was f o u n d to b e slightly stiff a n d osteoa r t h r i t i s was diagnosed. As the sternal f r a c t u r e (Fig. 1) was painful, h e was admitted. T h e f r a c t u r e - d i s l o c a t i o n o f the atlanto-axial j o i n t was diagnosed on repeat radiographs and reduced
CASE REPORT I was driving on a wet road to the hospital when I suddenly and unexpectedly skidded. 1 went into the off-side ditch and was thrown on to the steering wheel, cracking my breastbone. I could not get an inertia belt for my model of car, so was wearing the static lap and diagonal belt, but it was only done up loosely for comfort. The belt then held me and my head went forward but didn't hit anything. I had a severe pain in my chest but noticed no other pain. I got out of the car and some people kindly drove me into the hospital. When I arrived I felt rather shaky so [ reported to casualty where a fractured sternum was diagnosed and I was admitted to the ward. My neck felt increasingly stiff on the right hand side and after a few hours was very painful indeed. A fracture of the odontoid was diagnosed and I was put on skull traction, which relieved the pain immediately and completely. Now, a year later, rotation to the right is slightly limited but otherwise movement is full. At the end of
Fig. 1. Fracture of the sternum.
Jefferiss: Unusual Seat-belt Injury
immediately with traction on Crutchfield tongs (Fig. 2). After 4 weeks a plaster collar was applied and he went home a week later. The joint was stable at 12 weeks but a polythene collar was worn for another 3 months (Fig. 3).
311
extension forces. This patient had a flexion injury caused by inefficient application of an unyielding seat belt and was diagnosed with the difficulty recorded by Durbin (1957) at t h i s / e v e / a n d was treated in the manner he recommended. This
Fig. 2. Anteroposterior and lateral view at diagnosis.
Fig. 3. Lateral views at 12 weeks.
DISCUSSION Gissane and Bull (1968) drew our attention to seat-belt injuries, and London (1975) has recently emphasized the efficacy of proper restraint. Voight (i975), in the same review, reports injuries o f the upper cervical spine due to
patient has recovered the good mobility that Horlyck and Rahbek (1974) found usual in high cervical spine injuries that had no neurological involvement. Any symptom in the neck demands good quality radiographs with an anteroposterior view,
312
Injury : the British Journal of Accident Surgery Vol. 7/No. 4
o p e n - m o u t h view a n d laterals w i t h the n e c k flexed a n d extended. T h e presence o f fracture o f t h e s t e r n u m ( p r o b a b l y due to t h e steering wheel) w h e n a seat belt was w o r n m a y be a p o i n t e r to a n o t h e r m o r e serious injury.
Acknowledgements I a m grateful to the general p r a c t i o n e r for his enthusiastic c o - o p e r a t i o n a n d to M r F. C. D u r b i n u n d e r w h o s e care h e was treated.
REFERENCES
DURBIN F. C. (1957) Fracture-dislocations of the cervical spine. J. Bone Joint Surg. 39B, 23. GISSANE W. and BULL J. P. (1968) Seat-belt injuries. Br. Med. J. 4, 641. HORLVCI~ E. and RAnBEK M. (1974) Cervical spine injuries. Acta Orthop. Scand. 45, 845. LONDON P. S. (1975) Clinical aspects of the disruptive effects of road traffic accidents on the h u m a n body. Acta Orthop. Scand. 46, 460. V o l a n t G. E. (1975) Injury patterns in traffic accidents and suggested preventive measures. Acta Orthop. Scand. 46, 475.
Requestsfor reprintsshouldbe addressedto:C. D. Jefferiss, Senior Registrar, Princess Elizabeth Orthopaedic Hospital, Wonford Road, Exeter, EX2 4UE.
ERRATUM
We regret that in the article by K. C. Chong, P. B. Chacha and B. T. Lee, 'Fractures of the neck of the femur in childhood and adolescence', Injury, 7, 111-19, Figs. 6a and 6b were transposed.
