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From the authors' files, case examples of thoracolumbar injuries sustained by lap-shoulder belted front seat occupants, in frontal crashes, are presented. Additional cases were found in a review of the clinical literature. The biomechanical literature was reviewed, identifying laboratory studies on thoracolumbar spinal injuries. Suggested mechanisms in the production of these injuries in frontal type car crashes are postulated.

The “seat belt syndrome”, first described in 1961, identified abdominal organ injuries related to the use of the lap belt. Many articles have further documented detailed descriptions of intraabdominal lap belt related trauma. Lumbar spine distractions were later added to this injury list. Lap belt injury literature not infrequently hypothecates that some, if not all, of these seat belt syndrome injuries would be prevented, eliminated, or at least significantly reduced in frequency by the use of lap-shoulder belts. This report, based on data from crash investigations, documents lap-shoulder belt intraabdominal injuries occurring by belt loading alone, without significant intrusion and without significant dynamic flexing of the torso of the restrained front seat occupant.

The effects of child safety seats have been well documented in the medical literature. Scattered throughout the medical literature are individual case reports of cervical injury to children restrained in child restraint systems. A review of the literature is provided identifying previous documented cases. The authors also provide new case details of children with cervical spine injury without head contact. An overview of the growth of the infant and specific details in the cervical spine that may contribute to significant cervical injury without head impact is presented.

Crash injury reduction via lap-shoulder belt use has been well documented. As any interior car component, lap-shoulder belts may be related to injury in certain crashes. Relatively unknown is the fact that cervical fractures or fracture-dislocations to restrained front seat occupants where, in the crash, no head contact was evidenced by both medical records and car inspection. An extensive review of the available world's literature on car crash injuries revealed more than 100 such cases. A review of the NASS 80-88 was also conducted, revealing more examples. Cases from the author's own files are also detailed.

A comparative analysis of detailed road crash data from four different environments is presented. Three of the studies were on-scene investigations of crashes from Adelaide, Australia; Birmingham, and Worcestershire, England. The fourth set of data was taken from ACIR reports by Cornell Aeronautical Lab., Inc. of predominantly rural crashes in the United States. Where necessary the data were reanalyzed so that the variables being discussed were compatible. Comparisons are drawn between speeds at impact, areas of impact, vehicle damage severity, seated position, injury severity, anatomical injury distribution, and causes of injury for the four sets of data. The results show that there are considerable similarities between rural crashes in England and the United States, and urban crashes in Adelaide and Birmingham. Further, urban crashes have quite distinct characteristics from rural crashes.

Car collisions from a representative; sample of.urban and rural accidents in Great Britain have been analyzed. sA damage severity index scale has been developed which involves comparing the damage to a case vehicle with damage to a similar make and model vehicle which has been in an experimental impact. Damage severity is then correlated with injury severity for four crash configurations: head on, front corner, side, and rear end. The benefits from lap/diagonal seat belts show an increase in at least 12 mph in equivalent barrier speeds for the same injury level in head-on and front-corner impacts, but in side impacts there is no significant benefit to the occupants remaining in the cars. Penetration of the passenger compartment in side impacts and rollover is shown to be closely related to injury severity. When better experimental data are available, this method should allow different makes and models of cars to be assessed in terms of injury prevention.

Some aspects of an on-the-spot study of 425 urban road accidents in Birmingham, England are presented. Injury patterns to pedestrians, motorcyclists and front seat car occupants are summarized. The origins of these injuries in relation to road and vehicular impacts are discussed. Vehicle components causing injury to pedestrians and to car occupants are analysed. Crash helmet effectiveness in motorcycle impacts is discussed and some comment is made on seat belt fitting and use.