186 Injury, 5, 186-187

An unusual seat belt injury John Anderson Registrar in Orthopaedic and Accident SurgerF, The General Infirmary. Leeds

Summary A patient with serratus anterior palsy, attributed to seat belt trauma, is described.

SEAT belts have been in general use since the early fifties and have undoubtedly saved many automobi le passengers f rom death and serious injury (Backstrorn, 1963; Depar tment of the Environment , 1972; Foldvary and Lane, 1972). The first report of an injury caused by a seat belt w a s in 1956 (Kulowski and R.ost, 1956). Since then numerous cases of seat belt injuries have appeared in the literature (Witte, 1968; Will iams and Kirkpatrick, 1971 ; Beresford, 1971), and the pattern of seat belt injuries has recently been reviewed (Shennan, 1973). The list of seat belt injuries is growing and the following case report demonstrates yet another injury which is attr ibutable to seat belt trauma.

CASE REPORT A 47-year-old office-manager was involved in a road traffic accident in August, 1972. He was dr iv ing a 1969 Ford Corsair in the early hours of the morning when he fell asleep and collided head-on with a lamp post at a speed of about 35 m.p.h. He was wearing a static seat belt of the lap and diagonal variety. The car was a write-off because of extensive front- end damage, but the passenger's compartment was not deformed. He received a bump on the head, some minor wounds of the left hand and face, and a fractured third left metacarpal. Because of the head injury he was admitted to hospital for observa- tion. On admission he also complained of a painful right shoulder, and was thought to have a minor soft-tissue injury.

When seen in the fracture clinic he again com- plained of a pain in his right shoulder with loss of movement. He denied any previous shoulder trouble and first noted symptoms after the accident. Pro- nounced winging of the right scapula (Fig. 1) with reduced abduction of the right arm was present but there was no sign of injury to the brachial plexus or

1 !

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Fig. l .--Pronounced winging of the right scapula occurred.

Anderson:An Unusual Seat belt Injury 187

to the shoulder muscles. X-ray films of the shoulder showed no bony injury but a chest film revealed fractures of the anterior portion of the first and second ribs on the right side.

One year after the accident the winging of the scapula was still present but the shoulder was not causing any discomfort. He had no difficulty in carrying out his occupation or performing his usual daily tasks.

C O M M E N T About 250 cases of serratus anterior palsy have been reported in the literature since it was first described by Velpeau in 1837. Johnson and Kendall (1955) reviewed 111 cases and showed that injury was responsible for about half of the cases. The injury may be direct, as in a blow to the neck, or indirect with forcible depression of the shoulder. To date there have been no reported cases ascribed to a seat belt.

The ideal positioning of the anchorage point for the diagonal component is the subject of discussion (Bull, 1973). An anchorage point high up on the slide pillar is thought to be responsible for some serious injuries of the soft tissues of the neck, whereas a low anchor- age point is criticized as being liable to cause injury of the cervical spine. The latter state- ment does not appear to have been substantiated in real accidents. In the case described, the anchorage point was 5 cm. above the sitting shoulder height of the injured man.

I t is hoped that the current government sponsored programme wilI increase the use o f seat belts and that those who deal with accidents should be familiar with the patterns of injury which may be encountered f rom their use.

I t is hoped that examples of seat belt injuries will continue to be reported because it is only f rom this informat ion that the ideal design of seat belts can be developed.

Acknowledgements The author wishes to thank E. B. Longton, Esq., M.Ch.(Orth.) F.R.C.S. for his permission to present the case and M. A. Nelson, Esq., F.R.C.S. for his advice and encouragement.

REFERENCES BACKSTROM, C. G. (1963), 'Traffic injuries in south

Sweden with special reference to medicolegal autopsies of car occupants and the value of safety belts ', Acta chir. scand., Suppl., 308, 1.

BERESFORD, H. R. (1971), 'Meralgia parasthetica after seat belt trauma ", J. Trauma, 11, 629.

BULL, J. P. (1973), personal communication. DEPARTMENT OF THE ENVmONMENT (1972), Road

Accidents 1970. London: H.M.S.O. FOLOVARY, L., and LANE, J. (1972), 'Seat belts for

Victoria ', Med. J. ,4ust., 13 May, 1054. JOHNSON, J. T. H., and KENDALL, H. O. (1955),

' Isolated paralysis of the serratus anterior muscle ', J. Bone Jt Surg., 37A, 567.

KULOWSK[, J., and Ros~, W. B. (1956), ' ln t ra- abdominal injury from safety belts in auto accidents ', Archs Surg., 73, 970.

SHENNAN, J. (1973), ' T h e seat belt syndrome', Br. J. hosp. Med., 10, 199.

WmL~AMS, J. S., and KIRKPATRICK, J. R., (1971), 'The nature of seat belt injuries', J. Trauma, 11, 207.

WITTE, C. L. (1968), ' Mesentery and bowel injury from automobile seat belts', Ann. Surg., 167, 486.

Requests for reprints should be addressed to:--J_ Anderson, Esq., F.R,C.S. (Edin.), Senior Registrar in Orthopaedic Surgery, Middlesbrough General Hospital, Middlesbrough, Teesside.