Chong Mark, Broome Guy, Mahadeva Dhirendra, Wang Stewart
Department of Orthopaedics, Cumberland Infirmary, United Kingdom.
J Trauma. 2011 Apr;70(4):838-44. doi: 10.1097/TA.0b013e3181df6848.
Prior studies identified that crash severity (delta V), occupant position, and restraint systems as reliable predictors of crash injuries to lower extremity, but very little have been written on the subject of upper extremity.
This is a retrospective analysis of Crash Injury Research and Engineering Network database in a Level I trauma center focusing on severe upper extremity injuries. The aim was to investigate the relationship between types of the "crash" and "occupant" factors on the pattern and severity of upper extremity injuries after a frontal collision.
Majority of the injuries were soft tissues nature (67.6% soft tissue vs. 32.4% fractures). There were 144 fractures to the upper extremity, 12.5% were "open" fractures; 74.5% of the fractures sustained in the upper extremity occurred distal to the elbow, whereas soft tissue injuries predominated in the humerus. Also noted that occupants who sustained fractures were on average 6.7 kg lighter than those who sustained soft tissue injuries (84.5 kg soft tissue vs. 77.86 kg fracture, p < 0.05). We postulate that there may be a protective effect of "soft tissue cushion" toward protecting the content from serious harm, in this case the humerus. Instrument panel, airbag, and seat belts were the main injury source. After adjusting for other modifiers, occupants who sustained fractures had a significantly higher Injury Severity Scores (mean Injury Severity Scores 21.88 vs. 17.68, p < 0.05). This implied that those who sustained fractures to upper extremity most likely had associated significant injuries to other body region, necessitating further medical attention.
Further improvement in vehicle safety performance in the form of "depowered" airbag and efficient energy absorbing material within the vehicle interior is warranted.
先前的研究确定碰撞严重程度（速度变化量）、乘员位置和约束系统是下肢碰撞损伤的可靠预测指标，但关于上肢损伤这一主题的文献却很少。
这是对一级创伤中心的碰撞损伤研究与工程网络数据库进行的回顾性分析，重点关注严重上肢损伤。目的是研究正面碰撞后“碰撞”和“乘员”因素类型与上肢损伤模式及严重程度之间的关系。
大多数损伤为软组织损伤（软组织损伤占67.6%，骨折占32.4%）。上肢有144处骨折，其中12.5%为“开放性”骨折；上肢骨折的74.5%发生在肘部远端，而软组织损伤在肱骨处更为常见。还注意到，发生骨折的乘员平均比发生软组织损伤的乘员轻6.7千克（软组织损伤者84.5千克，骨折者77.86千克，p<0.05）。我们推测，“软组织缓冲”可能对保护内部结构免受严重伤害具有保护作用，在这种情况下是对肱骨的保护。仪表板、安全气囊和安全带是主要的致伤源。在对其他影响因素进行调整后，发生骨折的乘员的损伤严重程度评分显著更高（平均损伤严重程度评分21.88比17.68，p<0.05）。这意味着那些上肢发生骨折的人很可能还伴有身体其他部位的严重损伤，需要进一步的医疗关注。
有必要通过采用“减力”安全气囊以及在车辆内部使用高效能量吸收材料等方式进一步提高车辆安全性能。
