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Seat belt sign trauma4/16/2024 Total spinal precaution was maintained all through her admission. Given the extensive multitrauma and circulatory failure, the patient was admitted into the intensive care unit (ICU) and co-managed by different surgical specialties who adopted a staged operative approach and prioritisation of care. There was no relevant medical history or use of regular medications by the patient. However, she was haemodynamically unstable with clinical features of hypovolaemic shock and required significant fluid resuscitation and emergency exploratory laparotomy. Neurologically, the cranial nerves, reflexes, anal sphincter tone, limb motor power (except the left upper limb) and sensory examination were all normal. There were also seat belt bruises in her anterior chest and abdominal walls and generalised peritonitic abdomen. On clinical assessment at the emergency department, the patient was fully conscious, with a 5 cm right frontal scalp laceration, midline lumbar spinal tenderness and painful swelling and deformity of the left mid-arm. The patient was a restrained front seat passenger who had a long period of extrication from the vehicle which was completely decimated. Our patient was a young woman in her 20s who was airlifted to our hospital which is a major trauma centre, from the scene of a high-speed head-on motor vehicle collision, in which the driver of the colliding vehicle had died at the spot. We discuss the challenging surgical management, highlighting the role of radiological imaging in such cases, and provide a literature review. The patient was successfully treated by a dedicated multidisciplinary team who adopted a staged surgical approach and prioritisation of care. In this report, we describe seat belt syndrome occurring with Chance fracture dislocation of the second lumbar vertebra without neurological deficits in a young woman involved in a high-speed head-on vehicle collision leading to death of one of the occupants. 8 The presence of complete fracture-dislocation of the lumbar spine without neurological deficits is a rarity. This eponymous variant deserves a special mention as it is a horizontal fracture extending posteriorly from the vertebral body into the pedicles, transverse processes, laminae and the spinous processes. 7 GQ Chance in 1948 had described a fracture type occurring in patients wearing a lap belt during motor accidents. Result of one such injury is the ‘seat belt syndrome’ which is described as the association of seat belt sign with bowel rupture and lumbar spine fracture. 2 3 Despite the safety of seat belts, there have been many reports of injuries and fatalities ascribed to their use or inadvertent misuse. 1 The mandatory and proper use of seat belts has invariably led to the greatest reduction in the severity of injuries and deaths especially in rollover collisions in which they prevent the ejection of the restrained occupants from the vehicle. Globally, it is estimated that about 1.2 million persons, half of whom are within the productive ages of 15–44, die each year from road traffic collisions. We discuss the challenging surgical management, highlighting the role of radiological imaging in such cases and provide a literature review. To the authors’ knowledge, this is the first report of such a case in Australasia. There were no manifested neurological or other deficits after 1 year of follow-up. The patient was successfully treated by a dedicated multidisciplinary team which adopted a staged surgical approach and prioritisation of care. These injuries which resulted from high-speed vehicle collision and led to death of one of the occupants were readily detected by trauma series imaging. We describe a young woman with completely disrupted Chance fracture of the second lumbar vertebra in association with left hemidiaphragmatic rupture/hernia, multiple bowel perforations, splenic capsular tear, left humeral shaft and multiple rib fractures. Unstable Chance fractures of the spine without neurological deficits have been reported infrequently. The seat belt syndrome is a recognised complication of seat belt use in vehicles.
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