Lap belt iliac wing fracture: a predictor of bowel injury in children

Abstract

Lap belt restraints in motor vehicle collisions have been associated with a variety of injuries, mainly bowel and lumbar spine. Cephalad positioning of the belt over the intended position across the anterior superior iliac spines (which typically occurs in younger children) is thought to be responsible for the observed bowel injuries. We report two pediatric patients, both restrained by lap belts in high-speed collisions, who suffered iliac wing fractures in addition to bowel injuries. Unexplained free peritoneal fluid was the sole CT finding in one patient (a teenage girl) who had a delay in diagnosis of bowel perforation. These cases illustrate the high frequency of bowel injury in pediatric patients with iliac wing fractures associated with lap belt use.

Injuries caused by seatbelts

“…During NCAP tests, anthropomorphic dummies are secured into the vehicle by safety belts and vehicles are crashed into a fixed barrier at will be applied across the pelvis as a result. Occasionally this force results in fracture of the iliac wing which has been described in both adults (Greenbaum and Rolston, 1971) and children (Emery, 2002), and may be associated with other seatbelt related injuries such as hollow viscus injury (Emery, 2002).…”

Association Between the Seat Belt Sign and Intra‐abdominal Injuries in Children With Blunt Torso Trauma in Motor Vehicle Collisions

“…Pediatric studies of this topic primarily consist of case series or retrospective reviews. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] A single-center prospective study demonstrated an association between the seat belt sign and intra-abdominal injury in children, but was limited by its small sample size. 25 In contrast, one pediatric study failed to demonstrate any association between the seat belt sign and intra-abdominal injury.…”