Monthly Archives: May 2010

General

National Standards for Teen Drivers?

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During a single week in April, there were 18 driving deaths in Minnesota, most of them involving teens. In at least one crash, the driver was in violation of several of the state’s graduated driver license provisions. Graduated licensing is increasingly popular across the country, and incidents like this are prompting our legislators to tighten them.

One big problem is that each state sets its own licensing standards. And since most states insist on reinventing their own wheel, a patchwork of state standards has been enacted. Some have higher age minimums for obtaining a license. Others limit night driving or number of underage passengers. Most states have addressed phoning and texting while driving.

There is now a push in the US Senate to standardize graduated licensing rules in all states so there is a more even playing field.  The proposed legislation would:

  •  Make getting a driver’s license a 3 step process, including a learner’s permit, a restricted license, and finally an unrestricted license.
  • Prohibit nighttime driving without an unrestricted license.
  • Prohibit cell phone use without an unrestricted license.

The proposed law makes sense. Accident research has shown that states that adopt a more restrictive licensing policy see a significant reduction in crashes, and a reduction in injury crashes of nearly 40%. Fatal crashes in young drivers was reduced by a whopping 75% in these states!

The major problem with the proposed legislation is that the penalties for states not complying are rather heavy-handed. Such states would face losing some of their federal highway construction funding. Many states would face this issue soon if the law was enacted as it is now written.

Concerned parents should communicate with their legislators and support these efforts to protect their children. More immediately, though, parents need to be involved in the driving decisions of their children. Don’t allow them to drive after dark. Limit the number of passengers they can carry. Require them to use their seatbelts. And make sure they understand the consequences if they choose to break these rules: immediate and non-negotiable loss of driving privileges for a set period of time.

General

Trauma 20 Years Ago: Chance Fractures

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Centers that take care of blunt trauma are familiar with the spectrum on injury that is directly attributable to seat belt use. Although proper restraint significantly decreases mortality and serious head injury, seat belts can cause visceral injury, especially to small bowel.

Lap belt use has been associated with Chance fracture (flexion distraction injury to the lumbar spine) since 1982. The association between seat belts and intra-abdominal injury, especially with an obvious “seat belt sign” was first described in 1987. 

Twenty years ago, orthopedic surgeons in Manitoba finally put two and two together and reported a series of 7 cases of Chance fractures. They noted that 6 of the fractures were associated with restraint use. Seat belt sign was also present in 5 of the 6 patients with fractures and three of the six had bowel injuries.

The authors noted that many provinces were mandating seatbelt use at the time, and they predicted that the number of Chance fractures, seat belt signs and hollow viscus injuries would increase. On the positive side, the number of deaths and serious head injuries would be expected to decline.

Although this was a small series, it finally cemented the unusual Chance fracture, seat belt sign, and bowel injury after motor vehicle trauma.

Reference: Pediatric Chance Fractures: Association with Intra-abdominal Injuries and Seatbelt Use. Reid et al. J Trauma 30(4) 384-91, 1990.

Chance fracture