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The biomechanical behavior of 4-point seat belt systems was investigated through MADYMO modeling, dummy tests and post mortem human subject tests. This study was conducted to assess the effect of 4-point seat belts on the risk of thoracic injury in frontal impacts, to evaluate the ability to prevent submarining under the lap belt using 4-point seat belts, and to examine whether 4-point belts may induce injuries not typically observed with 3-point seat belts. The performance of two types of 4-point seat belts was compared with that of a pretensioned, load-limited, 3-point seat belt. A 3-point belt with an extra shoulder belt that “crisscrossed” the chest (X4) appeared to add constraint to the torso and increased chest deflection and injury risk. Harness style shoulder belts (V4) loaded the body in a different biomechanical manner than 3-point and X4 belts.

In a review of 540 crashes in which the steering-wheel airbag deployed, 38% of the drivers sustained some level of upper extremity injury. The majority of these were AIS-1 injuries including abrasions, contusions and small lacerations. In 18 crashes the drivers sustained AIS-2 or-3 level upper extremity injuries, including fractures of the radius and/or ulna, or of the metacarpal bones, all related to airbag deployments. It was determined that six drivers sustained the fracture(s) directly from the deploying airbag or the airbag module cover. The remaining 12 drivers had fractures from the extremity being flung into interior vehicle structures, usually the instrument panel. Most drivers were taller than 170 cm and, of the 18 drivers, 10 were males.

From our crash investigations of air bag equipped passenger cars, a subset of upper extremity injuries are presented that are related to air bag deployments. Minor hand, wrist or forearm injuries-contusions, abrasions, and sprains are not uncommonly reported. Infrequently, hand fractures have been sustained and, in isolated cases, fractures of the forearm bones or of the thumb and/or adjacent hand. The close proximity of the forearm or hand to the air bag module door is related to most of the fractures identified. Steering wheel air bag deployments can fling the hand-forearm into the instrument panel, rearview mirror or windshield as indicated by contact scuffs or tissue debris or the star burst (spider web) pattern of windshield breakage in front of the steering wheel.

Frontal crashes (11-1 o'clock) were reviewed from the National Accident Severity Study file (NASS) for years 1980-87. Adult drivers and front right passengers, with lower extremity injuries of the pelvis, thigh, knee, leg or ankle/foot were reviewed. Analysis of age differences, injury contacts, and effectiveness of the 3-point restraint system were studied. Unrestrained drivers have a higher frequency of knee injuries than passengers, fewer leg injuries than passengers and both have the same frequency of ankle/foot injuries. Older unbelted drivers have more injuries to the pelvis, leg, and ankle/foot region than do young drivers. Passengers have more leg injuries. The instrument panel is the major contact for most of the lower extremity injuries. Lap/shoulder belts significantly reduce lower extremity injury frequency.