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This is an overview of air bag injuries, a review of the literature and descriptions of air bag related injuries to the various body areas. Some unusual injuries are also included. The cases presented are from the author's files and one from the Special Studies Division of NHTSA.

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.

From the authors' files, case examples of thoracolumbar injuries sustained by lap-shoulder belted front seat occupants, in frontal crashes, are presented. Additional cases were found in a review of the clinical literature. The biomechanical literature was reviewed, identifying laboratory studies on thoracolumbar spinal injuries. Suggested mechanisms in the production of these injuries in frontal type car crashes are postulated.

Based on an analysis of the National Automotive Sampling System (NASS) database from calendar years 1995-2000, over 30,000 fractures and dislocations of the knee-thigh-hip (KTH) complex occur in frontal motor-vehicle crashes each year in the United States. This analysis also shows that the risk of hip injury is generally higher than the risks of knee and thigh injuries in frontal crashes, that hip injuries are occurring to adult occupants of all ages, and that most hip injuries occur at crash severities that are equal to, or less than, those used in FMVSS 208 and NCAP testing. Because previous biomechanical research produced mostly knee or distal femur injuries, and because knee and femur injuries were frequently documented in early crash investigation data, the femur has traditionally been viewed as the weakest part of the KTH complex.

A review of the UM series and of NCSS, NASS, CPIR and FARS Files, as well as Michigan accident data files was undertaken, as well as a review of the NTSB “Rear Seat Study”. From these files rear seat occupany is approximately 10%, with children 6 years of age or less being 1/5th of these. About 50-60% of those in the sear seat are adults. Most of the injuries are at the lower AIS levels, with adults being more seriously injured. Of the more serious or fatal injuries, the head and face predominate by far, in all types of crashes involving unrestrainded rear seat occupants. When belts are worn there are few seriously or fatally injured rear occupants and of these, the abdominal area predominates. From available data, rear lap-belted passengers have the same MAIS level (or less) when compared to their front seat lap-shoulder belted counterparts.

From the crash investigation files at the University of Michigan Transportation Research Institute (UMTRI), the crashes involving deployed airbags were reviewed. The total number of deployments is 898 of which 764 are frontal crashes with the principal direction of force (PDF) at 11-1 o’clock. Of the drivers in these frontal crashes 83% were using the belt restraint. Overall, seven of ten drivers have an AIS-0 or 1 level injury as the maximum or highest injury severity level (MAIS). Of the survivors, one in six had a moderate level injury (AIS-2) as their most significant injury and one in nine had an MAIS 3 or greater injury. Fatalities are rare. There is a difference between injury severity frequencies of belted vs. non-belted drivers. Three-quarters of the belted drivers had minor injuries compared to only half of those not belted. A difference was also noted at the AIS-2 level—belted vs. unbelted 14% vs. 23%.

This paper presents an analysis of front seat outboard occupants in frontal and rollover crashes. These occupants were lap belted, lap-shoulder belted or were unrestrained. In the frontal crash the lap-shoulder belt reduces the occurrence of the severe, serious, critical-to-life injuries, and fatalities in all regions of the body (head, neck, thorax, lower torso and extremities). In addition, there is a strong association between belt usage and the occupant escaping from the crash with no injury. In rollover crashes, belts reduce the frequency of the more severe injuries by preventing the occupant from being ejected. For those occupants not ejected from the car, belts effectively reduce fatalities and the more serious injuries.

An analysis of 211 automobiles having the ball-type E.A. device (GM cars - 1972–1980), involved in frontal crashes was made to determine the relationship between driver injury and the steering assembly. The majority of the drivers had MAIS of 0 or 1 (66%). The head was the most frequently injured body region with the lower extremities next in frequency. Of the unrestrained drivers studied, 43% had a thoracic injury, the majority of which were minor. There is no correlation between injury severity and steering rim or spoke deformation, or the amount of E.A. column compression. Specific terminology for certain aspects of the E.A. performance are suggested.

The purpose of this study was to assess, by use of computer simulations, the effectiveness of motorcycle helmets in reducing head and neck injuries in motorcyclist impacts. The computer model used was the MVMA Two-Dimensional Crash Victim Simulator. The study investigated a wide variety of impact conditions in order to establish a broad overall view of the effectiveness of helmets. It was found that helmet use invariably reduces dynamic responses which have a role in producing head injury and, in addition, almost always reduces the severity of neck response as well. For no configuration or condition does the helmet greatly increase the likelihood of neck injury. Thus, these simulations of a wide spectrum of motorcyclist impacts provide further evidence that helmet use significantly reduces the likelihood and severity of both head and neck injuries. This study was supported by the Insurance Institute for Highway Safety.

The objectives of this study are to quantify the biomechanical properties of the human neck which govern head and neck dynamic response and to establish the mechanisms responsible for primary aspects of response. Computer simulations with the MVMA 2-D and VOM 3-D occupant dynamics models were performed using head and neck sled input response data from human subjects at the Naval Biodynamics Laboratory for input and comparison. Predicted dynamic response data and preliminary values for biomechanical parameters in a three-dimensional head/neck model capable of accurately simulating response for −X, +Y, and −X+Y sled acceleration vectors are presented. The established analytical model should accurately predict head and neck responses in simulations of real-world automobile crashes where direct head impact is not involved. Additionally, the model can be used to assist in development of a design plan for the neck of advanced anthropomorphic test dummies.

The side impact, recently and currently the subject to of much debate, controversy and proposed NHTSA rule making, is a difficult type of crash to significantly reduce serious injuries and fatalites. Results from real-world crash investigations presents a confusing picture for the near-side passenger compartment crash. A direct relationship between the amount of crush and injury severity levels (MAIS) is not apparent. Exemplar cases of tow-a-way/injury crashes are presented at all AIS injury level of drivers in crashes with direct driver door crush damage.

Eight whole fresh-frozen cadavers (6 female, 2 male) that were elderly and/or female were laterally impacted using UMTRI's dual-sled side-impact test facility. Cadavers were not excluded on the basis of old age or bone diseases that affect tolerance. A thinly padded, multi-segment impactor was used that independently measured force histories applied to the shoulder, thorax, abdomen, greater trochanter, iliac wing, and femur of each PMHS. Impactor plates were adjusted vertically and laterally toward the subject so that contact with body regions occurred simultaneously and so that each segment contacted the same region on every subject. This configuration minimized the effects of body shape on load sharing between regions. Prior to all tests, cadavers were CT scanned to check for pre-existing skeletal injuries. Cadavers were excluded if they had pre-existing rib fractures or had undergone CPR.

This study continued the biomechanical investigations of forearm fractures caused by direct loading of steering-wheel airbags during the early stages of deployment. Twenty-four static deployments of driver airbags were conducted into the forearms of unembalmed whole cadavers using a range of airbags, including airbags that are depowered as allowed by the new federal requirements for frontal impact testing. In general, the depowered airbags showed a reduction in incidence and severity of forearm fractures compared to the pre-depowered airbags tested. Data from these twenty-four tests were combined with results from previous studies to develop a refined empirical model for fracture occurrence based on Average Distal Forearm Speed (ADFS), and a revised value for fifty-percent probability of forearm-bone fracture of 10.5 m/s. Bone mineral content, which is directly related to forearm tolerance, was found to be linearly related to arm mass.

In a previous study, the authors reported on the development of a finite-element model of the midsize male pelvis and lower extremities with lower-extremity musculature that was validated using PMHS knee-impact response data. Knee-impact simulations with this model were performed using forces from four muscles in the lower extremities associated with two-foot bracing reported in the literature to provide preliminary estimates of the effects of lower-extremity muscle activation on knee-thigh-hip injury potential in frontal impacts. The current study addresses a major limitation of these preliminary simulations by using the AnyBody three-dimensional musculoskeletal model to estimate muscle forces produced in 35 muscles in each lower extremity during emergency one-foot braking.

Lateral impact tests were performed using seven male post-mortem human subjects (PMHS) to characterize the force-deflection response of contacted body regions, including the lower abdomen. All tests were performed using a dual-sled, side-impact test facility. A segmented impactor was mounted on a sled that was pneumatically accelerated into a second, initially stationary sled on which a subject was seated facing perpendicular to the direction of impact. Positions of impactor segments were adjusted for each subject so that forces applied to different anatomic regions, including thorax, abdomen, greater trochanter, iliac wing, and thigh, could be independently measured on each PMHS. The impactor contact surfaces were located in the same vertical plane, except that the abdomen plate was offset 5.1 cm towards the subject.

Using the CDC (SAE J224), a comparison of the NASS data and the UMTRI field accident files (UM series) indicates a similar distribution of offset frontal crashes. Offset frontal damage occurs in 56-61% of crashes, often involving more than one third of the front of the car. Lap-shoulder belted drivers sustain more AIS 2 or greater injuries when there is interior intrusion and occur more often when the offset damage is in front of the driver. However, this may well be due to the severity of the crash. European studies have no uniformity as to offset frontal collision descriptors are difficult to interpret, or to compare one to another.

Crash injury reduction via lap-shoulder belt use has been well documented. As any interior car component, lap-shoulder belts may be related to injury in certain crashes. Relatively unknown is the fact that cervical fractures or fracture-dislocations to restrained front seat occupants where, in the crash, no head contact was evidenced by both medical records and car inspection. An extensive review of the available world's literature on car crash injuries revealed more than 100 such cases. A review of the NASS 80-88 was also conducted, revealing more examples. Cases from the author's own files are also detailed.