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Investigations of 1967 and 1968 model cars indicate that the injuries sustained by driver impacts to the steering assembly are markedly reduced because of the energy absorbing steering column. Drivers, however, are sustaining facial injuries from impact to the steering wheel rim even in low speed crashes. In more severe head-on collisions, the driver is compressing the energy absorbing column and is striking his face on the upper padded instrument panel in front of the steering wheel. Relatively severe facial fractures are sustained by impacting this portion of the panel.

The purpose of this literature review was to determine areas of automotive injury information that may add to knowledge of injury type, frequency, severity, and cause. This paper is a review of the literature concentrating on the period between 1965 and present. Literature on car, van, or 1ight truck occupants has been reviewed for injury frequencies, types, and locations. Current experimental biomechanical articles are also included. A search was made for descriptions of injury frequency, restraint effectiveness, and the causes of specific injuries. Medical and engineering journals, texts, and books were reviewed. For convenience, this report is divided into sections by body region with an overview introduction on the anatomy of the specific region.

Basilar skull fractures have previously been described as the result of cranial vault impacts. Such fractures resulting from impacts to the chin, face and/or orbital areas (non-cranial vault areas) have not been adequately documented. These types of fractures and the motor vehicle incidents in which the injuries were sustained will be described according to the type of crash and vehicles involved. Data on the tolerance levels of the basilar region of the skull are sparce at best. Case histories of non-cranial vault impacts, presented in a variety of crash types, document that facial impacts can be the sole cause of basilar skull fractures. A historical review of the basilar skull fracture literature is presented.

The effects of child safety seats have been well documented in the medical literature. Scattered throughout the medical literature are individual case reports of cervical injury to children restrained in child restraint systems. A review of the literature is provided identifying previous documented cases. The authors also provide new case details of children with cervical spine injury without head contact. An overview of the growth of the infant and specific details in the cervical spine that may contribute to significant cervical injury without head impact is presented.

From field crash investigations conducted by the authors, a series of well documented crashes will be presented. In each, at least one occupant was wearing a lap-shoulder belt. Detailed injury reports will be presented along with photographs of car damage, occupant contact areas, and where possible, the estimated impact speeds.

On-scene investigations of 104 fatal accidents involving 136 fatalities have shown that ejection from the vehicle was the leading cause of the fatalities. The data indicate that the majority of these victims could have survived by the use of the simple lap seat belt. The steering assembly -- the end of the steering column or steering wheel proper -- was the leading cause of the fatalities among drivers. The majority of these driver fatalities could not have been saved even with the seat belt-shoulder harness restraint. Other than death by ejection, the instrument panel was the leading cause of death of the front seat passengers, most of whom could have survived by using seat belts. Impacts to the door caused invasion of the passenger compartment, and most occupants would have died even if restraints had been used. To decrease the number of fatal injuries from automobile accidents, future designs of automobile interiors must include adequate crash attenuation features.

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.

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.

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.

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 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.

Mechanisms of thoraco-abdominal trauma were investigated utilizing unembalmed, repressurized human cadavers subjected to frontal impact with a steering wheel assembly. The focus of this research program was on trauma to the soft-tissue organs surrounded by the thoracic cage, as well as on the kinematic response of the thoracic cage. The results are compared to other thoraco-abdominal research programs conducted at the University of Michigan Transportation Research Institute (UMTRI) during the last eight years.

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.