Fatality risk versus sex and age was determined for ten categories of vehicle occupants (unbelted car drivers, helmeted motorcycle passengers, etc.). This paper describes such a study, made possible by two recent developments: first, the availability of a large data file, the Fatal Accident Reporting System, which gives information on more than one third of a million people fatally injured in traffic crashes second, a new technique, the double-pair comparison method, which, by focusing on vehicles containing two occupants, at least one of whom is killed, allows appropriate inferences to be made from such data. No large-scale epidemiologic study to investigate how sex and age affect fatal trauma risk from the same impact has been possible previously because large numbers of people are rarely subject to sufficiently similar major physical insults. We conclude that the previously reported association between aortic rupture and pelvic fracture can be further specified to include, predominantly, those patients with an anterior-posterior compression fracture pattern. There was no increased incidence of aortic rupture among patients with any other pelvic fracture pattern. When pelvic fractures were classified according to vector of force, 10 of 12 (83%) aortic ruptures occurred in patients with an anterior-posterior compression fracture pattern, an incidence of aortic rupture eight times greater than that of the overall blunt trauma population. Of 4,157 consecutive blunt trauma patients, 371 (8.9%) had pelvic fractures, 34 (0.8%) had ruptured thoracic aortas and 12 had both injuries. A retrospective review was performed to determine whether the relationship between aortic rupture and pelvic fracture could be further delineated using a pelvic fracture classification based on mechanism of injury. A fracture of the first rib is a hallmark of severe trauma its presence should alert the clinician to: 1) generalized massive trauma with abdominal, chest, and cardiac injuries 2) local injury to the subclavian artery and brachial plexus and 3) necessity of long-term followup for late-developing sequelae.īlunt trauma patients with pelvic fractures have been shown to have a two-fold to five-fold increased risk of aortic rupture compared with the overall blunt trauma population. One late-developing post-traumatic thoracic outlet syndrome occurred. Three patients had an associated injury of the subclavian artery, and the importance of this association is stressed. Brachial plexus injury (5) and Horner's syndrome (3) occurred in survivors. Neurologic lesions accounted for the majority of deaths, however, unrecognized abdominal injuries and pulmonary complications were significant causes of mortality.
The mortality associated with this injury was high (36.3%).
This injury is a harbinger of major trauma with 35 patients suffering a major chest injury, and abdominal and cardiac injuries occurring in 18 and eight patients respectively. First rib fractures occurred in 55 patients.
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