Foot fractures in restrained front seat car occupants: A long-term study over twenty-three years

Objectives: To analyze the mechanism of injury for foot and ankle fractures resulting from automobile accidents to create a basis for developing an im proved design for protection. Design: Retrospective. Setting: Level I trauma center with occident research unit. Patients: Automobile accident reports and medical records of individuals in jured in the accidents. Main Outcome Measurements: Technical indicators (collision type, impulse an gle, deltav, and extent of vehicle deformation) and clinical data (injury l ocation and severity [abbreviated injury scale and injury severity score] a nd long-term outcome). Results: From 1973 to 1996, 15,559 car accidents were analyzed. Two hundred sixty-one front seat occupants sustained fractures of the foot and ankle ( ankle, 41 percent; forefoot, 29 percent; midfoot, 20 percent; and hindfoot, 10 percent). Seventy-five percent of the fractures were classified abbrevi ated injury scale(foot) 2. The incidence, location, and abbreviated injury scale(foot) category of fractures were similar between driver (n = 210) and front seat passenger(n = 51). Fifty percent of the fractures occurred in h ead-on collisions and 34 percent occurred in accidents with multiple collis ions. The deltav ranged in 82 percent of car crashes between fifteen and si xty kilometers per hour. The;deltav and extent of foot compartment deformat ion correlated with the abbreviated injury scale. During our investigation, deltav increased; the injury severity score decreased; and the extent of d eformation did not differ significantly. Conclusions:Although overall car passenger safety has improved, the relativ e incidence of foot and ankle Fractures has increased. Comparing drivers an d front seat passengers, the foot pedals, steering wheel, or the asymmetric design of the dashboard did not influence injury incidence, mechanism, or severity. Foot fractures are mainly caused by the root compart ment deforma tion in head-on collisions, and therefore improvements in foot compartments are essential for fracture prevention.