A 10yo girl is sitting lapbelted in the rear of an SUV that is involved in a rear-end collision at 40mph. She complains of abdominal pain, and has an ecchymosis from the lapbelt going across her lower abdomen. Of the following, which is the LEAST likely injury the patient may have:
A. Small bowel injury
B. Kidney injury
C. Horizontal vertebral body fracture in lower spine
D. Spinal cord injury
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May 27, 2017 at 3:49 am
B. Kidney injury
The patient has a positive seatbelt sign, or ecchymosis on the lower abdomen from a lap belt. An MVA with a sudden stop results in a hyperflexion injury mechanism, and the lap belt can cause injury particularly when it is worn too high and exerts pressure on the abdominal contents. Common injuries from this mechanism are hollow viscus (small bowel in particular) injury, Chance fracture (horizontal vertebral body fracture) of the spine, and sometimes associated spinal cord injury. The kidneys are retroperitoneal and less likely to be injured by a hyperflexion mechanism.