Air bag use triggers new trend in injuries Survivors, who once might have died, suffer costly damage to lower extremities

October 06, 1994|By Ellen Gamerman | Ellen Gamerman,Sun Staff Writer

Lawrence Resch recently found a blood-smeared Playbill in one of his kitchen drawers. It had been sitting in his station wagon one night last October when an oncoming car veered into his lane. The front-end collision wrecked his car and crushed his legs. The memento from "George III" was splattered with blood.

"It's creepy when we find the things that survived," Mr. Resch says.

Mr. Resch, a 33-year-old Navy engineer from Columbia, counts himself among the items salvaged. Like many crash survivors, his good fortune rests mainly in the air bag that cushioned the blow when the two cars hit. But as Mr. Resch found, the life-saving device didn't leave him unscathed.

As the use of air bags grows, a new pattern of injuries is emerging. These medical problems are not caused by air bags. In fact, the devices save lives in nearly a quarter of all front-end collisions.

But while fewer motorists are dying of massive head and chest injuries, they are left with a different legacy: severe injuries sustained mainly by people who died of their injuries.

These problems, which primarily affect the lower body, can be costly, painful and debilitating. And they can last a lifetime.

In Mr. Resch's case, the accident sheared off part of his left ankle and splintered two bones in his right leg. He wonders whether he ever will be as active as he was before the crash. This may seem a minor concern, given how close he came to death, but it's an increasingly common complaint as the use of air bags grows.

"I have a feeling I'm never going to feel like my old self," said Mr. Resch, who now walks unassisted but can- not run or jump comfortably.

Trauma center doctors were among the first to spot the trend toward lower-extremity injuries. At the University of Maryland's Shock Trauma Center, Dr. Andrew R. Burgess is looking for ways correct a slew of secondary problems.

Dr. Burgess, head of orthopedic surgery at Shock Trauma, saw these severe injuries in the past but often wasn't able to analyze or treat them because the victims either were dead or dying from upper-body injuries.

"I never got to the point where I could take X-rays," Dr. Burgess said.

Now, he can actually talk to the patients who formerly would have been dead on arrival.

"These people, the dead ones, they looked like floppy rag dolls when they were being taken to the mortuary," he said. "Five years later, the same patient is looking around and saying, 'God, my legs hurt.' "

About five years ago, as air bags became more popular, Dr. Burgess began to notice crash victims with smashed lower bodies and relatively untouched torsos. At first, he thought the air bags might be defective. But soon he was convinced of just the opposite: the air bags were allowing people to live despite the violent blow of the crash.

In head-on collisions, the upper and lower body lunge forward with comparable force and speed. But when an air bag inflates, the top half of the crash victim bounces into a high-tech pillow while the bottom half slams into metal floor panels, --boards and pedals.

"We're seeing anything from a broken foot to half your leg being ripped off to a serious pelvic injury," said Ralph Hitchcock, director of the Office of Crashworthiness Research at the National Highway Traffic Safety Administration. "It's an expensive medical problem, it's traumatic, difficult to repair and can result in a lot of permanent disabilities."

Studying the patterns

The number of crash injuries per year is dropping as new safety features emerge. So medical experts now have the luxury of studying survivors' nonfatal injuries, from cracked hips to broken toes.

A team of University of Maryland researchers just completed a report on the changing injury trends associated with increased air bag use. The report analyzes the injuries of 10 crash victims admitted to Shock Trauma over the last two years, all of whom were driving air-bag-equipped cars. Researchers studied the speed, direction and impact points of the victims' bodies by reconstructing the accident through crash-site investigations and computer simulations.

In these accidents, the study shows, victims typically break tiny bones in areas critical to movement, such as hips, knees and ankles. The injuries can tease: While they don't sound serious, they can be longer-lasting and more painful than many major bone breaks.

In bones no bigger than pebbles, a fracture can mean lengthy precision surgery, multiple operations and long physical rehabilitation.

"It may be a minor bone," Dr. Burgess said, "but break it and you'll know it every step you take for the rest of your life."

Adding to the discomfort, these injuries aren't cheap. The University of Maryland study tallied in-hospital costs between $55,000 and $128,000 per patient. A recent statewide analysis found that lower-extremity problems account for 40 percent of all hospital costs relating to car crashes.

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