Chance Fractures in Missouri Kids: Boost ’til 4’9"!

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Your child might be eager to graduate out of booster seats (and you might want them out of your car too), but check to ensure that you’re not ditching the booster too early.
According to the NHTSA, your child should be in a safety seat until they are at least 8 years old, unless they are 4’9” tall. Parents were reluctant at first, given that most of us were out of car seats before we can even remember. Eventually, the “boost ‘til 8” campaign was borne, and 8 became the standard age to graduate children to adult seatbelts. In most states, it’s the law.
Now, child safety advocates are starting to look into whether this age-based campaign might be misleading.

Booster Seats During Car Accidents

Using a booster seat until age 8 is a relatively new safety standard. It has taken a lot of convincing to get parents to come around to the idea that kids above 5 should be in any kind of safety seat. The fact is, adult-sized seatbelts are not as effective when they’re worn by a person under 4’9”.
When a child who is shorter than 57” in height (4’9”) uses a standard seatbelt, two things can happen:

  • The shoulder belt sits across their neck or face; or
  • The child will put the shoulder belt behind their back, or under their arm for comfort

seat belt injury
This is not okay!! If the child puts the shoulder belt behind their back, she would only be restrained by a lap belt. While it is true that a lap belt could prevent her from being thrown through the windshield in the event of an accident, her upper body would still be forced forward—potentially causing a flexion injury to the spine.
This injury is known as a Chance fracture, and can lead to serious intraabdominal complications, contusions, and lacerations to the pancreas. To gain a better understanding of this serious seat belt injury, read about it on our personal injury blog.
To prevent Chance fractures and other seatbelt injuries, ensure that your child (and anyone in your car) has a height-appropriate shoulder strap across their chest.

Lap Belt Injury

A generation ago, Chance fractures were not all that uncommon among children. Today, shoulder and chest restraints have significantly reduced their incidence. In this case, the child had managed to squirm out of his shoulder restraints but still had the lap belt securely fastened when impact occurred.
The most common sites at which Chance fractures occur are the thoracolumbar junction (T12-L2) as well as mid-lumbar region. There is a high degree of concurrence between Chance fractures and intra-abdominal injuries (LeGay et al., 1990; Ceroni et al., 2004), with 50-60% sustaining such injuries as contusions or lacerations of the stomach, pancreas and/or small intestine.

Treatment for Chance Fractures

Fractures can typically be treated through stabilization of the lumbar region via casting or bracing for 2-3 months, accompanied by a program of physical therapy consisting of extension exercises for six months. If there is extensive ligamentous and soft tissue injury, surgery may be necessary as conservative management is unlikely to be successful.
Treatment for co-morbid abdominal or small intestine injuries range from conservative (resting the stomach and small intestine from solid food and administration of antibiotics) to surgical intervention (revascularization of the injured area). Either way, these injuries must be monitored constantly as a perforation of the bowel can lead to catastrophic infection and shock, and inadequate blood flow can progress quickly to multi-organ failure and death.
chance fracture injury

Long-Term Prognosis for Chance Fractures

Chance fractures—even without co-morbid abdominal/pancreatic/intestinal injury—are quite serious, and it is not unusual for the victim to suffer back pain for a year or longer following the injury. Prognosis for recovery depends on the severity of injury. In a 2007 article published in the journal, Spine, Mulpuri et al. identified a number of prognostic factors correlated with Chance fracture outcome. These include—but are not limited to:

  • Concomitant intra-abdominal injuries.
  • Facet joint involvement.
  • Degree of initial kyphosis (abnormal curvature) of the spine.
  • Extent of ligamentous involvement and injury.

Then Why Can Eight-Year-Olds Ride without a Booster?

The medical terminology might be complicated, but the bottom line is pretty easy to comprehend—seatbelts don’t fit children until the child is 4’9” tall. When your kid is 8, you can move them into adult seatbelts. If your kid reaches 4’9” before age 8, you can move them into adult seat belts. Sound reasonable? Great.
Now, let me ask you, when was the last time you saw a 4’9” seven-year-old? When was the last time you saw a 4’9” eight year old, for that matter? There are a few out there, but even the tallest girls – the girls in the 95th percentile of the CDC growth charts – won’t hit 57” until they’re nine years old.
The NHTSA admits on its website (in fine print at the bottom of the page) that proper seat-belt fit does not depend upon age, but upon height. If we’re supposed to be waiting for our kids to reach 4’9” before we let them use a standard seatbelt, that would be an average of age 10 for girls and 11 for boys.
This “boost ‘til 8” campaign has worked wonders for putting 6 and 7 year olds in booster seats, but it might be time to advertise height requirements instead of age. By putting age 8 at the front of the campaign, we’re creating an age window in which children are especially vulnerable to car accident injuries and deaths.
Riding in a car is ALREADY the most dangerous activity that your child does. Make sure they’re protected, and boost ‘til four foot nine.
Facet involvement tends to interfere with long-term prognosis. Associated abdominal injuries also indicate significant concerns for degenerative spinal changes and long-term recovery. If your child has suffered a chance fracture after being involved in a car crash, contact a Schultz & Myers Personal Injury Lawyers auto accident attorney today at 314.444.4444

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