Examination in hospital showed bruising with the imprint of the harness buckle under his chin, torticollis, and painful limitation of movement. No abnormal neurological signs were present in the limbs but he had slight difficulty with micturition for several weeks after an initial period of urinary retention lasting 24 hours.Radiographs of the cervical spine showed a fracture at the junction of both pedicles and lateral masses of C2 (Hangman's fracture). He wore a cervical collar for seven months while undertaking normal activities and this resulted in satisfactory healing with no neurological deficit.Case 2 A 16 month old boy was sitting in a British Standard 3254 approved car safety seat which had a nonfunctioning crutch strap. As a result of a collision he slid down over the faulty leg strap and under the waist straps, (figs la and b). His head toppled forward. On examination he had bruising around his neck and chest, with torticollis and limitation of spontaneous movement. There were no abnormal neurological findings.Initial radiographs were thought to show no fracture, but on subsequent review a fracture through the odontoid peg with displacement on flexion and some compression of the anterior body of C2 were evident. Treatment with a plaster of Paris Minerva jacket for one month and a brace for a further two months produced satisfactory healing and return of full neck movements.
DiscussionChildren who are not wearing restraints are more likely to be seriously injured in car accidents.2 Restraint by harnesses and car safety seats undoubtedly prevent both deaths and injuries,3 but such devices are often used incorrectly.4All manufacturers' fitting instructions emphasise the importance of replacing car seat restraints following violent stresses such as road traffic accidents, or if components become worn. Many instructions draw attention to the need for careful individual adjustment of the harness, and some recommend periodic inspection of all anchorage points and harness adjustment devices.These two cases show that despite this advice parents still fail to adjust the harness adequately and continue to use restraints which are malfunctioning and dangerous. We therefore recommend that all manufacturers explicitly advise periodic inspection by parents of all anchorage points and the harness and locking systems. This may show early abrasion and signs of undue wear which are indications for replacement of the restraint. Parents should also be advised that adjustments to the harness are necessary periodically not only to account for normal growth but also seasonally to account for the changes from light to thick clothing and vice versa.A design modification to ensure that it is impossible to assemble the locking mechanism without incorporating the crutch strap would be useful and would prevent parents continuing to use unsafe car seats as in case two. In addition, use of the currently copyright.
