The purpose of this study was to obtain more specific information on upper limb injuries sustained by front seat occupants in car accidents with a view to identifying injuries that are a priority for prevention and further research.

After identification of cases from the Vehicle Safety Research Centre (VSRC) through the Transport Research Laboratory (TRL) the appropriate hospital records and radiographs were reviewed. Data were analysed to identify the frequency and severity of upper limb injuries, the mechanism of injury and the impairment sustained in accordance with the American Medical Association guides [1]. The NHS financial costs of management for the upper limb injury and that for the patient in total were calculated.

Sixty two cases were reviewed (34 male), aged 18- 83 years (mean 44 years). There were 20 clavicle fractures, 18 elbow and forearm fractures, 16 shoulder and arm injuries, and 26 wrist and hand injuries.

The median upper limb Abbreviated Injury Score was 2 and the overall Injury Severity Score ranged from 4 to 50 (median 6). In terms of impairment, the upper extremity sensory deficit ranged from 0 to 9% and motor deficit 0 to 22.5% giving up to 5% sensory and 13.5% motor “whole person impairment”.

The mean estimated treatment cost for upper limb management was calculated at £2,200 compared with a total injury treatment cost of a mean £11,000 per person.

Limitations of the study include its retrospective nature and possible selection bias.

The study has identified the range and costs (impairment and financial) of upper limb injuries in road traffic accidents. These data will be used by researchers to both improve the current car crash dummies in the upper limb and to allow accurate finite element remodelling. Legislative changes to car requirements for upper limb safety may be brought forward in the longer term.