Air bag-induced orbital blow-out fractures

RATIONALE: Although air bags have decreased the risk of serious injury from motor vehicle crashes, their deployment is not innocuous and can result in injury. The force of the deploying air bag can cause orbital blow-out fractures. We investigated the circumstances that predispose a crash occupant to this particular injury. STUDY DESIGN: The authors conducted a case series. METHODS: A total of 150 orbital fractures occurred among 2,739 occupants in crashes included in the Crash Injury Research and Engineering Network (CIREN) database from January 1997 to July 2005. Ten orbital blow-out fractures attributed solely to air bag deployment were extracted and four reported in depth. Occupant, vehicle, and crash characteristics were reviewed for predisposing similarities and to investigate the mechanism of injury. RESULTS: All crashes had air bag deployment and a frontal or near-frontal principle direction of force. Nine of 10 injured occupants were positioned within the air bag's deployment zone at the time of impact as a result of a forward seat track position, falling asleep at the wheel, being unrestrained, or having decelerated before impact. Six of 10 occupants experiencing orbital blow-out fractures were of shorter than average height. Based on rigorous crash reconstructions, the orbital blow-out injuries were felt to be causally related to air bag deployment. CONCLUSION: Air bag deployment may result in orbital blow-out fractures. Occupants positioned in close proximity to the air bag during its deployment phase appear to be at increased risk for orbital blow-out fractures.