Rupture of the diaphragm in patients wearing seatbelts

Six diaphragmatic ruptures seen in a consecutive series of 435 cases of blunt abdominal trauma (1946-1976) are analyzed. All of the ruptures were sustained in car accidents, three of them with fatal outcome after severe trauma with multiple injuries. Four of the patients wore safety belts: in three of them a rather specific injury combination occurred--diaphragmatic rupture, multiple costal fractures, and pelvic or vertebral fracture. The role of the seatbelt in the pathogenetic mechanism of the rupture is discussed, and the possibility that the cause is the placement too high on the trunk, especially in short individuals, is raised.