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PubMed1983

Penetrating neck wounds.

Over a 15 year period 120 patients with neck injuries that penetrated the platysma were studied. Appropriate treatment was initiated in the emergency room. Sixty-one patients underwent exploration and 59 were observed. Two of the observed patients later required delayed operation. In 9.2 percent of the patients, two or more injuries were present within the neck, whereas in 30 percent the neck injury was only one of many bodily injuries. Length of hospital stay for the operative group of patients was 9 days and for the nonoperative group 5 days. There was one death. The complication rates in the operative and nonoperative groups were 2.5 and 1.7 percent, respectively. The major structures injured were within the venous system. The neck injuries were classified according to three zones defined by Saletta and Jones and their co-workers [4,5]. The majority were Zone II injuries. Our morbidity and mortality rates are slightly lower than those reported in most series. This review supports the concept that therapy for penetrating injuries to the neck should be individualized.

Adolescent↗
PubMed1995

Carotid artery occlusion after dog bite.

The etiology of most penetrating neck injuries is caused by missiles or stabbings. Irrespective of the cause of injury, management strategies require that life-threatening injuries to underlying deep neck structures such as esophagus, trachea, or carotid artery be promptly identified. A case is reported in which occlusion of the common carotid artery resulted from a dog bite to the neck. The patient presented to the emergency department with four neck lacerations but lacked focal neurologic symptoms suggestive of such an underlying deep neck injury. The carotid injury was identified by preoperative angiography and was repaired with a reversed saphenous vein interposition graft. The patient had full recovery without neurologic sequela. While injuries to deep neck structures as a result of animal bites are rare, these patients should be evaluated according to accepted protocols to exclude or identify such life-threatening injuries.

Adult↗
PubMed2002

Cervical injuries in Sweden, a national survey of patient data from 1987 to 1999.

Neck injuries are one of the most important injuries as they have the potential to influence the spinal cord. Data from most parts of the world are not sufficient to define a comprehensive view of mortality, morbidity, disability and handicap due to neck injuries. In Sweden, there are no data on the incidence of neck injuries. The aim of this study is to define the national incidence and causes of neck injuries in Sweden. An incidence study was undertaken with data from the injury surveillance program at the Swedish National Board of Health and Welfare. The investigation includes cervical vertebral fractures reported between 1987 and 1999, and cervical soft tissue injuries over a period of three years, from 1997 to 1999. Data between 1987 and 1996 were reported in ICD 9, while data from 1997 to 1999 were reported in ICD 10. During the study period, 14,310 non-fatal and 782 fatal cervical injuries occurred. A decreasing incidence for cervical fractures can be seen for the Swedish population, except for the elderly that have a slight increase in incidence. The incidence for cervical soft tissue injuries is almost constant. Cervical fractures demand longer periods of hospitalization than the soft tissue injuries. Transportation-related cervical fractures have dropped since 1991, while soft tissue injuries increased slowly between 1997 and 1999. Fall accidents are now the largest external cause of cervical fractures, and the population above 65 years accounts for almost 50% of the fall accidents. The male population has a higher incidence of cervical fractures, disregarding age. It is concluded that safety programs for transportation-related injuries in Sweden have been successful, while fall accidents are still substantial. Much more can be done to prevent neck injuries; especially to reduce the number of transportation-related cervical soft tissue injuries and fall injuries in the elderly population.

Adolescent↗
PubMedDate not supplied

Injuries in Rugby Union football.

In a prospective study of 185 players attached to 10 British rugby clubs, 151 injuries were recorded among 98 of them (53%) during a single season. Forwards sustained significantly more injuries than backs. The standard of rugby, players' body weights, degree of fitness, and presence of joint hypermobility did not affect the risk of injury. The leg was the most common site of injury. Head and neck injuries were significantly more common when play was static and on wet pitches. Scrummaging accounted for no neck injuries. Almost half the injuries occurred during the last quarter of games. Foul play might have caused as many as 47 (31%) of all reported injuries. Complete eradication of deliberately dangerous play would considerably reduce the high incidence of injuries in this sport.

Adult↗
PubMed2005

Effects of initial seated position in low speed rear-end impacts: a comparison with the TNO rear impact dummy (TRID) model.

Injury-producing mechanisms associated with rear-end impact collision has remained a mystery not withstanding numerous investigations devoted to its scrutiny. Several criteria have been proposed to predict the injury-causing mechanism, but none have been universally accepted. The challenge lies in determining a set of testing procedures representative of real-world collisions, wherein the results obtained are not only the same as human testing, but remain consistent with various subjects and impact conditions. It is hypothesized that one of the most important considerations in the testing methodology is the effect of initial seated position (ISP) on occupant kinematics during a rear impact collision. This study involves two parts that evaluates the effects of ISP during rear-end impact. In the first part, head acceleration results of computer simulation using Hybrid III TNO rear impact dummy (TRID) are compared to physical impact testing (PIT) of humans. The second part focuses on the computer simulation using TRID to obtain different neck parameters such as NIC (Neck Injury Criterion), NIJ (Neck Injury Predictor), neck forces and moments to predict the level of neck injury such as whiplash associated disorder (WAD) during low speed rear-end impact. In PIT, a total of 17 rear-impact tests were conducted with a nominal 8-km/hour change in velocity to 5 subjects in four different seated positions comprising of a normal position (NP) and three out of positions (OOP). The first position was a NP, defined as torso against the seat back, looking straight ahead, hands on the steering wheel, and feet on the floor. The second position was a head flex position (HFP), defined as the normal position with head flexed forward approximately 20 degrees. The third position was a torso lean position (TLP), defined as the normal position with torso leaned forward approximately 10 degrees away from the seat back. Lastly, a torso lean head flex position (TLHFP), defined as the normal position with the head flexed forward approximately 20 degrees and torso leaned forward approximately 10 degrees. The head acceleration plots from PIT reveal that for the third and fourth positions (TLP and TLHFP) when the subject torso leaned forward, the peak head acceleration for the subject decreased and there was also a delay in reaching the peak. The Hybrid III-TRID anthropomorphic test dummy (ATD) was used in the same four different seated positions using computer simulation software MAthematical DYnamic MOdel (MADYMO 6.0) and the head acceleration results were compared to PIT. The comparison demonstrates that the Hybrid III-TRID ATD with MADYMO can be a reliable testing procedure during low-speed, rear-end impact for the four ISPs considered since the head acceleration plots deviated within the range of PIT head acceleration plots for different human subjects. This ensures that the second part of the study with neck injury using computer simulation results is a reliable testing procedure. It can be observed that MADYMO results have a greater error when compared to PIT when more than one OOP condition is employed as in TLHFP. All these observations would help in providing a tool to better understand the injury mechanisms and provide an accurate testing procedure for rear-end impact.

Acceleration↗
PubMed2005

Effectiveness of helmets in skiers and snowboarders: case-control and case crossover study.

OBJECTIVE: To determine the effect of helmets on the risk of head and neck injuries in skiers and snowboarders. DESIGN: Matched case-control and case crossover study. SETTING: 19 ski areas in Quebec, Canada, November 2001 to April 2002. PARTICIPANTS: 1082 skiers and snowboarders (cases) with head and neck injuries reported by the ski patrol and 3295 skiers and snowboarders (controls) with non-head or non-neck injuries matched to cases at each hill. MAIN OUTCOME MEASURES: Estimates of matched odds ratios for the effect of helmet use on the risk of any head or neck injury and for people requiring evacuation by ambulance. RESULTS: The adjusted odds ratio for helmet use in participants with any head injury was 0.71 (95% confidence interval 0.55 to 0.92), indicating a 29% reduction in the risk of head injury. For participants who required evacuation by ambulance for head injuries, the adjusted odds ratio for helmet use was 0.44 (0.24 to 0.81). Similar results occurred with the case crossover design (odds ratio 0.43, 0.09 to 1.83). The adjusted odds ratio for helmet use for participants with any neck injury was 0.62 (0.33 to 1.19) and for participants who required evacuation by ambulance for neck injuries it was 1.29 (0.41 to 4.04). CONCLUSIONS: Helmets protect skiers and snowboarders against head injuries. We cannot rule out the possibility of an increased risk of neck injury with helmet use, but the estimates on which this assumption is based are imprecise.

Adolescent↗
PubMed2005

Comprehensive head and neck trauma screening: the USS Cole experience.

A prospective study was designed to determine the incidence of occult head and neck injuries after initial triage of patients following the USS Cole terrorist bombing. All 39 patients evacuated to Landstuhl Regional Medical Center underwent comprehensive head and neck examinations, regardless of known diagnoses at the time of arrival. Appropriate interventions were performed, and detailed summaries were added to the patients' records. Initial triage listed nine of 39 patients as having sustained head and neck injuries. After screening by an otolaryngology team, 23 of 39 patients were identified as having head and neck injuries requiring further care. The majority of head and neck injuries were not initially reported to the head and neck trauma service. Our conclusion is that occult head and neck injuries are common after blast injuries. Early identification and intervention by a subspecialty head and neck trauma team can aid in achieving optimal outcomes after blast injury.

Craniocerebral Trauma↗
PubMed2004

Helmets for preventing injury in motorcycle riders.

BACKGROUND: Motorcycle crash victims form a high proportion of those killed or injured in road traffic accidents. Injuries to the head, following motorcycle crashes, are a common cause of severe morbidity and mortality. It seems intuitive that helmets should protect against head injuries but it has been argued that motorcycle helmet use decreases rider vision and increases neck injuries. This review will collate the current available evidence on helmets and their impact on mortality, and head, face and neck injuries following motorcycle crashes. OBJECTIVES: To quantify the effectiveness of wearing a motorcycle helmet in reducing mortality and head and neck injury following motorcycle crashes. SEARCH STRATEGY: Databases including the Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2003), MEDLINE (January 1966 to February 2003), EMBASE (January 1985 to February 2003), CINAHL (January 1982 to February 2003), IRRD (International Road Research Documentation), TRANSDOC, TRIS (Transport Research Information Service), ATRI (Australian Transport Index) (1976 to Feb 2003), Science Citation Index were searched for relevant articles. Web sites of traffic and road accident research bodies including government agencies were also searched. Reference lists from topic reviews, identified studies and bibliographies were examined for relevant articles. SELECTION CRITERIA: We considered for inclusion studies that investigated a population of motorcycle riders who had crashed, examining helmet use as an intervention and with outcomes that included one or more of the following: death, head, neck or facial injury. Studies included any that compared an intervention and control group and, therefore, included any randomised controlled trials, non-randomised controlled trials, cohort, case-control and cross-sectional studies. Ecological and case series studies were excluded. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened reference lists for eligible articles. Two reviewers independently assessed articles for inclusion criteria. Data were abstracted by two independent reviewers using a standard abstraction form. MAIN RESULTS: Fifty-three observational studies were identified of varying quality. Despite methodological differences there was a remarkable consistency in results, particularly for mortality and head injury outcomes. Motorcycle helmets appear to reduce the risk of mortality although, due to heterogeneity in study design, an overall estimate of effect was not calculated. There was some evidence that the effect of helmets on mortality is modified by speed. Motorcycle helmets were found to reduce the risk of head injury and from five well-conducted studies the risk reduction is estimated to be 72% (OR 0.28, 95%CI 0.23, 0.35). Insufficient evidence was found to estimate the effect of motorcycle helmets compared with no helmet on facial or neck injuries. However, studies of poorer quality suggest that helmets have no effect on the risk of neck injuries and are protective for facial injury. There was insufficient evidence to demonstrate whether differences in helmet type confer more or less advantage in injury reduction. REVIEWERS' CONCLUSIONS: Motorcycle helmets reduce the risk of mortality and head injury in motorcycle riders who crash, although the former effect may be modified by other crash factors such as speed. Further well-conducted research is required to determine the effects of helmets and different helmet types on mortality, head, neck and facial injuries. However, the findings suggest that global efforts to reduce road traffic injuries may be facilitated by increasing helmet use by motorcyclists.

Accidents, Traffic↗
PubMed1996

National health insurance consumption and chronic symptoms following mild neck sprain injuries in car collisions.

OBJECTIVE: To map the extent of sick leave and number of claims made for health insurance among persons who had suffered neck sprain (whiplash) injuries in traffic accidents, and to map subjective feeling of health and quality of life among patients several years after the injury. DESIGN: A retrospective study of neck sprain injuries after car accidents and a comparison to the patients' use of sick leave caused by neck pain prior to the accident. SETTING: The Emergency Clinic at The University Hospital in Trondheim, Norway. SUBJECTS: 426 patients with neck sprain injuries after car accidents during 1985-1990. MAIN OUTCOME MEASURES: Information from Trondheim Social Security office about sick leave, and results from 345 patients who answered a questionnaire with respect to quality of life measures. RESULTS: 27% had been reported sick during the period after the car accident, and 5% had claimed health insurance, 58% reported sustained symptoms linked to the accident. CONCLUSIONS: Many reported sustained symptoms after neck sprain injuries, 16% of them reported being in a bad state of health.

Accidents, Traffic↗
PubMed1989

Trends in maxillofacial injuries in war-time (1914-1986).

In view of evidence of increasing ophthalmic injury in modern warfare we examined available data for evidence of any changes in the incidence of head and neck injuries since 1914. Although data concerning maxillofacial injuries were available for only five of 26 conflicts, we could find no evidence of increasing incidence of head and neck injury. Overall mean incidence of head and neck injury was 16%; greater than expected in terms of random wounding and the proportion of whole body surface area (12%). Data from the Falklands Campaign and Northern Ireland indicate that 3-8% of all casualties sustained middle or lower third fractures of the facial skeleton. Specialists who have expertise in maxillofacial surgery therefore remain an indispensable part of casualty care in modern warfare. Terrorist activity appeared to give rise to more head and neck injury than either rural attack or minor or major conventional war.

Blast Injuries↗
PubMed2005

Biomechanical investigation of head impacts in football.

OBJECTIVES: This study sought to measure the head accelerations induced from upper extremity to head and head to head impact during the game of football and relate this to the risk of mild traumatic brain injury using the Head Impact Power (HIP) index. Furthermore, measurement of upper neck forces and torques will indicate the potential for serious neck injury. More stringent rules or punitive sanctions may be warranted for intentional impact by the upper extremity or head during game play. METHODS: Game video of 62 cases of head impact (38% caused by the upper extremity and 30% by the head of the opposing player) was provided by F-MARC. Video analysis revealed the typical impact configurations and representative impact speeds. Upper extremity impacts of elbow strike and lateral hand strike were re-enacted in the laboratory by five volunteer football players striking an instrumented Hybrid III pedestrian model crash test manikin. Head to head impacts were re-enacted using two instrumented test manikins. RESULTS: Elbow to head impacts (1.7-4.6 m/s) and lateral hand strikes (5.2-9.3 m/s) resulted in low risk of concussion (<5%) and severe neck injury (<5%). Head to head impacts (1.5-3.0 m/s) resulted in high concussion risk (up to 67%) but low risk of severe neck injury (<5%). CONCLUSION: The laboratory simulations suggest little risk of concussion based on head accelerations and maximum HIP. There is no biomechanical justification for harsher penalties in this regard. However, deliberate use of the head to impact another player's head poses a high risk of concussion, and justifies a harsher position by regulatory bodies. In either case the risk of serious neck injury is very low.

Acceleration↗
PubMed1981

Cervical injuries suffered in automobile crashes.

The National Crash Severity Study data in which occupants sustained severe, critical-to-life, or fatal cervical injuries were reviewed. Of passenger cars damaged severely enough to be towed from the scene, it is estimated that one in 300 occupants sustained a neck injury of a severe nature. The neck-injury rate rose to one in 14 occupants for those ejected from their cars, although many of these injuries resulted from contacts within the car before or during the process of ejection. Severe neck injuries were rather rare in cars struck in the rear, but were more common in frontal and side impacts. Occupants between 16 and 25 years of age had such injuries more than twice as often as those in any other age group. Most of the neck injuries of a more severe nature involved the cervical spine or spinal cord. Injuries of the anterior aspect of the neck were relatively infrequent, and usually resulted from direct blunt impacts. National projections of the number of fatalities related to cervical injuries indicates that 5940 deaths, or approximately 20% of all in-car deaths, include fatal cervical spine injuries, and that about 500 cases of quadriplegia per year result from automobile accidents.

Accidents, Traffic↗
PubMed2004

The influence of seatback characteristics on cervical injury risk in severe rear impacts.

The determination of the optimum seatback characteristics for the mitigation of serious and catastrophic neck injury during high-speed rear-end collisions remains a topic of continued investigation. Despite a number of prior research efforts, both field data and sled test studies have yet to define a single optimal seatback performance criterion. Further, recent developments in seatbacks have introduced new designs into the field that have not been compared to more traditional designs. Analysis of NASS data from 1980 to 1999 demonstrated that at changes in velocity (DeltaV) above 40 kph, rear-end collisions have a dramatically lower risk for catastrophic injury than frontal, near-side or far-side impacts. Unfortunately, owing to the small penetration of newer seatback designs in the automotive fleet, it is not possible to examine the influence of seatback design parameters on serious neck injury using these data alone. Accordingly, seven rear impact HYGE sled tests were conducted using a wide range of seat designs. Upper and lower neck load cells were used to measure neck forces and moments in restrained 50th male Hybrid III anthropomorphic test devices (ATD). Additionally, the neck injury criteria (Nij) was computed. Unlike prior studies that have examined the standard seated ATD or the dramatically out-of-position ATD, these tests were conducted using an ATD seated in non-standard but typical driving position. The results of this study indicate that several descriptions of seatback behavior, such as quasi-static ultimate force are poor predictors of ATD neck loading. It also suggests that, for the severe crash studied, an optimum range of seatback stiffness exists, which appears to be in the mid-range of seatback stiffnesses available in current production vehicles. These data continue to illustrate the complex relationship of seatback design parameters to neck injury risk.

Accidents, Traffic↗
PubMed1997

The effects of padded surfaces on the risk for cervical spine injury.

STUDY DESIGN: This is an in vitro study comparing cervical spine injuries produced in rigid head impacts and in padded head impacts. OBJECTIVES: To test the hypothesis that deformable impact surfaces pose a greater risk for cervical spine injury than rigid surfaces using a cadaver-based model that includes the effects of the head and torso masses. SUMMARY OF BACKGROUND DATA: It is widely assumed that energy-absorbing devices that protect the head from injury also reduce the risk for neck injury. However, this has not been demonstrated in any experimental or epidemiologic study. On the contrary, some studies have shown that padded surfaces have no effect on neck injury risk, and others have suggested that they can increase risk. METHODS: Experiments were performed on 18 cadaveric cervical spines to test 6 combinations of impact angle and impact surface padding. The impact surface was oriented at -15 degrees (posterior impact), 0 degree (vertex impact), or +15 degrees (anterior impact). The impact surface was either a 3-mm sheet of lubricated Teflon or 5 cm of polyurethane foam. RESULTS: Impacts onto padded surfaces produced significantly larger neck impulses (P = 0.00023) and a significantly greater frequency of cervical spine injuries than rigid impacts (P = 0.0375). The impact angle was also correlated with injury risk (P < 0.00001). CONCLUSIONS: These experiments suggest that highly deformable, padded contact surfaces should be used carefully in environments where there is the risk for cervical spine injury. The results also suggest that the orientation of the head, neck, and torso relative to the impact surface is of equal if not greater importance in neck injury risk.

Adult↗
PubMed2006

Management of cervical stab wounds in low volume trauma centres: systematic physical examination and low threshold for adjunctive studies, or surgical exploration.

INTRODUCTION: In Nordic countries penetrating neck injuries (PNIs) are infrequent and management has traditionally been guided by surgeons' preferences. Some form of selective non-operative approach is currently practised in most urban trauma centres. OBJECTIVE: To examine demographic features and treatment outcome of non-ballistic penetrating neck injuries in southern Finland and provide management guidelines for centres with low volume of penetrating neck trauma. MATERIALS AND METHODS: Retrospective analysis of 85 platysma penetrating neck injuries in two southern Finland hospitals (Helsinki University Central Hospital, HUCH and Tampere University Hospital, TaUH) was carried out using the ICD-10 based hospital databases to identify PNI-patients. RESULTS: The incidence of admitted patients with penetrating neck injuries was 1.3/100000/year. Fifty-two (61%) injuries were caused by random acts of violence, 28 (38%) were self-inflicted and 5 (6%) were accidents. Of all 85 patients, 52 (61%) underwent operative exploration with a negative exploration rate of 65%. Hard signs for vascular or aerodigestive trauma were present in 23 (27%) patients and all of these were operated with a negative exploration rate of 30%. Two patients had no hard signs on physical examination but were operatively explored and significant injuries were found in both patients. The hospital mortality rate was 0% and the overall complication rate for operated patients was 7.7%. CONCLUSIONS: Trauma centres managing PNIs infrequently should have an individually tailored management protocol for penetrating neck injury patients. If mandatory exploration is not practised, a systematic physical examination should be the mainstay of diagnostic work up but the threshold for adjunctive studies should be low. Although not evident by the current data, protocol-based management could be useful in decreasing treatment variation and enhancing residency training.

Adult↗