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PubMedDate not supplied

[Myocutaneous pectoral flap for reconstruction of head and neck traumatic injuries: case report].

Our objective was to demonstrate performance of myocutaneous flap as feasible by general surgeons. The setting was a secondary-level health care trauma center. A male of 26 years of age suffered injuries on the left side of his neck and left shoulder due to a gunshot. Deltoid, trapezius, clavicle, transverse cervical artery, and supraclavicular space were damaged with exposure of pleura; resultant damaged area measured 12 cm. Debridement was performed in steps until healed tissue appeared. A 18-cm defect resulted, and a pectoral flap was used for reconstruction with satisfactory evolution. Performance of pediculed myocutaneous pectoral flap by general surgeons with basic draining in reconstructive procedures is feasible.

Adult↗
PubMedDate not supplied

MRI of cerebrum and cervical columna within two days after whiplash neck sprain injury.

The present study was undertaken to evaluate if MRI within 2 days of a motor vehicle accident could reveal pathology of importance for understanding long-term disability after whiplash neck-sprain injuries. As part of a prospective study cervical and cerebral MRI was performed on 40 neck sprain patients with whiplash injury after car accidents. The imaging was done within 2 days of the injury to make sure that any neck muscle bleeding, oedema or other soft tissue injuries could be detected. The MRI findings from the patients were both correlated to reported symptoms 6 months after the accident and compared to a control group of 20 volunteers. The MRI of both brain and neck revealed no significant differences between the patients and the control group. When the patients were grouped according to the main MRI findings at intake and compared according to the development of subjective symptoms reported by the patients, the only significant difference was more headaches at 6 months in the groups with disk pathology or spondylosis when compared to the group with no pathology. In conclusion, MRI within 2 days of the whiplash neck-sprain injury could not detect pathology connected to the injury nor predict symptom development and outcome.

Accidents, Traffic↗
PubMed2003

Outcome of posttraumatic fibromyalgia: a 3-year follow-up of 78 cases of cervical spine injuries.

OBJECTIVE: To assess the outcome of fibromyalgia syndrome (FMS) after cervical spine injury. METHODS: Seventy-eight of 102 (77%) patients with neck injury were recruited 3 years after the original study in 1996. Twenty of the original 22 patients with FMS were available for reevaluation in 1999. A count of 18 tender points was conducted by thumb palpation, and tenderness thresholds were assessed by dolorimetry at 9 tender sites. All patients were interviewed about the presence and severity of neck and FMS-related symptoms. FMS was diagnosed by using the American College of Rheumatology 1990 criteria. Additional questions assessed measures of physical functioning and quality of life. RESULTS: Sixty percent of the 20 patients who had FMS in 1996 still had it 3 years later. All the 11 women with FMS, but only 1 of the 9 men with FMS, met FMS criteria in 1999. Only 1 of 58 patients who had no FMS in 1996 developed FMS. The quality of life scores for most patients improved, their tenderness scores decreased, and all remained employed. CONCLUSIONS: The outcome of posttraumatic FMS in patients with neck injury seems to be more favorable in men than in women; however, this finding should be interpreted with caution because of the small sample. Patients who do not develop FMS within 1 year of neck injury have a low probability of developing FMS in the future, comparable to the incidence of FMS in the general population.

Adult↗
PubMed1976

Aneurysms of extracranial carotid arteries.

Twenty-three extracranial carotid artery aneurysms were encountered in 19 patients. Arteriosclerosis was evident in 16 aneurysms. Severe arterial hypertension affected all patients with arteriosclerotic lesions. Trauma, penetrating neck injury once, and blunt neck injury three times caused four aneurysms. Three aneurysms resulted from earlier carotid artery operations. All 19 patients were symptomatic. Neurologic symptoms affected 13 individuals. Local symptoms referable to the aneurysmal mass troubled 15 patients. Twenty-one aneurysms were treated operatively. There was no operative mortality. Aneurysmectomy with arterial reconstruction was performed 16 times. Aneurysmorrhaphy was undertaken on four occasions and carotid ligation once. Two strokes and multiple cranial nerve injury accounted for three operative complications. No neurologic complications occurred during follow-up totaling 360 man-months. These lesions may be successfully treated by a carefully performed, properly selected operation.

Adolescent↗
PubMed2005

Adult cavovarus foot.

Cavovarus foot deformity, which often results from an imbalance of muscle forces, is commonly caused by hereditary motor sensory neuropathies. Other causes are cerebral palsy, cerebral injury (stroke), anterior horn cell disease (spinal root injury), talar neck injury, and residual clubfoot. In cavovarus foot deformity, the relatively strong peroneus longus and tibialis posterior muscles cause a hindfoot varus and forefoot valgus (pronated) position. Hindfoot varus causes overload of the lateral border of the foot, resulting in ankle instability, peroneal tendinitis, and stress fracture. Degenerative arthritic changes can develop in overloaded joints. Gait examination allows appropriate planning of tendon transfers to correct stance and swing-phase deficits. Inspection of the forefoot and hindfoot positions determines the need for soft-tissue release and osteotomy. The Coleman block test is invaluable for assessing the cause of hindfoot varus. Prolonged use of orthoses or supportive footwear can result in muscle imbalance, causing increasing deformity and irreversible damage to tendons and joints. Rebalancing tendons is an early priority to prevent unsalvageable deterioration of the foot. Muscle imbalance can be corrected by tendon transfer, corrective osteotomy, and fusion. Fixed bony deformity can be addressed by fusion and osteotomy.

Adult↗
PubMed1991

Skateboarding injuries in children. A second wave.

Motivated by a number of skateboard-related injuries seen in an emergency department, we undertook an investigation of skateboarding injuries in the mid-1980s. We studied US Consumer Product Safety Commission injury frequency estimates, which indicated a resurgence of these injuries: 19,182 in 1984 and 37,180 in 1985. Children 10 to 14 years old were injured with greatest frequency. Nontrivial injuries were more common among children younger than 5 years old, reflecting a larger proportion of head and neck injuries. Boys sustained more frequent and more severe skateboard-related injuries. Observed injury patterns (head and neck injuries in younger children, extremity injuries in older children, and more severe head and neck injuries in older children) probably reflect the role of psychomotor development on both risk exposure and biomechanics. Likely prevention strategies include warnings against skateboard use by children younger than 5 years, prohibition of skateboards on streets and highways, and the promotion of use of helmets and other protective gear.

Adolescent↗
PubMed1997

[Penetrating head and neck gunshot injuries. A 10-year neurological material].

37 patients with penetrating injuries of the head or upper neck caused by gunshot wounds were admitted to the neurosurgical department during the ten-year period 1986 to 1995. There was a marked preponderance of males. 29 of the cases were attempted or successful suicides, four were homicides, and four were presumed to be accidents. The most common weapons used were pistol and rifle. Nine patients were under the influence of alcohol or drugs. There were eight survivors, seven of whom were operated on. Four of the patients suffered reduced vision, two of whom became blind. Two had hemiparesis, one had moderate mental dysfunction, and one recovered completely. None of the patients who were unconscious upon admission to hospital and had bilateral brain injury survived.

Adolescent↗
PubMed2003

Chronic neck pain of traumatic and non-traumatic origin: a population-based study.

Chronic neck pain is a common cause of disability. The effect of neck trauma on the development of chronic neck pain has been debated. In this population-based study, 8,356 persons (25-79 years) were randomly selected from a geographically well-defined area in northern Sweden. 6000 answered a self-administered questionnaire. We evaluated the data from all participants in the age range 25-64 years, a total of 4,392 persons. 18% reported chronic neck pain, defined as continuous pain of more than 6 months duration. 5% had a history of neck trauma and 13% had no such history. Of all patients with chronic neck pain, 30% had a history of neck injury. We divided all subjects with a chronic neck pain into two groups: those with or without a history of neck trauma. When studying the effect of sociodemographic data, self-perceived health and working conditions, multiple regression analysis showed that the trauma group consisted of significantly more younger men, who were more frequently on sick-leave and that their perceived health was worse than those without a neck injury. We found no significant differences concerning BMI, marital status, educational level, smoking habits, psychosocial work situation on the Karasek questionnaire or physical activity during leisure time or at work.

Adult↗
PubMed1997

Personality profile among symptomatic and recovered patients with neck sprain injury, measured by MCMI-I acutely and 6 months after car accidents.

The relationships between personality and psychiatric symptoms and long-lasting physical symptoms were assessed in 88 neck sprain patients injured in car accidents. The Millon Clinical Multiaxial Inventory (MCMI-I) was completed at time of occurrence (intake) and 6 months after the injury. The neck sprain patients were divided into three subgroups according to symptoms 6 months after the accident. In addition, the total neck sprain group was compared with three other subject groups. The results indicated that the three neck sprain subgroups did not differ on the MCMI-I neither at intake nor 6 months later. The total neck sprain patients group was significantly different from patients with major depression on all scales of the MCMI-I, but not significantly different compared to patients with localized musculoskeletal pain. Compared to a group of health personnel, there were only a few significant differences. The study does not support the view that premorbid personality traits can predict outcome for neck sprain patients.

Accidents, Traffic↗
PubMed2005

Neck structure injuries in Hanging--comparing retrospective and prospective studies.

Deaths due to hanging are common among suicides. Various studies in the forensic literature have reported considerable differences in the frequency of hyoid bone or thyroid cartilage fractures and injuries to the musculature and the vasculature of the neck. Some important reasons to which these variations could be attributed include: lack of a common method for examination of neck structures, varying degrees of thoroughness in examining the neck structures and lack of seriousness in the documentation of the findings (as cases of hanging are almost always suicidal) thus affecting the results of retrospective studies. The present study was conducted retrospectively (1994 to 1999) and prospectively (2000 to 2003) on 108 cases of hanging. Seventy-one per cent of the cases were male and 29% female, aged between 15 to 60 years. Hanging was typical in 20% of cases and atypical in 80%; it was complete hanging in 46% of cases and incomplete in 54% of cases. Neck structure fractures were found to be more common in atypical complete hangings; the incidence was found to be 10% in the retrospective group and 27% in the prospective group. Contusions and lacerations of musculature were found in 20% of cases in the retrospective group and 34% in the prospective group, thus stressing the need for thorough postmortem examinations and meticulous documentation of the findings.

Adolescent↗
PubMed1999

Injuries of motorcyclists and bicyclists examined at autopsy.

Few studies of autopsy findings of persons dying of head and neck injuries in cyclists have been published. We performed a retrospective analysis of injury severity and the relation between head and neck injuries and helmet use. Seventy-six bicyclists and motorcyclists were collected from among the forensic autopsy at the Jikei University School of Medicine. From autopsy findings and accident reports, the abbreviated injury scale (AIS) and the injury severity score (ISS) were calculated and analyzed epidemiologically. As a result, helmet use significantly decreased the severity of head and neck injuries but had no effect on overall injury severity or the severity of injuries to other body regions. Furthermore, helmets had little effect on injuries remote from the point of impact, injuries resulting from angular acceleration, or injuries at the junction of the head and neck. These findings may be useful for both forensic pathologists and clinicians evaluating injuries in bicyclists and motorcyclists.

Accidents, Traffic↗
PubMed2006

Cervical resistance training: effects on isometric and dynamic strength.

INTRODUCTION: Neck injuries signify a physical fitness and human system problem with high operational significance. The prevalence of injuries in tactical aviators has been reported to be as high as 84%, although few report engaging in neck-specific strengthening exercises. It is generally believed that neck strengthening may result in fewer neck injuries. This study was designed to investigate the effects of 12 wk of cervical strength training (3 d x wk(-1)) on isometric strength, dynamic strength, and hypertrophy in a sample of military men. METHODS: Participants were tested for each of the above-mentioned variables before and after the training program as well as at 4-wk intervals, and results were compared with a control group that performed no cervical resistance training. RESULTS: Results indicated significant improvements in isometric strength and dynamic strength, typically occurring as early as 4 wk and improving throughout the 12-wk period. Modest increases in neck circumference were also noted. DISCUSSION: These findings have implications for military personnel at risk of neck injury in their occupational activities.

Adult↗
PubMed2005

Epidemiology and outcome of bicycle injuries presenting to an emergency department in the United Kingdom.

OBJECTIVES: To describe the epidemiology, injuries sustained and outcomes of patients presenting to an emergency department after a bicycle accident in Cambridge, England. METHODS: A prospective study was conducted of all individuals treated as a result of a cycling accident between 1 April 2003 and 31 July 2003. Information was collected from injured cyclists or relatives by a standardized questionnaire. This included patient demographics, details relating to the accident, and injuries sustained. RESULTS: A total of 293 injured cyclists presented during the study period. The most commonly injured were men (65.5%) in isolated bicycle accidents on roads without cycle paths during daylight hours. Only 20.8% of patients wore helmets. The majority of those injured at night (62.5%) had consumed alcohol (P<0.05). Upper limb injuries were most frequently sustained (64%), with an even distribution of lower limb (24%), head (23%) and facial (22%) injuries. Truncal and neck injuries were uncommon. CONCLUSIONS: Although it is recognized that the use of bicycle helmets contributes to a decrease in mortality from head injuries, this should not be the only focus for decreasing the morbidity associated with cycling accidents. Campaigns for safer cycling practice, more dedicated cycle routes and to discourage cyclists from drinking and cycling are essential to decrease the numbers of these injuries.

Accidents, Traffic↗
PubMed2001

Risk factors for neck pain: a longitudinal study in the general population.

The objective of the study was to examine the 1-year cumulative incidence of episodic neck pain and to explore its associations with individual risk factors, including a history of previous neck injury. A baseline cross-sectional survey of an adult general population sample made up of all 7669 adults aged 18-75 years, registered with two family practices in South Manchester, United Kingdom, identified the study population of adults with no current neck pain. This study population was surveyed again 12 months later to identify all those who had experienced neck pain during the follow-up period. At follow-up, cumulative 1-year episode incidence of neck pain was estimated at 17.9% (95% confidence interval 16.0-19.7%). Incidence was independent of age, but was more common in women. A history of previous neck injury at baseline was a significant risk factor for subsequent neck pain in the follow-up year (risk ratio 1.7, 95% confidence interval 1.2-2.5), independent of gender and psychological status. Other independent baseline risk factors for subsequent neck pain included number of children, poor self-assessed health, poor psychological status and a past history of low back pain. We have carried out a prospective study in a general population sample and demonstrated that established risk factors for chronic pain predict future episodes of neck pain, and shown that in addition a history of neck injury is an independent and distinct risk factor. This finding may have major public health and medicolegal implications.

Adolescent↗
PubMedDate not supplied

Whiplash injuries in Finland: a prospective 1-year follow-up study.

OBJECTIVES: The aim of the study was to define how many whiplash injuries occur in Finland in traffic accidents and the degree of severity of these injuries using the whiplash-associated disorders (WAD) classification presented by the Quebec Task Force, and to define possible long-term health effects caused by whiplash injury as well as the duration of whiplash-associated sick-leaves. METHODS: This was a prospective one-year-follow-up study. Fourteen insurance companies paving compensations for traffic accidents in Finland sent the accident reports and medical certificates of all neck injuries attributable to traffic accidents to the research team. The material was collected from neck injuries that had occurred in traffic accidents during the year 1998. RESULTS: The majority of those suffering a whiplash injury were women. On the basis of the WAD classification, most whiplash injuries were mild, belonging to grades WAD I and II. At one year from the accident nearly 10% considered that their health had been impaired significantly as a result of their neck injury. Over 10% of those questioned had been on sick-leave for over a month but only 1.5% had been on sick-leave associated with the injury for more than 6 months. The most common symptom after one year was neck pain or neck pain combined with headache and symptoms in the upper extremities. No major changes related to the seasons of the year were found. CONCLUSIONS: The number of reported neck injuries in proportion to all traffic accidents involving physical injuries is small, even in proportion to rear-end collisions. In a considerable proportion of collision patients, whiplash injury does result in significant impairment which can last as long as a year after the accident. The WAD classification predicts the duration of work disability and the long-term health damage caused by the injury. Since the appearance of symptoms and the individual need for rehabilitation due to impaired functional capacity do not depend solely on the tissue damage and biomechanical forces involved in the collision, in the future it will be important to determine which factors are responsible for the differences in coping after a collision.

Accidents, Traffic↗
PubMed2005

The effect of muscle activation on neck response.

Prevention of neck injuries due to complex loading, such as occurs in traffic accidents, requires knowledge of neck injury mechanisms and tolerances. The influence of muscle activation on outcome of the injuries is not clearly understood. Numerical simulations of neck injury accidents can contribute to increase the understanding of injury tolerances. The finite element (FE) method is suitable because it gives data on stress and strain of individual tissues that can be used to predict injuries based on tissue level criteria. The aim of this study was to improve and validate an anatomically detailed FE model of the human cervical spine by implement neck musculature with passive and active material properties. Further, the effect of activation time and force on the stresses and strains in the cervical tissues were studied for dynamic loading due to frontal and lateral impacts. The FE model used includes the seven cervical vertebrae, the spinal ligaments, the facet joints with cartilage, the intervertebral disc, the skull base connected to a rigid head, and a spring element representation of the neck musculature. The passive muscle properties were defined with bilinear force-deformation curves and the active properties were defined using a material model based on the Hill equation. The FE model's responses were compared to volunteer experiments for frontal and lateral impacts of 15 and 7 g. Then, the active muscle properties where varied to study their effect on the motion of the skull, the stress level of the cortical and trabecular bone, and the strain of the ligaments. The FE model had a good correlation to the experimental motion corridors when the muscles activation was implemented. For the frontal impact a suitable peak muscle force was 40 N/cm2 whereas 20 N/cm2 was appropriate for the side impact. The stress levels in the cortical and trabecular bone were influenced by the point forces introduced by the muscle spring elements; therefore a more detailed model of muscle insertion would be preferable. The deformation of each spinal ligament was normalized with an appropriate failure deformation to predict soft tissue injury. For the frontal impact, the muscle activation turned out to mainly protect the upper cervical spine ligaments, while the musculature shielded all the ligaments disregarding spinal level for lateral impacts. It is concluded that the neck musculature does not have the same protective properties during different impacts loadings.

Accidents, Traffic↗