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At least 433 records · Page 24Linked to original sources
PubMed1984

Initial management of penetrating neck wounds--a selective approach.

The management of anterior penetrating neck injuries remains highly controversial. This is a review of our treatment of such injuries over the preceding decade. During the first 6 years all injuries were explored. Of 75 patients explored, only 33 (44%) had significant injuries. During the last 4 years, patients were managed selectively. Patients with bleeding, crepitation, dysphagia, compromised airways, or for whom full clinical evaluation was not possible underwent prompt formal operative exploration. All other patients were observed. Of 48 patients who underwent explorations, 41 (85%) had significant injuries. Thirty-six patients were observed with no adverse sequelae. Ancillary diagnostic testing was only routinely done in level I injuries. Over the last 10 years we evolved from mandatory exploration to selective exploration of anterior penetrating neck injuries. Our experience confirms the safety and cost-effectiveness of a selective exploration policy. Furthermore, observation does not mandate extensive ancillary diagnostic testing for level II and level III injuries.

Adult↗
PubMed1964

ECONOMIC ASPECTS OF "WHIPLASH" INJURY.

The term "whiplash," used to describe a neck injury received in an automobile accident, has no foundation in medical science to support the complaints of persons suing for damages. The term is gaining unwarranted popularity as a term describing an injury, even though there are no clinical or pathological findings to support it."Whiplash" cases today account for an estimated 30 per cent of all injuries in automobile accidents. Direct compensation for damages paid to persons injured in automobile accidents in the United States in 1961 amounted to approximately one billion, seven hundred million dollars. It has been estimated that five hundred and eighty million dollars of that amount was paid in compensation on allegation of neck injuries.

Accidents, Traffic↗
PubMed1997

Epidemiology of bicycle injuries and risk factors for serious injury.

OBJECTIVE: To determine the risk factors for serious injury to bicyclists, aside from helmet use. DESIGN: Prospective case-control study. SETTING: Seven Seattle area hospital emergency departments and two county medical examiner's offices. PATIENTS: Individuals treated in the emergency department or dying from bicycle related injuries. MEASUREMENTS: Information collected from injured bicyclists or their parents by questionnaire on circumstances of the crash; abstract of medical records for injury data. Serious injury defined as an injury severity score > 8. ANALYSIS: Odd ratios computed using the maximum likelihood method, and adjusted using unconditional logistic regression. RESULTS: There were 3854 injured cyclists in the three year period; 3390 (88%) completed questionnaires were returned 51% wore helmets at the time of crash. Only 22.3% of patients had head injuries and 34% had facial injuries. Risk of serious injury was increased by collision with a motor vehicle (odds ratio (OR) = 4.6), self reported speed > 15 mph (OR = 1.2), young age (< 6 years), and age > 39 years (OR = 2.1 and 2.2 respectively, compared with adults 20-39 years). Risk for serious injury was not affected by helmet use (OR = 0.9). Risk of neck injury was increased in those struck by motor vehicles (OR = 4.0), hospitalized for any injury (OR = 2.0), and those who died (OR = 15.1), but neck injury was not affected by helmet use. CONCLUSIONS: Prevention of serious bicycle injuries cannot be accomplished through helmet use alone, and may require separation of cyclists from motor vehicles, and delaying cycling until children are developmentally ready.

Adolescent↗
PubMed2005

The effect of helmet use on injury severity and crash circumstances in skiers and snowboarders.

The aim of this study was to examine the effect of helmet use on non-head-neck injury severity and crash circumstances in skiers and snowboarders. We used a matched case-control study over the November 2001 to April 2002 winter season. 3295 of 4667 injured skiers and snowboarders reporting to the ski patrol at 19 areas in Quebec with non-head, non-neck injuries agreed to participate. Cases included those evacuated by ambulance, admitted to hospital, with restriction of normal daily activities (NDAs) >6 days, with non-helmet equipment damage, fast self-reported speed, participating on a more difficult run than usual, and jumping-related injury. Controls were injured participants without severe injuries or high-energy crash circumstances and were matched to cases on ski area, activity, day, age, and sex. Conditional logistic regression was used to relate each outcome to helmet use. There was no evidence that helmet use increased the risk of severe injury or high-energy crash circumstances. The results suggest that helmet use in skiing and snowboarding is not associated with riskier activities that lead to non-head-neck injuries.

Head Protective Devices↗
PubMed1995

Maxillofacial growth after neck burn injury at a young age: an experimental study in the rabbit.

An experimental model was designed to define alterations in the normal mandibular growth process under the influence of postburn neck contractures. Additionally, this craniofacial growth model was used to compare two early treatment modalities of neck burns in their capability to minimize contracture and hence allow for normal mandibular growth and development. Growth implies increase in size as well as change in shape and position. These three aspects of growth were defined accordingly to Björk as rotations. The intramatrix rotation expresses the change in mandibular shape, and the matrix rotation expresses the change in mandibular position relative to surrounding structures. The total rotation expresses both, and together with the measurement of the mandibular length, they represent the increase in mandibular size. Thirty-two 7-week-old rabbits were divided at random in four groups of eight rabbits each and randomized for selection for the 14 operation days defined as t = 0: Group A: controls to define normal mandibular growth Group B: untreated third-degree neck burns Group C: third-degree neck burns treated by a full-thickness skin graft Group D: third-degree neck burns treated by a myocutaneous flap All animals underwent placement of two bone markers in the maxilla. With biweekly intervals, standardized lateral skull roentgenographs were taken until the rabbits reached the age of 21 weeks. In this time period, major growth accelerations including the pubertal growth spurt took place. By the use of 13 reference points and 7 reference lines, rotations and distances were calculated. Statistical analysis of the data was performed. The results show that the normal mandibular length was unaffected in all groups. There were no statistically significant changes in matrix, intramatrix, and total rotations of the mandible and the maxilla. There was a statistically significant difference in the displacement of the mandibular reference point between all groups, suggesting a variable degree of normal backward skull rotation, namely, due to group B. Explanations to be considered concerning the fact that the only minor differences were found in group B: 1. Drawbacks of the animal model: differences in skin texture, postnatal mandibular growth, and head position compared with those of humans. 2. Other functional adaptation mechanisms such as changes in head position, which are recruited at first in adapting to disturbances of homeostasis, were not measured. Soft-tissue compensation probably has overcome major bony deformations. Nevertheless, some drawbacks of the model can be viewed as ideal concerning treatment of neck burns.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1998

Use of the perineal and perineal-abdominal (transpubic) approach for delayed management of pelvic fracture urethral obliterative strictures in children: long-term outcome.

PURPOSE: The results of 2 surgical approaches to restore urethral continuity in children with pelvic fracture urethral obliterative strictures were retrospectively reviewed. MATERIALS AND METHODS: From 1980 to 1995, 30 boys 3.8 to 15.4 years old (median age 8.4) with urethral distraction injuries associated with pelvic fracture were treated with delayed 1-stage anastomotic repair. Surgical access was perineal in 15 cases and perineal-abdominal (transpubic) in 15. There were also associated injuries in 13 patients, including bladder neck laceration in 3. Overall postoperative followup ranged from 2 to 17 years (median 8.5). RESULTS: The stricture-free rate of 1-stage anastomotic repair with perineal and perineal-transpubic access was 84 and 100%, respectively. Four recurrent strictures were treated successfully with additional perineal-transpubic anastomotic urethroplasty in 3 patients and internal urethrotomy in 1. Urinary incontinence developed in 1 boy in the perineal group and in 3 in the transpubic group. Retrospectively associated bladder neck injury was related to the original trauma in 3 of the 4 incontinent boys. The remaining child had overflow incontinence due to an acontractile detrusor. On review 3 of the 4 incontinent patients had severe, unstable type IV pelvic fractures. CONCLUSIONS: Children with urethral distraction injuries associated with pelvic fracture require perineal-transpubic exposure when urethral obliterations of 3 cm. or greater develop or local complications are present in the affected area, making it impossible to create a tension-free, spatulated epithelium-to-epithelium anastomosis to restore urethral continuity via the perineal route. This study also supports previous reports that suggest a relationship of urinary incontinence and associated bladder neck injury with severe pelvic fracture rather than with delayed urethral repair.

Abdomen↗
PubMed1994

Injuries produced by judicial hanging. A case report.

A judicial hanging occurred in the state of Washington. Neck injuries were studied by MRI (Magnetic Resonance Imaging) and CT (Computed Tomography). In addition, vertebral arteriograms were performed to evaluate the nature of the neck injury. This report details the anatomical changes produced by judicial hanging.

Adult↗
PubMed1996

Color Doppler sonography in penetrating injuries of the neck.

PURPOSE: To determine whether color Doppler sonography can be a sensitive alternative to screening arteriography for identifying arterial injury in patients with penetrating traumatic neck injuries. METHODS: Fifty-two patients admitted to our trauma center with penetrating neck injuries (gunshot wounds and lacerations) were examined prospectively with color Doppler sonography, and findings were compared with the results of angiography (n = 44), with findings at surgery (n = 4), and with clinical status (n = 4). RESULTS: Color Doppler sonography correctly detected all serious injuries of the carotid arteries (n = 6; 5 diagnosed at angiography and 1 at surgery) and all injuries of the vertebral arteries (n = 4; all diagnosed at angiography). Sonography missed 1 instance of reversible narrowing of the internal and external carotid arteries and did not show 2 normal vertebral arteries. CONCLUSION: Color Doppler sonography was as accurate as angiography in screening clinically stable patients with zone II or III injuries and no signs of active bleeding. Our initial results suggest that in the future, sonography may be used as a screening examination for arterial lesions in patients with penetrating neck injuries.

Adolescent↗
PubMed2006

Injury potential of a three-year-old Hybrid III dummy in forward and rearward facing positions under CMVSS 208 testing conditions.

This research focuses on the injury potential of children in forward and rearward facing child restraint seats in frontal collisions. Vehicle crash tests were completed following the guidelines outlined in the Canadian Motor Vehicle Safety Standard 208 using a Hybrid III three-year-old dummy in a convertible forward/rearward facing child restraint seat. The seat was equipped with a five-point restraining system and the experimental test was completed in the forward facing configuration. A numerical model employing a similar set-up as the experimental crash test was developed and numerically simulated using LS-DYNA. To verify the numerical simulations, the head and chest accelerations as well as neck loads and moments were compared to the experimental findings and it was observed that a reasonable correlation between the experimental and numerical observations existed. Further numerical simulations were completed to investigate the influence of positioning the three-year-old dummy in the rearward configuration on the head and neck injury potential during frontal crash. Through an analysis of injury criteria, using neck loads and head accelerations, it was observed that the rearward facing child dummy sustained significantly lower levels of neck injury criteria while exhibiting similar levels of the head injury criteria as the forward facing child dummy.

Acceleration↗
PubMed2005

Odontoid Lateral Mass Interval (OLMI) asymmetry and rotary subluxation: a retrospective study in cervical spine injury.

The aim of the study was to evaluate the significance of odontoid lateral mass interval (OLMI) asymmetry on open-mouth view, in neck injury patients who have otherwise normal cervical spine x-rays. Thirteen neck injury patients were reviewed. Average age was 23.5 years (range, 16-30 years) and average follow-up was 15 weeks (range, 6-39 weeks). All the patients, referred from the casualty department, had computed tomography (CT) scans because of the OLMI asymmetry to rule out rotary subluxation. Clinically none of the patients had torticollis. CT scans were reported normal except for OLMI asymmetry, in 11 patients. Two patients were reported as having rotary subluxation and one was found, after normal initial plain films, to have an undisplaced lateral mass fracture of the atlas with bony avulsion of the transverse ligament. The average OLMI asymmetry was 3.1 mm (range, 2-4 mm). The authors concluded that although OLMI asymmetry has low sensitivity and specificity for true subluxation or instability, it may be a sign of significant cervical injury and should be evaluated with CT.

Accidents, Traffic↗
PubMed1987

Injuries sustained in rugby by wearers and non-wearers of mouthguards.

Previous studies have shown a higher prevalence of head and neck injuries in non-wearers when compared with wearers of mouthguards. The purpose of the present study was to compare the pattern of injuries to those of past studies and also to investigate whether the injuries sustained differed significantly between wearers and non-wearers. A sample of 321 university students participating on 555 player occasions was studied in a cross-sectional survey. No statistically significant differences (p greater than 0.05) were found between wearers and non-wearers of mouthguards with respect to head and neck injuries in general and to oral injuries in particular. We conclude that injuries sustained at rugby in this study were not associated with the use or non-use of mouthguards.

Adolescent↗
PubMed2006

Endovascular management of vascular trauma.

Over the past several decades, catheter-based and endovascular techniques have been used with increasing frequency for the management of trauma. This is particularly true for the management of solid organ injury and vascular injuries resulting from pelvic fracture with the use of embolization techniques for successful arrest of active hemorrhage. Likewise, there is a large body of literature regarding the management of acute traumatic vascular injuries involving traditional open surgical techniques. Currently, however, there is sparse literature on the management of vascular trauma with endovascular techniques. The endovascular management of vascular trauma seems particularly appealing in the management of blunt truncal injuries, especially in the setting of severe concomitant brain and lung injury. Extremity and neck injuries are probably best handled by traditional methods of surgical proximal and distal control, the exception to this being base of skull injuries where there is no ability for distal vessel control, and "watershed" areas between the trunk and extremities where proximal vascular control can be quite difficult. This chapter reviews current literature with regard to the endovascular management of traumatic vascular injuries with regions being broadly defined as neck, trunk, and extremity.

Abdomen↗
PubMed1997

Athletic head injuries.

Recent studies have shown a decrease in mortality from head and neck injuries, especially in American football. This has resulted from rule changes and their enforcement, equipment modification, improved coaching and training techniques, and educational programs for neck injuries. Morbidity data, however, are not as complete, particularly as they apply to concussion, the most frequent type of head injury in contact sports. Questions on this condition that still need to be answered before a sound medical disposition can be made are the possible cumulative damage from repeated concussions, and whether one concussion renders a player more susceptible to a second. Currently, decisions on when to allow a football player to return to a game or participate in future contests are arbitrary and based primarily on the experience of the team physician. Certainly, further studies are essential before these decisions can be based on sound scientific data. Thus, the pioneer work of Richard Schneider needs to be continued.

Athletic Injuries↗
PubMed1995

Penetrating neck trauma in children: a reappraisal.

The management of penetrating neck injuries in adults is controversial, with a trend toward selective neck exploration. These injuries are uncommon in children, and only limited information exists regarding their management. To assess the management of these injuries in the authors' geographic region, they reviewed the records of children with injuries penetrating the platysma muscle who were treated between 1980 and 1994. Forty-six children (aged 2 to 16 years) suffered a total of 55 penetrating neck injuries. The injuries were classified according to type and location. Fifty-two percent were caused by missiles, 30% by stab wounds, and 18% by dog bites. Fifty-eight percent of injuries were in zone II, 31% in zone I, and only 11% in zone III. The diagnostic workup, including arteriography, esophagography, or endoscopy, was performed preoperatively in 10 patients. Overall, 21 patients had exploration, and the rate of negative explorations was 48%. All cases explored for bleeding or a positive diagnostic workup result were found to have significant injury. On the other hand, all neck explorations performed solely because of injury to zone II were negative. The overall morbidity and mortality rates were 31% and 7%, respectively. A more selective approach, similar to that used for adult patients, emphasizing preoperative diagnostic evaluation, is recommended to decrease the rate of negative neck explorations among children.

Adolescent↗
PubMed1997

Increased rates of fibromyalgia following cervical spine injury. A controlled study of 161 cases of traumatic injury.

OBJECTIVE: To study the relationship between cervical spine injury and the development of fibromyalgia syndrome (FMS). METHODS: One hundred two patients with neck injury and 59 patients with leg fractures (control group) were assessed for nonarticular tenderness and the presence of FMS. 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 using the American College of Rheumatology 1990 criteria. Additional questions assessed measures of physical functioning and quality of life (QOL). RESULTS: Although no patient had a chronic pain syndrome prior to the trauma, FMS was diagnosed following injury in 21.6% of those with neck injury versus 1.7% of the control patients with lower extremity fractures (P = 0.001). Almost all symptoms were more common and severe in the group with neck injury. FMS was noted at a mean of 3.2 months (SD 1.1) after the trauma. Neck injury patients with FMS (n = 22) had more tenderness, had more severe and prevalent FMS-related symptoms, and reported lower QOL and more impaired physical functioning than did those without FMS (n = 80). In spite of the injury or the presence of FMS, all patients were employed at the time of examination. Twenty percent of patients with neck injury and 24% of patients with leg fractures filed an insurance claim. Claims were not associated with the presence of FMS, increased FMS symptoms, pain, or impaired functioning. CONCLUSION: FMS was 13 times more frequent following neck injury than following lower extremity injury. All patients continued to be employed, and insurance claims were not increased in patients with FMS.

Adult↗
PubMed2001

Cervical pharyngoesophageal and laryngotracheal injuries.

Aerodigestive tract injuries in the neck are found in about 7% of penetrating neck injuries and are very rare in blunt trauma. A combination of a good physical examination with endoscopy and esophagography can reliably diagnose all significant injuries. Airway control in laryngotracheal trauma is the most urgent priority and is often a difficult procedure. Although selected small pharyngeal and laryngotracheal injuries may be managed nonoperatively, all other aerodigestive tract injuries should be managed with early operation.

Esophagus↗