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Over the past 12 months, the Victorian Trauma Centre at the Alfred Hospital, Melbourne, has dealt with serious head and neck injuries associated with angle grinder use. Three cases are presented, documenting the circumstances and severity of these injuries and subsequent management. Angle grinder injuries are a source of serious morbidity and mortality, much of which is preventable.
Intracranial occlusion of the internal carotid artery secondary to minor head or neck injury is uncommon. We report the case of an 18-year-old man who sustained a minor head and neck injury during a fist fight and developed a left hemiparesis resulting from thrombosis of the supraclinoid portion of the right internal carotid artery. Conservative inpatient treatment with low dose heparin and aspirin resulted in a gradual, steady improvement. Two months later, after an intensive program of physical therapy, the patient showed good progress; his facial weakness had lessened and his left hemiparesis was mild. Although there is no ideal treatment for internal carotid artery occlusion secondary to minor trauma, conservative treatment should be undertaken unless there are progressive or recurring ischemic symptoms, in which case an extracranial-intracranial bypass operation should be considered.
INTRODUCTION: Cervical spine fractures and dislocations are uncommon injuries that can have serious neurological consequences. These injuries require adequate stabilisation to prevent further spinal cord injury during transfer between hospitals. Evacuation often requires a combination of road ambulance, helicopter and fixed wing aircraft from military hospitals. This paper outlines the neck injuries sustained during Op Telic and discusses the need for Halo vests to be available at Role 3. METHODOLOGY: The MND(SE) Hospital databases were used to identify all casualties admitted with either a "Cervical" or "Neck" injury. The databases covered the period from 24 March 2003 until 15 April 2004. The diagnoses were categorised into minor and serious cervical spine injuries. We defined a serious cervical spine injury as either a fracture or dislocation. We looked at the discharge letters of all casualties evacuated to a Role 4 hospital to confirm whether the casualties had serious cervical spine injuries. RESULTS: Forty seven casualties were admitted and all were British except three, two Iraqi civilians and one US soldier. Thirty three casualties were returned to their unit for duty, or discharged at the airhead on return to the UK. Fourteen casualties required hospital treatment. There were five serious cervical spine injuries over the study period which included one Hangman's fracture of C2, one flexion compression injury of C5, one flexion compression injury of C7, one unifacetal dislocation and one bifacetal dislocation. CONCLUSIONS: Five casualties were treated at MND(SE) Hospital for serious injuries to the cervical spine. Two patients were transferred without Halo stabilisation after failing to obtain halos in Iraq. One casualty was kept until a Halo was flown out from the UK. RECOMMENDATIONS: All unstable cervical spine fractures should be stabilised with a Halo Vest prior to transfer from Role 3. Halo Rings and Vests should be available at Role 3 facilities.
A case of delayed death after suicidal hanging is presented. At first the examination of the scene did not provide any evidence of strangulation. The macroscopic and microscopic findings of the massive neck injury including cricotracheal disruption are described and discussed. In spite of this severe trauma, the capability to act was undoubtedly preserved. Death was due to hypoxia from bilateral pneumothorax caused by the massive neck injury.
Thrombosis of the extracranial portion of the internal carotid artery as a result of nonpenetrating head and neck injury is not uncommon. However, intracranial occlusion of the internal carotid artery after minor head and neck injury without skull fracture is rare. We report a case of 14-year-old male who suffered a minor head injury during an athletic meeting of his school and developed a right hemiparesis and a lethargy state resulting from thrombosis of the supraclinoid portion of the left internal carotid artery. On admission, skull films and a CT scan revealed no abnormality. One hour later, he fully recovered. One day later, no definite lesions were detected on T1-weighted and T2-weighted image of MRI, but an abnormal high signal lesion in the left frontal lobe was detected on diffusion-weighted image of MRI. On additional MR angiography, intracranial occlusion of the internal carotid artery due to dissection was demonstrated.
Burn injuries to the face and neck present a unique challenge to the burn team and must be treated with considerable care and vigilance by the rehabilitation team to prevent potential contractures that may occur. Standard guidelines for treatment of the head and neck have not been established. This article presents the results of a comprehensive survey that examined the similarities and differences in the rehabilitation techniques used in various burn centers for the treatment of these injuries. The results obtained from the survey responses demonstrate several similarities in treatment throughout the continuum of care, revealing the potential for the development of a uniform rehabilitation protocol for the treatment of burn injuries to the face and neck.
This article reviews the many clinical and laboratory investigative research reports on the frequency, causes, and biomechanics of human cervical spine impact injuries and tolerances. Neck injury mechanisms have been hypothesized from clinically observed cervical spine injuries without laboratory verification. However, many of the laboratory experiments used static loading techniques of cervical spine segments. Only recently have dynamic impact studies been conducted. Results indicate that crown-of-head impacts can routinely produce compression of the neck with extension or flexion motion. However, the two-dimensional (midsagittal) movement of the head bowing into the chest does not routinely produce flexion/compression type damage to the cervical spine. Flexion/compression damage to the cervical spine can be produced by prepositioning the subject so that upon impact, a three-dimensional motion of the head and neck occurs. Future laboratory research is needed to determine the forces and impact directions required to produce the various known fracture types and dislocations for a clear, accurate description of the cervical spine impact dynamics.
The pattern and severity of injuries sustained by 174 vehicle occupants consecutively admitted to the Accident and Emergency Department of the Edinburgh Royal Infirmary were prospectively documented. Drivers (DR) accounted for 66% of the patients, 20% were front seat passengers (FSP) and 14% were rear seat passengers (RSP). Injured patients were more likely to be male, young, intoxicated and not wearing a seat-belt. The position of the patient within the vehicle at the time of the accident and point of impact significantly affected the pattern of injury sustained. The majority of injuries were sustained by the upper body and the pattern of injury is discussed. Most accidents occurred at low speeds and higher speeds were associated with an increased severity of injury. Seat-belts reduced the overall severity of injuries, in particular those to the face and chest, but may increase the risk of neck injury. Head-rests do not appear to influence the incidence of neck injury. Clinically apparent alcohol intoxication was associated with a markedly increased risk of severe injury.
Recent studies have shown a decrease in the mortality rates from head and neck injuries, especially in American football. This has resulted because of rule changes and their enforcement, equipment modifications, improved coaching and training techniques, and educational programs for coaches, trainers, and team physicians on the early recognition of head and neck injuries. However, morbidity data is not as complete, particularly as it applies 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. Presently, 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. Data on the incidence, mechanisms, and prognosis of transient spinal cord signs and symptoms, such as spinal cord concussion and the central core symptoms, is also incomplete. What is the long-term prognosis for players who suffer frequent "burners"? Certainly, further studies are essential before these questions can be answered. Thus, the pioneer work of Richard Schneider needs to be continued.
BACKGROUND: External laryngeal trauma (ELT) is a rare but clinically important injury. OBJECTIVE: To perform the first population-based, time series analysis of the epidemiology, management, and outcomes of ELT using an 11-state, inpatient sample database containing more than 54 million patients. PATIENTS: Three hundred ninety-two patients with a primary or secondary diagnosis of ELT were identified. Over a 5-year period, the incidence of ELT in this series was 1/137,000. The mean (+/-SD) age was 37 (+/-7) years, and the overall mortality rate was 2.04%. Two hundred forty-eight patients required surgical intervention. RESULTS: The average length of stay for 67 patients not requiring surgical intervention for any injury was 3 (+/-2) days, with no mortality. One hundred eighty patients underwent endoscopy, with 14 requiring tracheotomy alone and 57 requiring tracheotomy plus laryngeal repair. The average length of stay and the mortality rate were higher in these latter groups. Overall, 139 patients underwent tracheotomy, with a mortality rate of 5%, while 96 patients underwent laryngeal repair, with a mortality rate of 1%. Surgical treatment was performed in 140 patients with ELT within 24 hours after presentation, while another 60 received treatment within 48 hours. Associated injuries included skull base or intracranial injury (13%), open neck injury (9%), cervical spine injury (8%), and esophageal or pharyngeal injury (3%). CONCLUSION: External laryngeal trauma is a rare injury, with most patients requiring surgical intervention.
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We analyzed the gene expression pattern in mouse skin following compression of the neck by fluorescent mRNA differential display (FDD-PCR). RNA was isolated from the skin tissue immediately or 30 min after ligation at the neck for 25 min resulting in death (Group A-0, Group A-30). Control mice underwent no compression of the neck and were killed by decapitation (Group C-0, Group C-30). FDD-PCR and sequence analysis revealed that the faciogenital dysplasia gene (Rho member families) and secreted frizzled related protein 1 (modulator of Wnt networks) were enhanced only in the Group A-30. In addition, common salivary protein 1 and mouse 0 day neonate skin cDNA clone z4631433E12 from the RIKEN full-length enriched library were also induced in Groups A-0 and A-30. These findings were consistent with the results of statistical analysis by ANOVA following quantitative real-time PCR. No differences in band pattern were observed between Group C-0 and Group C-30. Therefore, our findings suggested that the altered expression of genes was associated with signal transduction. The results may contribute to clarifying the pathophysiology of compression of the skin and may be useful in the diagnosis of suffocation.
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