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PubMed2001

Dynamic performances of different seat designs for low to medium velocity rear impact.

There is good evidence that seat design and impact severities in terms of delta-V and acceleration plays a role in AIS 1 neck injury outcomes in the event of a rear impact. This study evaluates a number of current production seats to assess the AIS 1 neck injury protection potential at different impact severities. Five different seat designs were exposed to four different impact severities in a sled simulating a rear impact. The same delta-V produced with different peak accelerations generated very different dummy responses. Head restraint position influenced the angular and horizontal displacement of the head relative to torso and the time of head to head restraint contact. The lowest motion of the head relative to the torso was found in the two anti-whiplash seats tested. The results of the study can be used for the design of future vehicle seats and anti-whiplash systems.

Abbreviated Injury Scale↗
PubMed1997

[A case of traumatic extracranial internal carotid artery dissecting aneurysm treated by proximal ligation and STA-MCA bypass].

We present a case with the traumatic extracranial internal carotid artery dissecting aneurysm. A 21-year-old man was involved in a motorcycle accident, resulting in multiple injuries but no apparent head and neck injuries. Head CT was normal on his admission. He was discharged from his local hospital 3 weeks after the accident without any neurological deficits. Five weeks after the accident, he suddenly presented with a motor aphasia and a right hemiparesis. CT and MRI showed infarctions in the left para-Sylvian and the left angular areas. Angiography showed a left extracranial carotid artery dissecting aneurysm at the level of C1 vertebral arch. The patient was initially managed by an anticoagulant agent, but he suffered from another transient ischemic attack due to distal embolism from the aneurysm. Balloon occlusion test of the left ICA was performed under monitoring EEG, SEP. Mean stump pressure (MSP) revealed 60 mmHg. and MSP/Mean systematic blood pressure revealed 67%. We judged that the left ICA ligation was a safe method to treat this patient, however, considering the patient's age and the side of the lesion, left STA-MICA bypass and ligation of the left ICA were carried out in one stage. Postoperatively, the patient did not show any cerebral ischemic complications and angiography showed disappearance of the aneurysm and patency of the bypass. The left MCA territories were filled well by cross circulation and the bypass.

Accidents, Traffic↗
PubMedDate not supplied

Treatment of bipolar, seizure, and sleep disorders and migraine headaches utilizing a chiropractic technique.

OBJECTIVE: To discuss the use of an upper cervical technique in the case of a 23-year-old male patient with rapid-cycling bipolar disorder, sleep disorder, seizure disorder, neck and back pain, and migraine headaches. CLINICAL FEATURES: The patient participated in a high school track meet at age 17, landing on his head from a height of 10 ft while attempting a pole vault. Prior to the accident, no health problems were reported. Following the accident, the patient developed numerous neurological disorders. Symptoms persisted over the next 6 years, during which time the patient sought treatment from many physicians and other health care practitioners. INTERVENTION AND OUTCOME: At initial examination, evidence of a subluxation stemming from the upper cervical spine was found through thermography and radiography. Chiropractic care using an upper cervical technique was administered to correct and stabilize the patient's upper neck injury. Assessments at baseline, 2 months, and 4 months were conducted by the patient's neurologist. After 1 month of care, the patient reported an absence of seizures and manic episodes and improved sleep patterns. After 4 months of care, seizures and manic episodes remained absent and migraine headaches were reduced from 3 per week to 2 per month. After 7 months of care, the patient reported the complete absence of symptoms. Eighteen months later, the patient remains asymptomatic. CONCLUSION: The onset of the symptoms following the patient's accident, the immediate reduction in symptoms correlating with the initiation of care, and the complete absence of all symptoms within 7 months of care suggest a link between the patient's headfirst fall, the upper cervical subluxation, and his neurological conditions. Further investigation into upper cervical trauma as a contributing factor to bipolar disorder, sleep disorder, seizure disorder, and migraine headaches should be pursued.

Adolescent↗
PubMed2004

WorldSID Dummy Head-Neck Biofidelity Response.

Accident studies indicate that serious neck injuries are generally infrequent in side crashes. However, given the rapid changes in side impact protection technology, such as side airbags and curtain systems, the nature of head-neck interactions is likely to change. Consequently, the newest generation of anthropomorphic test devices for side impact should provide realistic prediction of the head-neck kinematics and include meaningful measurements related to risk of head and neck injury. The WorldSID dummy has been assessed against a set of five test conditions that have been used to define biofidelity impact response targets. Three of the five test conditions are recommended by ISO TR9790 (ISO 1997), the NBDL 7.2 G, 6.9 m/s lateral sled impact reported by Ewing et al. (1977) and Wismans et al. (1986) , the Patrick and Chou lateral, 6.7 G 5.8 m/s (1976) and Tarriere lateral 12.2 g, 6,1 m/s sled impact (ISO 1997). Due to its expected loading environment, the dummy neck performance has also been evaluated for neck bending in frontal flexion and extension (Mertz and Patrick, 1971). The 5th test condition is the NBDL 45 degrees frontal-oblique sled test (Wismans 1986, Philippens 2004). The latter and two of the ISO TR9790 test conditions form the basis of the draft IHRA requirements for evaluating side impact dummy biomechanical responses. The paper reports on the findings of the assessment of the WorldSID pre-production dummy. The Mertz and Patrick OC moment-head angle corridor is used as supplemental requirement for frontal flexion-extension. The biofidelity requirements contain both kinematic and dynamic response targets. The neck has a good performance for NBDL lateral and Tarriere requirements, and the Mertz OC moment-flexion angle. The performance for the Patrick and Chou, the NBDL oblique test conditions and the Mertz OC moment extension angle are fair to marginal. The repeatability performance of the dummy was found to be good for all lateral and most oblique test parameters. The neck design does not allow much more further optimization without fundamental changes.

Journal Article↗
PubMed2004

The possibility to use simple validated questionnaires to predict long-term health problems after whiplash injury.

STUDY DESIGN: A prospective follow-up study. OBJECTIVES: To evaluate the relation of the state of health before the accident and the significance of the symptoms reported soon after the injury to the situation 3 years after the injury. To evaluate the possibility of using simple validated questionnaires to predict long-term health problems after the injury. SUMMARY OF BACKGROUND DATA: A whiplash injury is generally benign in its natural course. However, some of the patients have diverse and prolonged symptoms. Although several prognostic factors have been suggested for the poor recovery, in most cases the factors leading to prolonged disability remain unclear. METHODS: In collaboration with traffic insurance companies, we gathered information of neck injuries that occurred in traffic accidents in Finland in 1998. After the insurance company received a notification of a neck injury and consent from the injured party to participate in the study, they sent the information to the research team. The first inquiry was sent to the patients as soon as possible. One- and three-year follow-up questionnaires were posted to those who responded to the first inquiry. A total of 144 persons returned the 3-year follow-up questionnaires and form the material of this study. RESULTS A poor state of health or frequent neck pain or headache before the accident did not have any significant relation to the poor outcome 3 years after the accident. The extent of neck pain and lower back pain reported soon after the accident was significantly associated to a poor outcome in the follow-up. The Neck Disability Index questionnaire was significantly related to the poor outcome after 3 years. CONCLUSIONS: The subjective experience of a notably decreased level of activity because of the neck pain when supplemented by the enhanced score of Neck Disability Index questionnaire predicts well poor outcome in long-term follow-up and can be used as a tool to identify persons who are at risk to suffer long-term health problems after whiplash injury.

Accidents, Traffic↗
PubMed2006

Neck muscle activation and head postures in common high performance aerial combat maneuvers.

INTRODUCTION: Neck injuries are common in high performance combat pilots and have been attributed to high gravitational forces and the non-neutral head postures adopted during aerial combat maneuvers. There is still little known about the pathomechanics of these injuries. METHODS: Six Royal Australian Air Force Hawk pilots flew a sortie that included combinations of three +Gz levels (1, 3, and 5) and four head postures (Neutral, Turn, Extension, and Check-6). Surface electromyography from neck and shoulder muscles was recorded in flight. Three-dimensional measures of head postures adopted in flight were estimated postflight with respect to end-range of the cervical spine using an electromagnetic tracking device. RESULTS: Mean muscle activation increased significantly with both increasing +Gz and non-neutral head postures. Check-6 at +5 Gz (mean activation of all muscles = 51% MVIC) elicited significantly greater muscle activation in most muscles when compared with Neutral, Extension, and Turn head postures. High levels of muscle co-contraction were evident in high acceleration and non-neutral head postures. Head kinematics showed Check-6 was closest to end-range in any movement plane (86% ROM in rotation) and produced the greatest magnitude of rotation in other planes. Turn and Extension showed a large magnitude of rotation with reference to end-range in the primary plane of motion but displayed smaller rotations in other planes. DISCUSSION: High levels of neck muscle activation and co-contraction due to high +Gz and head postures close to end range were evident in this study, suggesting the major influence of these factors on the pathomechanics of neck injuries in high performance combat pilots.

Adult↗
PubMed2000

Biomechanical analysis of injury criterion for child and adult dummies.

The development of human injury tolerance is difficult because of the physical differences between humans and animals, the available dummies, and tissue of the cadaver. Furthermore, human volunteer testing can clearly only be done at subinjurious levels. While considerable biomechanical injury evidence exists for the adult human based on cadaveric studies, little information is available for the pediatric population. However, some material is available from skull bone modulus studies and from the fetal tendon strength and early pediatric studies of the newborn. A review of living human, animal, and human cadaveric studies, which forms the basis for head-neck injury criterion are given. Examples of the use of the Hybrid III dummy for injury prediction such as in the Malibu rollover tests and air bag mechanisms show neck injury levels are considerably above the proposed Malibu 2000 N level.

Accidents, Traffic↗
PubMed1994

Duplex scanning replaces arteriography and operative exploration in the diagnosis of potential cervical vascular injury.

BACKGROUND: The pursuit of a diagnosis is more aggressive in suspected cervical vascular injury than in extremity vascular proximity injury, since the complications of missing the neck injury may result in irreversible neurologic damage. Most institutions use arteriography and operative exploration, but these modalities identify only 10% of cervical vascular traumas. While duplex scanning is the screening test of choice for carotid occlusive disease, few published reports have described experience with this modality in cervical vascular trauma. PATIENTS AND METHODS: To determine if duplex scanning can replace arteriography or operative exploration as the initial screening modality in the assessment of potential cervical vascular trauma, we performed a prospective evaluation in two parts. First, we used duplex scanning and cervical arteriography, concomitantly, to rule out injury in 15 patients. We then used duplex scanning alone in 85 patients, reserving arteriography for cases in which the scan revealed an arterial injury. RESULTS: Duplex scans and arteriography and operation diagnosed cervical vascular trauma equally well. Eight injuries were identified in all areas of the cervical arterial tree. No duplex scans have been falsely negative or falsely positive. Use of duplex scans instead of arteriography saved $1,252 per case. CONCLUSIONS: Duplex scanning detects cervical vascular injuries as effectively as arteriography or operation, and is faster and less expensive. This approach expands the utility of diagnostic ultrasound in the evaluation of trauma patients. It has become the procedure of choice for diagnosing cervical vascular trauma at our institution.

Angiography↗
PubMed2004

External injuries to the neck after free fall from great height.

Falls from great height are suicidal in most cases. Any antecedent trauma that would indicate an involvement of a third party should, however, be excluded in each case. Herein lies the difficulty in such cases since injuries prior to the fall which could be of criminal nature may be masked by the impact injuries. Injuries on unexposed parts of the body should always raise the suspicion of an involvement of a third party. This applies especially for neck injuries. By a retrospective analysis of 132 cases of falls from great height, the authors conclude, however, that neck injuries may occur after free fall from great height on a flat surface without antecedent trauma.

Accidental Falls↗
PubMedDate not supplied

Management of the helmeted athlete with suspected cervical spine injury.

Improper handling of an unstable neck injury may result in iatrogenic neurologic injury. A review of published evidence on cervical management in the helmeted athlete with a suspected spinal injury is discussed. The approach to the neck-injured helmeted athlete and the algorithms for on-field and emergency department evaluations are reviewed. The characteristics of the fitted football helmet allow safe access for airway management, and helmets and shoulder pads should not be initially removed unless absolutely necessary. Prehospital and emergency personnel should be trained in the indications for removal and in proper helmet, shoulder pad, and facemask removal techniques. If required, both helmet and shoulder pads should be removed simultaneously. Radiographs with equipment in place may be inadequate, and the value of computed tomography and magnetic resonance imaging in these helmeted patients has been studied. If adequate films cannot be obtained with equipment in place, helmet and shoulder pads may need to be removed before radiographic clearance. A plan should be formulated to prepare for such unexpected clinical scenarios as cervical spine injuries, and skills should be practiced. Airway and cervical spine management in these helmeted athletes is an area of ongoing research.

Airway Obstruction↗
PubMed1993

Three-dimensional head axis of rotation during tracking movements. A tool for assessing neck neuromechanical function.

The purpose of this article is to report normal variation in the screw (helical) axis of rotation of the head during various types of natural tracking movements. Nine normal subjects and eighteen subjects with neck injury faced a grid of targets separated by 10-degree intervals, and were instructed to use a head pointer (laser) to track whatever target was lit. Various horizontal, vertical, and oblique target sequences were employed. The normal subjects exhibited several consistent trends in finite screw axis parameter variation: vertical movements have a laterally-directed axis whose midsagittal plane crossing position is a function of the head orientation (typical range C3-T1); oblique movements have a diagonally-directed axis and an even greater orientation-specific range (C1-T1); and horizontal movements have a vertical axis that is modified near horizontal orientation extremes and is asymmetrically influenced by upward and downward bias orientations. Subjects with neck injury were seen to exhibit a variety of abnormal screw axis patterns.

Algorithms↗
PubMed2000

Snowmobile injuries and deaths in children: a review of national injury data and state legislation.

BACKGROUND: Snowmobiling is a popular family sport, with annual expenditures over $9 billion. The size and speed of snowmobiles make them potentially dangerous to children. Pediatric snowmobile-related trauma has not been studied in the United States. METHODS: We analyzed 291 pediatric snowmobile- related injuries and 75 deaths reported to the Consumer Product Safety Commission from 1990 to 1998. We reviewed snowmobile legislation in the states that reported at least 1 death to the Consumer Product Safety Commission during this time period. RESULTS: The most common sites of injury were the extremities (48.8%) and the head, neck, and face (28.2%). Head and neck injuries were the predominant cause of death (66.7%). The most common diagnosis was contusion/abrasion (30.9%), followed by laceration (22%), fracture (20.3%), and strain/sprain (14.4%). Nonfatal injuries most often involved ejection from the snowmobile (26.1%), but striking a stationary object was the most common mechanism in fatal crashes. The review of state legislation revealed that few age restrictions or helmet laws exist. Children as young as 8 years old may legally operate a snowmobile in some states. Often, restrictions do not apply to snowmobile use on private property, where 43% of pediatric snowmobile-related injuries occurred. CONCLUSIONS: Head, neck, and face injuries are common nonfatal injuries and are the most common cause of death. State legislation often lacks age restrictions on private property, and laws requiring helmet use are rare. Legislators have not addressed the dangers of pediatric snowmobile-related injuries. Helmet laws and age restrictions similar to those enacted for motorcycle riders are necessary and appropriate.

Adolescent↗
PubMed1994

Reflex mechanisms of death in missile injuries of the neck.

Three cases of missile injury to the neck are reported, two homicides and one suicide. In two fatalities, the autopsy revealed contusion of the spinal cord due to direct missile injury of the cervical spine but without laceration of the spinal dura. It was concluded that the temporary cavity following penetration of the bullet caused contusion of the spinal cord with subsequent reflex cardiac arrest. In the suicide case, the entrance wound was in the mouth, the bullet track traversed the pharynx and the cervical spine with complete transection of the cord, and the bullet lodged in the right scalenus muscle. The lack of vital signs such as blood aspiration, which was expected because of the injury of the pharynx, also indicates immediate occurrence of death owing to a reflex mechanism in this case. The underlying reflex mechanisms are discussed in the light of clinical experience in the treatment of paraplegics as well as the findings in experimental contusion and transection of the cervical cord.

Adult↗
PubMed1998

[Nerve cell damages in whiplash injuries. Animal experimental studies].

Mechanical loading of the cervical spine during car accidents often lead to a number of neck injury symptoms with the common term Whiplash Associated Disorders (WAD). Several of these symptoms could possibly be explained by injuries to the cervical spinal nerve root region. It was hypothesised that the changes in the inner volume of the cervical spinal canal during neck extension-flexion motion would cause transient pressure changes in the CNS as a result of hydro-dynamic effects, and thereby mechanically load the nerve roots and cause tissue damage. To test the hypothesis, anaesthetised pigs were exposed to experimental neck trauma in the extension, flexion and lateral flexion modes. The severity of the trauma was kept below the level where cervical fractures occur. Transient pressure pulses in the cervical spinal canal were duly recorded. Signs of cell membrane dysfunction were found in the nerve cell bodies of the cervical spinal ganglia. Ganglion injuries may explain some of the symptoms associated with soft-tissue neck injuries in car accidents. When the pig's head was pulled rearward relative to its torso to resemble a rear-end collision situation, it was found that ganglion injuries occurred very early on in the neck motion, at the stage where the motion changes from retraction to extension motion. Ganglion injuries did not occur when pigs were exposed to similar static loading of the neck. This indicates that these injuries are a result of dynamic phenomena and thereby further supports the pressure hypothesis. A Neck Injury Criterion (NIC) based on a theoretical model of the pressure effects was developed. It indicated that it was the differential horizontal acceleration and velocity between the head and the upper torso at the point of maximum neck retraction that determined the risk of ganglion injuries.

Animals↗
PubMed1998

On-field management of potential cervical spine injury in helmeted football players: leave the helmet on!

OBJECTIVE: Improper handling of an unstable neck injury in the prehospital setting may result in potential iatrogenically induced neurologic injury. On-site management of the neck-injured, helmeted football player differs from that of other traumatic cervical spine injuries. Controversy still exists regarding helmet removal protocols for stabilizing the cervical spine of helmeted football players with a suspected neck injury. This article provides a critical review of the scientific evidence on cervical spine management in helmeted football players with a suspected cervical spine injury. DATA SOURCES: A computerized literature search of databases (MEDLINE, Sportdiscus) and a manual search of journals from the sports medicine, emergency medicine, orthopedic, and athletic training literature identified articles related to the topic. Additional references were reviewed from the bibliographies of the retrieved articles. STUDY SELECTION: Conclusions are based on five quasi-experimental study designs evaluating motorcycle, football, and hockey helmet removal. In addition, an attempt was made to correlate articles relating to airway and cervical spine management in general trauma to the helmeted athlete. MAIN RESULTS: Several studies support the recommendation not to remove the helmet or shoulder pads in the prehospital setting unless absolutely necessary. If necessary, both helmet and shoulder pads should be removed together as a unit. There are neither published studies in support of helmet removal nor any case reports of increased morbidity to athletes because of failure to remove the helmet in the prehospital setting. CONCLUSIONS: Although studies support the notion that iatrogenic neurologic deterioration may occur with improper handling and attempted removal of the helmet in the prehospital setting, there is no literature to support increased morbidity associated with not removing helmet and shoulder pads. Stabilization of the cervical spine in an injured football player does not require routine prehospital removal of the helmet and shoulder pads before transport.

Cervical Vertebrae↗
PubMed2006

[Domestic violence: an analysis of injuries in female victims].

This study aimed to evaluate the prevalence of head and neck injuries in females based on complaints registered as bodily harm or cruel and unusual punishment at the Women's Defense Precinct in Araçatuba, São Paulo State, Brazil, in 2002. A total of 204 police inquiries were conducted in 2002, resulting in 33 police reports of bodily harm and cruel and unusual punishment to females. The police reports were examined as to victim's age and site of injury. The results showed that injuries are inflicted on various age brackets, with a higher prevalence in children and adolescents. In addition, the highest prevalence of injuries was in the head and neck, encompassing the area where dentists work and where they should be prepared to treat victims of such violence.

Adolescent↗
PubMed1997

Immediate management of posterior urethral disruptions due to pelvic fracture: therapeutic alternatives.

PURPOSE: We retrospectively reviewed the results of 3 types of initial management of pelvic fracture urethral disruption in children. MATERIALS AND METHODS: From 1980 to 1994, 35 boys 2 to 15 years old (mean age 8.1) with prostatomembranous urethral disruption were treated, including 17 who also had associated injuries. Immediate treatment included suprapubic cystostomy and delayed urethroplasty in 19 patients (group 1), urethral catheter alignment without traction and concomitant suprapubic cystostomy in 10 (group 2), and primary retropubic anastomotic urethroplasty in 6 (group 3). RESULTS: In all patients in groups 1 and 2 severe urethral obliteration developed. Four group 3 patients (66%) had a stricture at the site of anastomotic repair. After delayed urethroplasty 16 group 1 (84%) and all 10 group 2 patients were continent. However, only 3 group 3 patients (50%) achieved continence. Retrospectively associated bladder neck injury occurred in 5 of the 6 incontinent boys. Erections were observed before and after treatment in all but 3 children. Unstable pelvic ring fractures (type IV) comprised 28% of all pelvic fractures with a high rate of associated injuries. CONCLUSIONS: As described, urethral alignment was not beneficial for avoiding urethral obliteration. Therefore we recommend suprapublic cystostomy as the only form of initial treatment in these cases. Urinary incontinence seems more likely related to associated bladder neck rupture and the severity of pelvic fracture rather than to initial treatment or delayed urethral repair. Consequently, when associated bladder neck injury is present, we advocate immediate surgical repair.

Adolescent↗
PubMedDate not supplied

[Cervical foreign body. An unusual case].

Treatment for penetrating neck injuries remains highly controversial. Surgical intervention is mandatory in case of a patent wound or if unable to stabilize the patient. Otherwise, a selective approach is not an accepted option, although this criterion is becoming more popular due to its low morbidity and the likelihood to cure some unidentified injuries. We present a patient with a neck trauma caused by a metallic rod in a labour accident without any symptoms. The rod penetrated into his jugular vein and reached the heart area where it has remained imbedded for 5 years.

Adult↗