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PubMedDate not supplied

Acute cervical strain. Evaluation and short term prognostic factors.

An independent examiner evaluated 179 consecutive private ambulatory litigant patients with soft tissue neck injuries (whiplash) from automobile injuries. Treatment of all patients consisted of neck and shoulder exercises with the exclusion of cervical collars, cervical traction and hospitalization. Forty-three patients had intermittent cervical traction in addition to the exercises. All patients were encouraged to resume their usual work and other activities. The presence of interscapular or upper back pain prognosticated a less favorable result. The average length of treatment was 7.4 weeks. Thirty-seven per cent of the patients with asymptomatic; 16 per cent showed no significant recovery. Older patients recovered as well as younger patients. There was no relation between X-ray findings of flattening or reversal of the cervical lordotic curve and the degree of recovery.

Adult↗
PubMedDate not supplied

Penetrating injuries of the visceral compartment of the neck.

Penetrating injuries of the visceral compartment of the neck are uncommon but potentially life threatening. A retrospective review of patients who sustained penetrating trauma to the laryngotracheal complex was conducted at the Level I trauma center of the University of Louisville Hospital in Kentucky. Sixteen patients were identified and their records reviewed for type of injuries, treatment, complications, and 1-year follow-up. The majority of patients were men who sustained injuries that were violent in nature. Zone II of the anterior neck was the most commonly injured area, with the trachea (69%), esophagus (38%), and larynx (31 %) the most commonly injured structures. Although 31% underwent angiograms, only 13% showed vascular injuries. Eighty-one percent of the patients had injuries involving more than 1 major structure of the neck. Neck exploration was performed in 81% of the patients and tracheotomies in 75% as well as repair of the trachea (50%), larynx (31%), and esophagus (38%). There is significant mortality associated with these injuries (13% in our study), and many of the patients have long-term sequelae such as dysphagia, hoarseness, and prolonged tracheotomy.

Adolescent↗
PubMedDate not supplied

Dental aspects of 1248 cases of child maltreatment on file at a major county hospital.

The frequency of head, face, mouth, and neck injuries due to child maltreatment was investigated in a review of 1248 cases on file in the pediatrics office at Hennepin County Medical Center in Minneapolis, Minnesota, from January, 1985, to December, 1989. There were 485 boys (38.8%) and 763 girls (61.2%) examined. Physical abuse cases (41.0%) outnumbered sexual abuse (35.4%) and neglect episodes (23.6%). The gender ratio was distributed equally except in sexual abuse, where there were 4.7 girls for each boy examined. More than half of the children (52.9%) were in the 0-to-4 year age group. Considering all cases together, 37.5% presented with injuries to the head, face, mouth, and neck. However, that percentage doubled (75.5%) when physical abuse episodes were reviewed alone. The intraoral injuries seen were five tooth fractures, three tongue and tongue frenulum lacerations, two lip frenulum lacerations, 11 injuries to the oral mucosa, eight palatal lesions, two fractures of the mandible or maxilla, loose and missing teeth, and dental neglect. Despite the high frequency of injuries, no dentists examined children at the time of the hospital intake or referred children for suspicion of maltreatment in the population studied. The findings suggest the importance of involving dental professionals in identifying, reporting, and preventing child abuse and neglect.

Adolescent↗
PubMed1980

The late whiplash syndrome.

A condition commonly seen after motor vehicle accidents is studied. This is the "late whiplash" syndrome, which is defined as a collection of symptoms and disabilities seen more than six months after a neck injury occurring in a motor vehicle accident. A series of 300 cases is examined. With the use of factor analysis the syndrome is defined as consisting of headache, neckache, neck stiffness, and depression, as well as anxiety, all of which are strongly correlated with each other. There is, on the other hand, a poor correlation with physical or radiological abnormalities. The condition is common in women, especially in the 21 to 40 years' distribution. It is shown that social variables may be relevant n the production of the syndrome.

Accidents, Traffic↗
PubMed1989

Strangulation. A conceptual approach for courtroom presentation.

A conceptual approach is presented herein to assist forensic pathologists in their courtroom explanation of asphyxial deaths due to strangulation. Two-dimensional visual aids have been designed for jurors to understand easily the anatomic structures of the neck, the classic external features of asphyxia, and the directionality of force applied to the neck, as well as internal neck injuries associated with various forces.

Asphyxia↗
PubMed2003

Seat properties affecting neck responses in rear crashes: a reason why whiplash has increased.

Whiplash has increased over the past two decades. This study compares occupant dynamics with three different seat types (two yielding and one stiff) in rear crashes. Responses up to head restraint contact are used to describe possible reasons for the increase in whiplash as seat stiffness increased in the 1980s and 1990s. Three exemplar seats were defined by seat stiffness (k) and frame rotation stiffness (j) under occupant load. The stiff seat had k=40 kN/m and j=1.8 degrees /kN representing a foreign benchmark. One yielding seat had k=20 kN/m and j=1.4 degrees /kN simulating a high-retention seat. The other had k=20 kN/m and j=3.4 degrees /kN simulating a typical yielding seat of the 1980s and 1990s. Constant vehicle acceleration for 100 ms gave delta-V of 6, 10, 16, 24, and 35 km/h. The one-dimensional model included a torso mass loading the seatback, head motion through a flexible neck, and head restraint drop and rearward displacement with seatback rotation. Neck displacement was greatest with the stiff seat due to higher loads on the torso. It peaked at 10 km/h rear delta-V and was lower in higher-severity crashes. It averaged 32% more than neck displacements with the 1980s yielding seat. The high-retention seat had 67% lower neck displacements than the stiff seat because of yielding into the seatback, earlier head restraint contact and less seatback rotation, which involved 16 mm drop in head restraint height due to seatback rotation in the 16 km/h rear delta-V. This was significantly lower than 47 mm with the foreign benchmark and 73 mm with the 1980s yielding seat. Early in the crash, neck responses are proportional to ky/mT, seat stiffness times vehicle displacement divided by torso mass, so neck responses increase with seat stiffness. The trend toward stiffer seats increased neck responses over the yielding seats of the 1980s and 1990s, which offers one explanation for the increase in whiplash over the past two decades. This is a result of not enough seat suspension compliance as stronger seat frames were introduced. As seat stiffness has increased, so have neck displacements and the Neck Injury Criterion (NIC). High-retention seats reduce neck biomechanical responses by allowing the occupant to displace into the seatback at relatively low torso loads until head restraint contact and then transferring crash energy. High-retention seats resolve the historic debate between stiff (rigid) and yielding seats by providing both a strong frame (low j) for occupant retention and yielding suspension (low k) to reduce whiplash.

Accidents, Traffic↗
PubMed2005

Does the National Emergency X-ray Utilization Study make a difference?

OBJECTIVE: To assess whether the introduction of the National Emergency X-ray Utilization Study guidelines in a UK emergency department reduced the number of patients having cervical spine radiographs and altered the accuracy of diagnosis of cervical spine injury. METHODS: This was a prospective, observational study. The number of patients with recent neck injury who had cervical spine radiographs taken was assessed for 3 months before and three months after the introduction of the National Emergency X-ray Utilization Study guidelines to an urban emergency department in the UK. The number of injuries missed by emergency department doctors during the two 3-month periods was also recorded. RESULTS: Prior to using the guidelines, 252 of 715 patients (35%) were X-rayed and when using the guidelines, 268 of 706 patients (38%) were X-rayed. No significant difference was observed between the rates of X-ray in the two groups (P=0.288). No injuries were missed by emergency department doctors either before or after the introduction of the guidelines. CONCLUSION: Introduction of the National Emergency X-ray Utilization Study guidelines to a UK emergency department did not reduce the number of patients having cervical spine radiographs after neck trauma and had no effect on the pick-up rate for cervical spine injuries.

Cervical Vertebrae↗
PubMed1982

The late whiplash syndrome: a study of an illness in Australia and Singapore.

A condition commonly seen after motor vehicle accidents, the Late Whiplash Syndrome, which is defined as a collection of symptoms and disabilities seen more than six months after a neck injury occurring in a motor vehicle accident, is examined in a series of 300 cases. The author suggests that the development of the Late Whiplash Syndrome, some of whose characteristics are viewed as illness and some as illness behavior, depends on social variables. The differential distribution in Western countries and in Singapore is related to sanctions against entry into the sick role associated with this type of injury which are present in countries such as Singapore. Conversely, motor vehicle injury is legitimized in Western Countries such as Australia as an historical overview shows. The author's model of the Late Whiplash Syndrome lends itself to generalizations about the development of social illness in different cultures.

Accidents, Traffic↗
PubMed1990

Injury biomechanics of the human cervical column.

In this study, the authors have developed a technique to replicate clinically relevant traumatic cervical spine injuries and determined the injury biomechanics. Because of the importance of compressive forces in neck injuries, this research was conducted using compression as the primary load vector. Six fresh human cadaveric head-neck complexes were prepared by fixing the distal end in methylmethacrylate. Tests were done with varying loading rates to include quasistatic and dynamic conditions. For quasistatic experiments, the proximal end was fixed to the piston of the testing device. In dynamic tests, the cranium was unconstrained, and to maintain stability, the effects of the spinal musculature were simulated by means of pulleys, deadweights, and springs in the anterior and posterior parts of the head-neck complex. Quasistatic tests conducted at a rate of 2.0 mm/sec produced cervical spine trauma at forces ranging from 1.7 to 2.3 kN, with deformations ranging from 2.2 to 3.7 cm. The specimens were deep-frozen at the level of injury, preserving the local deformation of the tissues to enable a detailed evaluation immediately after the injury. Dynamic tests conducted at velocities of 3.2 to 5.7 m/sec resulted in impact injuries at one level of the head-neck complex. The applied forces at the vertex were considerably higher than those recorded at the distal end. The failure deformations for both the quasistatic (2.2-3.7 cm) and dynamic (1.7-3.2 cm) tests, however, were found to be similar, suggesting that the human head-neck complex is a deformation-sensitive structure.

Aged↗
PubMed2003

Fatal trauma to the neck: immunohistochemical study of local injuries.

As fatal trauma to the neck is often associated with short survival times, proof of vitality may often be difficult using standard histochemical techniques. Soft tissue neck injuries resulting from strangulation by ligature or manual strangulation were examined immunohistochemically using antibodies to myoglobin, fibronectin, C5b-9 and MRP14, and compared to controls consisting of accidental soft tissue neck injuries as well as undamaged neck soft tissue. Although survival times in the study and control groups were unknown and certainly some individual variation may be expected in the time course of normal wound development, both the study and control groups demonstrated similar time courses in the immunohistochemical detection of antigen. Myoglobin was always found in those samples in which only one antigen was shown to be involved in an injury-specific pattern; myoglobin and fibronectin were found in samples with dual antigen involvement. Samples involving three antigens always included C5b-9 in addition to myoglobin and fibronectin. The single positive MRP14 sample in the study and control groups was simultaneously positive for the other markers used. Myoglobin, fibronectin, C5b-9 and MRP14 are therefore suitable for immunohistochemical detection of vital reactions and estimation of temporal relationships in the early posttraumatic period after neck trauma.

Adolescent↗
PubMedDate not supplied

Dissection of the vertebral arteries: case report and discussion.

Vertebral artery dissection is an unusual condition with potentially protean neurologic presentations. It may occur spontaneously or follow apparently minor neck trauma. Ischemic symptoms related to the posterior circulation ensue and may be due to obstruction or embolization. The ensuing stroke is ischemic, although subarachnoid hemorrhage may be a complication as well. A case of vertebral artery dissection in a young woman who developed symptoms approximately one week after mild neck injury is reported, and the topic is reviewed.

Adult↗
PubMed1998

Injury mortality and morbidity among children in the United Arab Emirates.

UNLABELLED: The objective of this study was to identify the major causes of accident mortality and morbidity among children (0-14 years) in Al-Ain, United Arab Emirates (UAE). A retrospective descriptive study was set in the Al-Ain Hospital and Preventive Medicine Department, Ministry of Health, Al-Ain. Subjects were all patients aged 0-14 years who were seen at Al-Ain Hospital for injury during the 12-month period January to December 1995, and all recorded deaths aged 0-14 years in Preventive Medicine Department from 1980 to 1995. RESULTS: Mortality: 301 children (69.4% males, 30.6% females) died after accidents from 1980 to 1995. UAE citizens and other Arabs represented the majority of deaths. Most mortality (28.6%) occurred in the 1-4 year age group. Head and neck injury was the major type of injury causing death (57.5%). The most common cause of accidental death was road traffic accidents (boys 67.1%, girls 60.4%), followed by drowning and burns (8%). Morbidity: Pediatric trauma cases seen during 1995 totaled 17,498, representing one third of all patients attending the Hospital Emergency Room. About 70% of encountered injuries occurred among boys; 44.6% of cases were UAE citizens. The most common trauma type was contusion (40.2% boys; 40.6% girls), the most common type of trauma in boys and girls (30.4% and 36%, respectively). In the age group <5 years, the most common causes of trauma were fall (41.1%), blunt trauma (38.7%) and burns or scalds (64%), while in 5-9 year olds, the most common cause was road traffic accidents (40%). Finally, in 10-14 year olds, the most frequent causes were traffic accidents (32.8%) sharp objects injuries (38.3%), and fights and sporting (28.9%). CONCLUSION: More boys than girls presented with injury and the majority were nationals. Road traffic accidents mainly occurred in children over 10 years.

Accidental Falls↗
PubMed2006

Investigation of injury potential through matched pair drop testing.

The National Highway Traffic Safety Administration has concluded that there is a relationship between roof intrusion and the risk of injury to belted occupants in rollovers events. Previous testing on many different production vehicle types indicates that damage consistent with field rollover accidents can be achieved through inverted drop testing from small drop heights. It has been shown in previous drop test pairs with Hybrid III dummies, that the amount of roof intrusion is related to occupant neck injury. This paper analyzes inverted drop testing performed on Ford F250 Crew Cab production and reinforced pickups. Each of these pickup tests used Hybrid III test dummies in order to evaluate the occupant injury potential in relation to roof intrusion. The reinforced truck's residual crush was an order of magnitude less than the production truck crush. These tests indicated that the reduction of roof crush resulted in a direct reduction in neck loading and therefore an increase in occupant protection. In addition, it was found that the restraint loading was inversely related to the neck loading of the dummies.

Accidents, Traffic↗
PubMed1976

Penetrating trauma of the neck.

Two hundred forty-six patients admitted to the Trauma Unit of Cook County Hospital with penetrating neck wounds have been reviewed. A policy of mandatory neck exploration combined with a systematic approach to resuscitation and a diagnostic evaluation including neck and chest X-rays, endoscopy, and arteriography has been employed. The study has revealed a high incidence of negative neck explorations (63%) but minimal morbidity (less than 1%), no mortality, and a brief duration of hospitalization in the negative exploration group. Patients with positive explorations had an 8% morbidity and a 9% mortality rate. In addition, 13 of the patients with positive explorations had clinically negative wounds which might have been overlooked if selective management had been utilized in this series. We conclude that a policy of mandatory neck exploration is justified and advisable for patients sustaining penetrating neck injuries.

Adolescent↗
PubMed2004

Burns and tracheo-oesophageal-cutaneous fistula.

We report an unusual case of electric burns suffered by a 15-yr-old boy. The patient's neck had come in contact with a high voltage broken electric wire and by reflex he had pulled it away with his right hand. He presented with a tracheo-cutaneous fistula with a right-sided pneumothorax. Emergency airway management included insertion of a tracheostomy tube through the traumatic opening in the neck and insertion of an intercostal tube drain. When the diagnostic endoscopy revealed an externally communicating tracheo-oesophageal fistula, protecting the lower airways from gastrointestinal contamination became a priority. The patient was anaesthetized through the traumatic tracheostomy and a formal low tracheostomy was done below the level of the fistula. The patient then underwent oesophageal reconstruction with a stomach free flap. Tracheo-oesophageal-cutaneous fistula is a rare presentation of electric burns. The anaesthetic management of the emergency difficult airway in any penetrating neck injury can be extremely difficult requiring a carefully planned multi-disciplinary approach.

Adolescent↗
PubMed2002

Avulsion transverse ligament injuries in children: successful treatment with nonoperative management. Report of three cases.

Neck injuries in children most commonly affect the upper cervical spine. Injuries of the transverse ligament and its attachments may result in C1-2 instability, but the optimum form of treatment is unknown. Three patients, who ranged in age from 5 to 11 years, sustained transverse atlantal ligament injuries with unilateral avulsion fracture of the osseous tubercle of C-1. One child was injured in a fall and two were involved in motor vehicle accidents. Although all patients presented with neck pain, none exhibited neurological deficits. Plain radiography demonstrated no evidence of osseous injury, but an increased predental interval was noted in each case. Computerized tomography (CT) scanning demonstrated the avulsion fractures, and magnetic resonance imaging revealed evidence of soft-tissue injuries in the occipital-C2 ligamentous complex. All children were managed with external immobilization (halo vest in two and a Sterno-Occipito-Mandibular Immobilizer brace in one), for 6 to 12 weeks. Follow-up CT scanning demonstrated reattachment of the avulsed osseous tubercle, and dynamic cervical spine radiographs revealed the absence of C1-2 instability. The results of these cases suggest a role for external immobilization in the treatment of osseous avulsion injuries of the transverse atlantal ligament in children.

Cervical Vertebrae↗
PubMed2001

Traumatic Brown-Séquard-plus syndrome.

BACKGROUND: In the 1840s Brown-Séquard described the motor and sensory effects of sectioning half of the spinal cord. Penetrating injuries can cause Brown-Séquard or, more frequently, Brown-Séquard-plus syndromes. OBJECTIVE: To report the case of a 25-year-old man who developed left-sided Brown-Séquard syndrome at the C8 level and left-sided Horner syndrome plus urinary retention and bilateral extensor responses following a stab wound in the right side of the neck. RESULTS: Magnetic resonance imaging demonstrated a low cervical lesion and somatosensory evoked potentials confirmed the clinical finding of left-side dorsal column disturbance. At follow-up, the patient's mobility and bladder function had returned to normal. CONCLUSION: This patient recovered well after a penetrating neck injury that disturbed function in more than half the lower cervical spinal cord (Brown-Séquard-plus syndrome).

Adult↗