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PubMed1995

Delayed subluxation of an occult traumatic odontoid fracture in an elderly patient.

The issue of whether a traumatic but occult cervical spine fracture can exist has generated significant debate in emergency medicine. The profound clinical and legal implications of missing an unstable cervical spine injury are well known to the emergency care provider. An elderly patient who satisfies all of the rigorous criteria for this type of injury is discussed. The patient experienced delayed subluxation of her acute odontoid fracture during a flexion/extension examination completed in the ED, with resultant development of cervical discomfort. Elderly victims of trauma with an appropriate mechanism of injury should be suspected of subtle or occult neck injuries.

Accidents, Traffic↗
PubMed1999

A retrospective review of air bag deaths.

OBJECTIVE: To describe occupant and crash characteristics in the first 27 publicly released investigations of air-bag-related fatalities. METHODS: A retrospective review of the first 27 released crash investigations of air-bag-induced fatalities was conducted. Data were obtained by the National Highway Traffic Safety Administration. RESULTS: Three separate groups of occupants are described: adult drivers, school-aged children riding in the right front passenger seat, and infants installed into rear-facing infant car seats placed into the right front passenger seat. Female drivers were significantly likely to be short-statured. Male drivers tended to be slumped over the wheel. Eleven children (100%) were improperly restrained and thrown forward by preimpact braking. Adults tended to have serious chest injuries, while children tended to have CNS or neck injuries. All three infants had fatal CNS injuries. The average deltaV (change in the vehicle's velocity at the moment of impact) was 12 mph and the average bumper crash was 8.8 inches. CONCLUSIONS: Air bags can cause fatal injury to car occupants in low- or moderate-speed crashes. Data suggest that proximity to the air bag at the time of deployment is the critical risk factor for fatal injury.

Accidents, Traffic↗
PubMed1997

Injuries from hovercraft racing.

A 31-year-old man presented with a potentially serious neck injury following a racing hovercraft accident. Previous reports of hovercrafting injuries could not be found, and a review of the sport's own records was undertaken. This shows there to be a wide range of injuries sustained from the sport, although most of them are minor. However, there are some worrying trends, and further studies are being undertaking in order to improve the sport's safety record.

Accidents↗
PubMed1989

Non-ejection cervical spine injuries due to +Gz in high performance aircraft.

The potential for significant neck injuries exists in today's high performance fighter aircraft. The G-loads required to produce injury need not be excessive, nor is experience level necessarily protective. Eight cervical spine injury cases, due to or aggravated by +Gz in F-15 and F-16 aircrew members are reviewed. These include two compression fractures (C5/C7), three left HNP's (C5-6/C6-7), one fracture of the spinous process (C7), one interspinous ligament tear (C6-7), and one myofascial syndrome (C6). Mechanisms of injury and evaluation are discussed. Exercise conditioning may play an important role in prevention and protection. The role of screening X-rays and improving equipment remain as areas where further work needs to be done.

Adult↗
PubMed1985

Emergency thoracotomy: a four-year review.

The case records of 200 patients who had emergency thoracotomy for penetrating trauma were reviewed. The mortality was 47% (93/200) for the entire series, 27% (21/79) for stab wounds and 60% (72/121) for gunshot wounds. Of 55 patients who underwent thoracotomy in the emergency department, 8 (15%) survived. Twelve patients "dead" at the scene could not be resuscitated. Nineteen patients sustained cardiac arrest in the ambulance, 3 (16%) of whom survived. Of 19 who had cardiac arrest in the emergency department, 5 (26%) survived. Of 38 patients who had cardiac arrest in the ambulance or emergency department, 14 with stab wounds had a 43% survival and 24 with gunshot wounds had a survival of only 8%. Patients who underwent thoracotomy in the operating room (OR) had a higher survival, 68% (99/145). For those with thoracic, extremity, or neck injuries, survival was 81% (93/115). For those who had an OR thoracotomy for aortic cross-clamping because of abdominal injuries, survival was only 17% (5/30). Early thoracotomy has a place in the management of patients who have cardiac arrest in the ambulance or emergency department because of penetrating chest, neck, or extremity injuries, especially if caused by stab wounds. Cross-clamping of the thoracic aorta for massive abdominal bleeding should be applied selectively.

Adolescent↗
PubMed2005

Relationship between Northwick Park neck pain questionnaire and cervical spine MR imaging findings.

The study was aimed at determining the association between the self-report of pain and disability by means of Northwick neck pain questionnaire (NPQ) and cervical spine MR imaging findings. A random sample of 251 patients, 132 men and 119 women aged 43+/-13 years, submitted with neck pain were investigated. Patients with previous discitis, surgery, neoplasm or hospitalized for cervical spine trauma were excluded. All patients completed the NPQ and were studied with sagittal gradient-echo T1 and turbo spin-echo T2, axial gradient-echo T2* and heavily T2 weighted MR myelographic weighted images. MR images of the two most affected disc levels were read, offering an MR imaging score from 0 to 30. There was no statistically significant correlation between NPQ and MR imaging scores. From the NPQ items, only difficulty in sleeping and numbness were related to the MR imaging score. Disc extrusion was the only MR finding almost significantly associated with NPQ (P=0.054). Neck injury did not increase NPQ scores. In patients with neck pain, NPQ scores do not correlate with MR imaging findings. NPQ and cervical spine MR imaging show different facets of the multidimensional complex of neck pain.

Adult↗
PubMed1983

Injuries sustained from high-velocity impact with water after jumps from high bridges. A preliminary report of 10 cases.

Autopsy findings in 10 cases of high-velocity impact with water--all suicides--are demonstrated. The injuries vary from no lesion at all to severe injuries, the fatal injuries predominately located to the thorax and the spine. All but one victim fell 35-37 meters; the last one fell 51 meters. The cause of death was drowning in six cases; in four cases, injuries were responsible for the fatal outcome. Head and neck injuries of any importance were not observed in the present investigation.

Adult↗
PubMed1995

The limitations of current seatbelts in Europe--some population considerations.

Seatbelts are most likely to function as they were designed if the car occupants' survival space remains uncompromised during an impact. Crashed cars with negligible passenger compartment intrusion were used to study seatbelt effectiveness in that situation. Belted front seat occupants were investigated together with their front impacted vehicles. Current model seatbelts were seen to prevent many more forward contacts than those seen in a similar study 15 years ago. In the earlier study, head contacts occurred to 65% of drivers whereas the current sample contained 24%. The present study also found that thigh or knee contacts were common occurrences for drivers and front seat passengers, as were thoracic injuries caused by loads from the belt itself and neck injuries caused by deceleration. The results emphasize how real people, unlike crash test dummies, have varied characteristics that influence seatbelt performance.

Accidents, Traffic↗
PubMedDate not supplied

Long-term sequelae following blunt thoracic trauma.

People experiencing blunt thoracic trauma may sustain multiple rib fractures, flail chest, cardiac or pulmonary contusions, injury to the great vessels, sternal fractures, clavicular fractures, neck injuries, and lacerations of the liver and/or spleen. Long-term sequelae from blunt chest trauma include chest wall deformities, persistent dyspnea, and cardiac, neurologic, or esophageal complications. Chronic pain, depression, and loss of functional status are also frequent components of recovery from trauma.

Humans↗
PubMed1992

[Injuries caused by automobile safety glass].

The report initially discuss the properties and application of tempered glass (TG) and laminated glass (LG) in motor vehicles. Although the trunk and extremities are injured these injuries are seldom life threatening. In contrast, head or neck injuries present a greater threat to life. Especially serious are TG injuries resulting in blindness. The resultant vehicle damage can appear not only as isolated glass cracking, which occurs regularly accompanying injuries without loss of consciousness, but as deformation of the vehicle interior adjacent to the windscreen. In the cases where more solid structures are impacted fatal injuries are possible. This report presents detail both of some real accident investigations and of 9 simulated oblique collisions using 9 post mortem human subjects (PMHS's). In these 9 simulations the head impacted during the primary impact phase against side windows constructed from TG. A modified tempered glass construction (two plates sandwiching a 3 mm air layer) was also tested. Impact angles were 35 to 45 degrees. The severity of facial laceration was dependent on collision severity, type of glass and glass damage resulting from head impact. Minor or severe cutting injuries of the face were caused. Only through the investigation of real accidents and accident simulations can occupant safety be improved.

Acceleration↗
PubMed1985

Injury pattern analysis of helicopter wire strike accidents (-Gz load).

Injury patterns in rotary wing aircraft wire strike accidents were reviewed to determine mechanisms of injury. It was found that U.S. Army Safety Center data showed that between 1 January 1974 and 31 August 1981 there were 167 wire strikes involving Army helicopters which resulted in 60 injuries and 34 fatalities at a cost of $12,809,100. Updated data on all military rotary wing aircraft accidents investigated between 1978 and 1982 were screened by the Division of Aerospace Pathology to determine the mechanisms of injury to flight deck personnel. From 13 December 1978 to 23 June 1982, three types of rotary wing aircraft were in eight fatal accidents. These mishaps accounted for 28 casualties: 14 fatalities and 14 injuries. Aviators comprised 64.4% of the fatalities. Injury pattern analysis showed 100% had major head and neck injuries with 66% having basilar skull fractures. Two-thirds had associated mandibular fractures or evidence of impact forces transmitted through the mandible to the skull. The same number had wedge-shaped chin lacerations from impact with the cyclic control stick. We postulate transmission of lethal impact forces primarily in the +Gz direction through the mandible to the skull. This suggests either improper use and/or failure of the seat and restraint systems.

Accidents, Aviation↗
PubMed1996

Multimodal treatment to prevent the late whiplash syndrome.

In order to assess the long-term efficacy of a multi-modal rehabilitation approach on whiplash injury, 60 patients were recruited within two months after neck injury. They were randomly allocated either to an experimental multimodal treatment (A) consisting of postural training, manual technique and psychological support or to a control treatment (B), using physical agents only, such as electrical and sonic modalities. Pain level, range of movement, self-rating scale of treatment efficacy and return-to-work delay were evaluated before and at the end of treatment, and later, 30 and 180 days after randomisation. The benefit obtained with treatment "A" was greater and longer lasting than that experienced using "B", despite the fact that the same benefit was obtained in joint mobility in the two groups. Patients undergoing the experimental treatment returned to their usual occupations sooner than the controls. The results seem to confirm the hypothesis of a multifactorial involvement as a possible mechanism for the late whiplash syndrome.

Adolescent↗
PubMed1998

A high rate of injury during the 1995 Rugby World Cup.

OBJECTIVE: To determine the frequency and nature of injuries sustained by the 416 players from 16 countries participating in the 1995 Rugby World Cup played in South Africa in May/June 1995. METHODS: The study was a prospective analysis of all injuries requiring medical attention during that competition. Data were collected by the match doctors on duty at each of the venues at which the matches were played. Data were collated and analysed. RESULTS: There were 48 preliminary and 7 final-round matches. Of a total of 70 injuries during the tournament, 58 occurred during the preliminary matches (frequency 30 injuries per 1000 player hours); the frequency was somewhat higher during the 7 final-round matches (43 injuries per 1000 player hours). Overall injury frequency was 1 injury every 0.8 matches during the preliminary and 1 every 0.6 matches during the final-round matches. Thirty per cent of injuries were to ligaments, 27% were lacerations and 14% were muscle strains. The lower limb accounted for 42% of all injuries, the upper limb for 29% and the face for 17%. Fifty-six per cent of injuries occurred during the tackle phase of play, 23% during the ruck and maul, 11% during open play and 9% during foul play. The scrum and line-out together contributed only 1% of all injuries. Loose forwards suffered 25% of all injuries; centres and wings 20%; prop forwards and half-backs 16% each; locks 14%; hookers 7% and fullbacks 3%. One player suffered a paralysing spinal cord injury during a preliminary match. The incidence of catastrophic neck injuries in the tournament was therefore 4.6 per 10,000 player hours. CONCLUSIONS: The frequency of injury in this competition is the highest yet recorded in any group of rugby players. The risk of rugby injury is therefore greatest in the best players in the game, challenging the view that superior fitness, skill and experience can reduce the risk of rugby injury. In contrast, the larger size, greater speed and superior competitiveness and commitment of the best rugby players in the world would explain why they are at the highest risk of injury. The high frequency of injury in international rugby has implications for: (i) the frequency with which such matches should be played; and (ii) the number of players needed to complete a season of international rugby.

Athletic Injuries↗
PubMedDate not supplied

[Cervical findings and petechial hemorrhages in falls from high positions].

Cases of combined suicide are infrequent findings, especially cases in which each method can be lethal. In interpretation of cases with a multitude of serious injuries it might be impossible to discover minor injuries which had occurred in the course of a preceding confrontation, because they may be masked by the general traumatization. In two cases of suicidal fall from a height neck injuries and petechial bleedings were found. The first case (woman 53 years) was a combination suicide (strangulation by ligature, deep incisions into her wrists, jump out of the window). The intensive petechial bleedings in the face could be explained as a result of ligature strangulation and the fracture of a lower thyroid horn as an indirect fracture resulting of the head traumatization. In the second case (girl, 14 years) petechial bleedings in the face were found. Furthermore the victim had marks on her neck-skin, consisting of well-lined bleedings and scratches, presenting a clear pattern, which could be related to a necklace. An explanation of these injuries as a result of a direct impact could not be given. Something must have happened prior the fall. Informations concerning the last hours before her suicide could not be obtained but a strangulation-attempt (by herself? by others?) must be ascertained. The histological investigation of the skin of this region arised a negative vital reaction, therefore a very short interval between that event and the death was assumed.

Adolescent↗
PubMed1993

Penetrating injuries to the neck: a safe, selective approach to management.

The most appropriate management of patients with penetrating injuries to the neck remains a controversial issue. In order to determine the safety and efficacy of a selective approach to the management of such patients, a retrospective review of our experience with penetrating injuries to the neck at Northwestern Memorial Hospital over the past 5 years since the designation as a Level I trauma center was undertaken. A total of 30 patients fulfilled entry criteria. Twelve patients underwent immediate operative exploration based upon clinical indications present at admission. Seventeen patients underwent further diagnostic evaluation, including angiography in 17 and contrast esophagography in eight. Endoscopy was used infrequently. The mortality rate was 13.3 per cent, there were two negative cervical explorations, and there were no missed injuries. The results support the application of a selective approach to the operative management of penetrating injuries to the neck.

Adolescent↗
PubMed1986

Injury to the upper cervical spine: fracture versus congenital anomaly.

As skull and cervical spinal radiographs are being obtained routinely on head and neck injuries, more incidental anomalies of the neck region are being detected. The differentiation of congenital anomaly from fracture can be difficult. The importance of this, however, cannot be underestimated because of the dire consequences of a missed cervical fracture. A case of such an anomaly and its presentation following injury is presented.

Adolescent↗