The hazards of anaesthesia in the injured patient.
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Analgesia↗
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Results for “Neck Injuries”
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Delayed bilateral internal carotid artery thrombosis following accidental strangulation.
A 24-yr-old male presented after a fishing accident in which he was pulled underwater by a rope attached to a crayfish pot. He was winched out of the water with the rope still around his neck, sustaining serious neck injuries that ultimately led to his death. After initial resuscitation, he remained fully conscious for approximately 8 h, after which there was a rapid and sudden deterioration in his level of consciousness. The presentation, investigation, management and subsequent postmortem findings are presented and discussed.
Adult↗
Unusual hanging deaths.
We describe the circumstances and medical findings of four unusual hanging deaths. In brief, the unusual features are tracheostomy, delayed death, self-mutilation combined with severe neck injury caused by lengthy drop, and homicidal hanging in a young girl.
Adult↗
Motor vehicle accidents: human causes and injuries sustained. An in-depth study of 35 accidents.
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Abdominal Injuries↗
Neck abscess after blunt cervical trauma.
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Abscess↗
Intraoperative endo-luminal ultrasound evaluation of urethral diverticula.
The imaging accuracy of a catheter-based endo-luminal ultrasound system was compared to traditional imaging techniques for surgical treatment of urethral diverticula in 7 women and 1 man. At surgical repair the urethra was catheterized directly with a 6.2F or 9F (12.5 or 20 MHz.) catheter-based ultrasound transducer, generating a 360-degree transaxial real-time image. The endo-luminal ultrasound images were compared with preoperative voiding cystourethrography (7 patients), transvaginal ultrasound examinations (3) and double balloon urethrograms (2). Surgical diverticulectomy was then done with endo-luminal ultrasound monitoring. Intraoperatively, all diverticula were well visualized by endo-luminal ultrasound, which demonstrated improved identification of the size and orientation of urethral diverticula, sludge within the diverticula, the extent of periurethral inflammation, diverticular wall thickness, and the distance between the diverticular wall and urethral lumen. In 3 patients the urethral connections of the diverticula were exceptionally well visualized. Comparison with traditional imaging revealed 2 false-negative and 1 false-positive voiding cystourethrograms, 1 false-negative transvaginal ultrasound study and 1 false-negative double balloon urethrogram. Intraoperative monitoring of the urethra enabled precise anatomical dissection, eliminated all diverticular components, and prevented inadvertent urethral and bladder neck injury. Urethral endo-luminal ultrasound is a valuable new adjunct in the evaluation of a variety of urethral abnormalities. This new ultrasound application permits visualization of the precise size, location, orientation and characteristics of urethral diverticula and surrounding tissues. Through enhanced imaging, surgical repair is facilitated. Further application of this technique should increase the diagnostic accuracy of urethral imaging beyond radiographic techniques currently available.
Catheterization↗
Syringomyelia associated with Hajdu-Cheney syndrome: case report.
OBJECTIVE AND IMPORTANCE: Hajdu-Cheney syndrome is a rare idiopathic bone disease based on a generalized bone dysplasia accompanied by acro-osteolysis. We describe a surgical case of this syndrome that was accompanied by neurological signs associated with cervical syringomyelia. CLINICAL PRESENTATION: A 41-year-old woman was referred to our hospital with mild quadriparesis and sensory disturbance resulting from a car accident. There was a neck injury. She showed almost all of the major characteristic clinical features and roentgenographic findings of Hajdu-Cheney syndrome with syringomyelia. INTERVENTION: Surgical treatment was indicated because of the progressive neurological deficits. Foramen magnum decompression and C1 laminectomy were performed, and the dura was exposed. The dura was opened at the area of the foramen magnum and C1. The occipitocervical posterior fusion was carried out with an iliac bone graft and titanium wires. CONCLUSION: Postoperatively, quadriparesis and sensory disturbance improved and the patient showed improved ambulation. Magnetic resonance imaging disclosed the well-decompressed foramen magnum. The syringomyelia disappeared in the segmental area of C2 and was decreased in the segmental areas of C5-T6. The treatment of this syndrome is symptomatic. In this patient, magnetic resonance imaging disclosed compression of the brain stem by basilar invagination and platybasia, disturbance of cerebrospinal fluid flow at the level of the foramen magnum, and syringomyelia. It was suspected that the obstruction of cerebrospinal fluid flow at the level of foramen magnum caused the cervical syringomyelia. However, the long-term prognosis remains uncertain. Follow-up is necessary to assess the final result of the treatment.
Adult↗
Apophysial joint degeneration, disc degeneration, and sagittal curve of the cervical spine. Can they be measured reliably on radiographs?
STUDY DESIGN: Interexaminer reliability study. OBJECTIVES: To determine the reliability of grading apophysial joint and disc degenerative changes and the reliability of measuring sagittal curves on lateral cervical spine radiographs. SUMMARY OF BACKGROUND DATA: Several authors have proposed that the presented of degenerative changes and the absence of lordosis in the cervical spine are indicators of poor recovery from neck injuries caused by motor vehicle collisions. The validity of those conclusions is questionable because the reliability of the methods used in their studies to measure the presence of degenerative changes and the absence of lordosis has not been determined. METHODS: Kellgren's classification system for apophysial joint and disc degeneration, as well as the pattern and magnitude of the sagittal curve on 30 lateral cervical spine radiographs were assessed independently by three examiners. RESULTS: Moderate reliability was demonstrated for classifying apophysial joint degeneration with an intraclass correlation coefficient of 0.45 (95% confidence interval, 0.09-0.71). Classifying degenerative disc disease had substantial reliability, with an intraclass correlation coefficient of 0.71 (95% confidence interval, 0.23-0.88). Measuring the magnitude of the sagittal curve from C2 to C7 had excellent interexaminer agreement, with an intraclass correlation coefficient of 0.96 (95% confidence interval, 0.88-0.98) and an interexaminer error of 8.3 degrees. CONCLUSIONS: The classification system for degenerative disc disease proposed by Kellgren et al and the method of measurement of sagittal curves from C2 to C7 demonstrated an acceptable level of reliability and can be used in outcomes research.
Analysis of Variance↗
Outcome of anterior cervical discectomy and fusion as perceived by patients treated for dominant axial-mechanical cervical spine pain.
STUDY DESIGN: An extensive outcome questionnaire using a visual analog scale, the North American Spine Society Satisfaction Questionnaire, a Modified Roland and Morris disability index, and a modified Oswestry Disability Index was used to assess the outcome of anterior cervical discectomy and fusion for those with neck pain. OBJECTIVE: To document the clinical outcome for 87 patients who underwent anterior cervical discectomy and fusion for the primary indication of neck pain, as assessed after an average follow-up period of 4.4 years. SUMMARY OF BACKGROUND DATA: Clinical outcome studies of anterior cervical discectomy and fusion with validated patient-perceived outcome measurements are few. METHODS: From the authors' database, 87 patients were identified who had undergone an anterior cervical discectomy and fusion for primary indication of dominant neck pain, and who had completed an extensive outcome questionnaire regarding pain and self-function at a mean 4.4-year follow-up assessment. RESULTS: This study documents a self-perceived satisfactory outcome rate of 82%. Patients reported on improvement of pain using visual analog scales, on function using modified Oswestry and modified Roland-Morris disability indexes, and on satisfaction using the North American Spine Society outcome tool. On an assessment 4.4 years on the average after the surgery, 82% of the patients (71/87) self-perceived their outcome to be good, very good, or excellent. Pain improvement was reported by 93% of the patients (81/87), whose average visual analog rating changed from 8.4 before surgery to 3.8 after surgery. The self-rated functional status improved approximately 50% on both the Oswestry and the modified Roland-Morris disability indexes. CONCLUSIONS: Properly selected patients who present with a primary indication of chronic neck pain report a high percentage of change in their self-perceived level of pain and function when treated with anterior cervical discectomy and fusion. Patients' self-expressed improvement with surgical management, as compared with their preoperative dissatisfaction because of their neck condition, documents that this surgical treatment is a reasonable option.
Adult↗
Computed tomography and magnetic resonance angiography in cervicocranial vascular disease.
Although catheter angiography, or digital subtraction angiography (DSA), is still regarded as the gold standard for imaging of cervicocranial vascular disease, its morbidity, cost, and time-consuming features have prompted the development of noninvasive techniques based on computed tomography (CT) and magnetic resonance imaging. With the advent of powerful software, CT and magnetic resonance angiography are complementing and, in some cases, even replacing DSA in the diagnostic evaluation of carotid atherostenosis, unruptured aneurysms, dissections, stroke, penetrating trauma to the neck, and dural venous sinus occlusive disease. They offer advantages over DSA not only in reduced morbidity and time-saving but also in assessment of brain parenchyma, quantitative perfusion, and abnormalities of vessel walls. In the evaluation of blunt neck injuries and intracranial vascular malformations, fistulas, and vasculitis, CT and magnetic resonance angiography still do not provide as much information as DSA.
Cerebral Angiography↗
Management guidelines for participation in collision activities with congenital, developmental, or postinjury lesions involving the cervical spine.
OBJECTIVE: Conditions involving the cervical spine in athletes requiring a management decision are numerous. This report presents appropriate guidelines for return to collision activities in those with congenital, developmental, or postinjury lesions. DATA SOURCES: Information was compiled from > 1,200 cervical spine lesions documented by the National Football Head and Neck Injury Registry and an extensive literature review. DATA SYNTHESIS: Available data as well as a clinical understanding of injury mechanisms have resulted in the development of reasonable management guidelines. Each of the congenital, developmental, and posttraumatic conditions presented are determined to present either no contraindication, relative contraindication, or an absolute contraindication to sport participation on the basis of a variety of parameters. Conditions included in the discussion are odontoid anomalies; spina bifida occulta; atlanto-occipital fusion; Klippel-Feil anomalies; cervical canal stenosis; spear tackler's spine; traumatic conditions of the upper, middle, and lower cervical spine, including ligamentous injuries and fractures; intervertebral disc injuries; and postcervical spine fusion. CONCLUSION: The proposed guidelines should be used in the decision-making process in conjunction with other such factors as the age, experience, ability of the individual, level of participation, and position played, as well as the attitude and desires of the athlete and his or her parents following an informed discussion of the problem with particular regard to potential risk.
Athletic Injuries↗
Where do we go after the three standard cervical spine views in the conscious trauma patient? A survey.
The objective of this study was to assess, by questionnaire survey, national practice in respect of radiological assessment of the cervical spine in the conscious adult patient with suspected neck injury. The physicians in charge of accident and emergency departments with more than 25000 new patients per year were sent a questionnaire. One hundred and ninety-one replies were received from 243 physicians (79%). Sixty-five per cent of departments have written protocols for imaging the cervical spine. Seven per cent of departments use fewer than the three standard views for clearing the cervical spine. If adequate views do not visualize the cervicothoracic junction, 89% use swimmer's views and 12% use supine oblique views, prior to computerized tomography scanning. It is concluded that the majority of departments use three standard views in the first instance. Swimmer's views are the most common additional X-rays taken if the C7-T1 junction is not visualized, even though supine oblique views give better information about spinal alignment. Imaging of the cervical spine following trauma is difficult and guidelines should be drawn up to address these problems.
Adult↗
Medical coverage for track and field events.
Providing medical coverage at a track and field event is similar to other spectator events, but there are some important differences. With simultaneous events occurring over a large area, reliable communication with quick access to all event sites is mandatory. Preparation needs to include a prearranged emergency response plan for each event. Because field events involve throwing heavy and sometimes sharp objects (discus, hammer, shot put, and javelin) or landing in a cushioned pit (high jump, pole vault), sites need well-demarcated, constantly monitored boundaries with properly installed, well-maintained safety equipment. All personnel involved in monitoring these events should be educated on proper procedure in managing potential head or neck injuries. Event officials must also remained focused on their tasks, avoiding the distractions that simultaneous events can cause. Because most events are outdoors, appropriate protection and recovery sites for heat, cold, and sun exposure should be arranged.
Arm Injuries↗
Virtopsy hemorrhage of the posterior cricoarytenoid muscle by blunt force to the neck in postmortem multislice computed tomography and magnetic resonance imaging.
In forensic autopsies, one of the most important and common signs of violence to the neck is hemorrhages of the soft tissues. The Institute of Forensic Medicine in Bern evaluates the usefulness of postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) of forensic cases prior to autopsy. The aim of this study was to prove the sensitivity of postmortem MSCT and MRI in the detection of hemorrhages of the neck muscles. A full body scan prior to and a detailed scan of the explanted larynx after autopsy were performed. MSCT detected multiple fractures of the larynx. Detailed MRI was able to demonstrate the hemorrhage of the left posterior cricoarytenoid muscle. The minor hemorrhage of the right posterior cricoarytenoid muscle could not be detected with certainty. Although more experience is required, we conclude that combined MRI and MSCT examination is a useful tool for documentation and examination of neck muscle hemorrhages in forensic cases.
Asphyxia↗
Anterior neck reconstruction with pre-expanded free groin and scapular flaps.
To improve aesthetic and functional outcomes in the reconstruction of severe anterior neck burn deformities and to reduce donor-site morbidity, pre-expansion of free-flap donor sites was performed in eight patients. In the first stage of reconstruction, the tissue expander was placed and gradually inflated over a period of 6 weeks. In the second stage, the anterior neck scar was resected up to the limits of the aesthetic unit of the neck, radical release of neck contracture was achieved by transection of contracted platysma muscle, and immediate coverage with a pre-expanded groin or scapular free flap was performed. The early postoperative course was uneventful. Physical therapy was started 1 week after the reconstruction. Long-term follow-up (mean, 4 years) of patients who underwent reconstruction of extensive neck burn deformities demonstrated good aesthetic and functional results. The advantages and drawbacks of using pre-expanded free flaps in the treatment of neck burn contractures are discussed.
Adolescent↗
Outcome after minor traffic accidents: a follow-up study of orthopedic patients in an inner-city area emergency room.
This follow-up study of consecutive traffic accident victims aimed to characterize the variation in recuperation time, to estimate the incidence of delayed recovery, and to identify predictors of nonrecovery 1 and 6 months after the accident. This study included 318 of 811 consecutive patients. Whiplash type neck injuries (48%) were the most common, followed by other minor injuries (38%). Self-perceived recovery was reported by 31% and 56% of the patients at 1 and 6 months, respectively. With control for mutual confounding variables in a multivariate model, injury severity, working status, and education were associated, respectively, with 4.5-fold, 3.2-fold and 2.3-fold gradients in odds of recovery not reported at 1 month. At 6 months, only working status (odds ratio [OR], 3.2) and education (OR, 2.3) were associated with the risk of reporting nonrecovery. The authors concluded that social factors are important predictors of outcome 1 and 6 months after minor traffic accidents.
Accidents, Traffic↗
A study of maxillofacial injuries in the elderly resulting from falls.
Falls are a major problem for the elderly, both in terms of the injuries sustained and the consequent loss of confidence and independence. Many studies, both prospective and retrospective, have investigated the possible causes and the resulting injuries following falls. However, no specific consideration appears to have been given to maxillofacial injuries. This survey examines the incidence of such injuries, over a three year period, in elderly patients presenting at an Accident and Emergency Department, and reviews the causes. Recognition of old age abuse is an essential aspect of the assessment of injuries in this group of patients.
Accidental Falls↗
Cerebral aneurysms and the 'missed' hemorrhage.
Eleven patients are described in whom a warning subarachnoid hemorrhage, preceding severe or fatal rupture of an intracranial aneurysm, was misdiagnosed; a 12th had a successful outcome from surgery after a single hemorrhage. Erroneous labels included meningitis, migraine, hysteria, tension, and head and neck injury. The vital importance of diagnosing an aneurysm before a major rupture occurs is emphasised. Apart from the 'warning leak', other signs may be due to the location or expansion of an aneurysm, which should alert doctors to the diagnosis.
Adult↗