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[On the problem of injuries of the neck and head of the femur in newborn infants].
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[ON THE PROBLEM OF THORACIC DUCT INJURIES DURING RADICAL NECK DISSECTION].
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Laryngotracheal transection in blunt trauma of the neck.
Laryngotracheal injuries are relatively rare following blunt trauma to the neck and chest but results in a high degree of morbidity and mortality. Complete disruption of the trachea is extremely rare and a systematic approach is needed for early diagnosis and management. The symptoms and physical signs do not necessarily correlate with the severity of injury as was observed in the presented cases here. An early diagnosis and surgical exploration is a must for a reasonably favourable outcome.
[Direct and indirect trauma in resuscitation (author's transl)].
To provide accident surgeons working under extreme conditions with reports on the results of their efforts, the complications of resuscitation measures in 30 atraumatic deaths in which a final fall was to be excluded were analyzed in a fundamental study. According to these results, there are two predilection sites for injuries, viz., the thorax and neck. Thus, injuries to the bones of the thorax, which had occurred in 70% of all cases, were found regularly in rigid emphysematous thorax, and in 40% in elastic thorax after external cardiac massage. The typical secondary injuries are dealt with. Because of the great danger of a liver injury as observed in two cases, resuscitation measures using an extrathoracic cardiac massage machine appear to be problematic even if injuries to the bones of the thorax can be avoided in an elastic thorax. Injury to the neck after intubation occurred nearly as often as injuries to the thorax after external cardiac massage. Local injuries were predominantly small hemorrhages and abrasions at the base of the tongue and in the tonsillar ring on the right. Hemorrhages in the neck musculature are likely to be attributed to the abutment injury, and the retropharyngeal hemorrhages to hyper-extension. The single organ most frequently injured overall was the cervical spine with an injury frequency of 66%. However, there was no indication, not even in a single case, that resuscitation measures had shortened the life of a patient.
Management of carotid injuries in a hostile neck using endovascular grafts.
Pseudoaneurysms and iatrogenic injuries of the extracranial carotid artery are not common but represent unique operative challenges with associated high morbidity and mortality. We report two cases in which a Wallgraft was used via percutaneous femoral access to treat such injuries. In the first, a 6-cm carotid pseudoaneurysm was successfully excluded by coil embolization of the external carotid artery and stent grafting across the carotid bifurcation. In the second case, an endovascular graft was used to treat an intraoperative common carotid injury in a re-operated, radiated neck. These cases demonstrate the utility of endovascular graft treatment of emergent carotid injuries.
Whiplash injury and chronic neck pain.
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Injuries to the eye and visual apparatus associated with injury to the head, neck, and chest.
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Aerodigestive injuries of the neck.
Cervical aerodigestive trauma is rare and most centers have a limited experience with its management. The purpose of this review was to study the epidemiology, diagnosis, and problems related to the early evaluation and management of these injuries. This was a retrospective study based on trauma registry and on chart, operative, radiological, and endoscopic reports. There were 1560 admissions with blunt or penetrating trauma to the neck. The overall incidence of aerodigestive trauma was 4.9 per cent (10.2% for gunshot wounds, 4.6% for stab wounds, and 1.2% for blunt trauma). All patients with aerodigestive trauma had suspicious signs or symptoms on admission. The most common life-threatening problem in the emergency room and directly related to the aerodigestive trauma was airway compromise. Twenty-nine per cent of patients with laryngotracheal trauma required an emergency room airway establishment because of threatened airway loss. Although rapid sequence induction was successful in the majority of cases, in 11.9 per cent there was loss of airway and a cricothyroidotomy was necessary. Overall, 9 per cent of cases with aerodigestive injuries were successfully treated nonoperatively. Thirty-six per cent of patients with laryngotracheal trauma and surgical repair were successfully treated without a protective tracheostomy. There was no mortality due to the aerodigestive injuries. Cervical aerodigestive trauma is rare. In conclusion, all patients with significant aerodigestive injuries requiring treatment had suspicious signs and symptoms. Airway compromise was a common problem in the emergency room. Loss of airway after rapid sequence induction is a potentially lethal complication and the trauma team should be ready for a surgical airway. Repair of laryngotracheal injuries without a protective tracheostomy is safe in selected cases.
Risk of pelvic injury from femoral neck guidewires.
Many of the devices used in the internal fixation of femoral neck fractures are cannulated and require the initial placement of one or more guidewires for accurate positioning. These wires are occasionally advanced inadvertently through the hip joint and the acetabulum. Pelvic visceral damage may follow. To assess this risk, we inserted three guidewires to a depth of 16 cm into each femoral neck of ten cadavers and explored the pelvis during autopsy. Thirty-two of the 60 guidewires had penetrated a pelvic organ. The literature on intrapelvic injuries associated with hip surgery is reviewed, and suggestions are offered on the avoidance of pelvic penetration during hip fracture fixation.
Acceleration injuries of the neck.
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Quadriplegia resulting from minimal injury to the neck (report of two cases).
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[Differential diagnosis of whiplash injury to the neck. Therapeutic and insurance-related consequences].
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[Whiplash injury of the neck from concepts to facts].
OBJECTIVES: To focus on a topic of traumatology and rehabilitation becoming recently a much debated public health problem. METHOD: A references search from Medline database with whiplash as keyword was carried out. Were selected articles with abstracts in french or english and focusing on accidentology, biomechanics, demonstrated lesions, epidemiology and treatments. RESULTS: From 1664 references found, 232 were reviewed. The usual mechanism of crash is a rear-end collision inducing in the occupants of the bumped vehicle a sudden lower cervical spine extension with upper flexion followed by a global flexion. In nearly 50% of the cases, the stress occurring in the collision is comparable to that observed in bumper cars. The velocity changes are seldom up to 15 km/h. A headrest at the level of the center of gravity of the head restrict significantly the extension of the neck. Every structure of the cervical spine could be damaged and mainly the facet joints but the lesions were only demonstrated in severes traumatisms. The discrepancies in incidence among the different countries could be related to their medicolegal system. Although subjectives, the early symptoms are rather similar among patients suggesting true anatomical or functional disorders but the chronicity seems to be mainly related to social and psychological factors. The association of: no posterior midline cervical tenderness, no intoxication, normal alertness, no focal neurological deficit and no painful distracting injuries has a good predictive value of the lack of osteo-articular lesion on X-rays. Except the grade IV of the Quebec task Force (0, no symptom; 1, pain and stiffness; 2, neck complaint and physical signs; 3, neck complaint and neurological signs; 4, fracture or dislocation) the use of a collar should be avoided and the cervical spine should be mobilized. CONCLUSION: In most whiplash injuries, the mildness should be early stated, mobilization encouraged, and procedures of compensation shortened.
CT angiography of the carotid arteries in trauma to the neck.
OBJECTIVES: serious vascular injuries to the neck may be asymptomatic or masked by other life-threatening conditions. Angiography, the "gold standard" vascular imaging modality, is an invasive procedure. Moreover, it is time-consuming and thus may delay a needed vascular intervention. The results of screening angiography are negative in more than 80% of cases. Therefore other less invasive and faster screening tests, such as the Doppler ultrasound and magnetic resonance angiography, have been tested. This retrospective study was done to evaluate the use of CT angiography (CTA) in suspected vascular injuries of the neck. METHODS: from 1995 to 1998, 16 patients with suspected traumatic carotid artery injury underwent CTA. Twelve of these patients had penetrating injuries and four had blunt injuries to the neck. CTAs were obtained by Elscint Twin Flash Spiral Scanner, while MIP reconstructions were carried out on an Omnipro, Elscint (Indy, Silicon Graphics) work station and interpreted by a radiologist. RESULTS: all the CTAs were diagnostic. Positive findings included one complete tear of the right common carotid artery (confirmed by surgery) due to a penetrating injury and one bilateral internal carotid artery thrombosis after blunt injury to the neck. In addition, three patients with multiple trauma were operated on, due to either proximity only or questionable neurological findings. Surgical exploration confirmed the negative findings seen on CTA. CONCLUSION: CT angiography of the carotid arteries in cervical trauma may be used as an accurate decisive tool for a needed surgical intervention. More studies with larger number of patients and comparison with angiography are needed.
[Multiple fractures of the atlas with delayed fatal thrombosis of vertebral artery following "whiplash" injury of the neck (author's transl)].
Report of the case of a 62 year old male, who died in a car crash on his way home from duty, when he had a frontal collison with annother car at a speed of about 70 km per hour. After the collision, the car had completely turned over to its wheels. As the man had put on the seat belts, he had not been cast against the front window so that there were no head injuries. Following an unconsciousness of about ten minutes the patient recovered quickly and was already fully oriented when arrived at hospital. No neurological symptoms could be substantiated. He only suffered from pain of the neck and had a marked swelling of the left side of the neck. A burstin fracture of the atlas vertebra (Jefferson-fracture) was overlooked in routine X-rays of the craniovertebral region. Eight days after the accident, the hitherto "well improving" patient died suddenly and unexpectedly. The autopsy revealed an obstructing thrombosis of the left vertebral artery, less than 24 hours old. The wall of the artery showed numerous dissecting ruptures with intramural bleedings.
Successful antibiotic treatment for a cervical spinal cord abscess following a stab injury on the neck.
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Management of penetrating injuries of the anterior triangle of the neck.
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