[Neck injuries due to accidents].
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Carotid Artery Injuries↗
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[Neck injuries].
Diagnostic work-up of neck injuries is dependent on vital signs, neurologic status and location of the wound. Patients who are haemodynamically unstable, who exhibit current arterial bleeding, expanding or pulsatile haematoma or respiratory distress after initial resuscitation are taken to the operating theatre without further delay. Patients who present stable vital signs or who are stable after resuscitation are subjected to further evaluation. Penetrating wounds below the cricothyroid membrane (zone I) and just below the clavicle and above the mandibular angle (zone III) are subjected to angiography. Explorations in these regions are associated with considerable morbidity and routine exploration is not warranted. Injuries between the cricothyroid membrane and mandibular angle are easily reached, and routine exploration is recommended. Selective diagnostic work-up with angiography, oesophagography and laryngotracheobronchoscopy is an alternative if available on a 24 hour basis. The common and internal carotid arteries are repaired in patients with focal or no neurologic deficit, and in patients with equivocal neurologic status secondary to hypoperfusion or intoxication. Ligation is performed if reconstruction is not feasible. Appropriate treatment of the comatose patient remains controversial. Oesophageal and tracheal injuries are primarily repaired.
Emergencies↗
Three-dimensional head kinematics and clinical outcome of patients with neck injury treated with spinal manipulative therapy: a pilot study.
OBJECTIVE: Finite helical axis parameters (FHAP) of the cervical spine and clinical measures were obtained to evaluate neck function and the clinical effects of spinal manipulative therapy in patients with "whiplash" (WL) type neck injury. DESIGN: Descriptive case series, 1 yr follow-up. SETTING: Three private chiropractic practices. SUBJECTS: Ten consecutive new patients with a history of neck injury, nine asymptomatic, volunteer controls. INTERVENTIONS: A 6-wk regimen of short lever manually assisted adjustments with an Activator Instrument, while acute, four patients received interferential electrotherapy. MAIN OUTCOME MEASURES: Cervical FHAP during normal movements, neck pain (visual analogue scale), active cervical range of motion and follow-up questionnaire. RESULTS: Based on six patients, the FHAPs appeared to mirror the clinical condition, being markedly deviant from the patterns observed in the control group for at least one or more of the tracking tasks for all but one of the patients. Mean pain scores decreased from 44.1 to 10.5 (t = 4.93; p < .0001) and mean total range of motion increased from 234 to 297 degrees (t = 5.68; p < .0001). At 1 yr, seven respondents noted stability of their symptoms at or near the level reported immediately after the 6-wk treatment period. CONCLUSIONS: Based on these preliminary data: a) FHAPs may aid in diagnosing and monitoring treatment of neck dysfunction, b) spinal manipulative therapy may be beneficial to some patients with neck injury and future study is warranted as a means to promote recovery of patients with neck injuries.
Adult↗
The National Football Head and Neck Injury Registry. Report and conclusions 1978.
The National Football Head and Neck Injury Registry has documented 1,129 injuries since 1971 that involved hospitalization for more than 72 hours, surgical intervention, fracture-dislocation, permanent paralysis, or death. Of this group of injuries, 550 were fracture-dislocations of the cervical spine, of which 176 were associated with permanent quadriplegia. It appears that during the last two decades, there has been a decrease in the incidence of direct fatalities, head injuries associated with intracranial hemorrhage, and injuries associated with death. Conversely, cervical spine injuries with fracture-dislocation and with permanent quadriplegia have increased. We believe that these observations are the result of the development of a protective helmet-face mask system that has effectively protected the head, and by so doing has allowed it to be used as a battering ram in tackling and blocking techniques, thus placing the cervical spine at risk of injury.
Athletic Injuries↗
Penetrating zone-II neck injuries in children.
Over a 4-year period, 1,237 children under 16 years of age were managed at our level-I pediatric trauma center, of which 24 (1.9%) had zone-II penetrating neck injuries. Six of these 24 children (25%) were explored surgically with positive findings in four and negative findings in two neck explorations; five children (21%) underwent radiologic or endoscopic studies and were observed; 13 (54%) were observed only and did not require studies or exploration. Nonoperative observation of penetrating zone-II neck injuries is safe and the procedure of choice if active observation can be performed and the facilities for immediate operative intervention are available.
Adolescent↗
[Head and neck injuries in equestrian accidents (author's transl)].
Horses' kicks can produce two types of head and neck injuries: injuries of the mid-face and injuries of the larynx. Typical cases as seen by the author are presented. The treatment of mid-face injuries is performed according to principles of plastic surgical repair. After frontal-nasal injuries, a revision of the nasal septum must be done. Involvement of the larynx requires external layer repair of mucosa and cartilage.
Adult↗
Are arteriograms necessary in penetrating zone II neck injuries?
The evaluation and management of potential arterial injuries in penetrating neck trauma are controversial. Routine surgical exploration or arteriography can be very expensive and time-consuming and can overburden available resources if used in all patients. We reviewed the records of 4035 patients seen in our trauma center during a 20-month period and identified a total of 110 patients (2.7%) with penetrating wounds to zone II of the neck; 50 were from gunshot wounds, 43 from stab wounds, 7 from shotgun injuries, and 10 from lacerations. In 42 (39%) patients there was no arteriogram or surgery based on location of the wounds or lack of any physical findings. None of these patients later had any evidence of an arterial injury. Forty-five patients (40%) had arteriograms based on proximity or a "soft" sign of vascular injury, which included evidence of significant bleeding or a stable hematoma. A total of 15 injuries to major arteries were identified: 3 common carotid, 5 internal carotid, and 7 vertebral. One patient died during initial resuscitation, and four patients went directly to surgery with no preoperative arteriogram for active bleeding and expanding hematoma (n = 1), an expanding hematoma (n = 2), and a large, stable hematoma (n = 1). Only one patient (of the 110) had a significant major arterial injury requiring surgery that was not predicted by physical findings. Nine arterial injuries were treated nonoperatively: six vertebral, two common carotid intimal flaps, and one small distal internal carotid pseudoaneurysm (diagnosed late). Three additional minor external carotid artery injuries were observed with no adverse sequelae.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Wallenberg's syndrome due to vertebral artery dissection following minimal neck injury--report of two cases].
We described two cases of the lateral medullary syndrome (Wallenberg's syndrome) due to vertebral artery dissection following minimal neck injuries. The first case was a 45-year-old man, who hit his head and often rotated his head because of posterior neck discomfort. Two years after the injury, he suffered from sudden sharp neck pain, nausea, and vertigo, which was followed by left hand numbness and difficulty in walking due to the right lateral medullary syndrome. Angiography showed right vertebral artery dissection at the fourth segment. The second case, a 48-year-old man, suffered from neck pain immediately after he hyperextended his neck for painting a wall. Within several hours, he experienced left hand numbness and difficulty in walking due to the lateral medullary syndrome. Angiography showed a saccular aneurysm and dissection of the right vertebral artery at the fourth segment. In both cases, minor traumas were thought to be the causes of vertebral artery dissection. We surveyed previously reported 84 cases (men: 50, women: 34) of the vertebral artery dissection due to minor traumas. Seventy per cent of patients were in their third or fourth decade of life. The main causes of trauma preceding the dissection were neck manipulation especially chiropractics (52%). The third segment was most vulnerable. Delay in onset following neck trauma could be more than a week, but in most cases the delay was less than 24 hours. Cervical rotation and extension were thought to precipitate dissection.
Aortic Dissection↗
Neck injuries: II. Atlantoaxial dislocation--a pathologic study of 14 traffic fatalities.
C1-C2 vertebral dislocations have not been commonly recognized at autopsy. Among 66 subjects with neck injuries, drawn from a series of 155 traffic fatalities, were 14 with injuries at the level of the atlantoaxial motion segment, ranging in age from 8 months to 93 years. Thirteen had sprains or lacerations of the atlantoaxial facet joints, and one had a healed C1 fracture. Six of the 14 had odontoid fractures. None had transverse ligament lacerations. Injuries of the alar ligaments and the tectorial membrane were frequent. Only 3 subjects had subaxial cervical injury. All 14 had evidence of impact to the head or neck. Four had fractures of the mandible or facial bones, and 5 had skull fractures. Subdural and subarachnoid hemorrhages were found in 7 and 6, respectively. Brainstem lacerations were not uncommon, but only one had a pontomedullary laceration. Spinomedullary cord injuries occurred in 5. Acute neurogenic shock was the major mechanism of death in 9 of the 14, including 5 with major cardiovascular lacerations. Delayed effects of craniocerebral trauma accounted for the majority of the remainder. The biomechanical mechanisms are discussed.
Accidents, Traffic↗
Postmortem radiology of head neck injuries in fatal traffic accidents.
A series of 146 victims of fatal traffic accidents were subjected to postmortem radiographic examination prior to medicolegal autopsy. A total of 42% were found to have radiographically demonstrable head injuries ranging from relatively simple linear skull fractures to massive skull damage. Free intracranial or intravascular air was demonstrated in more than 60%. A total of 21% had demonstrable neck injuries, most of which were localized to a single level at the craniocervical junction or the upper two cervical vertebrae. Flexion and extension studies of this area are of major importance in demonstrating the injury and locating potentially occult lesions for the forensic pathologist.
Accidents, Traffic↗
National football head and neck injury registry: report on cervical quadriplegia, 1971 to 1975.
Data on cervical spine injuries resulting from participation in football have been compiled by a national registry established in 1975. Information has been collected retrospectively by defined criteria since 1971. Efforts have been made to establish the mechanism of injury responsible in the majority of instances on the basis of epidemiologic evidence and recognized biomechanical principles. During the 5-year period, 77 deaths resulted from severe neck injuries. During this period, 1,275,000 players were exposed. Ninety-nine cervical fracture-dislocations resulting in permanent quadriplegia and 259 cervical fractures-dislocations occurred. There may be a "trend" towards an increase in permanent quadriplegia resulting from serious cervical spine injuries sustained while playing football. Apparently, the cause can be attributed to the helmet-face mask that has encouraged the use of the head as the primary point of contact in blocking, tackling, and head butting. The figures clearly identify defensive backs, linebackers, or specialty team members making tackles by using the head as the initial point of contact, as the individuals at greatest risk to sustain cervical spine injuries resulting in permanent quadriplegia.
Athletic Injuries↗
Neck injuries: I. Occipitoatlantal dislocation--a pathologic study of twelve traffic fatalities.
Twelve of 155 persons killed in traffic crashes had occipitoatlantal dislocations. Nine were vehicular occupants, 2 were cyclists, and one was a pedestrian. The dislocations involved various combinations of lacerations of the alar ligaments, the occipitoatlantal joint capsules, the dura mater, the tectorial membrane, the rectus capitis muscles, and the suboccipital muscles. In 2 instances, an occipital condyle failed instead of the corresponding alar ligament, producing condyle fractures. Atlas ring fractures occurred in 3 instances. Axial and subaxial cervical trauma were uncommon. Facial or mandibular fractures occurred in a majority of cases, vault skull fractures were uncommon, and basilar fractures were absent. Pontomedullary brainstem lacerations occurred in 9 of the 12, and 4 had midbrain lacerations. The majority of the victims succumbed to acute neurogenic shock as the sole or the major mechanism of death. The biomechanical basis for occipitoatlantal dislocation is discussed, and the author suggests that distraction, in concert with variable combinations of extension, rotation, and posterior translation is responsible for occipitoatlantal dislocations.
Accidents, Traffic↗
[Symptoms in patients with neck injury after a car crash. A retrospective study].
139 persons who contacted The Regional Hospital, Trondheim, between 1 January and 1 September for whiplash injury caused by a car crash from behind were asked whether they still had problems six months or more after the accident. 51% reported having symptoms and 12% reported serious problems. Five persons were still out of work because of the neck injury. 63% of the questioned persons were female and the percentage of women increased with increasing symptoms. There was no correlation between age and problems. There were more persons without symptoms among office employees (70%), managers/university educated persons (53%) and students/pupils (50%) than among unskilled workers/professional drivers (35%) and housewives/retired persons/pensioners/unemployed (35%).
Accidents, Traffic↗
Head and neck injuries in football.
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Athletic Injuries↗
[Head and neck injuries during soccer games].
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Brain Injuries↗
Sports medicine with reference to back and neck injuries.
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Adolescent↗