Differences in Neck Injuries of Dummy Models at Different Backrest Angles under Horizontal Negative Acceleration / 医用生物力学

Objective Based on the dummy model, to study the relationship between different backrest angles and neck injuries under the effect of horizontal negative acceleration (-Gx ). Methods The dummy model was fixed on the base of the acceleration platform facing the orbital direction, and the backrest angle was set at 17°, 22°, 30°, respectively. Each experimental group performed 10 repeated tests according to the same acceleration curve, differences between the upper and lower acceleration of the cervical spine under the same -Gx conditions were compared, and the neck injury criteria (NIC) was calculated and compared through curve fitting. Results The time-acceleration curves of the upper and lower cervical spine in the anteroposterior and vertical directions had the same shape with peak differences. In the anteroposterior direction (X-axis), the acceleration peak of the 22° backrest angle experimental group was slightly higher than that of 17° and 30° backrest angle experimental groups, but in the vertical direction (Z-axis), the acceleration peak of the 22° backrest experimental group was lower than that of 17° and 30° backrest angle experimental groups. In the anteroposterior and vertical directions, the NICmax measured by 22° backrest angle experimental group was relatively smaller, NICmax measured by 30°backrest angle experimental group was in the middle, and NICmax measured by 30° backrest angle experimental group was relatively larger. Conclusions There was a nonlinear relationship between the backrest angle and theneck injury. The neck injury of the dummy model with the backrest angle of 22° was smallest under the effect of-Gx in this experiment.

Dynamic Response and Damage Analysis of Human Head and Neck in Automobile Rear Impact / 医用生物力学

Objective To establish the precise finite element model of the head and neck based on human anatomical structure, so as to study neck injuries caused by rear impact at different speeds. Methods The model was based on CT scan images of the head and neck of human body. The Mimics software was used to reconstruct the three-dimensional (3D) bone, and the 3D solid ligaments, small joints and other tissues of the neck were improved and meshed by HyperMesh. The generated models included the head, 8 vertebrae (C1-T1), 6 intervertebral discs (annulus, nucleus pulposus and upper and lower cartilage endplates), facet joints (cartilage and joint capsule ligaments), ligaments, muscles, etc. Finally, the model verification and post-collision calculation were completed in the finite element post-processing software. Results The simulation results of the models under axial impact, front and back flexion and lateral flexion were compared with the experimental data to verify the effectiveness of the model. Then post-collision simulation at the speed of 20, 40, 60 and 80 km/h was conducted. At the speed of 20 km/h, there was no damage to the neck. At the speed of 40, 60 and 80 km/h, the ligament was the first to be damaged. As the speed increased, the stress on tissues of the neck increased continuously. At the speed of 80 km/h, the maximum stresses of the dense bone, cancellous bone and annulus of the cervical vertebrae were 226.4, 11.5, and 162.8 MPa, respectively. When the ligament strain reached the limit, tearing began to occur. Conclusions The finite element model of the head and neck established in this study has high bionics and effectiveness, and can be used for studying neck injury analysis in traffic accidents, which is helpful for the diagnosis, treatment and prevention of cervical spine injury to a certain extent.

The Effect on Head-Neck Injuries of Six-Year-Old Child Occupant by Misusing the Restraint System / 医用生物力学

Objective To explore the effect of restraint system misuse on head-neck injuries for rear occupant of 6-year-old children in frontal impact crashes. Methods Based on the previously validated 6-year-old child occupant finite element model, in terms of ECE R44 testing regulations, the impact crash under right and wrong use of restraint system was simulated in Pam-Crash software. Results The force and moment of the neck were the minimum by merely using booster seat, but the maximum intracranial pressure, the maximum stress and the maximum principal strain were larger than their damage threshold and would cause fatal brain damage in child head. The only use of adult safety belt would cause more serious damage in child neck with larger force and moment. Conclusions Two ways of misusing the restraint system would aggravate head-neck injuries of the 6-year-old child. The proper use of the restraint system can provide the best protective effect for head and neck of the 6-year-old child occupant.

Accidental Sharp Force Fatality Caused by a Broken Glass Cup / 대한법의학회지

Most sharp force fatalities are attributed to homicide or suicide, with only a few accidental cases reported to date. Broken glass accounts for most of these accidental fatalities. We herein report an unusual accidental death caused by a broken glass cup. A 21-year-old woman was found dead on the floor of her studio apartment. The studio was a duplex consisting of one room and a bathroom, with a stepped drawer leading to the second floor. She was lying face down with her legs spread apart in a large pool of blood, surrounded by many pieces of broken glass. There was an oblique cut measuring 9 cm in length in the right sternocleidomastoid region just above the right clavicle. The surface of the cut wound showed irregular edges and the internal jugular vein was severed in the depth of the wound. She appeared to have fallen down the steps onto the ground floor and been fatally injured in the neck by a piece of broken glass.

Emergent reconstruction of laryngeal penetrating neck injury: A case report

@#<p><strong>OBJECTIVE:</strong> This paper aims to describe an unconventional surgical procedure performed in a case of penetrating neck injury involving the larynx.</p><p><strong>METHODS:</strong></p><p><strong>Design:</strong> Case Report</p><p><strong>Setting:</strong> Tertiary Government Hospital</p><p><strong>Population:</strong>          One</p><p><strong>RESULTS:</strong> A 38-year-old man sustained a hacking laceration to the anterior neck that extended into the hypopharyngeal area, transecting the thyroid cartilage. After pre-emptive tracheostomy, the patient was referred to otorhinolaryngology - head and neck surgery due to the extensive hypopharyngeal injury. Neck exploration performed to control bleeders confirmed a Schaefer-Fuhrman Classification Group 3 penetrating neck injury. Anastomotic reconstruction of the hypopharynx, transected thyroid cartilage and strap muscles was attempted using absorbable sutures with post-operative re-establishment of structural continuity and documentation of full bilateral vocal fold mobility. The patient was about to be discharged home with a tracheotomy and nasogastric tube when he suddenly deteriorated and expired on the eighth post-operative day.</p><p><strong>CONCLUSION:</strong>  Our technique might be utilized in cases where urgent reconstruction of laryngeal structures is considered despite serious damage to the laryngeal skeleton, and may provide a temporary surgical option for similar cases in an emergent setting. However, we cannot recommend it as a routine standard on the basis of one case.</p><p><strong>KEYWORDS: </strong> larynx; penetrating neck injury; vocal cord; reconstruction, neck exploration</p>

Predictors of functional outcome after hanging injury / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Suicide becomes a serious problem in today's society and hanging is a common method of suicide. We want to find the factors which can predict the final functional outcomes of these cases.</p><p><b>METHODS</b>All patients who presented to Accident and Emergency Department (ED) of the National Cheng Kung University Hospital from 1st January 2005 to 31th December 2013 with a hanging injury were included in this study. All cases were divided into good outcome group and bad outcome group according to Glasgow Outcome Scale (GOS). Data was analyzed by Mann-Whitney test and chi-square test.</p><p><b>RESULTS</b>Glasgow Coma Scale (GCS) < 3, pupil dilation and no pupillary light reflex both at the scene and ED were the factors to indicate poor functional outcome. Out-hospital cardiac arrest (OHCA), acidosis (pH < 7.2) and the need for intubation once arriving at ED were also related to poor functional outcome. OHCA cases all had poor functional outcome.</p><p><b>CONCLUSION</b>GCS, pupil size, pupillary light reflex, OHCA and acidosis are useful as prognostic factors. GCS = 3 lead to a very poor outcome. However, the functional outcome seems good in patients with GCS>3. There parameters can help to predict the outcome before treatment.</p>

Penetrating neck injury: Collaterals for another life after ligation of common carotid artery and subclavian artery / 中华创伤杂志(英文版)

Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause potentially life-threatening hemorrhage but also need profound surgical expertise in management. Development of collateral circulation in neck is well known; however, there is scarcity of literature on the role of collateral formation in neck trauma. Here, we present a unique case of penetrating gunshot injury to neck with right common carotid and right subclavian artery injury with hemorrhagic shock managed with ligation of these vessels as a life-saving procedure. The patient presented with no neurological or motor deficits in immediate postoperative period owing to the collateral circulation between right vertebral artery and right common carotid and right subclavian artery.

Establishment and validation of a dynamic finite element model of human head-neck / 医用生物力学

Objective To construct a three-dimensional (3D) dynamic head-neck finite element model which ac cords with the anatomical structure,and study its dynamic responses under the extemal force.Methods By using the neck CT images of a Chinese adult male volunteer and obtaining the 3D cervical point cloud data,the finite element model of cervical spine was established using ICEM-CFD and HyperMesh software.This model,including vertebrae,intervertebral discs,facet joints,ligaments and cartilage tissues,and combining with the es tablished and verified head finite element model,was assembled as human head-neck finite element model with detailed anatomical structures.Results The model was validated by data of head-neck axial impact experiments reported in previously published literature.The simulation results showed that the neck deformation,head acceleration,head force and injury positions were preferably consistent with the experimental data.Conclusions The established 3D dynamic finite element model can be used to study head-neck dynamic responses and damage mechanism in the fields of traffic safety and impact injuries.

Establishment and validation of a dynamic finite element model of human head-neck / 医用生物力学

Objective To construct a three-dimensional (3D) dynamic head-neck finite element model which accords with the anatomical structure, and study its dynamic responses under the external force. Methods By using the neck CT images of a Chinese adult male volunteer and obtaining the 3D cervical point cloud data, the finite element model of cervical spine was established using ICEM-CFD and HyperMesh software. This model, including vertebrae, intervertebral discs, facet joints, ligaments and cartilage tissues, and combining with the established and verified head finite element model, was assembled as human head-neck finite element model with detailed anatomical structures. Results The model was validated by data of head-neck axial impact experiments reported in previously published literature. The simulation results showed that the neck deformation, head acceleration, head force and injury positions were preferably consistent with the experimental data. Conclusions The established 3D dynamic finite element model can be used to study head-neck dynamic responses and damage mechanism in the fields of traffic safety and impact injuries.

The Neck and Posterior Fossa Combined Penetrating Injury: A Case Report / 대한신경손상학회지

Here we report a case of penetrating neck injury to the posterior fossa that was shown, using high-resolution computed tomography (HRCT) and digital subtraction angiography (DSA), to involve no vascular injury. A 54-year-old man was brought to the emergency department after a penetrating injury to the left side of the posterior neck and occipital area with a knife. He was in an intoxicated state and could not communicate readily. On initial examination, his vital signs were stable and there was no active bleeding from the penetrating site. Because of concern about possible injury to adjacent vessels, we performed HRCT and DSA sequentially, and identified that the blade of the knife had just missed the arteriovenous structures in the neck and posterior fossa. The patient was then transferred to the operating room where the knife was gently removed. Further careful exploration was performed through the penetrating wound, and we confirmed that there were no major injuries to the vessels and neural structures. Postoperative computed tomography revealed that there was minimal hemorrhage in the left cerebellar hemisphere. The patient made a full recovery without any neurologic deficit. In this case, HRCT is a suitable tool for the initial overall evaluation. For the evaluation of vascular injury, DSA can be a specific and accurate tool. Mandatory exploration widely used for penetrating injuries. After careful preoperative evaluation and interpretation, simple withdrawal of material can be a choice of treatment.

Post Mortem Study Of Injuries to the Internal Neck Structures in Cases of Death Due To Hanging.

Virtually all hangings are suicidal in nature and all ligature strangulations are homicidal in nature. So for the purpose of police investigation differentiation between two is very important and necessary. It is generally said that deaths due to hanging are devoid of any injury to the internal neck structures while in strangulation these injuries are always present. So injuries to the internal neck structures are sometimes used as differentiating factor between hanging and strangulation along with other factors. Aim: The aim of this study is to know the prevalence of injuries to the internal neck structures in deaths due to hanging. Method: This study was conducted at mortuary of the civil hospital, Ahmadabad in the year 2013. Total 40 cases of deaths due to hanging were randomly selected. Result: Out of these 40 cases 26(65%) were male and 14(45%) were female. 22 (55%) cases were showing injuries to the internal neck structures in the form of haemorrhage in to the soft tissues and strap muscles or fracture of superior horn of thyroid cartilage or greater cornue of hyoid bone. However these injuries are mainly found present beneath the ligature mark except some indirect injuries e.g. haemorrhage at the origin of sternomastoid muscle and avulsion fracture of greater cornue of hyoid bone due to over stretching of thyro-hyoid membrane. These injuries in cases of hanging are not extensive as found in cases of death due to strangulation. In one case extension distraction fracture of cervical spine at c3-c4 level was found which very rare finding in suicidal hanging is. Conclusion: From the present study it is evident that injuries to the internal neck structures are not very uncommon in the hanging. Though the extent and frequency of injuries are less compare to the ligature strangulation.

Control de daños en trauma penetrante de cuello: Abordaje multidisciplinario / Damage control in penetrating trauma to the neck: Multidisciplinary approach

Objetivo: Demostrar el abordaje diagnóstico y terapéutico para el tratamiento de urgencia en las heridas penetrantes en el cuello por proyectil de arma de fuego. Sede: Centro Médico del Instituto de Seguridad Social del Estado de México. Diseño: Presentación de caso clínico. Descripción del caso: Varón de 46 años de edad, con antecedente de herida penetrante en el cuello por arma de fuego, presentando un orifico de entrada en el mentón sin orificio de salida, con compromiso de la vía aérea, siendo protocolizado de acuerdo con los criterios del Apoyo Vital Avanzado en Trauma (ATLS), con control temporal de la vía aérea, efectuando la intubación orotraqueal electiva apoyado por el Servicio de Anestesiología y realizando tratamiento quirúrgico inmediato. Se identificaron las lesiones, y la reparación de las mismas con control de daños se realizó de manera quirúrgica. Conclusión: El identificar de manera rápida y eficaz las lesiones que comprometan la vía aérea superior y, por ende, la vida, así como realizar control de daños en forma oportuna es importante en el ejercicio y quehacer diario del cirujano general. Por esto, es importante tener el conocimiento adecuado de la anatomía del cuello en sus tres zonas, así como de las técnicas quirúrgicas empleadas en este tipo de casos.

Objective: To demonstrate the diagnostic and therapeutic approach for the emergency treatment of neck penetrating injuries due to firearm bullets. Setting: Centro Médico del Instituto de Seguridad Social del Estado de México. Design: Case presentation. Case description: Man of 48 years of age with antecedents of penetrating injury to the neck by a firearm, entrance orifice in the chin without exit orifice, compromising the upper airway. The patient was, subjected to the advanced trauma life support (ATLS) protocol, with temporal control of the airway, performing an elective orotracheal intubation, with support from the anesthesia service and performing surgical treatment immediately. Injuries were identified and repaired with damage control exerted surgically. Conclusion: Identifying rapidly and efficiently the injuries that affect the upper airway and, hence, life itself, as well as performing timely damage control is important in the daily activities of the general surgeon, Therefore, it is necessary to have an adequate knowledge of the neck's anatomy in its three zones, as well as to master the surgical techniques used in these cases.

Anesthetic management of penetrating neck injury patient with embedded knife: A case report / 대한마취과학회지

Penetrating neck injuries can be a fatal event and they are difficult to manage for both surgeons and anesthesiologists. So, adequate preoperative evaluation is important to improve the patients' outcomes, but this can not be done for hemodynamically unstable or uncooperative patient. Here we present our clinical experience with a patient with a penetrating neck injury and who was hemodynamically stable, but she was uncooperative and the knife was still embedded in her neck. The surgical exploration and bronchoscopic examination were successfully done under monitored anesthesia care.

A Case of the Common Carotid Artery Penetrating Injury by Grass Cutter Fragment / 대한이비인후과학회지

There are many vital structures in the neck, but they are not protected by bone. The neck is vulnerable to injury, and difficult to evaluate the extent of injury. Especially, penetrating neck wounds are potentially dangerous and require emergency treatment. A 56-year-old man with a penetrating neck injury by a grass cutter fragment was transferred from another hospital. There were no immediate life-threatening signs or symptoms. Carotid artery injury was suspected in the computed tomography scan. Emergent exploration was implemented by vascular surgery to remove the grass cutter fragment that had penetrated the left common carotid artery. We report a rare case of common carotid artery penetrating injury that was treated without any complications.

Penetrating Neck Laceation with Epiglottis Amputation Which Was Successfully Repaired / 대한이비인후과학회지

Penetrating traumatic laryngeal injuries are relatively rare and traumatic injuries to the epiglottis are extremely rare. The present case is 58-year old man with suicidal history, chronic alcoholism, and schizophrenia who complained of neck laceration and unconsciousness after stab injury. Examination revealed a large transverse laceration of 7 cm in size, penetrating deep to the level of thyroid cartilage from the lateral border of the sternocleidomastoid muscle, exposing the thyroid cartilage. There was about a 3 cm-sized deep wound under the thyroid gland level but no major vessel injury. The stump of transected epiglottis accompanied by rupture of thyroid membrane was shown but the esophagus was intact. We sewed the amputated epiglottis with the rest of the epiglottis by using two Lambert sutures with vicryl 4-zero on each side under general anesthesia. There was no necrosis of the severed epiglottis, swallowing difficulty, and aspiration on eating food. We report here on the penetrating laceration with subtotal transection of epiglottis that was successfully repaired.

Near fatal fall complicated by penetrating neck injury with uneventful outcome: a case report.

Fall from height is commonly associated with long bones fractures or neurological compromised outcome. On the other hand, penetrating neck injury is linked to life threatening complications especially when the injury involves major blood vessels, spinal cord, cervical spines and aerodigestive tracts. However, in some rare circumstances, a patient may suffer both the eventful fall from height complicated with penetrating neck injury. We report a patient who presented with a wooden stick passing through the lateral side of his neck after an episode of fall. He survived without any residual complications.

Delayed presentation of an unusual transpharyngeal penetrating neck injury by a wooden stick: a case report

Penetrating neck trauma is a horrifying injury. Patients may present with sudden death, or life threatening injuries such as catastrophic haemorrhage, major vessel injury, injuries to the respiratory or digestive tract, neurological deficits, or bony injuries of the cervical spine. Other less life threatening symptoms may be associated with such injuries. We present here a case report of a 2-year-old child who sustained a transpharyngeal penetrating neck injury that occurred while playing with a wooden stick. He presented one month later with an abscess in the posterior triangle of the neck.

Neck fracture case at low speed in frontal collision / 대한법의학회지

Neck fracture is a major cause of death in traffic accidents and this injury pattern occurred normally in a frontal collision or overturn process. This study investigates a case of neck fracture from a low speed collision. In this case examined, the passenger in the front seat of the car was pulled back and did not have the seat belt on. As the vehicle slipped on a frozen road surface in a downward hill and crashed into the shoulder of the road at low speed. But strangely, even though his neck is fracture there were not any collision marks on interior of the car. This study applied computer simulation to analyze this case and we found out that the upper part of the person was rotated and raised at the time of collision and his neck was fully bent by interference with roof and we also know that the seat belt did not resist the passenger who pulled back his seat.

Diagnosis and managements in neck injury syndrome associate with craniocerebral injury / 中国医师进修杂志

Objective To analyze the clinical behavior and correlative mechanism of the patients with the syndrome of neck injury associate with craniocerebral injury,to investigate its incidence for contributing to the diagnosis and therapy of the patients with the craniocerebral injury and improving the postoperative result. Methods Two hundred and eighty-three patients with craniocerebral injury treated from June 2000 to July 2003 were studied retrospectively. Results In 283 patients, 42( 14.8%) patients presented the syndrome of neck injury clearly in symptom or sign, of whom 39 ( 13.7% ) patients were diagnosed neck injury finally, 3 (1.1%) patients were clinically conclude neck injury. The syndrome mainly presents with noncerebral and nonaural vertigo incorresponding with the recovery of brain injury. Noncerebral, nonaural and nondigestive vomit. Intractable nuchal rigidity incorresponding with the recovery of brain injury. Motion and position limited, stubborn neck malaise, transient spinal cord injury. The symptoms were easy to be improved by neck motion control, neck traction,block therapy, massage and physiotherapy lamp. Conclusion The syndrome of brain-neck injury is a common injury. To learn the syndrome and take the regular therapy can improve the therapeutic efficacy of the craniocerebral injury.

Fatal Thrombosis of Internal Carotid Artery Following Minor Blunt Trauma to the Neck / 대한법의학회지

Fatal traumatic thrombosis of the right internal carotid artery occurred in a 37-year-old woman following minor blunt cervical trauma (grasped her neck) during an altercation. An external examination revealed only linear abrasion of right side of neck. The autopsy revealed a thrombosis in the right internal carotid artery and thromboembolism in right middle cerebral arteries. The gross and microscopic findings of the internal carotid artery are presented and the significance of minor cervical blunt trauma and the possible mechanism for the vascular lesion are discussed.