Upper Cervical Trauma in Motor Vehicle Collisions

Abstract

Motor vehicle collisions can cause a variety of injuries in pedestrians and vehicle occupants. Fatal and nonfatal trauma to the upper cervical spine, that is, atlanto-occipital junction, atlas and axis, can be part of this spectrum. Certain distinctive injuries (for example, “hangman's fracture”) which occur result from the unique anatomic structure of this area and the various disruptive forces such as extension, distraction (tension), compression (axial loading), shear, and inertia generated during collision. Correlation of autopsy findings or radiological information of these cervical injuries or both with scene investigation can be informative not only in the determination of morbidity and mortality, but also in the assessment of injury mechanisms and improvements in occupant protection.

Atlantoaxial Rotatory Fixation in the Setting of Associated Congenital Malformations

“…It has been noted that disruption of the tectorial membrane and the apical and/or alar ligaments most likely contribute to such a dislocation and one that most likely followed hyperflexion in our patient to result in anterior craniovertebral dislocation. 50 Such ligamen- tous complexes are also responsible for resisting rotation and lateral translation of the atlantoaxial region. Thus, disruption of such ligaments clearly contributes to such a dislocation.…”

Preventing motor vehicle crashes related spine injuries in children

“…The different types of injuries result from the specific mechanism of injury and the type of disruptive forces applied, including flexion, extension, distraction, compression, lateral bending, and shear. [14] Alker et al [15] performed a radiographic examination of 312 victims of MVC with respect to cervical spine injuries. Most fractures/dislocations involved the craniocervical junction and the upper cervical area.…”

Postmortem Multislice Computed Tomography and Magnetic Resonance Imaging of odontoid fractures, atlantoaxial distractions and ascending medullary edema

“…In a follow-up paper [14] in which a larger number of deceased persons were examined postmortem by conventional x-ray techniques, Alker et al again did not focus on the cause of death. Shkrum et al [15] and Cain et al [16] used plain radiographs for the detection of head and neck injuries after fatal traffic accidents. Using the conventional x-ray technique, however, it is often difficult to detect fractures of the dens axis, because in the majority of cases open-mouth roentgenograms of the levels C1 and C2 [17,18] cannot be carried out due to postmortem rigor of the jaw musculature.…”