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.
Adams
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Department of Pathology and Laboratory Medicine, University of South Florida, Hillsborough County.
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001268:Atlanto-Axial Joint / Q000293:injuries*; D001270:Cervical Atlas / Q000293:injuries; D002675:Child, Preschool; D004388:Dura Mater / Q000473:pathology; D005147:Facial Bones / Q000293:injuries; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000473:pathology; D006801:Humans; D007223:Infant; D004204:Joint Dislocations / Q000150:complications / Q000473:pathology*; D008023:Ligaments, Articular / Q000293:injuries; D008297:Male; D008337:Mandibular Fractures / Q000150:complications / Q000473:pathology; D008875:Middle Aged; D019838:Neck Injuries; D009809:Odontoid Process / Q000293:injuries; D012189:Retrospective Studies; D012769:Shock / Q000209:etiology; D012887:Skull Fractures / Q000150:complications / Q000473:pathology; D013345:Subarachnoid Hemorrhage / Q000150:complications