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Tue Oct 11 05:24:50 BST 2005

I don’t know if this will advance the discussion of
clearing C-spine injuries, but I figure it’ll do more
than adding to the recent political commentary.  I’ve
worked on motorcycle accidents for about 30 years now
and published a couple papers on neck injuries in
fatal crashes (citations below).   All of the
published cases (about 380 so far) have had a
detailed, layer-by-layer dissection of the anterior &
posterior neck, which included removal of the cervical
cord (often en bloc with the brain) for neuropath
analysis.     

What really stood out was not the fractures or
dislocations – which were relatively uncommon – but
the soft tissue injuries, particularly hemorrhage in
the carotid sheath, hemorrhage around the vertebral
arteries at C6 and C1 and subluxation of the
atlanto-occipital and atlanto-axial joints, which
typically showed up as stretching or laxity of the
joints -- but only when the head was rotated or a
tension load placed on the neck.  If I recall
correctly, 5-10 mm of excess motion in a joint was
pretty common.  

Overall, ~7% of fatals had C1-C2 fracture only, ~10%
had dislocation-only and 2% had fracture-dislocation
at C1-C2.   But about 55% showed signs of subluxation.
 About one-third of the total had some type of injury
to the cervical cord, usually minor contusions around
C1-C2.  

I know these were all fatalities, but I’ve always
suspected that there are more subluxation injuries
among severely injured riders than I’ve seen diagnosed
in non-fatal cases, and I’ve often suspected the
reason is partly because of reliance on X-rays that
don’t pick up the evidence.   To quote one my favorite
people, the eloquent architect of Iraq intervention,
Donald Rumsfeld, “Absence of evidence doesn’t mean
evidence of absence.”  

JIM OUELLET

~~~~~~~~~

Hurt, HH, Jr., Ouellet, JV & Rehman, I,  Epidemiology
of head and neck injuries in motorcycle fatalities, 
in Mechanisms of Head and Spine Trauma,  (A Sances, DJ
Thomas, CL Ewing, SJ Larson & F Unterharndscheidt,
Eds.),  Aloray Publishers, Deer Park, NY, 1986.

Kasantikul V, Ouellet JV & Smith TA,  Head and neck
injuries in fatal motorcycle collisions as determined
by detailed autopsy,  Traffic Injury Prevention, 4
(3), 255-262, 2003.  

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