Neck injuries: II. Atlantoaxial dislocation--a pathologic study of 14 traffic fatalities

Area of Science:

• Forensic Pathology
• Biomechanics
• Trauma Surgery

Background:

• C1-C2 vertebral injuries are infrequently identified during autopsies.
• Traffic fatalities present a significant source of data for studying severe neck trauma.

Purpose of the Study:

• To investigate the prevalence and characteristics of C1-C2 vertebral injuries in traffic fatalities.
• To identify associated injuries and determine the primary causes of death in these cases.

Main Methods:

• Autopsy analysis of 155 traffic fatalities.
• Detailed examination of 66 subjects with neck injuries, focusing on the atlantoaxial segment.
• Documentation of associated craniofacial, intracranial, and spinal cord injuries.

Main Results:

• 14 subjects (8 months to 93 years) had atlantoaxial injuries, including facet joint sprains/lacerations and odontoid fractures.
• Alar ligament and tectorial membrane injuries were common; transverse ligament lacerations were absent.
• Associated injuries included head/neck impact, facial/skull fractures, and intracranial hemorrhages.
• Acute neurogenic shock was the primary cause of death in 9 cases, often with cardiovascular lacerations.

Conclusions:

• Atlantoaxial injuries are a critical, often overlooked, component of fatal traffic trauma.
• These injuries frequently lead to acute neurogenic shock and death, underscoring the need for improved recognition.
• Understanding the biomechanics of these injuries is crucial for developing effective prevention strategies.