Death from atlanto-occipital dislocation in a boy due to personal water craft collision

Injuries associated with use of personal water craft (PWC) typically include fractures, lacerations, or head injuries. Deaths are rare. We recently encountered an unusual case of a collision between two PWCs in which a 9-year-old boy was struck on the left side, causing the vehicle to rock and him to twist upward and to the right. There was rapid extension, flexion, and rotation of his head. At postmortem examination, it was established that the boy died from atlanto-occipital dislocation and brainstem transection. The risk of atlanto-occipital dislocation is high in children under 10. The tectoral ligament which stabilizes the upper cervical spine can be torn or ruptured by hyperextension-flexion injury. Some atlanto-occipital dislocations in children can be stabilized and recovery is possible, but in this case of complete ligament rupture and brainstem transection, death was immediate.