Analysis of features of frontal collision of class D cars

Currently, there is a significant increase in road accidents, which can be associated with an increase in the number of cars, the condition of roads in the country and compliance with road discipline by road users. Modern automotive industry pays great attention to road safety. This is ensured by changes in the design of car interiors, which significantly affects the nature of injuries to victims of road accidents. That is why the solution of this issue has become extremely relevant for forensic expert practice. Aim of the work. To establish the characteristic injuries of the driver and passenger in the cabin of class D cars in a frontal collision. Material and methods. The analysis of road accidents from 2008 to 2021 in Zhytomyr, Rivne, Volyn regions of Ukraine is carried out. Cases of a fatal head-on collision with a driver and passenger in the front seat of a car with an engine capacity of 2-2.5 liters up to 4.7 meters long and 1.81 meters wide were considered. General and special methods used: system-structural analysis, observation, comparison, description. In addition, a forensic examination of the damage was conducted. Statistical analysis included primary data processing by descriptive statistics methods and null hypothesis testing by multifactor analysis. Results. A number of new features have been identified, which are inherent in the damage received in the cabin of a class D car, which can help to identify during the forensic examination. In particular, you should pay attention to the presence of neck injuries. According to the literature, injuries of the cervical spine are among the key and include: rupture of the atlanto-occipital ligament, dislocation and subluxation of the atlanto-axial joint, damage to the spinal cord and its membranes. Conclusions: The location and morphological features of spinal injuries can be used as diagnostic criteria in determining the location of the victim in the cabin of a mobile car class D in a frontal collision. The most informative is the analysis of injuries of the cervical spine of the driver and front passenger.

C1-C2 Subluxation after Mild Cervical Spine Trauma in a Child

We report a case of a seven-year-old girl who presented with a “Cock-Robin” head tilt and cervical spine injury after falling from her bed. Initial cervical spine X-ray reported a fractured clavicle. However, almost four weeks later, the torticollis had not resolved. Computerized tomography (CT) of the cervical spine revealed subluxation of the atlanto-axial joint at C1-C2. Cervical spine magnetic resonance imaging (MRI) did not show any spinal cord injury. Manual reduction and hard collar placement were attempted, yet C1- C2 subluxation recurred. The child was placed into halo traction and then into a halo vest. CT scan showed near complete resolution of C1-C2 subluxation. Three months later the halo device was removed, and the patient was placed in a hard cervical collar then transitioned into a soft collar over a four month period. During this time, the patient received physical therapy. Final cervical spine radiographs revealed proper cervical spine alignment and resolution of C1-C2 subluxation.

Anatomic Considerations for Injection of the Lateral Atlanto-Axial Joint

Objective We aimed to define the potential complications of intra-articular steroid injections into the lateral C1-2 articulations and safety margins to the relevant structures. Methods A total of 488 contrast-enhanced computed tomography angiogram (CTA) “arch to vertex” studies were retrospectively reviewed for theoretical intersection of the vertebral artery or thecal sac and distance of the named structures from the anticipated/theoretical trajectory of injection into the lateral C1-C2 joint. Results Patients were 60.4±15.8 years old and 55.5% male. In total, seven vertebral arteries and 11 thecal sac theoretical intersections were found. In cases without a direct intersection, the distance from the trajectory (range) was 0.71±0.18 (0.22–1.44) cm to the vertebral artery and 0.6±0.22 (0.14–1.8) cm to the thecal sac. Conclusions Although injection of steroid into the lateral C1-C2 articulation for pain management has historically been reported to carry risk of severe complications due to close proximity and location variability of surrounding structures, our study quantifies the potential risk of such injections. Further, our analysis suggests that preprocedural imaging should be considered.

Congenital deformation of the posterior arch of the atlas: Subluxation of the atlanto-axial joint with temporary quadriplegia

Instabilities of the craniocervical junction can be of rheumatic, traumatic, or congenital origin. The reported patient has a congenital malformation of the cervical spine, which is frequently observed in patients with Klippel–Feil syndrome. Her posterior arch of the atlas (C1) is hypoplastic and a chronic subluxation of the atlanto-axial joint would be possible. Although most common fusions in Klippel–Feil syndrome patients exist at C2/3, the majority of studies about Klippel–Feil syndrome deal with pediatric or adolescent individuals. Through extreme flexion of her neck, there was a compression of the spinal cord by the odontoid process. This led to a quadriplegia lasting about 10 min. Over the following weeks, all of her symptoms started to diminish. This situation turned out to be the third episode involving temporary neurological disorders in this 60-year-old female’s life.

Grisel Syndrome: Prompt Diagnosis, Prompt Management Equals Happy Ending

Grisel syndrome is a rare cause of torticollis resulting from subluxation of the atlanto-axial joint (C1-C2 vertebra) joint from surrounding soft tissue inflammation. Atlanto-axial joint injuries typically occur in the setting of trauma. However, here we report a case of a non-traumatic cause of atlanto-axial joint subluxation in a child. The child initially presented to our centre with 5 days history of torticollis preceded by a few days of upper respiratory tract symptoms. The initial radiograph of the cervical spine did not demonstrate any obvious abnormality. However, due to a high index of suspicion by the attending physician, a CT of the cervical spine was performed, which indeed revealed an atlanto-axial subluxation. The patient was put on cervical traction for a few days, and discharged well with soft collar and analgesia.