ISSN: 0022-1198
CODEN: JFSCA
Page Count: 9

Neck Injuries: II. Atlantoaxial Dislocation—A Pathologic Study of 14 Traffic Fatalities
Adams, VI
University of South Florida and Medical Examiner Department, Florida

(Received 22 May 1991; accepted 16 August 1991)

Abstract

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.

Keywords:
pathology and biology, central nervous system, motor vehicle accident, craniocervical dislocation, atlantoaxial dislocation, neurogenic shock

Paper ID: JFS13263J
DOI: 10.1520/JFS13263J
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