Neck Injuries: III. Ligamentous Injuries of the Craniocervical Articulation Without Occipito-atlantal or Atlanto-axial Facet Dislocation. A Pathologic Study of 21 Traffic Fatalities

Craniocervical ligamentous injuries without dislocation of the occipito-atlantal or atlantoaxial motion segments have been described rarely if at all. Among 155 traffic fatalities were 21 persons with such injuries. Among the 21 fatalities were 20 alar ligament injuries, eight tectorial membrane injuries, and ten injuries of the subaxial cervical spine. All 21 had craniocerebral trauma, including twelve with skull fractures, seven with facial or mandibular fractures, eight with subdural hemorrhages, twelve with subarachnoid hemorrhages, seven with cerebral contusions, five with cerebral lacerations, two with midbrain lacerations, nine with pontomedullary lacerations, and four with spinomedullary injuries. The mechanisms of death was acute neurogenic shock in seven victims, acute neurogenic shock in combination with other physiological derangements in six, acute neurogenic respiratory arrest in three, brain swelling in two, and mechanisms unrelated to head and neck trauma in three victims. In six victims, the neck injury did not contribute to death. No conclusions regarding the biomechanical mode of injury are drawn.