Injuries deeper than the platysma are considered as penetrating neck injuries, constituting approximately 5% - 10% of all trauma. Many vital organs are at risk from a penetrating neck injury. These injuries in zone 1 have the highest mortality, because the injuries are close to the vital organs and difficult to access surgically. A 41-year-old male, a car mechanic by profession, presented to the emergency department with a penetrating neck injury on the right side. CT scan demonstrated a metallic foreign body in zone 1 between the right internal jugular vein and the common carotid artery. The patient was asymptomatic, and the foreign body was removed surgically. This case shows a rare presentation of a penetrating neck injury with a foreign body located in zone 1, where no vital internal structure was injured. As of now, no previous case report has been identified on such presentation. Thus, it will provide a valuable addition to the pre-existing literature.
Humans ; Male ; Adult ; Neck Injuries/diagnostic imaging* ; Wounds, Penetrating/diagnostic imaging* ; Foreign Bodies/diagnostic imaging* ; Jugular Veins ; Tomography, X-Ray Computed ; Carotid Artery Injuries/surgery* ; Carotid Artery, Common

Humans ; Joint Dislocations/diagnostic imaging* ; Neck Injuries ; Disability Evaluation

Although penetrating neck trauma (PNT) is uncommon, it is associated with the significant morbidity and mortality. The management of PNT has changed significantly over the past 50 years. A radiological assessment now is a vital part of the management with a traditional surgical exploration. A 22 years old male was assaulted by a screwdriver and sustained multiple penetrating neck injuries. A contrast CT scan revealed a focal pseudoaneurysm in the left common carotid artery bulb. There was no active bleeding or any other vascular injuries and the patient remained haemodynamically stable. In view of these findings, he was initially managed conservatively without an open surgical exploration. However, the patient was noted to have an acute drop in his hemoglobin count overnight post injury and the catheter directed angiography showed active bleeding from the pseudoaneurysm. Surgical exploration 40 hours following the initial injury revealed a penetrating injury through both arterial walls of the left carotid bulb which was repaired with a great saphenous vein patch. A percutaneous drain was inserted in the carotid triangle and a course of intravenous antibiotics for five days was commenced. The patient recovered well with no complications and remained asymptomatic at five months followup.
Carotid Artery Injuries ; diagnostic imaging ; surgery ; Carotid Artery, Common ; surgery ; Computed Tomography Angiography ; Humans ; Male ; Neck Injuries ; diagnostic imaging ; surgery ; Wounds, Penetrating ; diagnostic imaging ; surgery ; Young Adult

Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause potentially life-threatening hemorrhage but also need profound surgical expertise in management. Development of collateral circulation in neck is well known; however, there is scarcity of literature on the role of collateral formation in neck trauma. Here, we present a unique case of penetrating gunshot injury to neck with right common carotid and right subclavian artery injury with hemorrhagic shock managed with ligation of these vessels as a life-saving procedure. The patient presented with no neurological or motor deficits in immediate postoperative period owing to the collateral circulation between right vertebral artery and right common carotid and right subclavian artery.
Adult ; Carotid Artery Injuries ; diagnostic imaging ; surgery ; Carotid Artery, Common ; diagnostic imaging ; surgery ; Humans ; Ligation ; Male ; Neck Injuries ; diagnostic imaging ; surgery ; Subclavian Artery ; diagnostic imaging ; injuries ; Tomography, X-Ray Computed ; Wounds, Gunshot ; diagnostic imaging ; surgery

Diagnostic Errors ; Female ; Femoral Neck Fractures ; diagnosis ; diagnostic imaging ; Femur Neck ; diagnostic imaging ; injuries ; Humans ; Radiography ; Young Adult

OBJECTIVEWe evaluated a new hypothesis of acetaminophen therapy to reduce the necessity of imaging in patients with probable traumatic cervical spine injury.

METHODSPatients with acute blunt trauma to the neck and just posterior midline cervical tenderness received acetaminophen (15 mg/kg) intravenously after cervical spine immobilization. Then, all the patients underwent plain radiography and computerized tomography of the cervical spine. The outcome measure was the presence of traumatic cervical spine injury. Sixty minutes after acetaminophen infusion, posterior midline cervical tenderness was reassessed.

RESULTSOf 1 309 patients, 41 had traumatic cervical spine injuries based on imaging. Sixty minutes after infusion, posterior midline cervical tenderness was eliminated in 1 041 patients, none of whom had abnormal imaging.

CONCLUSIONPatients with cervical spine trauma do not need imaging if posterior midline cervical tenderness is eliminated after acetaminophen infusion. This analgesia could be considered as a diagnostic and therapeutic intervention.

Acetaminophen ; administration & dosage ; Adolescent ; Adult ; Analgesics, Non-Narcotic ; administration & dosage ; Female ; Humans ; Iran ; Longitudinal Studies ; Male ; Middle Aged ; Neck Injuries ; diagnostic imaging ; drug therapy ; Prospective Studies ; Radiography ; Spinal Injuries ; diagnostic imaging ; drug therapy ; Unnecessary Procedures ; Wounds, Nonpenetrating ; diagnostic imaging ; drug therapy

Radiology is an important adjunct to clinical practice, but for many clinicians, requesting X-rays was something that was learnt on the job. This article provides guidelines on when and how to request X-rays for acute conditions such as head and cervical spine trauma, suspected rib and extremity fractures, low back pain and acute abdominal pain. We also highlight what to write in the request form, in order to obtain maximum value from the examination and allow the radiologist to generate a useful, accurate report.
Ankle Injuries ; diagnostic imaging ; Cervical Vertebrae ; diagnostic imaging ; Emergency Service, Hospital ; standards ; Fractures, Bone ; diagnostic imaging ; Health Care Costs ; Hospitals ; Humans ; Medical Errors ; prevention & control ; Neck Pain ; diagnostic imaging ; Radiology ; methods ; organization & administration ; standards ; Spinal Injuries ; diagnostic imaging ; Tomography, X-Ray Computed ; X-Rays

OBJECTIVETo compare the differences of radiographical and functional outcomes between traditional and minimally invasive approach in treating Hawskins type I fractures of the talar neck.

METHODSFrom February 2000 to February 2008, 37 patients underwent reduction and internal fixation using two different approaches. In minimally invasive approach group, there were 16 males and 2 females, ranging in age from 20 to 47 years, averaged (35.2 +/- 3.1) years, and in traditional approach group, there were 15 males and 4 females, ranging in age from 22 to 44 years, averaged (35.3 +/- 2.3)years. All the patients had Hawskins type I fractures. The following data were compared between two groups: operation time, blood loss, length of incision and function of ankle joint. All the patients were graded by Hawkins points-scoring system after operation.

RESULTSAll patients were followed up. The duration ranged from 2 to 10 years, with an average of 5.6 years. The index such as operation time, blood loss and the length of incision of patients in minimally invasive approach group were significantly less than those of patients in traditional approach group. According to AOFAS points-scoring system, the score of minimally invasive group was higher than that of traditional approach group.

CONCLUSIONCompared with traditional approach, minimally invasive approach can protect blood supply better, get better clinical effects,which is worth of choosing to treat Hawskins type II fractures of talar neck.

Adult ; Case-Control Studies ; Female ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Neck Injuries ; diagnostic imaging ; physiopathology ; surgery ; Recovery of Function ; Retrospective Studies ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: In treating schwannoma patients, it is critical to determine the origin of the tumor to preserve nerve function. We evaluated the validity of preoperative imaging studies in distinguishing the neurological origin of the schwannomas of the head and neck, and the efficacy of intracapsular enucleation in preserving nerve function. MATERIALS AND METHODS: In 7 cases of schwannomas in the head and neck region, we predicted whether the tumor originated from the vagus nerve or the cervical sympathetic chain through imaging studies including computed tomography (CT) and magnetic resonance imaging (MRI). All patients were performed intracapsular enucleation, and the function of the vagus nerve and the sympathetic nerve was evaluated preoperatively and postoperatively. RESULTS: Preoperative imaging studies showed 6 cases where the tumor was located between the carotid artery and the internal jugular vein, and 1 case where the tumor was located posteriorly, displacing the carotid artery and the internal jugular vein anteriorly. At the time of operation, we confirmed schwannoma originating from the vagus nerve on the first 6 cases, and schwannoma originating from the sympathetic nervous system on the last case. All patients went through successful intracapsular enucleation, and of the seven schwannoma cases, 6 patients maintained normal postoperative neurological function (85.7%). CONCLUSION: Preoperative imaging studies offer valuable information regarding the location and origination of the tumor, and intracapsular enucleation helped us to preserve the nerve function.
Aged ; Diagnostic Imaging/methods ; Female ; Follow-Up Studies ; Head and Neck Neoplasms/complications/diagnosis/*pathology ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Neurilemmoma/complications/diagnosis/*pathology ; Peripheral Nervous System/injuries/physiology ; Sympathetic Nervous System/physiology ; Tomography, X-Ray Computed/methods ; Treatment Outcome ; Vagus Nerve/physiology

This study was conducted to develop a three-dimension finite element (FE) model of Chinese human neck for dynamic response during impact condition. A 50th percentile adult human in good health was chosen as a model. The 3-D FE model of C1-T1 was constructed by using of SCT scanning technology to get the data of DICOM format, using software Materialisc mimics, Pro-E to achieve three-dimension reconstruction, and using software TrueGrid to mesh. The model was composed of cervical vertebra, discs, facet joints, ligaments and muscles, which consisted of 24916 nodes and 15023 elements, including 14626 eight-node solid elements, 19 two-node link elements and 378 two-node cable elements. In LS-DYNA, the dynamic response of human neck under frontal impact was investigated and compared with experimental results so as to validate the model. The method proposed can develop complex FE model with eight-node elements fleetly and accurately in order to make computing more stably. The developed three-dimension FE model was used for dynamic response during impact condition, which may be helpful to studies on the injury of Chinese human neck.
Accidents, Traffic ; Adult ; Biomechanical Phenomena ; Cervical Vertebrae ; diagnostic imaging ; injuries ; physiology ; Finite Element Analysis ; Humans ; Imaging, Three-Dimensional ; methods ; Male ; Models, Biological ; Neck ; physiology ; Stress, Mechanical ; Tomography, Spiral Computed ; Whiplash Injuries ; etiology ; physiopathology