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72 Z. Rechtsmedizin 1 (1973)

handle is hein.journals/injlegame72 and id is 1 raw text is: Z. Rechtsmedizin 72, 1-7 (1973) © by Springer-Verlag 1973 Originalarbeiten-Original Papers Rekonstruktion des Unfallherganges bei Halsverletzungen* ** Georg Schmidt und Dimitrios Kallieris Institut fur gerichtliche Medizin der Universitat Heidelberg (BRD) Eingegangen am 31. Oktober 1972 Reconstruction of Accidents from Injuries of the Neck Summary. Because of a difficult postmortem examination, which requires much time, injuries of the neck are not always recognized distinctly. According to Weil (1968), the cervical vertebrae were injured by more than 50% of the traffic victims. Autopsy technique: The usual section of the scalp is lengthened behind the ears along the sternocleidomastoidmuscle to the manubrium sterni. In this way the superficial muscles of the neck may be well displayed. If a bone injury is suspected, x-ray examination must follow after removing the muscles in layers. By angiography of the arteriae vertebrales or carotides, suspected injuries of the vessels can be detected. The cervical and if necessary the breast and lumbar vertebrae are removed. Biomechanics. The biomechanic-functional unit, head - neck - trunk, exhibits this speciality that an acceleration or deceleration between head and trunk often takes place. Less frequent are the direct injuries of the neck. Acceleration works in axial and linear direc- tion as pressure or tension. Muscle strainings, band lacerations and disruption of the vertebrae or the cranial base (circle fracture) occur. In case of tension the fragments of the os occipitale lay outside and in case of pressure within the cranial cavity. Forces as in the case of whiplash of following trunk impact work as rotational acceleration with the result of wringing off the neck. Dynamical tension loading of the cervical vertebrae with 160-360 kp results in disruption after lengthening from 6 to 11 cm, whereas pressure of 1350 to 1800 kp is needed for lacera- tions. So the violability is much greater by tension than by pressure. So far the description implies short (5-160 msec) and quick (> 15 km/hr or 1300 rad/ secs) motions according to dynamic impact. In case of quasi static pressure more fractures of the vertebral pedicles are detected, perhaps by shearing forces, to which the neck is exposed. The neck marrow can also be crushed vigorously, if vertebral bodies are dislocated. Injuries of the arteriae vertebrales are less frequent. Although measurements with reference to the loading capacity of the neck are known, experiments in a greater extent are nevertheless necessary. Reconstruction. Apart from the tensile lacerations which appear on the neck in front lateral following the cleavage directions of the skin, direct trauma to the skin of the neck is well known and is not to be discussed here. The tearing lines require some time for their formation. The nature of the injuries of soft tissues and better - bones permits to recognize the dynamic (whiplash) or quasi static (pressure against abutment) origin. It is good to decide, whether the flexions of the neck were coming, from the front or the back or the sides. The locality of the lacerations illustrate well the direction of the hyperextension. These conclusions must be demonstrated by a critical examination of all details, for example the injuries of the head, damaging of cloths, foreign bodies in wounds and observations of intravital and post- mortal origin. * Teilweise vorgetragen auf dem IV. Internationalen Kongrell fur Verkehrsmedizin in Paris, September 1972. ** Herrn Prof. Dr. med. Berthold Mueller zum 75. Geburtstag gewidmet. 1 Z. Rechtsmedizin, Bd. 72

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