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Bunny Suit
Published in R. Annie Gough, Injury Illustrated, 2020
The three of us resorted to manual labor. With hands on his head and our feet on the gurney, we pressed and pushed. With a crunch, we finally forced the last connection of bone to give way. The brain was examined, the dura was stripped, the pituitary was removed, and it was placed in the tissue storage jar. The coroner examined the base of the skull, feeling the smooth round opening with her gloved fingers. The joint where the skull meets the neck is called the Atlanto-Occipital joint, the AO. It is where C1, known as the atlas, the first cervical spine vertebra, articulates with the occipital bone of the skull base. The structure and function of the joint is best realized in nodding yes and no and in safely turning the head from side to side, protecting all the arteries in the neck that carry blood to the brain. This man had a wide AO joint; too wide. In fact, his AO had separated. By definition, his head came off his neck. This is a typical injury associated with motorcycle crashes, something a helmet will not protect against. Wildly dangerous to the spinal cord and brain stem, this injury was considered to be the cause of death.
Regional injuries and patterns of injury
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
The spine is a complex structure with interlocking but mobile components often described as having anterior, middle and posterior ‘sub-columns’. Damage to one of the sub-columns is unlikely to result in instability: if the middle column is damaged then the likelihood of instability, neural damage is increased, and if all three columns are involved then fracture-dislocations and spinal cord damage is expected. The spine is designed to flex to a great extent but lateral movement and extension are more limited. The spine is very commonly injured in major trauma such as road traffic collisions or falls from a height, and severe injury with discontinuity is easily identified. The history of the event (e.g., the height fall distance) is often very important in predicting the potential injury patterns, but distances may be poorly estimated by bystanders. Sometimes the spinal injuries are more subtle and at post mortem it is only after careful dissection that damage to the upper cervical spine and, in particular, disruption of the atlanto-occipital joint will be revealed.
Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
Internally, the occipital bone is marked by grooves for several dural sinuses: the sigmoid sinus (“S-shaped”), superior sagittal sinus, and the transverse sinuses. It also contains fossae for parts of the brain: the fossae for the cerebellum and the fossae for the occipital poles of the cerebral hemisphere (Plates 3.10 through 3.12). The atlanto-occipital joint is made by the occipital condyles and the superior articular facets of the atlas bone, which is part of the vertebral column (the atlas bone is named after Atlas, the mythical man who balanced the world on his shoulders, as the atlas balances the head on the neck). The atlas includes the anterior arch, superior articular facet, transverse process, and posterior arch (Plate 3.31b and c). Note that the transverse ligament of the atlas holds the dens to the anterior arch of the atlas. The retropharyngeal space is situated posterior to the cervical viscera and extends from the basilar part of the occipital bone to the superior mediastinum.
Vesalius criticism on Galen’s musculoskeletal anatomy
Published in Acta Chirurgica Belgica, 2019
Konstantinos Markatos, Dimitrios Chytas, Georgios Tsakotos, Marianna Karamanou, Maria Piagkou, Elizabeth Johnson
The spine is another region that was criticized by Vesalius. Although Galen argued that lateral flexion and rotation in the cervical spine includes lifting and separation of the atlanto-occipital joint surfaces, Vesalius wrote that separation does not occur and movements of the atlanto-occipital joint are caused due to the convex nature of its surfaces and due to muscles and ligaments [7,8]. Regarding the anatomy of the sacrum, Vesalius disagreed with Galen, who considered that the sacrum consisted of three bones [3,7,8]. In contrast, Vesalius noticed that it usually consisted of six bones [7,8], an opinion that would obviously be criticized later.