Contemporary History of Spine Fractures Following Deck-Slap Injury: From Deck Blast During World War II Naval Battles to Axial Trauma During Touristic Speedboat Sea Cruise in 21st Century

In large-scale naval battles during World War II, sailors sometimes sustained serious lower limb injuries when explosion blast of sea mines was transmitted from underneath through the metal deck of the ships. Some of these sailors were thrown in the air due to the blast and sustained axial trauma of the spine when they landed on the hard deck, which was thus called a deck slap by Captain Joseph Barr in 1946, among others. Nowadays, this peculiar mechanism has shifted to the civilian setting. Tourists unaware of the danger may sustain spine compression fractures when they sit at the bow of speed boats while underway on a calm sea. When the craft unexpectedly crosses the wake of another ship, tourists are thrown a few feet in the air before suffering a hard landing on their buttocks. This historical vignette is presented as a preventive message to help to reduce this poorly known yet avoidable "summer wave of vertebral fractures."

Fracture of the odontoid process in a male individual from the medieval necropolis of Maro (Málaga, Spain)

Traumatic injuries are commonly reported in paleopathology. However, fractures of the odontoid process in past populations are uncommon and therefore such injuries may be easily overlooked. This paper describes alterations of the first and second cervical vertebrae, the atlas and axis, of a male individual of advanced age from the medieval necropolis of Maro (Málaga, Spain). These alterations were observed through macroscopic evaluation and radiological analysis. This individual's skeleton is well-preserved, with degenerative changes present in the appendicular skeleton and the rest of the vertebrae. Our differential diagnosis included aplasia of the dens, bifid dens, dens duplicated, ossiculum terminale persistens, os odontoideum, and odontoid process fractures. We concluded that the most likely condition was a broken odontoid process fused with the anterior arch of the atlas, a pseudarthrosis demonstrating that the individual survived this fracture. This study is one of the first reports of an odontoid process fracture in ancient contexts.

A history of spine biomechanics. Focus on 20th century progress

The application of mechanical principles to problems of the spine dates to antiquity. Significant developments related to spinal anatomy and biomechanical behaviour made by Renaissance and post-Renaissance scholars through the end of the 19th century laid a strong foundation for the developments since that time. The objective of this article is to provide a historical overview of spine biomechanics with a focus on the developments in the 20th century. The topics of spine loading, spinal posture and stability, spinal kinematics, spinal injury, and surgical strategies were reviewed.

Perimortem weapon trauma in an adult male skeleton from the Italic necropolis of Opi Val Fondillo (VI-V century BC; Central Italy)

The author describes weapon traumatic lesions in an adult male skeleton, that was excavated in the Italic necropolis of Opi Val Fondillo, Central Italy. The preservation of the skeleton is very good. The skull shows a linear lesion across the diploE of the right parietal and occipital bones; the edge of the traumatic lesion is smooth and perpendicular to the bone surface. The injury was probably inflicted with a sharp-edged weapon and the violence of the stroke caused the detachment of bone fragments and fractures that radiate from the point of impact. A sharp-edged linear traumatic lesion, probably inflicted with a blade, is visible on the ventral surface of the vertebral bodies of atlas and axis; the blade detached the right transverse process of the atlas and penetrated in the vertebral body of the axis. Another sharp-edged linear traumatic injury is observed on the anterior surface of the body of thoracic vertebrae. There are no traumatic lesions of the ribs and the last injury was probably inflected down with a blade, while the body lying on the ground. The posterior surface of the diaphysis of the right femur shows an incomplete perimortem fracture, probably due to a compression down upon. Probably the adult male was killed during a fight and enemy had done with him, while he was lying on the ground holding fast his legs strongly. A comparison is made between the lesions and the modality of combat as well as the type of the weapons used by the Samnitic warriors.

Lumbar Spine Fracture in a 34,100-year-old Skeleton: The Oldest Known Prehistoric Spine Fracture

WE EXAMINED SPECIAL pathological changes of the lumbar spine from skeleton remains referred to as "Stetten 1," one of the earliest specimens of modern humans dating from the Early Stone Age (Upper Paleolithic). The skeleton was discovered during archaeological excavations under Riek in 1931 in the Vogelherd Cave near Stetten, close to the Lone Valley of southwestern Germany. The archaeological context is the so-called Aurignacian period (40,000-30,000 yr ago), representing the earliest cultural step of modern humans in Europe. Accelerator mass spectrometry with (14)C measurement yields a calibrated age of these remains averaging 34,100 years before the present. The L3-L4 vertebrae exhibit marginal bone fusion on the right side with a smooth surface. They show 20- to 30-degree kyphosis secondary to wedge impaction of the L4 vertebral body. The facet joints and vertebral bodies reveal small marginal osteophytes with even joint surfaces, indicating low degenerative changes. Stetten 1 is characterized by the presence of a healed lumbar spine fracture. It documents the earliest known case thus far of spine fracture among modern humans.

Medieval management of spinal injuries: parallels between Theodoric of Bologna and contemporary spine surgeons

In recent decades there have been revolutionary technological advances in the management of traumatic spinal column injuries. Despite these advances, the basic principles of reduction and stabilization of vertebral fractures and dislocations remain similar to those proposed by ancient and medieval physicians. Theodoric of Bologna, in his text Chiurgica de Theodoric (ca. AD 1267), described an extracorporeal approach to the management of traumatic spinal column misalignments. Surprisingly, his techniques are still used in many instances by contemporary spine surgeons, despite the availability of a more advanced technological armamentarium than that existent in medieval times.

Nelson's wound: treatment of spinal cord injury in 19th and early 20th century military conflicts

During the first half of the 19th century, warfare did not provide a background for a systematic analysis of spinal cord injury (SCI). Medical officers participating in the Peninsular and Crimean Wars emphasized the dismal prognosis of this injury, although authors of sketchy civil reports persuaded a few surgeons to operate on closed fractures. The American Medical and Surgical History of the War of the Rebellion was the first text to provide summary of results in 642 cases of gunshot wounds of the spine. The low incidence of this injury (0.26%) and the high mortality rate (55%) discouraged the use of surgery in these cases. Improvements in diagnoses and the introduction of x-ray studies in the latter half of the century enabled Sir G. H. Makins, during the Boer War, to recommend delayed intervention to remove bone or bullet fragments in incomplete injuries. The civil experiences of Elsberg and Frazier in the early 20th century promoted a meticulous approach to treatments, whereas efficient transport of injured soldiers during World War I increased the numbers of survivors. Open large wounds or cerebrospinal fluid leakage, signs of cord compression in recovering patients, delayed clinical deterioration, or intractable pain required surgical exploration. Wartime recommendations for urological and skin care prevented sepsis, and burgeoning pension systems provided specialized long-term rehabilitation. By the Armistice, the effective surgical treatment and postoperative care that had developed through decades of interaction between civil and military medicine helped reduce incidences of morbidity and dispel the hopelessness surrounding the combatant with an SCI.

History of posterior thoracic instrumentation

The term “backbone” appears in many expressions used in modern day society. In any scenario, it has one central meaning: stability. Best defined as a foundation that is able to sustain multiple stressors without adversely affecting integrity, the commonly and appropriately termed backbone of humans is the spinal column. As the central focus of stability in our species, the spine is subject to a great degree of trauma and mechanical forces. A variety of methods have been developed throughout history in the treatment of spinal column injury. Initial treatment involved the use of simple traction devices for the reduction of spinal fractures; these have evolved to include the current insertion of spinal instrumentation. The authors review the historical treatment and development of posterior instrumentation for thoracic spinal injury.

The case of James A. Garfield: a historical perspective

In 1881, President James A. Garfield was shot in the back and died 79 days later. During this time, many controversies arose that had repercussions for years to come. Who was to manage the President's care? A prominent local physician took on the case, but after Garfield's death, he was highly criticized for inappropriate care and for excluding more highly qualified surgeons. Where was the bullet? Multiple opinions were given including that of Alexander Graham Bell. The correct suggestion turned out to be that of a young, unknown assistant demonstrator of anatomy. What was the proper treatment? Local wound care, removal of the bullet, and laparotomy all were considered. Many have felt that the choice of treatment may have proved to be worse than the injury itself. What did the autopsy show? Even this was controversial, with different observers claiming different results. This historical perspective reviews the case as well the controversies that surrounded it.

[The importance to nineteenth century hospital medicine of an anatomic specimen of severely traumatized vertebrae. Scientific history at the Museum of Pathologic Anatomy in the Hospital of Trieste]

The museum of pathological anatomy, established in Trieste in 1847, a few years after the opening of the general hospital, keeps a sole pathological finding of "lethal vertebral trauma" dated 1903 and prepared by one of the fathers of Trieste's pathological anatomy, Enrico Ferrari (1874-1970). This museum object recalls a clinical sensitivity in traumatology going back to Simone Pertot (1845-1907), the first pathologist of Trieste, but also the clinical observations of one of Billroth's disciples, the triestine Arthur Menzel (1844-1878), head of the i.v. Surgery Division. Giving this museum object its historical scientific genesis means answering the following questions: Why does the pathologist provide clinical medicine with such a preparation? In other words, what pragmatic meaning does it have? What is its function? In the practical clinical activity of the above-mentioned hospital's medicine, the state of disease finds its meaning in concepts like diagnosis and prognosis and, therefore, the same epicritic function of the pathologic sample representing vertebral trauma. Its "clinical" meaning is in the pathologist's and clinician's ability at elaborating a pathognomonic sign which is able to put forth, at the patient's bedside, the physiopathological laws determining the seriousness of the trauma taking place in the organism.

[What is known today about the treatment of injuries of Charles IV in the year 1350]

The author proceeds with his earlier 1990 contribution ou the complementary examination of the skull of the Czech king and Roman emperor Charles IV. Direct relationship between the injury to the cervical spine and the newly detected healed fractures of the mandible was established. A strong blow on the king's chin induced the four-fold dislocated fracture of the mandible. Based on our present knowledge of medieval medicine, and especially facial traumatology an attempt was made to clarify the treatment methods applied in management of the king's injury.

Craniocervical injuries in judicial hangings: an anthropologic analysis of six cases

Restoration projects and archaeologic excavations in two Canadian prisons resulted in the recovery of the skeletons of six felons executed by judicial hanging. Damage inflicted by hanging on various skeletal elements was observed. Among the injuries seen were fractures of the hyoid cornua, styloid processes, occipital bones, and cervical vertebral bodies (C2) and transverse processes (C1, C2, C3, and C5). Despite the general uniformity of the hanging technique, which involved a subaural knot, the trauma to the skeletal elements and the cause of death varied among individuals. Although some of this variation was probably due to minor differences in hanging practices, individual anatomic peculiarities of the victims likely also contributed.

Brief communication: when Adam delved ... an activity-related lesion in three human skeletal populations

A rare, activity-related lesion, the clay-shoveller's fracture, was identified during osteological analysis in three human populations dating from the Roman to the later Medieval period in England, circa fourth to 14th centuries A.D. The prevalence of this fracture in these populations suggests an osteological indicator for several possible manual activities, but also one that may be the result of a long-standing human subsistence adaptation requiring digging in the soil. Since males as opposed to females appear to be preferentially affected, the occurrence of such injuries has the potential to provide an insight into the sexual division of labor in earlier human populations.

Victor Horsley's surgery for cervical caries and fracture. The Centennial Anniversary

On August 25, 1895, Victor Horsley, the doyen of British neurosurgery, presented the results of his surgery for trauma and caries (tuberculosis) of the cervical spine at the Surgery Section of the British Medical Association Annual Meeting. All of the patients recovered from their operations and four were in attendance at the meeting to attest to the results of their operations. For the surgeon of 1895, laminectomy of the cervical spine was a daunting undertaking. Although effective anesthesia and antiseptic techniques had become available, roentgenologic evaluation of spinal fracture and disease was still a future diagnostic modality. The special relationship of Victor Horsley with William Gowers, neurologist of Queen's Square Hospital, London, is presented. The status of therapy for cervical fracture and tuberculosis at the close of the 19th century is described to gauge the magnitude of this event as a major contribution to the progress of spinal surgery.

The occurrence of cervical fractures in victims of judicial hanging

Cervical vertebrae from 34 victims of judicial hanging were examined. In only six cases was there a fracture of the axis and only one other fracture was seen in the series. The fractures were of two types. Three were the traditional 'Hangman's fracture' whilst three were of a type previously unreported. The incidence of fracture was unassociated with drop, date age or hangman. The results of the post mortems on these subjects were reviewed and found to be grossly inaccurate with regard to fractures. The results indicate that the traditional hangman's fracture occurred in only a small proportion of cases of judicial hanging. The cause of fractures and cause of death in judicial hanging are discussed with a brief history of judicial hanging in this country.