Biomechanical aspects of whiplash injury

Probably the best-known and most controversial injury nowadays is the whiplash injury. The collision forces do not necessarily have to leave external damages on the head, rather they lead to compact brain injuries.

In lethal cases, which appear seldom, greater bleedings of the head callosity can be found during the post mortem examination, even though no injuries can be seen from the outside. Then a whiplash injury by a rear impact accident with a compact brain injury is not an absolute whiplash injury. But also an absolute whiplash injury without head impact can lead to cerebral injuries.

This could be proved in 1968 by Ommaya et al. in an experiment with monkeys. So a whiplash injury is a distortion of the cervical spine with or without cerebral involvement. According to the Quebec Task Force on Whiplash-Associated Disorders (Spitzer et al. 1995), peripheral disorders such as pain or stiffness in the neck and cerebral disorders such as headache, dizziness, tinnitus, concentration and memory disorders, deglutition dysfunctions and temporomandibular dysfuncions (functional disturbances in the area of the lower jaw at the passage to the temple) are symptomatic. A fibrillating or blurred sense of vision also appear frequently. These symptoms appear with a characteristic latency (time delay) of 0 to 72 hours.

The cerebral symptoms mentioned above are relevant in order to chronify a disease. Unfortunately just these symptoms provoke heavy controversies among physicians during the assessment of the connection with the accident (causality).

A whiplash injury can emerge almost everywhere: During a traffic accident, while doing sports or at work. Yes, it can even happen while skiing or in an airplane, although it has to be said that car accidents are by far the most frequent reason for a whiplash injury.

The critical factor for the occurrence of a whiplash injury is not the place, but the mechanism of the accident, i.e. the body has to perform the movement of a whip stroke. The exact course of such a whip movement during a rear-end collision can be seen in the subchapter.

The common diagnostic method with a whiplash injury of the cervical spine is shown in the adjacent diagram and can be looked up in appropriate medical literature. But there are examinations that are generally less known in the emergency departments of hospitals: First, the determination of the brain’s state is mostly missing, even though the appearance of the symptoms mentioned above indicate a damage. Second, the examination of the passage from head to neck is missing. And also the next problem appears here: The possible injuries of the brain, of the passage from head to neck and also of the jaw area (see above) need an interdisciplinary treatment. Thus, depending on the severity of the case specialists from orthopaedics, neurology, ENT medicine, maxillary surgery and neurosurgery would have to cooperate in the creation of a diagnosis and the corresponding treatment.

Mostly a whiplash injury is only treated from the point of view of an orthopaedist. This may be sufficient in light cases of the whiplash injury. However, if the patient’s discomfort does not ease, examinations by the specialists mentioned above to clarify the circumstance would immediately have to be ordered. And this is mostly not done, with fatal consequences for the patient, so that irreparable damage can possibly result.