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."

Life and Death in Italian Prehistory: The Case of the Sailor from Spina.

BACKGROUND: There are few reported cases in the literature of spinal injuries from the past, and all of them resulted in the death of the individual or led to severe health consequences. From the historical record, it is well known there were no cures or treatments for spinal lesions in the past. Given the paucity of historical documents focused on this topic, anthropological research on spinal injuries can contribute with important information regarding the medical history of this kind of trauma. Moreover, skeletal trauma and occupational markers may be crucial for the reconstruction of habitual behaviors and the identification of causes and timing of death. We report results of an anthropological study of a case of vertebral injury discovered in an individual from the Italian Iron Age that highlights this important topic. The aim of this study was to assess the habitual activity pattern and manner of death of an ancient inhabitant of Spina in Padanian Etruria (northeastern Italy). METHODS: We performed a detailed anthropological and paleopathological analysis of skeletal remains. RESULTS: The unknown individual was identified as a middle-aged man characterized by a particular trauma to the spine. Lesion analysis revealed a perimortem injury at the L2-L3 level. Characteristic markers on the bones indicated intense physical activity carried out during his life. CONCLUSIONS: This Etruscan, in all likelihood a sailor according to the occupational markers, did not survive a stabbing attack with a bladed weapon.

George Chance and Frank Holdsworth: Understanding Spinal Instability and the Evolution of Modern Spine Injury Classification Systems.

The concept of spinal cord injury has existed since the earliest human civilizations, with the earliest documented cases dating back to 3000 BC under the Egyptian Empire. Howevr, an understanding of this field developed slowly, with real advancements not emerging until the 20th century. Technological advancements including the dawn of modern warfare producing mass human casualties instigated revolutionary advancement in the field of spine injury and its management. Spine surgeons today encounter "Chance" and "Holdsworth" fractures commonly; however, neurosurgical literature has not explored the history of these physicians and their groundbreaking contributions to the modern understanding of spine injury. A literature search using a historical database, Cochrane, Google Scholar, and PubMed was performed. As needed, hospitals and native universities were contacted to add their original contributions to the literature. George Quentin Chance, a Manchester-based British physician, is well known to many as an eminent radiologist of his time who described the eponymous fracture in 1948. Sir Frank Wild Holdsworth (1904-1969), a renowned British orthopedic surgeon who laid a solid foundation for rehabilitation of spinal injuries under the aegis of the Miners' Welfare Commission, described in detail the management of thoraco-lumbar junctional rotational fracture. The work of these 2 men laid the foundation for today's understanding of spinal instability, which is central to modern spine injury classification and management algorithms. This historical vignette will explore the academic legacies of Sir Frank Wild Holdsworth and George Quentin Chance, and the evolution of spinal instability and spine injury classification systems that ensued from their work.

Global Trends of Researches on Sacral Fracture Surgery: A Bibliometric Study Based on VOSviewer.

STUDY DESIGN: Bibliometric analysis. OBJECTIVE: This study aims to identify and summarize the articles related to sacral fracture surgery, to compare the papers from different countries and journals, to show the trends of researches on sacral fracture surgery. SUMMARY OF BACKGROUND DATA: In recent years, studies on sacral fracture are growing rapidly, but there were no bibliometric studies regarding sacral fracture surgery. METHODS: Excel 2016 and VOSviewer were used to identify and summarize the articles from Web of Science between 1900 and 2018. Publication number, publication year, publication country, publication organization, publication source, author, sum of times cited, H-index, and journal's impact factors were recorded and analyzed. Bibliometric maps of co-citations and maps of co-occurrence of keywords are drawn. RESULTS: A total of 611 publications were extracted. United States published most articles (227, 37.2%), both total citations (3536) and H-index (32) of United States ranked first of all the countries. The most productive organization on sacral fracture surgery is Johns Hopkins University (14). Spine (43) published the most articles on sacral fracture surgery. The latest keyword "patterns" appeared in 2017 in 5 articles. Other relatively new keywords include "proximal junctional kyphosis," "spondylopelvic dissociation," "fragility fracture," "lumbopelvic fixation" that appeared in 2017 in eight, six, six, and 25 articles, respectively. CONCLUSION: This bibliometric study showed that there is a growing trend both in published articles related to sacral fracture surgery and relative research interest in the last 30 years. United States dominates the research regarding sacral fracture surgery. Johns Hopkins University, Johannes Gutenberg University of Mainz, and Harborview Medical Center are the best institutions related to sacral fracture surgery research. Spine, J Orthop Trauma, and Injury are the top three productive journals on sacral fracture surgery. Sacral fracture patterns, proximal junctional kyphosis, spondylopelvic dissociation, fragility fracture, and lumbopelvic fixation may be the new research hotspot in this field. LEVEL OF EVIDENCE: 5.

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.

[History of internal fixators. The subsequent importance for spinal surgery]. / Geschichte des Fixateur interne. Seine spätere Bedeutung für die Wirbelsäulenchirurgie.

BACKGROUND: This article presents a retrospective look at spinal implants of the 1970s and 1980s. OBJECTIVE: The historical development of internal fixators as the successor to external fixators. MECHANICAL PRINCIPLE: Pedicled screws are stably anchored in vertebral bodies of the thoracic or lumbar spine or the sacrum using a dorsal approach. They are joined by a rod as a longitudinal support, separated by freely selectable distances and in any desirable and initially modifiable angle. After locking this results in an angular and rotationally stable completely sunken bilateral construction for fixing two or more vertebrae together and the position can be manually adjusted using long lever arms on the pedicled screws. RESULTS: The first in vivo application in humans was on 22 December 1982 in Basel. The initial indications were unstable spinal fractures. The expectations placed on the new working principle of internal fixation and its realization were confirmed and short stretch fixation exclusively of the neighboring vertebra and immediate mobilization of patients could be routinely achieved. The indications were extended to include instability of the spine for conditions outside the field of traumatology. Further developments of implants and other technical solutions in the coupling system using the same basic principle in the direction of multisegmental applications, ease of operation and titanium-based materials became internationally established and were developed into universal spinal stabilization systems for spinal degeneration, deformities, tumors and olisthesis. CONCLUSION: The basic principle of spinal fixators (internal and external) is contained in the complete product range of dorsal stabilizing implants from practically all manufacturers worldwide and has become taken for granted.

A coinsidence, a chance or a misfortune? Hangman's fracture.

William R. Francis and Bassam El-Effendi shared a common ground: they were the first individuals to classify Hangman's Fractures. Interestingly, although they were unaware of each other, they classified and published their findings in the same year, published in the same edition of the same journal (but on different pages). This new classification system was a chance for notoriety for El-Effendi, yet it was a misfortune for Francis. Both physicians graduated in 1973 (from different universities). Also fellows at different universities in 1981, they were also both unaware they studied the same topic. Coincidentally, their paths crossed in the same edition of a journal where their studies were published in the same year, which was unprecedented in the literature. One classification scheme is well-known while the other is almost completely unheard of for no apparent reason other than chance for one and misfortune for the other.

Instrumentation of the posterior thoracolumbar spine: from wires to pedicle screws.

Over the past 120 years, spinal stabilization has advanced immensely. An updated review highlighting these advancements has not been performed in the past 20 years. The objective of this report is to provide a historical assessment of the decades outlining various key innovators, their techniques, and instrumentation. It is important to provide new generations of surgeons and students with historical evidence of the value of developing new techniques and instrumentation to improve patient care and outcomes.

Paulus aegineta: review of spine-related chapters in "Epitomoe medicoe libri septem".

STUDY DESIGN: Analysis of chapters related to spinal fractures and dislocations of an important medical book from medieval age. A historical study. OBJECTIVE: To present the sections on spinal fractures and dislocations in the treatise of Paulus Aegineta or Paul of Aegina, and to discuss their relationship with preceding and subsequent literature. SUMMARY OF BACKGROUND DATA: Paul of Aegina was influenced by precedent great authors and provided a significant link in the transmission of the surgical knowledge to present day via the prominent physicians of Islamic golden age. METHODS: The edition on which this study is based was translated from Greek into English by Francis Adams and was published in 1846 by The Sydenham Society in London in 3 volumes. The related sections were examined and compared with the treatises of earlier and subsequent writers. RESULTS: Although Paul of Aegina was influenced by Hippocrates, Celsus, and Galen, he also put forward his own opinions. The most prominent representatives of the Islamic Golden Age, Rhazes, Albucasis, Avicenna, and Haly Abas were influenced by Paul of Aegina. CONCLUSION: Paul of Aegina, who was the last representative of the Byzantine School, compiled approximately 1000 years of medical knowledge up to his own era. By taking on this task, he provided a significant link in the transmission of ancient knowledge to later generations. He is also considered as a bridge between Western and Eastern medicines as he conveyed medical knowledge of the ancient era to Islamic authors.

Biographical sketch: George L. Walton, MD and Walter E. Paul, MD.

This biographical sketch on George L. Walton and Walter E. Paul corresponds to the historic text, The Classic: Contribution to the Study of Spinal Surgery: One Successful and One Unsuccessful Operation for Removal of Tumor (1905), available at DOI 10.1007/s11999-010-1664-2 .

Hangman's fracture: a historical and biomechanical perspective.

The execution technique of hanging, introduced by the Angle, Saxon, and Jute Germanic tribes during their invasions of the Roman Empire and Britain in the 5th century, has remained largely unchanged over time. The earliest form of a gallows was a tree on which prisoners were hanged. Despite the introduction of several modifications such as a trap door, the main mechanism of death remained asphyxiation. This created the opportunity for attempted revival after the execution, and indeed several well-known cases of survival following judicial hanging have been reported. It was not until the introduction of the standard drop by Dr. Samuel Haughton in 1866, and the so-called long drop by William Marwood in 1872 that hanging became a standard, humane means to achieve instantaneous death. Hangmen, however, fearing knot slippage, started substituting the subaural knot for the traditional submental knot. Subaural knots were not as effective, and cases of decapitation were recorded. Standardization of the long drop was further propagated by John Berry, an executioner who used mathematical calculations to estimate the correct drop length for each individual to be hanged. A British committee on capital sentences, led by Lord Aberdare, studied the execution method, and advocated for the submental knot. However, it was not until Frederic Wood-Jones published his seminal work in 1913 that cervical fractures were identified as the main mechanism of death following hanging in which the long drop and a submental knot were used. Schneider introduced the term "hangman's fracture" in 1965, and reported on the biomechanics and other similarities of the cervical fractures seen following judicial hangings and those caused by motor vehicle accidents.

Patton: death of a soldier. Historical vignette.

General George S. Patton Jr. died as the result of quadriplegia sustained in a car crash in Germany in 1945. His x-ray films revealed a fractured C-3 vertebra and a posterior dislocation of C-4 on C-5. The likely cause of death was a pulmonary embolus. Details of his medical treatment are reviewed and compared with therapies that a patient with a similar injury would receive today.

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.