Case #1 - Cervical Injury, ADDITIONAL DETAILS

[ricki]

Two questions were recently circulated by email and PM regarding medical issues related to recent kiteboarding accidents. In the interest of fostering discussion, these questions have been reproduced below. If the membership wouldn't object, I would be pleased to post some of the responses received to date via email or PM.

NOTE: The identities of the victims and locations of the accidents are not included in these summaries. Given the nature of reported observations and difficulty of fact checking, these accounts would be best considered as plausible, hypothetical scenarios as opposed to actual incidents for purposes of discussion.

In Case #1, reportedly the 40 year old man suffered a fractured C2 vertebra while body dragging in shallow water (knee to waist deep), with a 6 m kite in light (3 bft. winds, 8 - 12 kts. with rare gusts up to 4 bft., 11 - 16 kts.). Conditions were partially cloudy with no storms or violent gusts reported to be present. Wind records have been found that confirm these conditions from a station. He had started his instruction on the day of the accident.

He was body dragging along with the instructor and one other student watching. The man was unhooked and presumably body dragging at a fairly low speed. Suddenly the man was seen to drop one side of the control bar and then the other. The kite fell to the water and the man eased face down in the water. He was not seen to have his head completely go below water while body dragging. I understand that he was found unconscious and was carried ashore. There was no external lividity or mark of impact observed on or about his head or upper torso. The bottom is said to consist of sand with no rocks. I have asked for more particulars about the man's size, weight, apparent conditions other sports, etc. There is to be an autopsy but it is unlikely that I will learn any details if things follow usual form.

No additional details about the victim may be forthcoming. From a lay perspective it might be concluded that there may have been some form of preexisting injury or weakness for what should have been relatively minor current induced trauma to cause a fatal fracture. Do you feel a preexisting condition would be necessary for a fatal fracture to occur under such conditions? Do any other impressions or ideas come to mind?

[ricki]

Two questions were recently circulated by email and PM regarding medical issues related to recent kiteboarding accidents. In the interest of fostering discussion, these questions have been reproduced below. If the membership wouldn't object, I would be pleased to post some of the responses received to date via email or PM.

NOTE: The identities of the victims and locations of the accidents are not included in these summaries. Given the nature of reported observations and difficulty of fact checking, these accounts would be best considered as plausible, hypothetical scenarios as opposed to actual incidents for purposes of discussion.

In Case #1, reportedly the 40 year old man suffered a fractured C2 vertebra while body dragging in shallow water (knee to waist deep), with a 6 m kite in light (3 bft. winds, 8 - 12 kts. with rare gusts up to 4 bft., 11 - 16 kts.). Conditions were partially cloudy with no storms or violent gusts reported to be present. Wind records have been found that confirm these conditions from a station. He had started his instruction on the day of the accident.

He was body dragging along with the instructor and one other student watching. The man was unhooked and presumably body dragging at a fairly low speed. Suddenly the man was seen to drop one side of the control bar and then the other. The kite fell to the water and the man eased face down in the water. He was not seen to have his head completely go below water while body dragging. I understand that he was found unconscious and was carried ashore. There was no external lividity or mark of impact observed on or about his head or upper torso. The bottom is said to consist of sand with no rocks. I have asked for more particulars about the man's size, weight, apparent conditions other sports, etc. There is to be an autopsy but it is unlikely that I will learn any details if things follow usual form.

No additional details about the victim may be forthcoming. From a lay perspective it might be concluded that there may have been some form of preexisting injury or weakness for what should have been relatively minor current induced trauma to cause a fatal fracture. Do you feel a preexisting condition would be necessary for a fatal fracture to occur under such conditions? Do any other impressions or ideas come to mind?

[ricki]

Some comments and ideas from an Emergency Physician follow. It would be good to receive the comments and opinions of other members and from various areas of practice. Even with the relatively small membership at this point, the broad diversity of training, experience and perspective from various parts of the medical profession is impressive.

"Case #1

I’m not sure what to make of this. A 6m kite in 16kt gusts is very unimpressive energy. That being said, it does not take as much force as you would think to break a cervical vertebra. Many people are paralyzed every year diving into pools. I see several a year at my hospital from body surfing as well. So the question becomes; how shallow was the water and what were the chances of impacting the bottom? Another mechanism consideration is the eponym for a C2 (pedicle) fracture which is a hangmans fracture. Judicial hangings cause extreme hyperextension displacing C2 forward on C3, which is the same mechanism in diving and motor vehicle collisions. Was a chicken loop not being used, or is it possible that a gust or mishandling of the kite could have caused the bar to impact under the chin? It is certainly possible that there could have been a preexisting condition or injury, but that is purely conjecture until an autopsy is available. This seems more of a freak incident than an avoidable injury."

[ricki]

Some comments and ideas from an Emergency Physician follow. It would be good to receive the comments and opinions of other members and from various areas of practice. Even with the relatively small membership at this point, the broad diversity of training, experience and perspective from various parts of the medical profession is impressive.

"Case #1

I’m not sure what to make of this. A 6m kite in 16kt gusts is very unimpressive energy. That being said, it does not take as much force as you would think to break a cervical vertebra. Many people are paralyzed every year diving into pools. I see several a year at my hospital from body surfing as well. So the question becomes; how shallow was the water and what were the chances of impacting the bottom? Another mechanism consideration is the eponym for a C2 (pedicle) fracture which is a hangmans fracture. Judicial hangings cause extreme hyperextension displacing C2 forward on C3, which is the same mechanism in diving and motor vehicle collisions. Was a chicken loop not being used, or is it possible that a gust or mishandling of the kite could have caused the bar to impact under the chin? It is certainly possible that there could have been a preexisting condition or injury, but that is purely conjecture until an autopsy is available. This seems more of a freak incident than an avoidable injury."

[Kitezilla]

Agee in most regards with the ER doc---and I have a few other thoughts...

1) not a lot of wind (agree)--+ it does take some force, BUT NOT much to impact the upper veterbrae (C1-C2-C3)...all in the impact + angle of impact

2.) My thought is that I don't believe it neccssary to hit bottem--( water is solid enough) with an object moving with forward velocity to cause a fatal Fx..

I believe that hitting the water alone with a forward momentum can cause a traumtic hyper-extension of neck ( cervical area) resulting in a fatal fx..

Rare- a billion to one but I've seen it happen

And to anyone who comes upon a suspected Spinal injury---
a few suggestions to help---
Spinal stability + Immobilization can be imperatitive--
make sure they are immobolized, flat,neck supports, towels------ the sand bags that you use to keep your kite down----would work great in place of a cervical collar

a fx can become a bad fx--- a bad fx ----can become worse..

No problem to err on the side of safety---everyone in the long run will be much relieved

jp

[Kitezilla]

Agee in most regards with the ER doc---and I have a few other thoughts...

1) not a lot of wind (agree)--+ it does take some force, BUT NOT much to impact the upper veterbrae (C1-C2-C3)...all in the impact + angle of impact

2.) My thought is that I don't believe it neccssary to hit bottem--( water is solid enough) with an object moving with forward velocity to cause a fatal Fx..

I believe that hitting the water alone with a forward momentum can cause a traumtic hyper-extension of neck ( cervical area) resulting in a fatal fx..

Rare- a billion to one but I've seen it happen

And to anyone who comes upon a suspected Spinal injury---
a few suggestions to help---
Spinal stability + Immobilization can be imperatitive--
make sure they are immobolized, flat,neck supports, towels------ the sand bags that you use to keep your kite down----would work great in place of a cervical collar

a fx can become a bad fx--- a bad fx ----can become worse..

No problem to err on the side of safety---everyone in the long run will be much relieved

jp

[ricki]

Thank you for your input Jane. There is a lot of good information coming out of this inquiry.

Here are some comments from an orthopaedic surgeon with some experience with neurological injuries:

"Case 1: there are several types of C2 fractures. The common ones are ' hangman's fracture" and odontoid fracture. There is a fair amount of room within the bony spinal canal at that level for the spinal cord, but if there is enough displacement of the fracture the spinal cord can be injured. I suspect his head hit the sandy bottom causing the fracture and likely injury to the spinal cord. He was unable to roll himself over and drowned. Some patients do have a congenitally narrow spinal canal and would require less displacement of the fracture to cause a neurological injury. "

[ricki]

Thank you for your input Jane. There is a lot of good information coming out of this inquiry.

Here are some comments from an orthopaedic surgeon with some experience with neurological injuries:

"Case 1: there are several types of C2 fractures. The common ones are ' hangman's fracture" and odontoid fracture. There is a fair amount of room within the bony spinal canal at that level for the spinal cord, but if there is enough displacement of the fracture the spinal cord can be injured. I suspect his head hit the sandy bottom causing the fracture and likely injury to the spinal cord. He was unable to roll himself over and drowned. Some patients do have a congenitally narrow spinal canal and would require less displacement of the fracture to cause a neurological injury. "

[ricki]

A few additional details have been added to the first post describing this hypothetical scenario. Do any impressions come to mind regarding potential causes and contributing factors to this accident?

[ricki]

A few additional details have been added to the first post describing this hypothetical scenario. Do any impressions come to mind regarding potential causes and contributing factors to this accident?

[ricki]

Here is some input regarding this case from a physician in charge of the ER of a hospital with a large neurotrauma unit. He discussed and compared conclusions with a neurosurgeon collegue at the hospital.

"We don't believe that there should be any preexsisting injury to cause the fatality. Even a minor hyperextension- trauma of the cervical spine can cause a C2 fracture and hence spinal cord injury on a high level leading to respiratory insufficiency and death. Body-dragging in too shallow water (even with a soft sandy sole) and touching the bottom with some speed ( N= m x V) seems enough to us to explain the accident. Besides hyperextension-trauma also axial head-trauma are the most important causes. We had a man in our intensive-care unit two years ago who suffered a C2 fracture just by falling from his Bycicle while he was standing perfectly stil. He survived with quadreplegia."

[ricki]

Here is some input regarding this case from a physician in charge of the ER of a hospital with a large neurotrauma unit. He discussed and compared conclusions with a neurosurgeon collegue at the hospital.

"We don't believe that there should be any preexsisting injury to cause the fatality. Even a minor hyperextension- trauma of the cervical spine can cause a C2 fracture and hence spinal cord injury on a high level leading to respiratory insufficiency and death. Body-dragging in too shallow water (even with a soft sandy sole) and touching the bottom with some speed ( N= m x V) seems enough to us to explain the accident. Besides hyperextension-trauma also axial head-trauma are the most important causes. We had a man in our intensive-care unit two years ago who suffered a C2 fracture just by falling from his Bycicle while he was standing perfectly stil. He survived with quadreplegia."

[spidermedic]

This one seems to scream freak accident. It's even possible that he had another kiteboarding accident earlier in the day and decided to keep going.

[spidermedic]

This one seems to scream freak accident. It's even possible that he had another kiteboarding accident earlier in the day and decided to keep going.