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Abstract
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"Whiplash" is an established term but would be more descriptive were it to refer to a whip with a seven-and-a-half-pound ball at its end.
Most extension-flexion injuries occur to occupants in the front car of rear end collisions where one vehicle impacts another, either relatively or actually at a standstill. The neck is rapidly and forcefully extended backwards, limited only by the occiput impinging on the dorsum or a surface within the passenger envelope. This is usually followed by forward flexion, limited only by the chin impinging on the chest or forward surface. The result of these forces is seen in all degrees from fracture dislocations of the vertebrae, with or without spinal cord injury, compression fractures of the bodies of the vertebrae, and fractures of the spinous processes and laminae, to rupture of the intervertebral discs, intervertebral ligaments, and/or tears of the anterior or posterior long ligaments of the vertebrae. Severe injuries can occur with no x-ray evidence.
The belief is widely held that these are simple sprains which will resolve with time and settlement of litigation. Most physicians and defense lawyers imply that complaining patients are often neurotics or malingerers presenting cases of "litigation neurosis" for consideration. With demonstrable objective findings, it is remarkable how seldom the frequent associated injuries are complained of.
There is considerable literature on this problem from the fields of orthopedics, neurology, physical and industrial medicine, ophthalmology and most of all, legal medicine. The latter material unfortunately is usually colored by the author's economic responsibility to the litigants.
This report covers cases seen for evaluation with proven objective ocular dysfunction following extension-flexion whiplash injury to the neck, with review of the literature which may explain these findings. |