Review: The Dynamics of Near Vertex Head Impact and its Role in Injury Prevention and the Complex Clinical Presentation of Basicranial and Cervical Spine Injury

The clinical presentation of cervical and basilar skull fractures following bead impact is often complex, particularly when multiple noncontiguous fractures are present. Based on the results of 22 human cadaver head-neck impact experiments, a biomechanical framework of spinal injury is developed in which these complex cases may be better understood. This includes the significance of head rebound, head and neck decoupling, cervical spine buckling, cervical injury mechanisms, basilar skull fractures, and cervical spine tolerance. These data also demonstrate that compliant pads significantly increase the risk for spinal injury though they also significantly reduce peak head force and the head injury criteria (p < 0.04). On the basis of these observations, we hypothesize that impact injury should be modeled as the dynamic response of two large masses, coupled by a segmented curved beam-column composed of seven small masses with interposed nonlinear viscoelastic flexibility elements.