Sunday, December 31, 2006

The Pathophysiology of Saddam's Death

Early Saturday morning (New York time) , we awoke to news of Saddam's hanging. Whether it was the just and correct punishment for the ex-leader of Iraq is not the purview of, i.e. we don't "go there". However, we do go where few others would, which is the actual mechanism of action in a death by judicial hanging. A typical hanging involves being suspended by the neck and can be classified as either "complete" or "incomplete."

When the whole body is hung off the ground and does not touch the floor or platform at the end of the drop, the hanging is said to be complete. Incomplete hangings imply that some part of the body is touching the ground.

Simple asphyxiation is very rarely the cause of death in most hanging injuries. Cervical spinal disruption secondary to the forces involved in the hanging are almost uniformly fatal. Significant cervical spine and associated injury to the spinal cord occurs in hangings that involve a fall from a distance greater than the body height.If that does not do the job than near-complete compression of both areterial and venous systems will induce a profound parasympathetic response and cerebral anoxia.

In a judicial hanging, as was prescribed for Saddam, the drop is at least as long as the height of the victim and the hanging is complete. In such cases, the mechanism of death is effectively decapitation, with separation of the head from the neck and torso, fracture of the upper cervical spine (typically traumatic spondylolysis of C2 in the classic hangman fracture), and transection of the spinal cord.

In judicial hangings, the head hyperextends as the noose stops the victim. Classically, the result is bilateral fracture through the pedicles of C2 (see pic at left); the body of C2 is displaced anterior to the vertebral body of C3.

These hangman fractures are seen best on the lateral radiograph of the cervical spine (see pic above). rarely delves into the political forum and will abstain in this instance as well but we are surprised by the casual stance the media has taken to airing such graphic pictiures.

It may seem hypocritical of us to cast aspersions when we have just dissected the mechanics of his death but we are read by like 4 residents and a couple of medical students - not seen by millions.

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