Author(s): R WATSONJONES
Types of vertebral-body fractures:This series of 252 fractures are classified in three groups,—simple wedge fracture, comminuted fracture, and fracture-dislocation. The simple wedge fracture is the most common and is due to a fall from a height, landing on the heels or the buttocks. It is often multiple; the intervertebral discs are uninjured; and spontaneous ankylosis is rare. The comminuted fracture is the most rare and is caused by forcible acute angulation. The intervertebral discs are ruptured, and bony ankylosis is common. Fracture-dislocation is due to the fall of a weight on the shoulders, and the spinal cord is usually injured.
2. Methods of reduction: The spine must be hyperextended to the normal limit. The position varies considerably in different patients; therefore, fixed or controlled degrees of extension by slings or curved surfaces are imperfect. The trunk should be entirely unsupported, so that it sags into space to the limit of the patient's extension movement.
3. Results of treatment:In the wedge and comminuted types of fractures, excellent anatomical results are possible by the postural method. Two-thirds of the patients reported that their spines were as good as before they were injured; 80 per cent. resumed their original occupations. The average period of incapacity for those engaged in heavy labor was ten months; for those engaged in light labor, seven months. In fracture-dislocations, immobilization in extension is advisable; laminectomy is not advisable. The prognosis is bad in high thoracic dislocations with paraplegia, fair in cervical injuries, and good in lumbar injuries.
4. Common sources of failure: Uncorrected wedging causes persistent pain, due to interarticular-joint strain. Neglect of minor details of the technique of postural reduction causes failure. The jacket must not be cut below the clavicles or above the groins. The cutting of an abdominal window is not advisable. Early ambulation is quite safe. The jacket must be renewed after a few weeks. The patient should be immobilized for from four to six months. Posterior spinal supports are inadvisable.
5. Hyperextension fractures: These fractures are very rare. In the two cases described, one was a fracture of the vertebral body and the other was a fracture of the pedicles.
6. Fracture-dislocation with locking of the articular processes: In lumbar fracture-dislocation with bilateral dislocation of the interarticular joint, lateral shifting of the spine may lock the articular processes. If the spine is hyperextended, reduction fails and cord injury may be increased by stretching. One and rarely both of the lower articular processes must first be excised.