FRACTURES

OF E.

Froni

This spine

was words

to

indispensable

Great

of

by

an

that

it is held critical

rather it

I)ersistent

deformity

than

the

the

anti

late

to impose

were

factor

as

arise

having

in

of the

importance

standard : 1) no

a

All

the

injuries

tenderness and

associatetl

his region

by

at

very

Level injuries 376

submitting

fact

it to careful

the

tight was

indeed

injury-Table and

the

isolated

strain; If

muscles in

was

two

cases

combined laminae There

dorso-lumbar I shows

fractures

the

of the

improve-

two anti

important

these

patients

‘svithstantl No

could

the patient

work

under

of years.

‘ ‘

falls extended

is much

greater

to

and with the were no examples though

at at

and

of

fractures

not

included.

so rare

JOURNAL

in

at

roof

the

the

lumbar pelvis

is

lumbo-sacral In

this

was

associated

some

be described which must

neck. levels.

AND

JOINT

or

dorso-

level.

the

BONE

of

this

different

OF

always

the

time,

to

is the

variety of fracture to of extension fracture not

THE

a fall down,

the

stress side

relation

shoulders,

lower at

contusion

in

by

‘ ‘

the

Ofl

is applied

one

cause which

buried

spondylolisthesis

twisting

to

significance

was force

were

he

hyperfiexion

are

distribution sacrum

than

late

positions.

was

if the

region,

all to

enough

knees

there

less

most

a number

is of

force

traumatic

with

fractures of the wedge fracture.” in the

the

and of

severe that

patient main

but

involved.

hamstring

the

function,

as mobility the

that

unless so for

usually

The If

in

ability cramped

to be

of

both is

fact

individual

INJURY

mechanism

stress.

hypothesis

estimation

properties

result done

a factor

usual

knees.

greatest

are

noted

fiexion

with lateral

his

in

violence, muscles,

The

coal-face

OF

of the the include

the their

criteria. to

which

namely,

in fact,

measurable

assessed

to

However,

the

had,

direct

to

shearing

between regions

This

rare of

it

The

subject

was

pain,

functional

and

spinae

pain.

receives

forward

“

tlue

erector

a forw’arti

head

lumbo-sacral

region.

the

residual

‘svith

with

were

of

treatment

be

assumption

are

ph\’sical

of

difficult.

perfect

tliscomfort

case

of such

s)lution, working

for

enough

assessment

more

gainetl

without

Because exacting

MECHANISM

particu1arl later as

perfect

“

of wedging

treatnient.

involving that

years-long

the

satisfactory

that

conditions

cases,

‘s’s’ortls: an

for

criteria

measurement

is much a

of stress

five

but

in function,

classifietl

fixed

the

was

supporteti

tiegrees

on

reason

precision, on

observed

was

; 2) the

provided

contlitions

or

repercussions

another

of

baseti an

therefore

follo’sv-up

straightforwarti

is

is

measurement.

complications

power

lumbar

been

slight

is

teaching it

it has in

; even

result the

clinics;

; and

of

results-

of

Nevertheless

vital

is a matter

however,

precise

average

miners

coal

basis

continental (1943)

upon

objects

anatomical

the

(1946)

pain

most is yet

necessary

safeguards

and

and

most

Watson-Jones

aching

has

of

(lorso-lumbar

of the

functional

a good was

Conwell

One

and

that

is insisted

authoritatively

function,

seemed

certain

these

as

of the

1945.

in

assumption

and

retluction

Hospital

anatomical

practice Key

authority

that and

of of

examined

were

an

ended

assumption

This

the

General

or fracture-dislocations

of the

by

Mansfield

between

result.

if perfect

so ‘uvitlely

jutigment

limiting

great cause

assessment

muscle

validity

the

period

relationship

writings

assumption

assessment

ment

six-year

of

examination.

The

‘ears,

fractures

the

SPINE

ENGLAND

Service

of 166

influenced

so

max’

and

the

MANsFIELD,

Accident

functional

d)flly

‘s’ertebrae

and

s’as

the

American

Britain

the

and

investigate

is possible

remains,

‘I he

tiuring

which

in recent

recovery

miners

a good

B#{246}hler (1935)

(if

and

examine

to

reiterateti in

to

DORSO-LUMBAR

NICOLL,

on a study

in 152

analysis other

Orthopaedic

is baseti

occurring

the in

paper

the

A.

THE

Cervical

SURGERY

FRACTURES

The

tlistribution

writers.

The

three

does

not

important

differ

point

vertebrae-the

note

dorsal,

OF

INJURY

Level

of

IN

and

above

OCCURRING

152

IN

of

Percentage total

.

7 12

1)orsal Lumbar Lumbar Ltmmhar Lumbar

12

.

.

.

.

34

20’S)

49

296 l6.3J 102 72 48

5

.

.

.

.

.

.

.

.

.

.

.

27 17 12

.

.

.

8

.

.

fractures

neural and

classified

(Table

II).

not

differentiate

did believed

fractures=

on

wetige

that

14

an

fifi’4

basis

tiiffers

from

the

wedge wedge

classification

fractures

or

fractures

w’ere

OF

of

I

cases Anterior Lateral

wedge wedge

fracture fracture

Fracture-dislocation Isolated

fractures

of

the

neural

.1 nterior

wedge

cannot,

be

fulcrum

or

so-called

wedge

inferior

it

and

other

the

common

(Fig.

the

severe

15).

and

19

14

9

The and

an

rupture

importance

are,

possible

damage

intact

of the can

in

posterior

fact,

(Figs.

since

10 and ‘uvith

lies

in

cord;

whereas

ligament

are

the

fact

that

forward cases

with

quite

free

good Many

in on

with

If

subluxation

processes.

in the

the

I I).

tiemonstrateti

spinous “perched”

this

the

is minimal.

fracture-subluxations

or even

interspinous

it

ligament

be

of

a fracture-dislocation to

cases

ligament

often

of recognising into

the tlisc

separation

upwards

converted

half

interspinous

This

displaced

in

intervertebral

undue

wedging

are

100

hut

of the

is severe,

from

is easily body

wedging

58 14

29

posterior

is inevitable.

inferred vertebra

which

vertebral

moderate

wedging

with

of one

varies, the

pulposus

joints

be

fractures

position of

can

facets

of the

unstable

intact,

wetiging

involving

nucleus

intervertebral

radiographs,

of

without

is at the

remains

posterior

extent

severe

of movement

of the

or

relatively

ercentage

152

J’racture-The

in fact,

fulclum

ment

by

fractures

8 21 arch

Total

facets

adopted isolated

FRACTURE

Number

the

main isolated

II

TABI.E

this

four and

cent.). TYPES

It

into

fracture-dislocation,

lateral

comminuted

(90)

anatomical

fracture,

This

of

1000

multiple

lateral

arch who

arch,

were

fracture,

(1943)

with

to

42

166

cases

other

continetl

72

.

of

by

were

PATIENTS

.

I

recorded

lumbar.

.

2 3 4

been injuries

.

wedge

neural

per

the

.

anterior

the

second

Number cases

has

of

11

of fracture-The

(15

I

which

cent.

10

Type

of

TABLE

FRACTURES

166

that

per anti

377

SPINE

Dorsal

types:

the

66

lumbar

fracttnre

Number

of

from

is that first

Total

fracture

DORSO-LUMBAR

I)orsal

Lumbar

\\‘atson-Jones

THE

materially

to

twelfth

LEvEL

OF

which

superior it is an displaceminimal from

this

danger. There body

is more

people

and

VOL.

31 B,

is a special

type

evenly

compressed.

there NO.

3,

is AUGUST

little

of

This or

1949

anterior no

wedge

fracture

“concertina”

angulatory

in type

deformity.

which

the

of

compression

As

a

rule

whole

of

the

occurs it

is

associated

vertebral in

older with

378

E.

degenerative

changes

ligament

remains

11 edge

fricture

15 per

cent.

violence cases

in

even

up

(Figs.

a’ith

that

occurs

in

the

present

cent.;

2).

importance

in

it

association

in

with

of late

\‘ertical

Lateral anatomical

cd)mminUted below’ are

clinical

to

one

side.

convex

The

side,

should

be

noteti

Certain is riot

good;

regartiless

related to

of the

either

tearing

to of

an

acute

the

the

processes which Retroperitoneal of

been eight

fulcrum.

by

redticet!

was

the

to

in the

will

be

in

in

fact

that

cent.

the

appear

associated

fractures Its

been

put

forward

2

months’

1)ody

and slight comminution

immobilisation but

that

the (Fig.

has

justify

been

is

described

and

has

It

is forced

of transverse

in certain

differentiation.

head

intervertebral

spaces This

series

its

patient’s

in

disc 2).

not

present

fractures

posterior

specially

21 per

associated

cent.

of fracture

displaced

usually show haemorrhage

the

wedge

later.

the

to

that

all

incidence,

on

the

a

and

processes

joint

is

forwards on

concave

the side,

4).

only

site

of

(lirect ft)r

a higher

it has

was no collapse fusion is occurring is comminution.

fracture

per

being

the

six

of

responsible simple

vertebral L. I without

the

of

after

vertebral that

to

of

constitute

type

fracture-dislocations.

discussetl

fracture

the

expect

seen

seen

lies

and

14

interspinous to

with

mechanism

were

often

well. There spontaneous when there

of

The

\\atson-Jones

especially

cases

wedge

history

are

ilio-psoas

abdominal

a

reasonable

(72

per

intervertebral muscle wide is not

catastrophe.

as

this

complete

cent.).

indicated

separation, uncommon

The which by

patients

pain may

associated

indicating and may in this THE

fracture.

I)

functional

pain, if present, fractures pain

joint

Two

with

gained

in anterior wedge fractures. 2) Residual (93 per cent.) whereas in anterior wedge

per cent. fracture level

3 and

series

stated

commimiution

healed and the ease’

wedging,

features

in this

this

anterior

was

usual

damage

(Figs.

clinical

Since

showmmig

an

characteristics the

the

associated

more

constitutes

unilateral

anti

are

be

fractures

is a type It

injur\’,

as

FIG.

hod narrow’etl,

fracture-’I’his and

cases

which

fracture

classifications.

fiexion-rotation

much

There is also The compression

amid

acdge

only

is wedge

often

previous

fact

act

1

compression

retropiilsion. F’ig. I). plaster the

to occurs.

have

redisplacement

11G.

al)ove

woulti

but

fails

to

accidents.

Comminution

explanation

which

and

mining

NICOLL

compression

fractures

series

3() per

and

nucleus vertical

cornnunzttwn-These spinal

to

the an(i

of all

I

as an

in

intact

A.

severe present

is commonly is usually at in also

The

recovery

at the

lateral

wedge

involve

the

fractures damage all the

series

with

JOURNAL

OF

of

fractures nerve the

wedge ANI)

40

the site of fifth lumbar root, transverse

to the soft tissues. signs and symptoms

lateral BONE

prognosis

as against

JOINT

fractures SURGERY

is or

FRACTURES

‘uvere

submitted

was

to

only

three

the

times

only

good

in lateral

in

series.

both liable

to

t’svo

cases

twenty-one

fractures

to

recover.

laterally

by

tear

the

The the

cord

nerve

have

lies

interspinous upward be

by

important, calls

for patient

reduction

in

locked. per with \‘OL.

amount

1)amage cent.

in

and

to

the

J)reseflt

the

Nd).

3,

AUGUST

that

lateral

is supported si(le

of

last,

between

in them

quality.

A test

position

and

prone

of

forward

tlisplacement

or

equina

corti series). and 1949

cauda There two

were with

max’ with

twent lateral

be

before

attempting

it

be

may

wedge

frequent of

as sinhl)le

with

facets.

simple

posterior fracture

All

these

dangerous.

be carried

and out

lateral

view.

If

inferred

that

the

in

fracture-dislocations eighteen

can It

manipulation

paraplegia,

fractures.

a

the such

is

may the

anti of

dislocation

manipulation

retiuction

in the

result

distinguished of the

repeating

that

there ‘Fhiere’ hint

deformity functional

forward

which

cases

which fusion.

in

is rupture

locking

is very

fact wedging.

fracture-dislocation

facets,

are

is more

perfect.

there

of the

dislocation the

best

a

displacement ‘ ‘

forward

very

between

the

and

equina

4

fracture bone

the

fracture-dislocation

fracture

fiexion

the

occur

fracture

cauda

by

opposite

max’

wedge

wedge and

and

cord

anterior

cord

so

nevertheless

the

fracture-dislocations, 31 B,

the

the

the

of lateral

Lateral wedge was spontaneous was considerable

perching

distinguish

of the into)

‘ ‘

except

to

the

on

If

.

in

degrees

facets,

arch,

carefully

This

greater

difference that

manipulation

radiographs

that

condition

‘s’s’as achieved

redisplacement, to

in any

cases

ligament,

fiexion.

was

was

was

Several

therefore,

the

forward

paralysis

fact

of the

or neural

retiuced

tiamage

is

dentate

there

4) 1)amage

avoided.

the

ligament.

facets

such

three

spinal

reduction

FIG.

been

in

subluxation

of the

and

essential

fracture

no

explanation

with retroperitoneal acute abdomen been taken twentyfruitless 1aparotom

Fracture-dislocation-The wedge

grafting.

the

fact,

3

Lateral wedge fracture haemorrhage simulating this radiograph had four hours earlier a

might

the

of

by

In

in twenty-one

roots

simple

above,

FIG.

was

probable

than

mentioneti

there )araplegias

3), before

(Fig.

to retiuce.

two

secured

379

SPINE

findings

difficult

; in

was

two

DORSOLUMBAR

negative

are

whereas were

THE

patients

result

There

failed

tethereti

with

fractures

anatomical

‘s’s’edge

in this

laparotomy,

3) These

diagnosed.

OF

by

is

this

turning

there

is no

facets

are (62

associate(l

380

E.

A.

NICOLL

FIG. Iraumatie failed amid 1)e’(l six spontani’otis

spondvlohisthiesns. the’ patient

re’funsed After two

ioths.

arrest pain

hut iii

the 1)0th

patient lower

FIG.

Fracttnre of lamina that time he had there

is still

no

of third

been forward

Closed operation. years still limbs.

Fracture of vertebra. A onl’ fibrous ‘Fhere is no

re’ductioii

I ‘laster

there’ had

was

referred

at

7

walking sliding

the’

vertebra.

ahoint. and

l’his

Note union

that has

patient

there

occurred

the

8

not seen until six weeks after been no forward sliding (Fig. 7).

was

has (Fig.

8).

The THE

patient JOURNAL

is now OF

second lumbar although there is sliding is minimal. the patient works

coal-face.

FIG.

lumbar

6

the lamina of fter three’ years, union, forward disability an(h

working BONE

ANt)

injury

and

during

Three years later at the coah’face. JOINT

SURGERY

FRACTURES

Neural

arch

fractures-These

associated

with

fracture

of

part lamina

so

slides

that

when anti

spond\’lolisthesis In

bilateral

Figure

7 was

about. no

He

not was

further At

the that

seen

level

the to

until

six

treated

of

the

body-weight

overlooked

at

this

level

consequent

should

fractures tendency

then

as

in

facet

remains

level

of injury

slide

forwards

weeks

after

by

simple

be

or

exerts

a forward

(and

aroused

it

fifth

the

the

fracture,

type

of laminar

fracture

spinous

injury,

line

bone to

the

classical

6).

The time

which

umo

do

as the

of

superior

facet type

above

the

of

fourth

patient

illustrated

he

been

had

occurred

has

(Fig.

9).

reduction these

and

after

supposed.

in

walking

readily

with

been

several

years same

after

injury,

is true

than

the

initially

there

covered

by

sometin1es removing 31 B,

of

may

be

rule

had this for

the NO.

for

more

review

great

six plaster. 3,

AUGUST

months, The 1949

wedging

union

AFTER

anatomical than

questions

were to

but

in

result taken

that

arise

to to

fracture

line

As

of the

Chance

j)oints

operations.

is more

be

in

whether

complete very the

often factors

any years

is

spine

of cases.

it was in

earlier

the

proportion

series, the

than

of

a high

maintained In

maintain

common

fracture-dislocations

present

recur, are

the

PsterirlY

or rupture

is stable.

recurred the

deformity. deformity

( I 948).

Chance and

since

grafting

of

had

see

body

facets,

immobilisation

and,

minimal

pains only

suspicion

level.

Q.

G.

the

of the ‘svhich

a series

deformity fractures

is

result,

REDUCTION

prolonged

reviewing

that

it

body.

by into

subluxation unnecessary

a good

been

slight

is no to

wedge

to

and

this

vertebral

recentl’

anteriorly

bony

and

needed

at

for

fracture

is bound

are

antI

described

by

found

simple

haminae

lead

(1947),

slitling

films

different,

laminar

9

cases

max’

is quite

bilateral

process

is follo’sved

reduction

Stanger

X-ray

process,

there

a

forward

transverse

is continued

There

way,

story

If

this)

perfect

spinous

and

the

stress.

to

niost

the

fracture

the

recognise

Redisplacement generally

VOL.

as

except part

in

the

are

\vrongl\’

variety,

which

vertebrae

easy

The

is horizontal

all

ligament,

failure

rather

of them

occurs

If it occurs

(Fig.

after

shearing

REDISPLACEMENT

The

half

interarticular

as

during

is a fractured

through

l)rCe55

through

posterior out,

bilateral

is important.

lumbar

is quite

if there

Chance’s

A special this,

passes

that

described never

the

behinti,

recumbency

fourth

sponth’lohsthesis.

al’svavs

into

is at

the

fact often

probably

is minimal

FI;.

In

which

of fracture

displacement,

inferior

the are

displacement.

is here with

the

injury

site

by

They

3).

laminar

vertebra

as shown

rare

381

SPINE

processes.

The is

the

(Fig.

lumbar

injuries,

extremely

there

DORSO-LUMBAR

transverse

fracture-dislocation.

for’svards

THE

rotation

of the

pedicles--an

a severe

of

are

fractures

the

OF

the

exception

case of

reduction within responsible

in

which

the in

period plaster,

a month for

of such

3s2

E.

re(lisplacement fact

an

can

Mechanism the

movement disc. 1ll

((‘al’s’t

at

an(I

interarticular 1930.)

J)roving

fulcrum

wediging

the

remains the

of

h’perflexion avulsion

of the the

UIM)fl

if the

stronger

fulcrum the

of

Thus, joints the

the

disc

the

radiographs be

Factors The are

most

Conzminution

of

fractures. However,

the

observed

only

to

full 2).

the

after

the

I 1).

mimmal

ligament. ; there is the

interspinotis

be

the

of

This

If

may

of subluxation

the

narrows (Fig.

evei

interspinous

processes.

are

Fig.

an

facets,

sequence

of

ligament

is

the

vertebral of these

the

body,

should

examined.

II

I 0 shows The fulcrum

femhi extension. pulposus.

Each

redisplacement

actuall’ fulcrum

inevitable

tiegree cases

space of the

this

of

intervertebral

of producing

i

spinous many

involved-the spine

intervertebral is at the’ nucleus

the

disc,

the

be considered

Furthermore,

intervertebral

sej)aratelv

the

erector

whenever

spinae

muscles

ruptured.

factors

after

concerned

vertebral

body

vertebral

the

reduction

of

in redisplacement ; crushing

can

of the

of the

vertebral twice

consolidation body

in the

has be

and

achieved;

however,

ligament,

blood

series)

can

vertebral now

be

intervertebral

fracturesconsidered.

disc

in which

comparatively

They

; and

supply the

out

(evidence half

to

rupture

collapse

in

simple

of wetlge

\\atson-Jones

(1943).

avascular

patients

necrosis

consolidation

be paid

associated

some

by of

the

price

invariably case

rare

as pointed

in about but

is almost

or both,

is is delayed,

a good

present

position

is six with

months

in plaster

damage

is inevitable

was of bone

to

whatever

the

disc,

happens

both’.

disc-This

intervertebral

recognised

reduction,

bod’-Comminution

it occurs,

retiuced

vertebral

be

on

ligament

md)VemTie’flt.

1 1 in

in

(Tomminution,

interspinous

Crushing can

the

When

(Fig.

disc

in front

capable

the

of

first

fulcrum

ligament.

interspinous

in the

is in

is crushe(l.

Fig.

partly

of the

of the

not

a varying

The

J)ulposus

part anti

the in

spinal

or

important

: comminution

the

and!

injured

concerned

three

result

is necessary

spine.

FIG.

of

are

overstretched

anatomical

spine-It

nucleus

leverage

of

; but

ligament.

of an

the

10

fle’xion

interspinous

a normal

the

anti

itself

normal

in

pstenor

of

separation

niechianism

full

a perfect

in the at

great

rupture

intact

structures

four

and

may

the

in

whether

h\’perflexion

of

process,

of

1io.

liorIMal

‘l’he joint

degree exerts

spinous

an(l

hut

is behinti

remains

t\’s’()

joints point

further,

degree

extension the

body still

anti

this any

vertel)ral

fracture

de)eflding

anti

Normally,

that intact,

procee(is

outset,

movement of fiexion

Galland

h\’perextension,

events

the

NICOLL

in treatment.

mechanism

is not

If the

at

objective

of flexion-extension

consider

to

be recognised

indispensable

A.

in the

the space

original may

is much

radiograph appear

to

by be normal

more

common

narrowing

than

of the

(Fig. THE

13).

disc

is often space

Sometimes

JOURNAL

OF

supposetl. 12)

though,

disc

can

be seen

the BONE

It

(Fig.

AND

JOINT

SURGERY

FRACTURES

OF

THE

DORSO-LUM

BAR

33

SPINE

#{163}

12

FIG.

Often

wrongly

diagnosed

subluxation tpe

with

and

But

deformity

as

perching

should

have will

a wedge

been

recur

prolapsed

damage

to

of the

into

the

disc

space

is inevitable, deformity

must

tissues

in

an

impossible, body

of

into

the

VOL.

31 B,

or

for

extreme

but the

it

spinal NO.

be

for

AUGUST

may (Fig. 1949

harmful cause 1).

severe

deformity

of the

interspinoushigament.

reduced

(Fig.

and

to have

and long to retropuision

and

it

is not

periods

in

do

so.

it the

disc futile

hope

Occasionally, of

the

in

there mans’

the

posterior

fact

later

Some

immobilise

achieving part

thinning

the

residual

damaged what

of of

Lastly, b\’

redisplacement

repair.

crushing

16(.

ligament

reduction.

is damaged, of

unstable (Fig.

interspinous

after

nt

a fracture-

is an

plaster

months

to of

in

This

is incapable

only

Itis

because the has recurred.

only When

supply

15).

immobilised

remained

recognisable fusion.

blood

accepted

is actually

canal 3,

no

position

vertebra

and be

anterior

has

therefore

may

fumlly

of the disc space inidicatinig that no blood sinpplv and is inCapal)le of repair reduction was maintained for six mi;ontlis inevitable-anti the’ inevitable huappenied disc space collapsed again (Fig. 14).

position is maintained later (Fig. 17) deformity

body

disc

disc

w’as

hong this Two years

spontaneous

the

rupture

It

vertebral

intervertebral

with

and

grafted.

however

the

fracture

facets

14

FIG.

complete disappearance (Fig. 12). The disc has Perfect anatomical of deformity was of th#{236}e plaster; the

of the

is ruptured.

to have

13

FIG.

\‘ertebral fracttnre with almost has been damaged irretrievably so that deformity is inevitable. (Fig. 13). Nevertheless recurrence three months after removal

the

is, disc

vertebral

soft in into)

fact, the body

384

E.

(),f the

Rupture completely

interspinous

ligament-This

ruptured,

significance

of

collateral

with

these of

with

sounti

healing

heals

unless

it

than

to

and the

of the

complete oe

was

The

degree

maintained

this physical

function.

The

coallield,

an(l

the

rest

the

of

observing

has

been

the

particular factors

under

stress

I t should

is the

some

to

of stress

crucial be

work

that

equivalent

for

factor,

repeated

two

and that

years

even

no

that end-result

of

.nterior

ANALYSIS

OF

Site

of pain

89

accepted

fracture

of the

in

is of two

of fracture. fractures.

localisation

features eased

with with

that

moderate

.

.

.

.

arch

.

.

.

the

site

tests

in a i\Iany

recovery returns at the

fail to under coal-face.

important, for

but

detaileti

unless

pain

analysis.

the

conclusions

residual

patient

may

be

had

acceptetl

eased

PAIN

of fracture

of

Pain at site of fracture

of

back pain

28% 93%

72% 7%

7 9

43% 33%

57% 67%

40%

60%

fracture;

2)

nearly

in 93 per after

Low

58 15

sustained

pain pain

of the exercise,

type

in the

always

such

fractures

cent.

(usually

anterior

low

back,

occurred

wedge

independent

in patients

and

had

towards

residual

the

fractures

it

of the with pain

side

was

lateral

of

the

wedging),

localised

to

the

cent.

residual

it was

site

of fracture who

RESIDUAL

to

89

of fracture

28 per

independently were

by

site

in only

patients

It occurred

the

patients

to the

in patients

of fracture

1) at

at

Of

was

.

types: Pain

relation

.

neural

Total

In

the

III \‘ITH

Number cases

w’e(lge fracture (hislocation

Fractures

whereas

had

coal-face.

work are

of than

areas.

grade of same-pain

it calls

the

have

prolonged

in actual

of

every

standard

I

at the

as complete that

CASES

fractumre

wedge

Lateral Fracture

site

and

endurance symptom

in

in miners

mining

of work

test

situated

service the

involved

disability-so

.

wedge

this

the highest is always the

involving

assurance.

T’pe

Pain

of 15

work,

common

exacting test

muscle

TABLE

site

amount in Figure recurred

a high

more to

most

are

an

was

the

a searching

providing

throughout

in

for was

centres,

times

the

centre reason

cure

seldom processes

subluxation

capacity

and

functional

and

without

by

positions,

surgeon

power as

ligament

extent.

rehabilitation

colleagues

posture

muscle

medial

compatible

illustrated

original

their

thirty-five

the

The

and

as mobility,

Perhal)s

full

vith

such

my

a rehabilitation of full work.

contlitions

Other

and

consulting

of all

experience not

tlischarged from to the demands

up

dld)Ile

a universal are

as

work

the

the

spinous

estimated

nevertheless to

surgeons are

of are

the

case

or The

DISABILITY

special

injuries and

the

but not

injuries rupture

fuse

torn,

process.

ruptured to

be

of cramped

have

of

In the

miners

orthopaedic

Spinal

community

centre

were adoption

case

can

months though

Britain

experienced

service.

of

rehabilitation I)atients stand

by

social

opportunity It

of Great

damage

partly

spinous

incomplete

it is easier

END-RESULT

the

the

a completely

spine,

six

patients and

overstretched,

the

radiographs.

plaster,

OF

all the stresses

miners

staffed

medical in

series

in and

of

for the

ANALYSIS

1) Pain-In

as

; but

of the

in lateral

of removing

considerable

same

of stability case

processes

be

of

Overstretching

restoration

ligament.

month

the

joint. the

may

avulsion-fracture

is exactly

In

NICOLL

ligament

without

knee

spinous

reduction

within

the

is sutured.

suture

separation

or

findings

ligament

A.

site by

and

after

anterior

wedge

of fracture complete brought

in 72 per rest, on

fractures, cent.

brought

again

by

on by severe THE

low

of these

JOURNAL

back

cases.

prolonged exercise OF

pain The

is the

sitting or BONE

or standing,

prolonged AND

rule.

characteristic

JOINT

forward SURGERY

FRACTURES

stooping.

These

They

are,

anti

much

plasters has

that

is to

even

in felt

it

and

per be

found

high

in

lumbar

the

causes his

no

the

flat

is quite

18;

the

The greater

early

muscles.

This

and

the

extends

pain

of

the

extensive

to to

the

hvper-extension Ever’

surgeon

haemorrhage

pelvic tends

attachment, to

subsequent

as

an

gravitate

to

fibrosis

end-result

stiffness

making

the

in many

movement

cent.).

in

this,

of

should

muscle.

Localised

test

by

per

always

due

of mobility

reproduced

of the

with

sprains

occurring

As evidence

treated (37

pathology. from

adhesions

position.

in muscle

past.

is illustrated

radiographs

part

is familiar

or joint

resulting

and

methods

of the

in the

fibrosis

stages

loss

a bone pain

fractures

other

that

to

than back

shortened

haemorrhage

made

which

to

wedge

by

attachment

be

disability,

fallacious.

Figure

anterior

is understandable

lower

floor,

due

in their

spinae

overstressed

on the

are

treated

in the

must been

they

because It

at

appreciable

hands

of low

erector

part.

so commonly has

rather

in cases

with

cases

2) Mobility-Reference it

pathology

immobilised

fractures,

dependent

because

tissue

that

385

SPINE

found

in those

on these

DORSO-LUMBAR

a soft

in patients than

THE

those

is probable ligaments

cent.)

operated

most

with

commoner

(80

who

the

and

muscles

it was

suggest

identical

contusions

damaged

be

findings

in fact,

OF

in

patient

text-books

in

Figure

is obviously

19

if

lumbo-dorsal

only

spifle

bend

forwards

and

as proof

of spinal

mobility,

are

occurring

svmptonl

the

of

the

at the

patient hip

put

shown

joints.

in

Because

/

I The

owner graphs

of their

could

of the spinae

will

group

muscles

for

his

full

can

be

measured

is due

to

31 B, F

NO.

use

3,

retain

the

with

a

the

cause

be

disease

causes

it

is usually

no

significant due

to

‘ ‘

long

poker

toes

or

muscle

is

hamstring

of

mean

In

the

characteristic

short,

is the

localised

best

movement.

resulting

that

mobile.

muscles

back.

trauma,

spasm

not

does

spine

‘ ‘

limitation

mobility The

These quite

technique

the

the

If

from

fusion

possible

pain,

there

thing is

and

gross

abolition

mobility.

are

muscle

VOL.

miners even

important.

inhibit

toinchi

test

it

livelihood.

they

a different

deficiency

most

endurance-\Vhereas is very

confused:

for

restore

and

to

lii mbo-dorsah

this

vhether and

.l)ilIty

19.

perform

of movement pain

Fig.

conditions can

happen

3) Power

radio-

whose in

vertebrae,

restriction

be

spine

depicted

and

damageti

that

the

occupational

of infancy of

of are

miner

two

distinct;

muscles fairly

actual

AUGUST

loss 1949

and

on

properties

of muscle-power a different

in

have

rehabilitation

prevent

full

in

doing

but

of

power,

muscle

strength

or

power and

and physiological

(Nicoll

their

accurately

muscle

the

they

of treatment of

is unimportant, depends

1948).

redevelopment. so

simply

it

is important to

painful

in the

endurance

erector of these

endurance-must basis; Pain,

not

and

they

however,

These to inhibition

call may

functions know

whether restricting

of

386

F.

full

output.

In

efficiency

for

the

miner,

eight

these

hours

muscles

without

\\‘e that

may

now

a good

will

be

the

whole

the

examineti

from

series.

on which

is indispensable aspects:

t\V()

It

is hoj)ed

I)

to

be

capable

are

orthodox

level

of

trying.

treatment result.

cases;

no

a high

particularly

DISABILITY

functional

individual

there

at

are

AND

a good

of

that

working

that

present-(itY

to

records

show

of

conditions

DEFORMITY

h\’pothesis,

result

to

under

BETWEEN

consider

anatomical

have

respite

RELATIONSHIP

NICOLL

A.

is I)ased,

The

hypothesis

2) statistical

grounds

analysis

whatever

for

the

of above

assumption. Early

in

injury.

In

a deformed of

the

spine

free

from

been

late

in

anti

tleformit\’

to

showed

gross

thirty

‘cears

sustaine(l

uniteti

symptoms

gross

admitted

hospital

suffering

it

impossible

of examination

ratiiogra)hs

had

it

was

course

and

had

an(i

that

a miner

ortlinary

back,

treateti

no

1940,

the

has

the

(ieformity

position

worked

at

is compatible

of the

with

‘as

20).

previously

; it

deformity

; the ever

to This

had

notice

never

been has

This

he

had

but

diagnosed

been

case

recovery,

cuff

that

fracture-dislocation

miner

since.

functional

a supraspinatous

not

(Fig.

coal-face

complete

from

or

completely

not

proves

only

that

there

may

be

complications.

,-

-..----.

FIG. Thirty

years

a three Eve’r’ with

ago

months other day hones’ --

‘ ,

Iiie’IItiOmiedl

iIi

PapYrtis. within a and has

Shortly

after

general

deformity

shown

spinous not his and

Ofl

was back

treatment the

ever

since

work

at

of the in

his

the

amicient

remedy

Edwnn

‘ ‘

SO

serious

bony undergrounti

that,

question.

At

radiograph that This

another developeti

for

six end

to he

miner

He

the

hati

Rehabilitation

as

2 1.

be

prominence. ripper-very

He

was

and he has been coal-face without the last five ears.

admitted,

pneumonia

suffering

soon

after

weeks,

any

treatment

by

of that

time

reduction

was

accepted

tieveloped

prevented Centre

fracture

other si’mptoms working at the interruption for

seen,

Figure

21

resulting in Sh)om)taneotns fusion ill a 1)51tmd)m) of deformity. The surgeon was nm)rtif)ed at this terrible result bunt the patient hmnmelf was dltllte 1)le’asel with it because he has no pain anl no

Sunith

was

in

so prominent

underlying the

was he(h. rul)he(l

in comfort.

at the an

\‘ertehral

a feather l)ack was

patient was

out

process

lie

his an thie

this

condition was

injured

‘l’reatnnent II)

shown

deformity

was

It proved so effective that ‘ear he as at the coal-face worked there ever since.

fracture-dislocation his

man

accidemit.

1)it

Ill

this

an him

had made heavy

as from

to be

the carrying

over

to

in

the

it and

The could

exercises, excise

recovery

equivalent

the

and result.

certain

in ortier

the anti

to retluce

impossible

bursa out

functional

work,

which

anatomical

adventitious

interrupted

a perfect

final

from

admission

anti

almost

the has

and bursa worked

every

way

JOINT

SURGERY

coal-face. THE

JOURNAL

OF

BONE

ANL)

to

FRACTURES

OF

THE

DORSO-LUMBAR

FIG. Fracture-dislocation vertebral body slipping between

The

case

as

paraplegia

shown

in

Fig.

recovered He

VOL.

31 B,

NO.

3,

22

of the’ spine with severe de’formnt’ amid incomiiple’te’ paraplegia. has split vertically and the spinal cord escaped complete section the fragments. Closure of the’ gap would have been dangerous zealous efforts at reehuiction niighit have ended in disaster.

110. Same

387

SPINE

AUGUST

1949

22,

three

years

and the is now

patient working

later. went as an

onilv and

‘Flit’ by over-

23 Spontaneous on; to achieve underground

fusiomi

with

a perfect ripper.

marke(l functional

deformity. result.

388

E.

The ihere

patient

s’as

Moreover, on

whose

so ntuch

radiographs

enthusiastic

the

cord

l)etweefl

the

position

and

halves

result

resumed

full

restricted

I)e(i

work

as

an

in

total

body.

made

Figure

in

undergroun(i

The

He

easily

He

has

facets.

the

‘I’here

locked-facet

case was

illustrated

attempts

at full

work

until

a further

to

s’as

reduction

to

in

damage

fl()

syndrome

1)ack

well

cord.

i’his

or the

‘I’his

coal-face.

accident

24 shos’s

Figure

the knovn

faileti.

at the

man He

flecessitate(l

These

examples,

perfect

achieved

perfect

prone

months.

The

)araplegia

pain

back

anti

mobility

in the

was

method

also

matie

continued arthrodesis

do

this

of the

final and is not

ankle

.nterior uleformity

exaniples proved

consecutive very

may is that

fact,

anti high

quoting rule

multiplied, were

residual indivitlual

the has

comparable standard

be there

despite

represent the

four

The noted,

results was

marketi patients

with to the

deformity in

However, than

A more

25

fracture no damage

the

It rule,

scientific

in fifty classified

patients

minimal disc

or

JOURNAl.

is compatible

present

is always

in which

to

are

case

all

recovery, analvseti

BONE

ANI)

who

refute

possible

is to examine

in whom

OF

series

attempt

method

as complete THE

the

any

is unscientific.

rather

went

symptoms

interspinous ligaments. Orthodemand three months in Fortunately the fracture was anti the patient was back at coal-face within three weeks.

that

deformity.

exception

cases. already

show

exceptions.

anti

ithout

of would

twenty-four

examples

the

Naturally,

recovery years

of the

before

joint.

wedge andl

rupture doxv plaster. overlooked

ago,

it understood.

functional for

locking

‘ears

Fio.

coulti

In by

many

with

a perfect

to

‘it1i

seen

of tiealirig

lumbar spine stabilisation in the tinl)atient gained a This radiograph after injury.

function

hypothesis

l)een the

the

the

a fracture-dislocation

patient

the which

which

function.

such

by

lying

into

from

the

of

was

completely

24

Fio. F’ractumre’-dislocation of with locked facets in was achiievedh spontaneously redluced 1)osition. The perfect functional resuilt. was taken five years

general

five

damage

it

significantly.

Lastly,

with

turned

for

impossible.

further

a miracle;

simply

nursed

no

paraplegia. was

inflicted i)\’

was

‘as

incomplete

reduction

have

patient he

had

Ofll\’

recovered

ripper.

22

complete

section

which

23.

Figure

that might

escape(i

vertebral was

is shown

in

reduction

had

of the

illustrated displacement

at

obviously

a Plaster

anatomical

anti

attempts

which t\\’()

are

comminution

NICOLL

A.

a that

that

has

a series as judged

in Table JOINT

SURGERY

IV.

FRACTURES

OF

THE

DORSO-LUMBAR

TABLE ANALYSIS

OF

THE

INCIDENCE WITH

OF

IV

RESIDUAL

PERFECT

DEFORMITY

FUNCTIONAL

wedge wedge

Lateral

fracture fracture

of

neural

From

Table

borne

out

patients

in

cent.)

this

gained

of these,

IV

it is clear

when

the

group,

thirteen

end-results

(38

in relation

20 1

3

.

.

.

1

8

arch

.

.

4

.

.

.

the showed results.

per

gained

cent.)

result

wedge

functional

fractures

good perfect

and

TREATMENT

FRACTURES

IN

AND

(excluding

(working

.

Light Light

Of

all

by

.

.

may

be

cases

selected

prognosis. (Table

died

23

(27%)

(h00#{176})

functional

same

fractures methods,

kind

treatment

analysis

was

treated 55

is not

in

cent.

scientific

a type

had

made

WITH

49

(100%)

plaster,

27

results,

per

really

therefore

of

9 (18%)

functional

of

whereas,

achieved

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because

it might

fracture

in relation

with to

per

cent.

of patients

an

good

end-

so happen inherently

individual

were treated

types

that better

of fracture

VI).

OF

TABLE

VI

IN

RELATION

TREATMENT ANTERIOR

WEDGE

End-result (working capacity)

10

Light Light

work work

underground on surface Total

It is seen plaster

that

were

by 31 B,

in the

classified

“functional” NO.

3,

AUGUST

.

group as

having

methods 1949

TO

END-RESULTS

5

.

.

.

.

35

.

.

50

of anterior gained

gained

wedge perfect

perfect

IN

FRACTURES

Fixation in plaster

Coal-face

VOL.

(55%)

86

of this

analysis

paraplegia)

13

.

“functional”

per and,

SPINE

27

.

perfect

IATIENTS

(10%)

(63%)

gaineti

(37

noted.

(27%)

54

9

dorso-lumbar

is

“Functional” treatment

.

called

152

irrecoverable

.

88

treated

had

on

ANALYSIS

in

or

work

as having

V is an

be

DORSO-LUMBAR

.

.

twenty deformity

Table

IN

THE

.

analysis

The

OF

.

with

for

END-RESULTS

.

surface

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This

Of eighty-eight

V TO

who

factor.

residual

results. factor

underground

patients

However,

RELATION

of had

work

classified

what

result.

results;

Fixation in plaster

Total

subsequently

separately.

a significant

End-result capacity)

Coal-face

a significant

functional

here

patients

is not is analysed

patients

FRACTURE-DISLOCATIONS

seventeen

24 (48%)

anatomical

Thirty-four

TABLE OF

-

26 (52%)

anatomical

of anterior

to treatment,

ANALYSIS

13

.

fifty-four

perfect

Residual deformity

.

that

group

anatomical result

-

Total

also

PATIENTS

.

Fracture-dislocation

Fractures

50

IN

RESULTS

(;ood

Anterior

389

SPINE

“

(20%)

Functional treatment

24

(63%)

(10%)

8 (21%)

(70%)

6 (16%)

( 100#{176}c)

38

fractures

20

results;

whereas

results.

In the

per

( lt)0,,

cent. 63

other

of patients per

groups,

cent.

treated of

the

patients

number

of

390

E.

patients in

treated

the

case

better

functionally

of

to

than

similar

the

average

per

cent.

hyperextension He

It

is

plaster

conclusions, applied

in

twenty-eight

(1931),

patients

seventeen

working

and

and

64

there

was

in the

Ruhr

gave

Coalfield,

fixation

disability

cent.

evidence

position

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per

some

physiological

treated

weeks

weeks

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in the

Magnus that

was

with

submitted

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not

absence

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dependent

soft

not

the

and

best

unstable

in

plaster

compensation

respectively

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include

fourth

45

for

level.

interspinous fourth

fifth

increasing

patients

point

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nearly

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‘ ‘

the

All

no

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increase

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simple

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with

cord.

functional

patients

admission,

rupture

of the

of

of

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be

treated degree

no

instance

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ligament

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examined

in

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of

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were

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of the

deformity

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fixation later,

interspinous

level

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stressed

there

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therefore, be

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at

patients

years

Stable

rupture

danger

these

several

injury

above

with

without must

cord

fractures

should,

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the

varieties.

fractures

there

and

in

the

fixation

spinal

unstable

laminar

laminar

disability,

It ‘ ‘

all

In

and

fractures

of

and

They

deformity.

a cause

problem

plaster.

treated

discharge,

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all group

in

is in itself

fracture-subluxations

stable

imniobilisation

it causes

significant

all

by

of view. on

the

prolonged

stable and

and

In

threatening not

great,

radiographically

all

in

between

; 4)

special

fractures

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FRACTURES

is into

fracture-dislocations,

thereby

is never

cosmetic

fractures

good

is stability

it is achieved

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wedge

vertebrae.

and

“

deformity

all

lumbar

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Unstable

ligament, anti

was

anti

a

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DORSO-LUMBAR

of treatment,

1)

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position,

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purposes

anterior

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OF

conclusions:

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shortened

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classification,

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in

in their

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in determining

position

especially

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factor

TREATMENT

Stable

lead

anatomical

important

and

tissues,

findings

a good

; 3) the

segments

damaged

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of fixation

damaged

“

to justify

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in plaster.

result

the

small

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of incapacity

comparing

NICOLL

plasters.

conclusions.

duration , this

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too

fracture-dislocations

results

came

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A.

and

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in

fact,

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“

three

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every

da

After

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assist

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work extension

Treatment were

Centre work,

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at

of by

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four

every

months

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weeks

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two

months

protective

Some

(Fig.

muscles

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patients

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of

progressively beat

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transferred

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the

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reproducing

twelve

no in bed

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massage

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patient

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in the

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treatment and

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endanger

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dispersal

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fracture, soft

scheme

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damaged

of eight

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that

of

per

until

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a period

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type

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anti starts

begins

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to rest

up,

At

difficulties

before

orthodoxy

gets

in this

immobilise

it may

(62

displacement

extension

absorption

he

and

fractures-When

or

in order only

Centre.

in the

vulnerable increasing

reduce

to increase

fracture-dislocations

of stable to

the

weeks

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against

either

to

is likely in

is always

treatment

“

Rehabilitation gratie

cord

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deformity

of paraplegia

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immobilised

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25). this “plaster

in the

neutral THE

JOURNAL

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in

unstable

or physiological OF

BONE

fractures position.

AND

JOINT

The SURGER\’

FRACTURES

associated

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or

bodies In

than full

practice, at

represent

the

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fusion

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patient

more

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anterior

lines,

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included

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deformity plaster

treated

present

ever

residual in the

fusion

in the

that

because are

degree

approximate

spontaneous

group

fusion

fusion sound

some to

391

SPINE

fracture-dislocations

; all of any

vertebrae

become

is

Moreover,

four

instead

of

two

fixed. The

double

“

the

above

not

to

extend

graft

clothes-peg

objections, the

will

graft

not

the

beyond It

eventually

Bosworth

it is now

spine

bodies.

being the

way.

A recent

long-term

and

functional

Bosworth

which

series

of fifteen

better

than

the

those

being

be

any

fractures by

by

posterior

treated

by

of determining

gained

of

taken

prejudiced

support

object

some

care

would

anterior

unstable

with

removed

fusion,

fusion

is firm

be studied

has

anterior

anterior

there

are

(1942)

supplement

unless will

results

to

at

that

followed-up

by

used

point

is believed

give

is being

described

graft

“

and

the

distracting

or

coal-face

DORSO-LUMBAR

anterior

Of ten

results

spontaneous

makes

spontaneous

the

THE

allowed

fusion.

best

undamaged

injury

therefore,

surgical

work

been

ligament are,

OF

the

whether

spontaneous

anterior

fusion.

Treatment of

of dorso-lumbar

traumatic

attitude

by

time

section

of

the

should

or

be

ignored

stabilisation

least

rapidly

and

grafting

not

universally

and

all in

that

had

been

forty-eight

hours

can

carried

accepted of

lesion.

surgeon

without

which indicates

the

the who

than

premise

on

discounts

most

shares

is

clinically

that

there that the

be the

which

all

these

incontrovertible

proof

these injury

sores out

case

of

in

spinal

while

that

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if reduction

views

possibility

views

complete

of pressure

would

with the

is complete

B#{246}hler points

sooner

explore

patients

contends

prevention

favour

would

disability,

is achieved.

grafting

who

on

Naffziger

Guttmann

on even

the

only

hand,

hours

and

those Some

operate

paraplegia

position

reduction

indications.

other

treatment

a conservative

among

as a permanent

However,

the

injury

that

be gained

out.

and

the

concentrated

displaced

stability

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forty-eight

accepted

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the

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would

irrecoverable

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efforts

spine

so for

an

having

aud

of the

others,

remains

at

paraplegia

regarding

surgical

Britain

open

others.

Penfield, On

Great

continent

and

block.

B#{246}hier and

cord

circumstances,

of view as

primary In

American

Cone

a spinal

and

paraplegia-The controversy.

in the

such

showing

of injury

of

Botterili,

others,

Guttmann,

the

occurs

while

paraplegia

Jefferson,

from

whereas

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case

with

a matter

Munro,

there

every

incomplete

adopted,

Rogers,

operation

almost of

is still

is generally

is favoured early

fractures

paraplegia

are

based

recovery accepts

is

within a

heavy

responsibility. Many for

surgeons

several level,

equina

accepted any

with

lead

manipulative

to

stabilising, neural

recently VOL.

of plaster

pressure

sores

can

be

the

patient

arches

NO.

are patients

3,

the

AUGUST

dictum the

or by

open only

thereafter intact, who 1949

cord

should by

some

a self-locking given

restored

of the

on external

reduced

graft support

spine or

stabilised agreed,

plaster

bed,

is

in

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whether

obtained

absence

of plaster

fixation,

internal frame.

fixation If the

be and

cauda

possibility

position,

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can

complete at the

if this

is generally cast

or

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in lesions

the

It

a Stryker

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letter-box no

involved,

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nursed

was

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maintenance by

lesions recovery

of Boston.

means

operation,

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after of late

itself

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either

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the

canal

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in which

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in two 31 B,

one

in accordance

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recovery

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form

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at

that

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lumen

to

and

This

and

the

position that

believe

days.

used. were

which spinous

This turned

is selfprocesses

was

adopted

regularly

for

392

F.

A.

NICOLL

1- ...

F’ractumre-dislocation the SpiflOIIs Processes. regularly for nursing fusion

has

paraplegia No external care’. Ten

occumrred.

FIG. Traunmatic on!;’ way

ivithi

Recover

(inset) fixation months from

the

_6

treated by ;vas used later reduction paraplegia,

self-locking letter-box and the patient was has l)een maintained in

this

27

spomidvlolnsthesms of reducing such

case,

was

FIG. (Fg.’. 27) treated cases 1)nit it lutist

atteflll)te’d

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by ope’mi reduction be dlone’ early. it

is

: a)

imulh)d)ssible,

THE

amid grafting Ianih)ulative 1)) dangerous. JOURNAL

d)F

graft of tuirneul audi

comnplete.

28 (Fig. reoluction

BONE

28).

This shioulldl

AND

JOINT

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SURGERy

FRACTURES

nursing

care

(Fig.

; reduction

26).

All

posterior

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Treatment upon

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VOL.

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28).

lighter

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Operation

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.

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27 and

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(Fig. result

experience to

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(Figs.

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the

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laminectomy there

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level

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fourth

of

spinal

occurred

graft three

393

SPINE

fusion

could

by

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of isolated

depends

until

Newcastle) decompression

knowledge

union

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DORSO-LUMBAR

self-locking In

evidence

obviously

of facets.

nor

canal

THE

maintained

methods

arches

Irwin

spinal

was

such

OF

functional

a small this

and

problem

number must

394

E.

A.

NICOLL

CONCLUSIONS Certain there

types

of dorso-lumbar

is reasonable

lateral

wedge

will

fractures)

inevitably

at the

and, there

many

if this

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be to

with

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periods.

More

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than

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assessed

and

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accurately

be

compatible

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in

an

position

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insignificant

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best

necessary,

anatomical

assisted

by

to

alone

whilst

be

functionally

be necessary

fusion

increase

fractures

perfect for

disability.

protection in the

posterior

to

not

, dorsal

case, can

tissues

beyond

fusion

Sometimes

any

produce

anterior

whether

in

will

(e.g.

result

soft

increase

deformity

experience

is likely

may

the

of these

corrected

damaged

in so doing. this

and some

anatomical

known

in

deformity

it is tloubtful

In

cannot

which

and

stable

immobilising

spontaneous

objective,

are stages.

The limits

for

cord

produce

maintained fusion,

is within

case

fractures,

jeopardise

should

early

deformity

procedure

In unstable may

the

is no

months-a

in the

if it is corrected.

recur

outset

function,

fracture

protection

will

extreme

the

aim

compatible

l’typerextension

anterior

stabilise

and

but

position

reinforce

ever

limits

by

a spine

posterior that

lacks

support. SUMMARY

1

.

A series

of 1 66 fractures

and

fracture-dislocations

of the

dorso-lumbar

spine

has

been

reviewed.

2.

A new

3.

A

method

type

of

distinctive

4.

fracture

clinical

The

cases

5.

of classifying

factors

this

At

with

and

responsible

the

the

series

now

6.

Treatment

(livision

previously

time

orthodox

reported

into

are

treatment to

shows

discussed

is based

a perfect

that

there

are

in the

light

of

stable

unidentified,

which

has

certain

is described.

and

it is considered

that

in most

outset.

is indispensable

cases

wedging,

features

the

is discussed

of

is suggested.

for redisplacement from

present result

injuries

lateral

anatomical

is predictable

anatomical

these

and

on

functional grounds

flO

the

unstable

assumption Analysis

for

foregoing

types,

the result. this

a perfect results

in

assumption.

conclusions.

the

that of the

This

recognition

of

is

based

which

is

of

a

on

crucial

importance.

REFERENCES L.

BOHLER,

(1935): D.

BO5WORTH,

H.

BOTTERILL,

J.,

CAL’f,

The

M.

(1946)

and

CONE

(1946)

JEFFERSON.

G.

(1936):

British

JEFFERSON,

G.

(1949):

Personal

and

A., St

(1931):

MAGNUS

the

Medical

E. C.

1).

(1948):

NicoLL,

E.

A.

(1948):

Journal

\V.

(1946):

Proceedings

STANGER,

J.

K.

(1947):

zur

Journal (1943):

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NS

Research

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of

s#{233}rie 17,

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John

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21,

Canada.

5.

452. of

Canada.

2, 1125.

Journal,

(1946):

The

Mosbv

\‘.

of

Management

of

Bone

31,

and

Joint

Dislocations

Fourth

Research 9,

Bone

and and

Joint Joint

3.

Surgery,

National

Unfalhheilkunde,

of

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59. 75,

Surger’,

of the

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of

Co.

8,

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Hefte

R.

W’ATSON-JONES,

Livingstolue,

American

(1931):

ScHMIEDEN

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d’orthop#{233}die

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MUNRO,

IENFIELD,

edition.

75, 593.

communication.

H.

zur

National

of

English

Obstetrics,

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Missouri: Hefte

the

National

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CONWELL,

Louis,

Fourth and

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Journal

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J.

(1930)

: British

L.

KEY,

of

M.

: Proceedings

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Gs’necologv

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(;UTT;IANN,

e(hition.

of

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GALLAND,

c;. Q. (1948)

CHANCE,

Treatment

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4,

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THE

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AND

JOINT

SURGERY