C DISLOCATIONS OF THE VERTEBRAL COLUMN
127
lie on the hard surface of a bed to prevent sagging. An additional pillow or roll is placed
underneath the fracture to ensure the normal contour of the spine (Figs. 73a-d). As seen
in the figure, the patient's hips, buttocks and sacrum, as well as the heels, are completely
free of pressure. From the initial supine position the patient is carefully turned by the
orderlies,
in one piece,
at 2-hourly intervals to the sides and later back to the supine
position, whereby the hyperextended position of the spine is secured by a heavy sandbag
in the lateral positions. The result of the reduction of the broken spine is followed up by
repeated control X-rays and the first X-ray controls are taken on the first day or two of
this treatment in order, if necessary, to correct or modify the position of the broken
vertebra. As a rule the bony stabilization through natural fusion occurs within 6-8 weeks,
the fibrous fusion, of course, earlier. Only in the minority of patients was there delayed
stabilization and the incidence of late instability was very low (Frankel
et aL,
1970;
Bedbrook, 1971). During the first few weeks, after the patient is transferred to his wheel-
chair, a light corset of plastic material is applied to avoid excessive movements and
control X-rays may give the indication for discontinuing the wearing of the corset.
From the experience gained on many hundreds of traumatic paraplegics and tetra-
plegics following spinal fractures and fracture-dislocations it can be concluded:
1
In compression fractures the compressed vertebral body, whether wedge fractures
or those with complete flattening of the whole vertebral body, can be re-expanded and
may remain more or less so. I do not share the view that simple wedge fractures do not
require reduction and fixation. To leave the impacted anterior part of the wedged vertebra
unreduced means ignoring the damage to the anterior longitudinal ligament, which in
such a case is crumpled up. If the wedged vertebra is re-expanded by postural reduction
the straightened anterior ligament helps to keep the reduced vertebral body, if not
permanently completely expanded, at least in a better position, thus preventing severe
angulation later (Figs. 60, 61, 62, 63, 64).
2 Dislocations and fracture dislocations of various types, including those of the most
severe burst fractures with avulsion of parts of the vertebral body and regardless whether
stable or unstable, can be successfully reduced and stabilized (Figs. 65, 66,67, 68, 71).
3 Atrophy of the back muscles which is the rule following long-term conservative
fixation in plaster casts, plaster beds and following operative procedures, can be absolutely
avoided, which is so important for the later physical readjustment of the paralysed.
4 Pressure sores, which hitherto were considered as inevitable, can be completely
avoided, thus preventing sepsis and avoiding long-term and costly conservative and
surgical treatment afterwards.
5 The continual change of posture counteracts stagnation in the urinary tract, thus
preventing the dreaded complications of ureters and kidneys following infection.
6 The constant change of posture has proved beneficial in restoring the disturbed
vasomotor control and thus better blood circulation, especially in the high lesions.
All this proves that if nature is given a change by appropriate conservative treatment
and proper positioning of the broken spine, the displaced vertebra and fragments will,
in the great majority of cases, find their correct place of re-alignment. It is as much an
inherent function of the natural forces of repair to stabilize the broken vertebra as near
as possible in physiological alignment as it is to repair defects in other parts of the body.
