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CHAPTER 12
and, therefore, has certain disadvantages in the initial treatment of acute patients with
fractures and fracture dislocations of the spine:
1
This frame is not electrically operated and needs the attendance of one if not two
nurses to operate it.
2 While hyperextension to reduce the fracture dislocation by posture can be easily
achieved in the supine position, this can only be maintained by time-taking and careful
manipulation on the part of the nurses when placing the patient into the abdominal
position. Otherwise the object of maintaining hyperextension to secure re-alignment and
promote stability of the broken spine is defeated.
3
For traumatic paraplegics with associated fractures of the hips, pelvis or long bones,
and in particular patients with haemothorax or pneumothorax (let alone those who are
unconscious), turning on to the abdominal position is clearly hazardous and, therefore,
contra-indicated, for such patients have then to maintain their recumbency in the supine
position day and night. Owing to lack of regular turning, development of pressure sores
is inevitable, as patients have shown admitted to Stoke Mandeville on this frame.
4 Cervical patients placed for long periods in the abdominal position have shown
disappearance of the normal contour of their spine.
5
The original Stryker frame was narrow and cumbersome, especially for heavily built
patients. Although this has been recently modified by a frame of greater width (Ascoli,
1970), the disadvantages, as mentioned in 1-4, still exist.
Traction and manipulation in fractures of the cervical spine
There is general agreement that these conservative procedures have to be carried out with
the greatest care and gentleness to prevent further damage of the cervical cord.
Traction of the cervical spine with the Glisson sling has been the method of choice
before the introduction of skeletal skull traction by Crutchfield (1933), but it is still
practised in some countries. In agreement with other workers in the field, I consider
this method as unsatisfactory. In the first place, it results more easily in redislocation of
the broken spine and cannot be employed in patients with associated injuries of the jaw.
Moreover, it causes unnecessary discomfort to the patient, and damage to the jaw and its
articulation is by no means unusual, if used for longer periods.
Traction may be combined with manipulation, but forceful manipulation and jerks
on the neck can be most harmful to the spinal cord by causing immediately complete
or partial tetraplegia and even death (Roger, 1942; Durbin, 1957). Walton (1893) was
the first to describe a method of manual manipulation consisting in full rotation to
disengage the locked facets followed by lateral flexion to lift the forward facet above the
posterior one. This was followed by rotation in the opposite direction, to place the facets
in their proper position. This rather forceful method was modified by Taylor (1924) and his
method was accepted by other workers in the field. Evans (1961) reported successful
manual manipulation in 17 cases of cervical dislocation under anaesthesia combined
with a muscle relaxant which greatly facilitates the reduction of the dislocation. However,
Harris & Whatmore (1969) reported extreme distraction of atlas and C2 vertebra follow
ing manipulation under anaesthesia of a C2/3 fracture-subluxation. In a recent paper
