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safe' and 'there is no danger of further damage to recovering nerve roots'. However,
Hardy (1965) obviously did not agree with this view, as the nursing of his operated cases
has been carried out precisely with the same routine and care as in the non-operated
cases, much on the same lines as practised at Stoke Mandeville since 1944. From personal
observations the author can only warn not to relax the most careful nursing after the
procedure.
Since 1953, we nave admitted to Stoke Mandeville just under 100 patients in whom
open reduction had been carried out elsewhere, and the conclusions which can be drawn
from this large material are as follows:
(a) This operation is by no means simple and safe, especially not in those cases in whom,
in addition to the fracture of the vertebral body, the spinous processes and pedicles are
broken. Therefore, the difficulties surgeons have to encounter should not be belittled
and Holdsworth himself (1954) withdrew his statement of the simplicity of this method.
(b) This method does not prevent re-dislocation regardless of what kind of metal
plate is used. This applies in particular also to that large straight plate propagated by
Meurig-Williams (Fig. 76). In fact, this type of plate produced such stiffness and rigidity
of the vertebral column associated with excruciating pain that the patient was not able
to bend and the plate had to be removed, and this was also necessary after using the
Wilson plate. To what tragic consequences an unsuccessful open reduction and fixation
with metal plates can lead is best shown by the X-rays and photograph of a young man
of 18, who sustained a fracture-dislocation which could have easily been reduced and
stabilized by conservative means (Figs, yya and b).
22 3
58.
I
• 4
58.
7-5-58
FIG. 76. Failure to maintain reduction by plating.
