D • GUNSHOT INJURIES AND STAB WOUNDS
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sustained a fracture of Cy vertebra. Moreover, vertebral fractures when associated with
other injuries may sometimes be overlooked.
A gunshot injury not infrequently produces a complete or incomplete transverse
lesion through bone fragments which are driven into the spinal canal. Frangenheim
(1916) found bone fragments in n out of 58 operated cases following gunshot injuries,
which, penetrating the dura, were driven into the spinal cord. Foerster found repeatedly
large bone fragments embedded within the roots of the cauda equina. Although bone
fragments lead, as a rule, to immediate damage of the spinal cord, in some rare cases they
give rise to delayed damage of the spinal cord. Bergmann (1922) reported about a
destruction of the 3rd to the 6th vertebral bodies of the cervical spine which, however,
only 4 to 6 weeks after the injury produced the first symptoms of spinal cord involvement.
Gunshot injuries of the spinal cord and cauda equina can be classified in the following
groups:
(i)
Missile penetrating the cord
The severance of the cord or its roots may be total or partial but even in a partial sever
ance of the cord the remaining neural elements or their vascular supply may be
irreversibly damaged by the force generated from the penetrating missile although the
missile itself may be small as shown in Fig. 84 of the patient referred to also in the chapter
on phantom sensations.
FIG. 85.
