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CHAPTER 13
treatment. The paraplegia below L2/3 remained unchanged but the patient made an
excellent rehabilitation and was full time employed in his former job in a factory and is
still alive.
Spread of the infection may lead to osteomyelitis resulting in disintegration of one or
several vertebrae, as described by Frangenheim (1916), Dietlen (1920) and others in the
First World War, especially following grenade injury, if the missile had not been removed.
One of our own cases who sustained a complete transverse lesion below T8 following
grenade injury in the Second World War developed osteomyelitis of the second lumbar
vertebra with fistula formation. He was admitted and Fig. 88a shows the large grenade
splinter and the osteomyelitic spine. Fig. 88b revealed, following contrast filling, the
grenade splinter lying in an abscess cavity. Following removal of the missile, and evacua
tion of the abscess and antibiotic therapy, the fistula closed and the osteomyelitis sub
sided. Fig. 88c shows the final result of the healed osteomyelitis and demonstrates the
osteoporosis of the vertebral column. The patient took up full-time employment and
worked for many years in an office. He lives at present in Italy and returns occasionally
for clinical check ups.
FIG. 89.
