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CHAPTER 15
TREATMENT OF ASSOCIATED INJURIES
Although it is realized that the treatment of a number of serious associated injuries will
need priority and will have to be dealt with at the hospital to which the paralysed patient
is admitted as a an emergency, should immediate transport to a spinal unit not be
feasible, it is important that the staff of a spinal unit be acquainted with the principles
of the management of the most common associated injuries.
Resuscitation
This has, of course, highest priority to get the spinal injured out of traumatic shock as
quickly as possible, especially if the associated injury has resulted in considerable blood
loss. Blood transfusions are the method of choice, preferably with fresh packed cells,
to restore oxygen-carrying capacity. Intravenous transfusion to restore electrolyte
balance should be given with great care to avoid over-transfusion, especially in high
thoracic and cervical lesions where the vasomotor control is abolished and the danger of
developing oedema of the lung is, therefore, increased. Dialysis procedures have to be
considered in cases with anuria which cannot be overcome quickly.
Fractures of long bones
The immediate conservative correction of uncomplicated fractures of long bones in the
paralysed area does not differ from that discussed in the chapter on pathological fractures.
The author agrees with McSweeney (1968) to delay surgery for fracture of the long bones
for at least 3-4 days until the patient's general condition is satisfactory and his vasomotor
control has recovered. In our experience throughout the years, fractures which virtually
never needed surgery were fractures of the scapula, clavicle, ribs, pelvis, calcaneus and
comminuted fractures near the end of long bones unless they produced gross deformity.
On the other hand, fractures of long bones in the paralysed limbs resulting in multiple
fragmentation or accompanied by pressure on larger vessels, fractures which are not
reducible due to inter-position of muscles, unstable fractures of ulna and radius and
certain avulsion injuries of patella or olecranon certainly need surgical correction includ
ing plating and nailing (Meinecke
et
a/., 1967). Tricot & Hallot (1968) favour early
osteosynthesis in fractures of lower limbs.
Abdominal injuries
The absence of bowel sounds, which occurs frequently in complete closed cervical
injuries, resulting in meteorism is certainly not an indication for immediate laparatomy.
Its management, including treatment of stress gastric and duodenal ulcers, has been
discussed in the chapter on intestinal function. Unlike gunshot and stab injuries of the
abdominal organs, associated injuries of internal organs to spinal fractures are rare.
Meinecke (1968) reported an unusual case of complete paraplegia due to fracture of L2
and L5 vertebrae with multiple associated injuries, who, on admission, was severely
