E • COMPLICATIONS
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shocked. An X-ray showed signs of abdominal complications as a result of a rupture of
the diaphragm. At operation 2 hours after admission an 18 cm tear in the diaphragm was
found through which stomach, spleen, transverse colon and greater omentum had moved
into the thoracic cavity. The entrails were replaced and the rupture of the diaphragm
closed. Postoperatively the patient developed haemothorax but recovered and made a
good rehabilitation.
Chest injuries
These are relatively frequent, especially associated to thoracic spinal fractures, consisting
in fracture of ribs, sternum, haemothorax, pneumothorax and contusion of the lung,
heart or aorta. Frankel (1968) mentioned a case of delayed rupture of the aorta who lived
for several days after his accident. The treatment of fractured ribs has been greatly
facilitated since the introduction of the Stoke Mandeville-Egerton turning bed, especially
in cases with multiple rib fractures associated with a sternal fracture resulting in 'flail'
chest. The serious complications of rib fractures are haemo- and pneumothorax. Haemo
thorax may develop gradually and is signified clinically by increasing dyspnoea, and an
X-ray will clarify the diagnosis. In our experience, repeated aspiration with a wide bore
needle has, usually, proved an adequate treatment. The diagnosis of a pneumothorax is
readily diagnosed by X-ray, and should be treated immediately by an intercostal drainage
tube connected to an underwater seal. Some of our patients with injuries of the thoracic
spine associated with rib fractures were suffering from chronic bronchitis before the
accident and, of course, are in danger of lung complication. They have to be watched
carefully and, if necessary, a temporary tracheostomy may become a life-saving measure.
Head injuries
Cerebral concussion is a frequent associated injury to many spinal injuries at any level.
Harris (1966) found 31 head or facio-maxillary injuries in 43 cervical cord injuries.
Cerebral concussion will usually clear up by conservative management in time, varying
from a few hours to several days followed by a state of confusion. Harris suggested that
the echo encephalography can be helpful in the diagnosis of acute intracranial haematoma.
Compound fractures of the skull have to be dealt with immediately. Another indication
for surgery in associated head injury can be rhinorroea of cerebral fluid as a result of a
fracture of the frontal sinus, if this does not cease spontaneously and an X-ray of the skull
reveals a pneumocephalus (Guttmann, 1936).
