The Treatment of Compressed and Impacted Fractures of the Bodies of the Vertebræ

Abstract

THE treatment of compression fractures of the bodies of the vertebræ has received a great deal of attention in recent years, since correct X-ray exposures have demonstrated the frequency of this injury. Decompression has been accomplished in several ways by different men. The method of decompression and reduction to be described was originated in 1927, and has been very successful and has proven to be safe. This paper deals only with those cases which do not have symptoms of injury to the spinal cord and those cases in which the demonstrable injury is limited to the body of a vertebra. The treatment is carried out in the manner to be described. The patient is given a general anesthetic to insure complete muscular relaxation during the process of decompression and reduction. Strong traction and counter-traction are obtained by having two men pull downward on the ankles while two others pull strongly upward on sheets crossed beneath the shoulders and over the chest. A sheet is folded to a width of eight inches and is passed beneath the injured segments as the patient lies on his back. Then by means of this sheet the operator and his assistant toss the patient straight upward and catch his weight while he is still in hyperextension; the strong traction is maintained throughout this maneuver. The force of the manipulation can be graduated to the individual case. Where impaction is present considerable force may be necessary to disengage the fragments. On the other hand, in cases in which there has been comminuation of the bone a gentle lifting motion will be found sufficient to restore the various portions of the bone to their normal relations. After the decompression has been done the reduction is maintained by placing the patient in marked hyperextension on a Goldthwait frame while he is still completely relaxed. The proper placing of the patient on a correctly curved bar is an essential step in this procedure. A cast is then applied in order to hold the corrected position. Experience indicates that the patient should not be placed in a face-down position while in the cast, as this has resulted in some reduction in the vertical height of a vertebral body which had previously been pulled out to a normal height. The time in the cast has usually been four months. In cases in which much bone destruction has occurred the time has been increased until the X-ray demonstrated the rebuilding of the bone structure. During previous discussions of this subject the question has often been asked, “Is such radical and long-continued treatment necessary in these simple compression fractures?” The answer is, “Yes.” The failure of immobilization and the failure even of stabilization operations to give satisfactory results, especially in industrial cases, is attested by Eikenbary, of Seattle, who reviewed two hundred cases in 1928.