Modern surgery, general and operative . nce shows plainly through themembranes even in photograph. The spinousprocesses of the second and third dorsal vertebraewere found fractured at the operation, and wereremoved (Thomas). division. As Walton says, no symptoms prove a hopeless crush of the cord:it is the persistence of the symptoms which does prove it (Jour. Nervousand Mental Diseases, Jan., 1902); I would add, the unchanging persistence ofthe symptoms proves it. Prognosis of Fractures and Dislocations of the Spine 855 A. J. McCosh CJour. Amer. Med. Assoc, Aug. 31 and Sept. 7, 1901)points ou
Modern surgery, general and operative . nce shows plainly through themembranes even in photograph. The spinousprocesses of the second and third dorsal vertebraewere found fractured at the operation, and wereremoved (Thomas). division. As Walton says, no symptoms prove a hopeless crush of the cord:it is the persistence of the symptoms which does prove it (Jour. Nervousand Mental Diseases, Jan., 1902); I would add, the unchanging persistence ofthe symptoms proves it. Prognosis of Fractures and Dislocations of the Spine 855 A. J. McCosh CJour. Amer. Med. Assoc, Aug. 31 and Sept. 7, 1901)points out that definite pressure is indicated by marked symptoms and ab-sence of reflexes. When there is not definite pressure the symptoms areirregular; there is incomplete palsy, or muscles of the same group show differ-ent degrees of paralysis; anesthesia is partial; signs of irritation are not dis-tinct, and there are patches of hyperesthesia and zones of paresthesia. If indoubt at the end of twelve hours, perform an exploratory Fig. 547.—Fracture of the odontoid process of the second vertebra and dislocation between the first andsecond vertebra a number of years after injury. (From X-ray Dept. of Jefferson Hospital.) The prognosis depends on the amount of damage done to the cord. Frac-ture-dislocations in the cervical region produce obvious deformity, stiffnessof the neck and irregularity of the spines, and a displaced vertebra may occa-sionally be detected by a finger in the pharynx. Crepitus can rarely bedetected unless a spinous process is frac-tured. The Rontgen rays aid diagnosisimmensely. The seat of cord injury maybe determined by a study of the palsyand other symptoms. Fracture-dislocation of the atlas oraxis usually causes instant death. Whenthe displacement is only trivial, the pa-tient may actually recover, but will prob-ably die of secondary cord disease. J. Blackwood of the U. S. Navy recordsa case of fracture of the atlas and axis andforward dislo
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