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Journal of Bone and Joint Surgery, 1937;19:584-602.
© 1937 by The Journal of Bone and Joint Surgery, Inc

THE TREATMENT OF FRACTURE-DISLOCATIONS OF THE CERVICAL VERTEBRAE BY SKELETAL TRACTION AND FUSION

WILLIAM CONE M.D.1 and W. G. TURNER M.D.2

1 The Department of Neurosurgery of McGill University, the Montreal Neurological Institute, and the Royal Victoria Hospital
2 The Department of Orthopaedics of McGill University, the Montreal Neurological Institute, and the Royal Victoria Hospital

Skeletal traction has been proved to be of great value in the reduction and immobilization of fracture-dislocations of the cervical spine, especially when the bed frame with its vertically movable, pulley-carrying cross-bar is used.

From our experience, we have concluded that fusion is indicated when more than one of the bony structures are injured. In fracture of a body alone, fusion is not necessary, but it is advisable in multiple fractures. We feel that when fracture of the odontoid is present, even though there is no other demonstrable vertebral injury, the patient is safer with fusion. When deformities recur after reduction, in spite of careful immobilization, fusion is imperative. Another important indication for fusion in high cervical lesions is paralysis of the neck muscles, due to cell involvement of the anterior horn. We feel that these conclusions are not radical. With fusion, the patient is protected immediately and from late recurrence of the deformity. Fusion not only insures much greater protection, but it allows the natural repair of the damaged vertebra to take place. In the occipitocervical fusions, rotation is lost, but considerable compensatory flexion remains. Below this level, the amount of mobility depends on the extent of the fusion. In this series the patients have resumed their previous activities and have not complained. The follow-up periods range from nine months to four years.

The age of the patients has ranged from six to seventy-two years. There have been no deaths and in none of the cases has there been wound infection. The twelve cases represent our total experience with fusion in the cervical region following trauma.


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