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Dislocation of the Spine

fracture, spinal, odontoid and ti


The displacement of one vertebra from it position on another is seldom effected withou fracture, except in the region of the neck. I the neck dislocation may occur between the axi and the atlas (p.61). It has been pointed out (se p. 61) that the odontoid process of the axis move in a ring of the atlas, that immediately behin is the canal of the spinal column, occupied b the spinal cord, and that separation betwee the odontoid process of the axis and the cur is effected by a ligament passing across betwee the two. Besides this ligament there are other one passing upwards from the top of the prom to the base of the skull, and two passing side ways to the base of the skull at the margins the large opening—foranmen magnum—throug which the spinal cord passes to join the braim These all aid in retaining the odontoid pe in its place. Nevertheless these ligaments ma be ruptured, and the axis torn from its conuel tions with the atlas above it. The result is the the peg is crushed backward upon the spin cord, destroying it, causing instant death, for is in this neighbourhood that the principal new centres exist which control the breathing, & This is one of the occurrences, and the innin diately fatal occurrence, in "broken neck" froi a fall or hanging.

Dislocations may occur in other parts of spinal column, though they are, as has bee said, rare without a fracture. The results am less serious the further down the column ti dislocation happens to be. What has been sai about fracture of the spine applies equal] here, and reference should be made to tin fracture. The signs of the two accidents am very similar.

The treatment also must fulfil the same coi ditions. Careful manipulation may be employe if any displacement of bone is apparent, to sr whether any setting is possible. The head an shoulders may be fixed while the legs are beiu very gently pulled downwards. It is doubtfu however, whether anyone but a surgeon ougl to try this. In any case the utmost caution ma be exercised. The injunctions given in discussir the treatment of fracture of the spine, namel absolute rest, careful nursing, attention to ti bowels, and in particular to the state of ti bladder, and the regular use of the catheter, required, avoidance of anything likely to ei courage the formation of bed-sores, &c., all the must be constantly kept in view. In turnir the patient, shoulder and hip should be turns at the same time, so that movement of the spine may be prevented.