286 Injury: the British Journal of Accident Surgery (1986) Vol. 17/No. 3

INJURIES OF THE HEAD AND SPINE

Fracture of the lumbar spine Three cases are described of fractures passing through the tip of a lumbar spinous process and then horizontally through the laminae, pedicles and body of the vertebra below; the body was also wedged.

Hall H. E. and Robertson W. W. (1985) Another chance: a non-seat belt related fracture of the lumbar spine. J. Trauma 25, 1163.

Spinal instability following fracture Twenty-one out of 27 patients made good recoveries with few or no symptoms and no demonstrable instability in flexion. The other 6 had persistent pain, and there was demonstrable instability of more than 11 in flexion.

Mazur J. M. and Stauffer S. (1983) Unrecognizable spinal instability associated with seemingly ‘simple’ cervical com- pression fractures. Spine 8, 687.

Cranial nerve palsy Eight patients with injuries of the cervical spine also had injuries of cranial nerves. All had sustained injuries of the head and this was regarded as the reason why the cranial nerves were injured.

Grundy D. J., McSweeney T. and Jones H. W. F. (1984) Cranial nerve palsies in cervical injuries. Spine 9, 339.

Bladder management and spinal injury The different methods of catheterization and their effects are described as well as the methods of investigating disorders of the bladder and its sphincters.

Grundy D. and Russell J. (1986) ABC of spine injury: urological management. Br. Med. J. 292, 349.

Neck pain after RTAs Twenty-two per cent felt no pain for at least 12 hours, 35 per cent still had pain after 6 months and 26 per cent after 1 year. Eighty-four per cent of painful necks followed blows from behind; supports for the head reduced the proportion of painful necks by 24 per cent.

Deans G. T., McGalliard J. N. and Rutherford W. H. (1986) Incidence and duration of neck pain among patients injured in car accidents. Br. Med. J. 292, 94.

Physiotherapy after spinal cord injury The measures described include the proper fitting and use of wheelchairs, getting in and out of bed and on and off the lavatory seat, as well as standing, walking when possible and also their exercises.

Biss S., Grundy D. and Russell J. (1986) ABC of spinal cord injury. Physiotherapy. Br. Med. J. 292, 388.

Cauda equina compression syndrome Neurological signs were about for 3 weeks after lumbosacral fracture-dislocation with marked forward shift. They were relieved by posterior decompression and fusion.

Schnaid E., Eisenstein S. M. and Webb J. D. (1985) Delayed post traumatic cauda equina compression syndrome. J. Trauma 25, 1099.

Diffuse axonal injury Diffuse axonal injury is one of the most important conse- quences of a serious blow on the head. It is usually associated with focal lesions in the brainstem and corpus callosum that are visible to the naked eye, but sometimes it can be iden- tified only under the microscope and this has important medico-legal implications.

Adams J. H., Doyle D., Graham D. I., Lawrence K. E. and McLellan D. R. (1985) Microscopic diffuse axonal injury in cases of head injury. Med. Sci. Law 25, 265.

Occupational therapy after spinal cord injury This article deals with splints and appliances as well as the activities that they either facilitate or render possible.

Henshaw J., Grundy D. and Russell J. (1986) ABC of spinal cord injury. Occupational therapy. Br. Med. J. 292, 473.

Fracture of styloid process Two cases are reported: one fell and then had pain and difficulty in swallowing, the other had apparently been struck in the throat. Both injuries were revealed by computed tomography.

McCorkell S. J. (1985) Fractures of the styloid process and stylohyoid ligament. J. Trauma 25, 1010.

Subdural haematoma mimicking ischaemia An 87-year-old woman experienced 12 episodes of what were regarded as transient ischaemic attacks until computed tomography showed a left-sided mass, 3mm thick.

Russell N. A., Goumnerova L., Atack E. A., Atack D. M. and Benoit 8. G. (1985) Chronic subdural haemotoma mimicking transient ischaemic attacks. J. Trauma 25, 1113.

MULTIPLE INJURIES

Care of critically injured patients Severity of injury was measured by a three-point scale in respect of, respectively, circulation, respiration, abdomen (and chest), motor activity and speech (CRAMS), and it was found that mortality rates were up to twice as high among the seriously injured treated in the community hospitals as in the level 1 centres.

Clemmer T. P., Orme J. F., Thomas F. 0. and Brooks K. A. (1985) The outcome of critically injured patients treated at level 1 trauma centre versus full-service community hospit- als. Crit. Care Med. 13, 861.

Fixation after closed multiple injuries Fifty-six patients with closed multiple injuries were studied to see if immediate fixation of fractures of the femur or acetabu- lum offered any advantage over delayed fixation with regard to the lungs, as judged by Paoz, fever and leucocytosis. They found that it did.

Seibel R., Laduca J., Hassett J. M., Babikian G., Mills B., Border D. 0. and Border J. R. (1985) Blunt multiple trauma (ISS 36), femur traction and the pulmonary failure-septic state. Ann. Surg. 102, 283.

Rating of injury severity Reliable estimates of the severity of injuries must be based on the inpatient records.

MacKenzie E. J., Shaper0 S. and Eastham J. N. (1985) Rating A.I.S. severity using emergency department sheets v in-patient charts. J. Trauma 25, 984.