Volume 1 Number 1 ROBERTS: TRAUMATIC PARAPLEGIA

Acknowledgements

I am grateful to Mr. T. McSweeney for his permiss ion to s tudy this g roup of pat ients who are under his care at the Mi d l and Spinal Injuries Centre , Oswestry, and to Mr. D. LI. Griffi ths for his help in the p repara t ion of this paper. I would also like to t h a n k Dr. R. Ol lerenshaw and his staff of the D e p a r t m e n t of Medical I l lus t ra t ion at the Manches te r Royal Inf i rmary for p repar ing the i l lustrations.

REFERENCES GUTTMANN, L. (1954), ' Ini t ia l Treatment of Trau-

matic Paraplegia ', Proc. R. Soc. Med., 47, 1103. - - - - (1959), ' Management of Spinal Cord Injuries ',

in Modern Trends in Diseases of the Vertebral Column (ed. NASSIM, R., and BURROWS, H. J.). London: Butterworth.

- - - (1963), ' Init ial Treatment of Traumatic Para- plegia and Tetraplegia', in Spinal Injuries (ed. HARRIS, P.). Royal College of Surgeons of Edinburgh.

11

HARDY, A. G. (1965), ' The Treatment of Paraplegia due to Fracture-dislocations of the Dorso-lumbar Spine ', Paraplegia, 3, 112.

HOLDSWORTH, F. W., and HARDY, A. G. (1953), 'Ear ly Treatment of Paraplegia from Fractures of Thoraco-lumbar Spine ', J. Bone Jt Surg., 35B, 540.

KALLIO, E. (1963), ' Injuries of the Thoraco-lumbar Spine with Paraplegia' , Acta orthop, scand., Supplement 60, 1.

KAUFER, H., and HAVES, J. T. (1966), ' L u m b a r Fracture-dislocation. A Study of Twenty-One Cases ', J. Bone Jt Surg., 48A, 712.

NICOLL, E. A. (1949), ' Fractures of Dorso-lumbar Spine ', Ibid., 31B, 376.

ROGERS, W. A. (1938), ' Cord Injury during Reduction of Thoracic and Lumbar Vertebral-body Fracture and Dislocation ', Ibid., 20, 689.

WESTERBORN, A., and OLSSON, O. (1951), ' Mechanics, Treatment and Prognosis of Fractures of Dorso- lumbar Spine ', Acta chir. scand., 102, 59.

WILLIAMS, E. W. M. (1963),' Traumatic Paraplegia ', in Recent Advances in the Surgery of Trauma (ed. MATTHEWS, D. N.). London: Churchill.

RequestsJbr reprints should be addressed to:--P. H. Roberts, Department of Orthopaedic Surgery, Withington Hospital, Manchester 20.

ABSTRACTS

Hip Prosthesis Intrame'dullary hip prostheses, although useful in

some cases, have long-term defects such as migration of the acetabulum and loosening of the prosthesis in the femur.

A new prosthesis has been designed in which a stainless-steel stem is joined to a high density poly- ethylene head by a trunnion bearing. Most flexion- extension movement of the hip takes place at this bearing, the head remaining relatively immobile in the acetabulum.

CHRlSTIANSEN, T. (1969), ' A New Hip Prosthesis with Trunnion Bearing ', Acta chit. scand., 135, 43.

Hip Prosthesis The Tor Christiansen trunnion bearing hip pros-

thesis has been inserted on 90 occasions: 73 fresh fractures, 2 cases of avascular necrosis, and 15 cases of osteoarthritis. Hospital mortality was 5.5 per cent. There was one postoperative dislocation and 7 cases of superficial and 2 of deep infection. Follow-up on 78 cases for periods from 2 to 25 months showed 34'6 per cent rated excellent, 42"3 per cent good, 19.2 per cent fair, and 3-9 per cent poor. Longer follow-up will be indicated.

RAMSrAD, K. R. (1969), ' A New Hip Prosthesis: Preliminary Report ', Acta chir. scand., 135, 47.

Syme's Amputation This author reviews the results of 51 adults and

32 children who had Syme's amputations. He stresses the importance of adhering to the basic principles and operative technique described by Syme if the stump is to be durable and trouble-free.

He concludes by advocating a modified prosthesis using a balloon-like air-filled cuff.

MAZET, R., jun. (1968), 'Syme's Amputation J. Bone ,It Surg., 50A, 1549.

Tetanus Cardiovascular disturbances have been reported in

severe cases of tetanus, and the Oxford workers in a series of publications have shown that these are due to sympathetic overactivity. In the paper in Anaes- thesia the physiological disturbances in 6 patients have been documented, and an excellent discussion is given for the reasons ascribing the sympathetic overactivity to the involvement of the autonomic system with the tetanus toxin.

The paper in the Lancet is mostly concerned with effective methods of treatment and the use of general anaesthesia and chlorpromazine is described, but cogent reasons are given for specific blockade of adrenergic effector mechanism rather than other forms of therapy. The dangers of beta blockade are stressed and the commonly used alpha adrenergic blockers are shown to have disadvantages. These workers, there- fore, recommend propranolol and bethanidine. The Oxford workers have made a major advance in methods of control of severe tetanus, and although they do not claim that the general use of sympathetic blockade will reduce the mortality of tetanus, from the work presented it seems very likely. Both of these papers are strongly recommended to all those who are likely to be involved in the care of patients suffering from tetanus.

PRvs-ROBERTS, C., CORBETT, J. L., KERR, J. H., CRA~TON SMITH, A., and SPALDING, J. M. K. (1969), ' Treatment of Sympathetic Overactivity in Tetanus ', Lancet, 1, 542; CORBETT, J. L., KERR, J. H., PRVS- ROBERTS, C., CRAMPTON SMITH, A., and SPALDING, J. M. K. (1969), 'Cardiovascular Disturbances in Severe Tetanus due to Overactivity of the Sympathetic Nervous System ', Anaesthesia, 24, 198.