ABSTRACT
Forty-two patients with cervical spine injuries immobilized in halo vests were studied prospectively to determine in vivo vertebral segmental motion. Lateral radiographs taken in the supine and upright positions within 5 days of injury demonstrated intervertebral motion. At noninjured levels, the positional change accounted for an average 3.9 degrees of angulation with the greatest motion occurring between the occiput and C1 (8.0 degrees). At the injured levels, sagittal plane angulation averaged 7.0 degrees and translation averaged 1.7 mm between the two positions. Fracture site motion did not correlate with either the fracture type or the injury level. Fracture site motion greater than 3 degrees of angulation or 1 mm of translation was observed at 35 (77%) of 45 injured levels. When treating patients who have unstable cervical injuries with halo vests, supine and upright radiographs should be obtained. If excessive motion is present, alternative methods of treatment should be considered.
Subject(s)
Casts, Surgical , Cervical Vertebrae/surgery , Fracture Fixation , Fractures, Bone/therapy , Spinal Injuries/therapy , Adolescent , Adult , Aged , Cervical Vertebrae/diagnostic imaging , Child , Child, Preschool , Female , Fracture Fixation/instrumentation , Fractures, Bone/diagnostic imaging , Humans , Male , Middle Aged , Movement , Occipital Bone/diagnostic imaging , Occipital Bone/injuries , Odontoid Process/diagnostic imaging , Odontoid Process/injuries , Postoperative Complications , Posture , Prospective Studies , Radiography , Spinal Injuries/diagnostic imagingABSTRACT
A rat model was created in which contaminated wounds were closed in either the presence or absence of autogenous bone graft. The recipients of bone graft were divided into two groups--one receiving autogenous cancellous bone, the other receiving nonviable autogenous autoclaved cortical bone. Quantitative bacterial cultures were collected both at the time of wound closure and 2 weeks after closure. A significantly increased level of soft-tissue contamination was associated with wound closure in the presence of either type of bone graft, indicating an overall adverse effect on soft tissues. A critical level existed such that at initial bacterial contamination levels greater than 10(4) organisms/g tissue, final contamination levels were significantly elevated. With initial contamination levels less than 10(4) organisms/g tissue, however, final bacterial contamination levels were not significantly different. These results may help explain the different rates of infection that have been reported when delayed primary closure of open fractures is done in conjunction with autogenous bone graft.
