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Alf Breig Skull Traction and Cervical Cord Injury.

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  • Alf Breig Skull Traction and Cervical Cord Injury.

    Case History
    An 18-year-old who had sustained a diving injury presented with compression of the body of C-5 and fracture and dislocation of the left lower articular facet. Immediately after admission (Karolin ska Hospital, Stockholm ) 5 kg cervical traction was applied. Most neurological functions below C-5 were extinct; he was able only to lift his shoulders and abduct his upper arms slightly.
    Eleven days after the injury the patient was referred to another unit, where he was submitted to the new regime : traction was immediately discontinued, and the cervical spine was dorsiflexed over a round bolster ; maintenance of dorsiflexion and cord relaxation was secured by Crutchfield tongs anchored in the frontal bones and loaded with 500 g.
    Twenty-four hours after spinal cord relaxation the patient regained sensibility to touch above the nipple level. Two days later the area of normal sensation extended to 5-6 cm below the nipple level. A week later, normal sensibility to light touch with cotton wool was restored in both legs and sacra l dermatomes. Fourteen days after cord relaxation catheterization and bladder training could be discontinued; the range of movements in the left arm and leg had increased. Two month s after admission cervical cord relaxation was made permanent by surgical fixation of the cervical spine in slight dorsiflexion (cervicolordodesis). Two weeks later spasticity in the legs diminished. The patient was able to walk short distances between bars with the aid of a splint on the right knee and a crutch -handled stick. Two years later he was largely rehabilitated, with no disabling symptoms.
    “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” Buckminster Fuller
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