370 ARTICULAR RHEUMATISM POLYARTHRITIS 



Etiology. Traumatism is often the cause of the fracture. 

 It can result from extraction of teeth. It may follow alveolar 

 periostitis, or exfoliation of a portion of the bone weakening 

 the jaw at this point. Extreme pressure from biting on hard 

 objects (stones of large size) can be a cause. Diseases of the 

 bones (fragilitas ossium) predisposing them to fracture. 



Symptoms. Difficulty in eating is the first symptom 

 noticed. Other symptoms are displacement of the maxilla 

 at the point of fracture, excessive salivation, and enlarge- 

 ment on the side affected. On examination crepitus and 

 movement between the portions of bone will be recognized 

 at once, 



Prognosis. Owing to the complications of infection, and 

 the difficulty in keeping the parts quiet, the prognosis is 

 unfavorable. 



Treatment. Various methods of treatment have been 

 tried. In fissuring without laceration of the mucous mem- 

 brane it is advisable to try wiring them together with silver 

 wire using the teeth as fixed points. In compound fractures 

 when infection takes place treatment is usually unsatis- 

 factory. Fixing the maxilla by the use of a leather pad or 

 muzzle in contact with the superior maxilla, disinfecting the 

 mouth twice daily, and giving liquid foods have proved the 

 most satisfactory treatment. 



In comminuted fractures where fragments of bone must 

 be removed but little can be expected of any treatment. 



Fracture of the Vertebrae. The points at which fractures 

 most commonly occur are in the cervical, lumbar, and coccy- 

 geal segments. 



Etiology. Most cases result from traumatism. 



Symptoms. The symptoms will depend upon the kind of 

 fracture, whether it is confined to portions of the vertebra? 

 outside of the canal or involves the canal with the spinal cord. 

 Crepitus and pain on manipulation of the parts are prominent 

 symptoms. Should the fracture be confined to the lateral 

 processes no other symptoms will be observed. In complete 

 fracture of the cervical vertebrae with involvement of the 

 cord, death may result in a few minutes, or hours. Complete 

 paralysis exists posterior to the point of the fracture. Fract- 



