FRACTURES OF VERTEBRA. 313 



aspect, the prognosis of the case is comparatively favorable, and 

 recovery is usually only a question of tinae. The severity of the lesion 

 corresponds in degree with that of the violence to which it is due, also 

 with the resulting complications and the situation of the wound. It 

 is simple when at the symphysis, but becomes more serious when it 

 affects one of the branches, and most aggravated when both are 

 involved. Fracture of the coronoid process becomes important prin- 

 cipally as an evidence of the existence of a morbid diathesis, such as 

 osteoporosis, or the like. 



The particular seat of the injury, with its special features, will, 

 of course, determine the treatment. For a simple fracture, without 

 displacemeijt, provided there is no laceration of the periosteum, an 

 ordinary supporting bandage will usually be sufficient; but when 

 there is displacement the reduction of the fracture must first be accom- 

 plished, and for this special splints are necessary. In a fracture of 

 the symphysis or of the branches the adjustment of the fragments by 

 securing them with metallic sutures is the first step necessary, to be 

 followed by the application of supports, consisting of splints of 

 leather or sheets of metal, the entire front of the head being then 

 covered with bandages prepared with adhesive mixtures. During 

 the entire course of treatment a special method of feeding becomes 

 necessary. The inability of the patient to appreciate the situation, 

 of course, necessitates a resort to an artificial mode of introducing the 

 necessary food into his stomach, and it is accomplished by forcing 

 between the commissures of the lips, in a liquid form, by means of a 

 syringe, the milk or nutritive gruels selected for his sustenance until 

 the consolidation is sufficiently advanced to permit the ingestion of 

 food of a more solid consistency. The callus will usually be suffi- 

 ciently hardened in two or three weeks to allow of a change, of diet 

 to mashes of cut hay and scalded grain, until the removal of the 

 dressing restores him to his old habit of mastication. 



FRACTUEES OF VEBTEBB,*;. 



These are not very common, but when they do occur the bones most 

 frequently injured are those of the back and loins. 



Causes. — The ordinary causes of fracture are responsible here as 

 elsewhere, such as heavy blows on the spinal column, severe falls while 

 conveying heavy loads, and especially violent efforts in resisting the 

 process of casting. Although occurring more or less frequently under 

 the latter circumstances, the accident is not always attributable to 

 carelessness or error in the management. It may, of course, some- 

 times result from such a cause as a badly prepared bed, or the acci- 

 dental presence of a hard body concealed in the straw, or to a heavy 

 fall when the movements of the patient have not been sufficiently 

 controlled by an effective apparatus and its skillful adaptation, but it 

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