on can usually be recognised in a
radiogram.

_Treatment._--Reduction should be attempted at once, before the
vertebrae become fixed in their abnormal position. Under anaesthesia
gentle extension is made on the head by an assistant, and the abnormal
attitude is first slightly exaggerated to relax the ligaments and to
restore mobility to the locked articular processes. The head is then
forcibly flexed towards the opposite side, after which it can be
rotated into its normal attitude (Kocher). Haphazard movements to
effect reduction are attended with risk of damaging the cord. After
reduction has been effected, the treatment is the same as that of a
sprain.

#Isolated Fractures of the Arches, Spinous and Transverse
Processes.#--Fractures of the arches and spinous processes usually
result from direct violence, such as a blow or a bullet wound, and are
accompanied by bruising of the overlying soft parts, irregularity in
the line of the spines, and by the ordinary signs of fracture.
Skiagrams are useful in showing the exact nature of the lesion. These
fractures are most common in the lower cervical and in the thoracic
regions, where the spines are most prominent and therefore most
exposed to injury.

In many cases there are no symptoms of damage to the cord or spinal
nerves, but when both laminae give way the posterior part of the arch
may be driven in and cause direct pressure on the cord, or blood may
be effused between the bone and the dura. In such cases immediate
operation is indicated. When there are no cord symptoms, the treatment
consists in securing rest, with the aid of extension, if necessary,
for several weeks until the bones are reunited.

The use of the X-rays has shown that one or more of the _transverse
processes of the lumbar vertebrae_ may be chipped off by direct
violence. The symptoms are pain and tenderness in the region of the
fracture, and marked restriction of movement, especially in the
direction of flexion. This lesion may explain some of the cases of
persistent pain in the back following injuries in workmen. It is
important to remember, however, that in a radiogram an un-united
epiphysis may simulate a fracture.

#Isolated Fracture of the Bodies--"Compression Fracture."#--The
"compression fracture" consists in a crushing from above downwards of
the bodies--and the bodies only--of one or more vertebrae. It is due to
the patient falling from a height and landing on the head, buttocks,
or feet