in such a way that the force is transmitted along the bodies
of the vertebrae while the spine is flexed.

If the patient lands on his head, the compression fracture usually
involves the lower cervical or upper thoracic vertebrae. When he lands
on his buttocks or feet it is usually the lumbar or the lower thoracic
vertebrae that are fractured (Fig. 207).

[Illustration: FIG. 207.--Compression Fracture of Bodies of Third and
Fourth Lumbar Vertebrae. Woman, aet. 28, who fell three storeys and
landed on the buttocks.]

As a rule, there are no external signs of injury over the spine. The
sternum, however, is often fractured, and irregularity and
discoloration may be detected on examining the front of the chest. The
recognition of a fracture of the sternum should always raise the
suspicion of a fracture of the spine. On examination of the back a
more or less marked projection of the spinous processes of the damaged
vertebrae may be recognised. In the cervical and lumbar regions this
projection may merely obliterate the normal concavity. The spinous
process which forms the apex of the projection belongs to the vertebra
above the one that is crushed. The cord usually escapes, but the
nerves emerging in relation to the damaged vertebrae may be bruised,
and this gives rise to girdle-pain.

Local tenderness is elicited on pressing over the affected vertebrae.
As might be expected from the nature of the accident producing this
lesion, it is often associated with serious injuries to the head,
limbs, or internal organs which gravely affect the prognosis.

The _treatment_ consists in taking the pressure off the injured
vertebrae in order that the reparative material may be laid down in
such a way as to restore the integrity of the column. In the cervical
region, extension is applied to the head, and a roller-pillow placed
beneath the neck. In the lumbar region, the extension is applied
through the lower limbs, and the pillow placed under the loins. The
patient is confined to bed for six or eight weeks, and before he gets
up a poroplastic or plaster-of-Paris jacket is applied. This is worn
for a month or six weeks.

#Traumatic Spondylitis.#--This condition is liable to develop in
patients who have sustained a severe injury to the back. It is
believed to originate in a compression fracture which has not been
recognised, and is probably due to the callus thrown out for the
repair of the fracture being subjected to strain and press