nd the contiguous intervertebral disc separated, is
rare, and is met with chiefly in the lower cervical region.

_Clinical Features._--The outstanding symptoms of total lesions are
referable to the damage inflicted on the cord. The diagnosis should
always be made by a consideration of the mechanism of the injury and
the condition of the nerve functions below the lesion. On no account
should the patient be moved to enable the back to be examined, as this
is attended with risk of increasing the displacement and causing
further damage to the cord. On passing the fingers under the back as
the patient lies recumbent, it is usually found that there is some
backward projection of the spinous processes, the most prominent
being that of the broken vertebra. The spinous process immediately
above it is depressed as the upper segment has slipped forward. Pain,
tenderness, swelling and discoloration may be present over the injured
vertebrae. It is usually possible to have skiagrams taken without risk
of further damage to the spine. There is complete loss of motion and
sensation below the seat of the lesion. The symptoms of total
transverse lesions of the cord at different levels have already been
described (p. 416).

_Treatment._--An attempt may be made to reduce the displacement under
anaesthesia, gentle traction being made in the long axis of the spine
by assistants, while the surgeon attempts to mould the bones into
position. No special manipulations are necessary, as the ligaments are
extensively torn, and the bones are, as a rule, readily replaced. A
roller-pillow is placed under the seat of fracture to allow the weight
of the body above and below to exert gentle traction, and so to
relieve pressure on the cord. Operative treatment is almost never of
any avail, as the cord is not merely pressed upon, but is severely
crushed, or even completely torn across. Even when the cord is only
partially torn, operative treatment is not likely to yield better
results than are obtained by reduction and extension. The usual
precautions must be taken to prevent cystitis and bed-sores.

Total fracture-dislocation between the _atlas_ and _epistropheus_
(axis), if attended with displacement, is instantaneously fatal (Fig.
209). This is the osseous lesion that occurs in judicial hanging.
Fracture of the odontoid process may occur, however, without
displacement, the transverse ligament retaining the fragment in
position and protecting the cord