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Tue, 5 Feb 2002 11:22:44 -0500

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GOD I love this list.  Always good sparring to be had.  

'...your approach is illogical. It is analogous to putting a traction splint
on every bruised thigh, "in case it is a broken femur, and we all know how
dangerous they can be!"'

I am habitually illogical; a walking enigma.  Chicks dig it.  That becomes
irrelevant, though, because your analogy is unbalanced.  

The femur is a long bone supporting an extremity.  When fractured, it
displays characteristic, typically observable signs, beyond pain.  And
traction splinting is at least as much a matter of pain control as patient
protection.  The cervical spine, on the other hand, is a series of rather
elaborately jointed bones assigned not merely to bear the weight of the
head, but also to protect the delicate cable which connects your brain to
your moving parts.  Fractures of the spine are much more difficult to
identify via clinical exam: frequently, the only sign is pain.  Finally,
splinting of the neck is an almost purely protective endeavor; surely we
don't do it for comfort!

'No,  We desperately need better tools, and one of the useful guides is to
look at the mechanism of injury. The crash is described as low energy. These
don't break necks.'

Little argument from me here.  You may recall that I'm usually the one
pleading for a means to avoid spinal immobilization.  There goes that enigma
thing again.  Somebody stop me.

Still, 'low energy' is tough to pin down: I've seen more than one frightful
neck fracture from a fall out of a chair.  It's increasingly clear that
kinematics aren't nearly as sensitive a predictor of injury as we once
thought.  Frankly, localized pain is probably a better guide, if you have to
choose.  Indeed, a fellow can drive an Indy car into a brick wall, and if he
comes away without spinal pain or tenderness, there's little cause to
immobilize.

'What else are you recommending immobilisation for, pray?  I would put the
odds at the odds that this person has undiagnosed osteogenesis imperfecta,
rheumatoid arthritis or a previous unstable undiagnosed neck fracture.
That's not a horse you would back.'

Rowley, please:  Car crash.  Neck pain.  Let's not monkey too much with
reality.  Unless the horse has blue sclerae, I'm comfy back here under the
bell curve.

Interesting, though, that when it comes right down to it, you and I are both
after the same thing: a useful formula for early prediction of spinal
injury.  Sadly, I'm almost certain it doesn't exist.

Thanks again and as always for the stimulating discussion.

Pret

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GOD I love this list.&nbsp; 
Always good sparring to be had.&nbsp; 
'...your approach is illogical. It is 
analogous to putting a traction splint on every bruised thigh, "in case it is a 
broken femur, and we all know how dangerous they can be!"' I am habitually illogical; a walking enigma.&nbsp; 
Chicks dig it.&nbsp; That becomes irrelevant, though, because your analogy is 
unbalanced.&nbsp; 
The femur is a long bone 
supporting an extremity.&nbsp; When fractured, it displays characteristic, 
typically observable signs, beyond pain.&nbsp; And traction splinting is at 
least as much a matter of pain control as patient protection.&nbsp; 
The cervical spine, on the 
other hand, is a series of rather elaborately jointed bones assigned not merely 
to bear the weight of the head, but also to protect the delicate cable which 
connects your brain to your moving parts.&nbsp; Fractures of the spine are much 
more difficult to identify via clinical exam: frequently, the only sign is 
pain.&nbsp; Finally, splinting of the neck is an almost purely protective 
endeavor; surely we don't do it for comfort!
'No,&nbsp; We desperately need better tools, and one of the 
useful guides is to look at the mechanism of injury. The crash is described as 
low energy. These don't break necks.'
Little argument from me 
here.&nbsp; You may recall that I'm usually the one pleading for a means to 
avoid spinal immobilization.&nbsp; There goes that enigma thing 
again.&nbsp; Somebody stop me.
Still, 'low energy' is tough to 
pin down: I've seen more than one frightful neck fracture from a fall out of a 
chair.&nbsp;&nbsp;It's increasingly clear that kinematics aren't nearly as 
sensitive a predictor of injury as we once thought.&nbsp; Frankly, localized 
pain is probably a better guide, if you have to choose.&nbsp; Indeed, a fellow 
can drive an Indy car into a brick wall, and if he comes away without spinal 
pain or tenderness, there's little cause to immobilize.
'What else are you recommending immobilisation for, pray?&nbsp; 
I would put the odds at the odds that this person has undiagnosed osteogenesis 
imperfecta, rheumatoid arthritis or a previous unstable undiagnosed neck 
fracture. That's not a horse you would back.'
Rowley, please:&nbsp; Car crash.&nbsp; 
Neck pain.&nbsp; Let's not monkey too much with reality.&nbsp; Unless the horse 
has blue sclerae, I'm comfy back here under the bell curve.
Interesting, though, that when it comes 
right down to it, you and I are both after the same thing: a useful formula for 
early prediction of spinal injury.&nbsp; Sadly, I'm almost certain it doesn't 
exist.
Thanks again and as always for the 
stimulating discussion.
Pret</BODY></HTML>

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