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Emergency medicine in our country is still a new medical discipline, which is develope in spite of objective connected difficulties with generally well-known problems of medical service in Poland. Essential part of patients treated on the field of activity of rescue--medicine are victims with injuries of osteoarticular system. According to many authors determine they to 40% patients provided in pre-hospital care time. Development of Polish emergency medicine happens on period of Decade of the Bone and Joint, declared by the World Health Organization on years 2000-2010. Consequences of bones and joints injuries are the reason protracted pain complaints and physical disability of gigantic number of patients. The goal of the Decade are among other things, activities aiming to improvement of efficiency of osteoarticular system injuries on place of event and in emergency medicine departments, in accordance to accepted procedures. It is an extremely essential meaning for patient's future and of final results of treatment, and a quality of life of these people. In Clinic of Emergency Medicine and Multiple Injuries in relationship to Decade of the Bone and Joint we investigate problems concerning diagnostics procedures and initial medical management of isolated osteoarticular injuries, and coexisted with injuries of other body regions. In this study we present management strategy of osteoarticular injuries in emergency medicine in aspect of goals realization of the Decade of the Bone and Joint.

Background and Purpose: There is no standard timing of the spinal cord decompression. Experimental animal models and clinical investigations on Methylprednisolone (NASCIS-2 and -3) indicate that the time up to 8 hours is the optimal therapeutic window for the early spinal cord decompression. We accepted this time window in our practice. A retrospective clinical evaluation of the early (up to 8 hours) operative decompression of the injured cervical spinal cord was undertaken., Material and Methods: The early operative decompression (range of 2-8 hours) of the cervical spinal cord was done in 32 patients (82% of operated cervical spinal cord injured patients). The neurologic clinical status of patients was assessed according to the ASIA impairment scale. In neurological terms 7 patients were completely and 25 incompletely impaired. Cervical spine injuries included 26 fractures and fracture-dislocations and the rest (6 cases) involved dislocations and disc ruptures. The mean patient age was 31.2 years (range of 16-69) and the average follow-up time was 13 months (range of 6-24). Methylprednisolone standard treatment was applied in all patients on admission to hospital. After diagnostic examinations patients were qualified and immediately operated. We performed 25 corpectomies, 6 discectomies and 1 decompressive laminectomy with stabilization in all cases., Results: The final assessment covers 29 patients because 3 (9.4%) of them died during 4-6 weeks after operation. One patient has not improved and still had A degree but 28 remaining patients (94.5%) have improved neurologically at follow-up. 69% of them recovered by one degree and 27.6% by two degrees on the ASIA scale. In the early postoperative stage during their hospital stay 47% of patients had one degree improvement., Conclusions: The early cervical spinal cord decompression creates optimal conditions for the neurological recovery. Encouraging results presented in the paper indicate the purposefulness of the decompression performed as fast as possible and indicate the necessity to make emergency services more efficient in order to shorten delivery time to specialized spine centers.

The problems related to injuries of the cervical spine with advances degenerative changes are discussed. The most frequent causes of these injuries were falls from height and traffic accidents. In the whole group of 185 patients most were aged over 50 years, and the lower part of the cervical spine was injured most frequently, with the extension mechanism being the usual force in the injury. Nearly half the cases (45%) had complete paralysis including the most severe form of partial injury.

3235 patients admitted to the hospital within 1965-1988 early after trauma to the spine, were treated. Using the case histories of these patients, the most frequent causes of lesions to the spine are delineated. Young persons are most frequently subjects to the trauma (66% up to 40 years of age) in urban regions. The most frequent causes of such a trauma include: road accidents, jumps to the water, suicidal jumps, fall from the steps, ladder, roofs etc. People in middle and advanced age are most frequently subjects to the trauma in rural regions. The most frequent causes of such a trauma include: falls from the horse-carriages, ladder, trees, roofs, and motorcycle accidents. Functional results of the treatment were also analysed. The authors consider these results favourable as the majority of victims admitted to the hospital had symptoms of the paralysis. Walking ability was restored in 59% of the treated patients. No significant difference in the functional results of therapy was noted in both patients from urban and rural regions. Objective difference is, however, significant, depending on the degree of lesions to the spinal cord seen at the admission to the hospital.

A series of 1365 patients treated between 1965 and 1987 because of spine injury resulting from the fall from the height was analysed. A fall from the height may cause hyperflexion, axial loading or hyperextension type of injury. Hyperflexion injury occurs usually after fall from horsedrawn wagon, scaffold, roof or pillar. Axial loading injuries dominate in falls from the ladder, tree, suicidal jumps and falls from lower height. There is remarkable correlation among the height of the fall, degree of nervous system injury and results of management.