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Open reduction of pelvic fractures.

show a beneficial effect of any pharmacologic treatment of human spinal cord injury. This work is encouraging, but in the past few years, a methodical search for agents that counteract the known effects of ischemia has provided compounds with more specific actions than corticosteroids. These agents are under extensive investigation using in vitro and in vivo trials in animals. The two types of compounds studied, NMDA-receptor antagonists and calpain inhibitors, act at different levels of the calcium cascade and may be synergistic. Other compounds have been developed to counteract the detrimental byproducts of lipid peroxidation. Thus, specific components of the cell derangement can be pharmacologically manipulated. In the future, patients with spinal cord injury may be treated like those with myocardial infarction. Once the injury has occurred, rapid transfer to a specialized center with experience in the medical and surgical treatment of spinal cord injury will be standard. As the molecular nature of spinal cord injury becomes unraveled, compounds (or combinations of compounds) will be designed to counteract different levels of the ischemic cascade. This may prove extremely valuable in preserving neurologic function.