Abstract. Lower limb fractures occurring in patients with established spinal paralysis were considered different enough to warrant variations in treatment usually provided to patients without paralysis. Treatment should ensure that the functional level will be unchanged after healing occurs. Splints made of soft materials were effective, inexpen sive, safe, and allowed for good healing with early rehabilitation.Key words: Spinal cord injury; Lower extremity fractures; Soft splints.THE RESULTS of a study from this institution on fractures of long bones in patients with spinal cord injury were published by Freehafer and Mast (1965). It becomes mandatory, therefore, to vary the treatment for the paralysed patient rather than to give the same treatments usually provided for the average patient without paralysis.Certain observations were made from our study in 1965 which formed the basis of subsequent treatment from which data for this study were gathered. From this experience the following impressions and recommendations have evolved:I. The functional level should be unchanged after fracture healing.2. Healing of fractures should take place with minimum risk of complications. 3. Non-operative treatment of fractures was recommended as the method leading to the most rapid union, the least number of complications, the quickest rehabilitation and the smallest morbidity rate.4. Patients should be out of bed in wheelchairs as soon as possible or within the first few days after fracture. 5.Traction was rarely indicated. 6. Plaster casts and splints or any hard materials used for immobilisation were potentially dangerous and should be avoided. 7.Open reduction was rarely necessary. Occasionally uncontrollable spas ticity could cause protrusion of bone fragments through the skin necessitating open reduction or simple removal of bony prominences.8. Shortening and angulation of healed fractures were acceptable in sitters, but rotational deformity in a sitter was unacceptable.9. Patients who walked should be treated by conventional methods which give an anatomical result permitting the patient to resume walking at the same functional level.