IntroductionSevere or minor repetitive trauma, inflammation, infection, tumors, and congenital ligamentous laxity have been etiologically implicated in scapholunate dissociation (SLD). While a few cases of patients with asymptomatic SLD have been reported in the literature, despite radiographically demonstrated widened scapholunate angles and rotatory subluxation of the scaphoid bone, these patients experienced only mild or no pain and no dorsal intercalated segment instability deformity. Here, we report the case of a monolateral non-traumatic SLD in a young 10-year-old girl that led to an important range of motion impairment with no wrist pain. The case represents a rarity for no previous history of trauma, young age, and no pain.Main symptoms and important clinical findingsIn our patient, an examination revealed a reduced range of motion in the left wrist and no pain during passive or active mobilization. The X-ray showed a 16 mm scapholunate gap in the anteroposterior roentgenogram. In this case, we suggested that congenital or developmental ligamentous laxity may be the cause of SLD. The diagnostic assessment was completed with a wrist MRI and CT.Therapeutic interventions and outcomesThe patient underwent an open dorsal surgery: we directly reduced the dislocated bones and fixed them with five percutaneous 1 mm k-wires. Finally, the scapholunate ligaments were repaired using bone-absorbable anchor sutures. The wrist was immobilized in a volar cast for 8 weeks. The patient was able to resume her daily life activities (included sport) within 12 months.ConclusionCarpus injuries are rare in children, and treatment, especially for young-age patients, is fraught with risks and remains controversial. Our case demonstrates that the patient has had a good clinical outcome. The physio-rehabilitation program for this patient has been of long duration. Most previous studies have shown excellent clinical results after an average of 2.4 years.

Introduction Restoration of spinal balance is a widely accepted principle of spinal surgery planning. There is a huge amount of data supporting the correlation of clinical outcome and the restoration of theoretical physiological curves of the spine. Flat or hypolordotic fixations are rarely seen today, but there is someone who claims that spinal balance principles are too often pushed to extremes and, surprisingly, there is still some resistance to accept the routinary application of these concepts in the “simple” degenerative surgery, claiming that in short fixations for degenerative lumbar spinal disease it is not mandatory to be strict in the restoration of correct, theoretical spinal parameters to achieve satisfactory clinical results. In this study we present a homogeneous population of patients, operated by a single surgeon in a 3 years time, 7 to 10 years ago, with homogeneous degenerative pathology and similar constructs (2 to 4-level fixations). The peculiarity of this study is that all the patients have been operated regardless to spinal parameters restoration, because at the time of surgery the presurgical planning of spinal curves was not being sistematically adopted. The population is therefore a kind of spontaneous randomization, with patients with a good restoration of spinal theoretical curves and patient who didn't get any correction of sagittal curves. Material and Methods 36 patients with homogeneous diagnosis of degenerative spinal disease, operated by a single surgeon with a 2 to 4-level fixation until 2010 has been selected. ODI and Prolo scales has been used for direct clinical evaluation. The mean last follow-up was 4 years 4 months, with a minimum of 3 years. Radiological assessment has been performed by lumbar standing XRays AP and LL pre and postop, and PI-LL mismatch and the difference between theoretical lordosis and effective postoperative lordosis have been calculated. Statistical evaluation used Spearman correlation test between PI-LL mismatch and clinical scales values. Results Statistical correlation exists between clinical scale values and PI-LL mismatch. As a qualitative result, we observed that the higher is the difference between theoretical lordosis and effective postsurgical lordosis, the higher is the incidence of construct failure. Conclusion According to the results of this study, respect of the spinal balance principles seems to be helpful to achieve good clinical results in a medium follow-up for lumbar degenerative patients. These results come from a dataset that is not culturally influenced by spinal balance principles, coming from the past. Additionally, the single-surgeon, single-observer and single-center experience is somehow minimizing the confounding factors that usually affects this kind of studies.