Severe fracture-dislocation of the thoracic spine without neurological deficit is rare. Both translational and rotational deformity of the midthoracic spine makes transection of the cord almost inevitable due to the confined dimensions of the cord and spinal canal. Even though associated fractures of posterior elements are frequently seen, they seldom result in neural sparing. The case of a 24-year-old man who sustained a severe rotational fracture-dislocation of T9/T10 with considerable anterolateral displacement is reported. Due to a fractured left pedicle and a right-sided vertical fracture through the posterior aspect of the vertebral body, alignment of the posterior elements in the spinal canal was maintained and there was no neurological deficit. The patient was operatively treated with posterior segmental instrumentation, and was completely asymptomatic at follow-up 5 years later.

We report on 30 unstable fractures of the thoracolumbar spine which were operatively treated between 1987 and 1992 with the AO Internal Fixator and transpedicular bone grafting. There were 26 flexion-compression fractures, 2 flexion-distraction injuries and 2 fracture-dislocations. Follow-up ranged from 2 to 5 years. All patients were examined and their histories reviewed. New radiographs were obtained and a standardized questionnaire on pain and on functional and economical status was answered. The radiographical analysis included measurement of the vertebral, segmental and local kyphosis and of the sagittal index. The preoperative vertebral kyphosis averaged +17 degrees and was corrected to +7 degrees at follow-up with the sagittal index improving from 0.59 to 0.86. The segmental respectively local kyphosis was reduced from +15 degrees respectively +8 to +5 degrees respectively -3 degrees. The fractured vertebra remained stable. We registered an average postoperative loss of correction of 4 degrees in the upper disc space due to collapse of the injured disc. The lower disc space was frequently overcorrected which was neutralized postoperatively due to a process of reequilibration of less than 3 degrees. The loss of correction occurred both before and after removal of the implant. There was no significant change of the sagittal plane apart from a successful realignment of the flexion-distraction injuries. Five out of 8 patients with neurological symptoms improved by at least 1 Frankel grade. We had no case of neurological deterioration. The results of the questionnaire were good or very good in 70%. At follow-up, the average back pain score was 3 out of 10, 10 being unbearable pain.

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From 1970 to 1980 155 supracondylar fractures of the humerus in children were treated conservatively by the method of Blount and 33 were treated surgically. The indications for operation were flexion-fractures, second- or third-grade compound fractures, vessel or nerve lesions and for easier nursing of polytraumatized patients. Out of 82 fractures treated by collar and cuff 64 (78%) show an ideal, 12 (15%) a good and 6 (7%) a satisfactory result two to ten years after the accident. In 18 cases one could see a defective varus function of more than five degrees.

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