Posterior lumbar apophyseal ring fractures are rare in adolescents. We report 4 such cases in Chinese adolescents. Two of the patients had a slipped capital femoral epiphysis; 3 of them were overweight/obese. All presented with low back pain and radicular pain. Apophyseal fractures of the upper lumbar spine usually involve the lower end plate, whereas those of the lumbar sacral spine usually involve the upper end plate. The radiological features and pathophysiology are discussed. Two of the patients were treated with laminotomy and diskectomy after conservative treatment failed. All patients had complete resolution of their neurological deficits at a mean follow-up of 2 years. Despite its benign nature, long-term follow-up is necessary to define the natural course and prognosis of the disease. A high index of suspicion is needed to diagnose these fractures in adolescents.

We reviewed 6 patients with atlanto-axial (C1-2) deformities secondary to neglected odontoid fractures. All patients (except one with recent injury) were asymptomatic for a long period before development of neck pain or myelopathy, despite obvious subluxation and kyphotic deformities at the C1-2 joint complex. Patients were treated conservatively, except for one who underwent posterior spinal fusion and occiput-to-C2 decompression for progressive myelopathy. The reactive new bone formation around the odontoid fracture may play a role in preventing further movement and development of myelopathy. Conservative treatment should be considered for neglected odontoid fractures in elderly patients with stable non-progressive C1-2 deformity.

No abstract

Purpose Minimally invasive surgeries have become increasing popular in Orthopaedics. This study evaluated the clinical and radiographic outcomes of application of the concept for correction of mild-to-moderate hallux valgus deformity. Methods From November 2005 to Feb 2010, 20 patients with hallux valgus deformity had distal metatarsal osteotomy performed using the minimally invasive surgical techniques described by P. Bosch. Three patients had bilateral operation done at the same setting. The patient age ranged from 29 years to 75 years (mean 55.1 years) with 2 men and 18 women. One 2 mm Kirschner wire was used to splint the osteotomy site, which was removed after 4 weeks to 5 weeks. The mean followup time was 22 months. Results All except one foot showed excellent to good grading using the American Orthopaedic Foot and Ankle Society Hallux Scale (total 100 points). The mean score improved from preoperative 53.0 points to postoperative 91.8 points. The hallux valgus angle improved from a preoperative mean of 31.3° to 15.7°, and the first intermetatarsal angle improved from 16.7° to 7.7°. There was no major complication encountered. All patients showed bony union with no avascular necrosis. Three patients had mild pin tract infection. Two patients had backing out of the K-wire and one of them required reinsertion. So far, no patients required reoperation due to recurrence. Conclusion Good clinical and radiographic results have been achieved with minimally invasive techniques for treatment of hallux valgus. This is an acceptable alternative operation for mild-to-moderate hallux valgus.

Posterior fracture dislocation of the shoulder is rare injury. Treatment is challenging especially for a complex type fracture dislocation with delayed presentation or a reverse Hill-Sachs lesion. We reviewed the surgical approaches, the reduction and fixation techniques, management of reverse Hill-Sachs lesion, pitfalls, and outcomes. We also shared our experience in treating a short case series of posterior fracture dislocation of the shoulder. There were no major complications such as wound infection, nerve palsy, non-union or avascular necrosis of the humeral head in our patients. All could cope with the original activities and had satisfactory recoveries of shoulder functions. The anterior deltopectoral approach alone had some limitation especially in the delayed cases and with complex fracture dislocation. The Utility approach was noted to be a versatile approach for the chronic or delayed cases.