Scoliosis requires three dimensional correction at a global level (curve correction) and at a local one (apical axial derotation) as well as sagittal balance management. Except for in situ contouring, previously reported surgical techniques for scoliosis correction hardly deal with all these issues. The aim of the current study was to evaluate long term clinical and radiological outcomes after in situ contouring in 85 patients with severe scoliosis (Cobb= 40 to 110°). Age influence (adults versus adolescents) and surgical approaches (anterior release and posterior correction and fusion versus posterior correction and fusion only) were also assessed. The results of the study show that the in situ contouring is comparable to other surgical techniques in terms of surgery duration and blood loss. Anterior release proved useful in severe scoliosis correction. No difference in peroperative complications was found between age groups nor between approach groups. However, adolescents recover faster than adults. No difference of revision rates in double approach versus posterior approach populations was found. No statistically significant differences were found between the adolescent and adult populations. The mean overall frontal correction reached 68%. The mean loss of correction amounted 5%. No significant evolution was found in sagittal curvatures, emphasizing the difficulties in restoring physiological curvatures in patients with severe scoliosis. Our results suggest the in situ contouring technique is fully appropriate for severe scoliosis correction, regardless of the patient’s age and approach. Besides it will not result in higher morbidity for one specific population and warrants similar outcome when properly applied.

Introduction: Surgical treatment of thoracolumbar spine fractures from T11 to L2 with correction of the traumatic kyphosis should be expected to avoid the deceptions observed with former treatments.

Material and methods: Seventy trauma victims (41 men and 29 women) underwent surgery between 1996 and 2003. According to the Denis classification, they presented: 16 compressions, 43 burst fractures, 8 seat belt fractures, and 3 disclocations. The Frankel classification was E:62, A:2, C2, D:2. Mean follow-up was 30.7 months. A pedicle screw protected with sublaminal hooks below and pediculotransverse claws above was used in 50 patients with a hybrid configuration in 20. Reduction was achieved by in situ cerclage. A secondary anterior graft was implanted for 38 patients.

Results: Patients were allowed to rise without contention on day 3. The traumatic angle measured with the sagittal index of Farcy (SIF) (the quality parameter used to study reduction) was 17 preoperatively and 1.6 after surgery. The loss at last follow-up was −2.2° with 81% of patients presenting normal or over correction. The loss was greatest (5.2°) for uniquely posterior approaches. The final Oswestry score was 29.8 (range 6–80) with a better result for the double approaches (20.7 versus 37.4, p< 0.001). Complications were phlebitis (n=1), sutured dural breaches (n=2), disassembly and nonunion (revision with a double approach) (n=1), infection (treated by wash-out and antibiotics) (n=10), retroperitoneal hematoma (treated by embolization) (n=1). Thirty-two patients resumed their work at seven months on average and 13 did not (25 without professional occupation).

Discussion: The overall results are better than those after orthopedic treatment. The rate of resumed work was 71%. This is an excellent result with a less aggressive treatment protocol (no corset) and shorter hospital stay (5–19 days). The protective hooks facilitate in situ cerclage, avoiding catching the screws and the risk of disassembly. The anterior graft is necessary when the reduction is discal and reduces the angle loss leading to less morbidity.

Conclusion: In situ cerclage enables constant sustained reduction of thoracolumbar fractures. Indication for surgery is often retained because of major deformation. Spinal fractures should be examined with the same assessment criteria as used for fractures of long bones and weight bearing should begin early to avoid the risks associated with prolonged bed rest.

Purpose: We report preliminary results after treatment of humeral fracturs with a Targon centromedullary nail (Aesculap(r)).

Material and methods: Forty-five patients, predominantly women, underwent surgery from June 2001 to June 2002. Mean age was 63.5 years. The right side predominated. The series included 28 proximal fractures (65.9 years): 3-4 fragments (n=14), two fragments (n=8), pathological fracture (n=3),metaphyseo-diaphyseal fracture (n=3); and 17 shaft fractures (59.5 years): pathological fractures (n=4), nonunion (n=3), trauma (n=10). The Beach position, fractured limb free, was used with a superolateral approach. We inserted 28 Targon PH nails, including nine long nails, for proximal fractures and 17 Targon H nails for shaft fractures. Nail diameter was 8 mm. Nails were locked with four self-locking proximal screws (5 mm) and two distal screws (3.5 mm). The patients were immobilised with an arm to body brace. Hanging limb exercises were initiated immediately and active exercises at bone healing. The Constant score and radiographic measures were recorded at last follow-up.

Results: Mean follow-up was 12.2 months. We had six deaths and five patients lost to follow-up. Bone healing was achieved at eight weeks on average. Fracture reduction was acceptable for 37 limbs, including three which required open reduction. There were nine postoperative complications: superficial infection (n=1), distal screw pull out (n= 3), distal screw fracture (n=1), nail fracture (n=1). The mean Constant score was 69 (30–96).

Discussion: Proximal fractures of the humerus are often comminuted displaced fractures requiring cephalic arthroplasty. Total functional recovery is often difficult leading to mid and long-term problems for this young population. Stable quadruple proximal locking, associated with good filling of the canal by the nail enables fracture stablisation and satisfactory maintenance of the tuberosities. This stable assembly allows early rehabilitation. These advantages are particularly important for shaft fractures in young patients. The material does however have certain limitations related to fragility of the distal screws which are situated near the circumflex bundle for the Targon PH nail.

Conclusion: Our early results are encouraging for humeral fractures, both in elderly and young patients. This type of osteosynthesis can be a useful alternative to arthroplasty and allows early rehabilitation necessary for good functional recovery.

Purpose: Removal of intra-articular foreign bodies (FB) constitues a major indication for elbow arthroscopy. The purpose of our study was to evalute our experience with arthroscopic treatment of elbow osteochondromatosis.

Material and methods: Between September 1988 and June 2001 we performed elbow arthroscopy in 25 active patients (15 manual workers, 8 athletes including 2 high-level) who presented intra-articular FB osteochon-dromatosis of the elbow. Male gender predominated (n=22). Mean age at intervention was 42 years (17–68). The right (n=21) and dominant (n=24) side predominated. The mean clinical course before arthroscopy was two years. Seven patients had had upper limb trauma (five with elbow injury) a mean 60 months (6–144) before arthroscopy. Clinical assessment before arthroscopy and at last follow-up (mean follow-up 60 months, 8–138) included pain score (visual analogue scale), the notion of blocking and joint effusion and joint motion, as well as index of functional impairment during occupational and recreational activities and a subjective satisfaction index. Standard x-rays and arthroscan were obtained before arthroscopy to identify and evaluate intra-articular foreign bodies. Cartilage damage and presence of synovial anomalies were evaluated on the preoperative scan and during the intervention. Arthros-copy was performed according to the same procedure in all cases: lateral decubitus, arm cuff, anterior expoloration (anteromedial and anterolateral access). Standard x-rays were also obtained after arthroscopy and at last follow-up.

Results: FB were found and extracted in all cases. Cartilage injury was associated in 14 cases. Synovectomy was performed systematically in case of synovitis, a macroscopic synovial anomaly, or to extract a FB trapped in the synovial (n=18). Osteophytes were shaved in 12 cases. The post-arthroscopic period was uneventful with no complications (vascular, nervous, infectious). Clinical improvement was significant and sustained and the occupational and recreational function indexes improved. The subjective satisfaction index remained high five years after arthroscopy. We did not have any clinical recurence (blockage) or radiographically detectable anomaly at last follow-up. Less favourable results (persistent pain) were obtained in patients who had cartilage injury.

Discussion: Arthroscopy appears to be a safe treatment with long-term efficacy for osteochondromatosis of the elbow. Long-term prognosis is influenced most by presence of cartilage injury.