Non contiguous fractures in spinal trauma are not infrequent occurrences. Incidences in the literature have been cited as 3.2 to 16.7%. Of these the combination of cervical and lumber spine injuries are very uncommon (less than 0.5%). Isolated traumatic lumbosacral spondylolisthesis is a very uncommon occurrence and English language literature search reveals less than twenty cases reported.

We present a case which is a combination of an unstable C2 body fracture with a traumatic spondylolisthesis of L₅ on S₁. This is an unusual injury pattern and has never been reported before.

The case of a 17 year old man who had non contiguous cervical and lumber spine injuries was described and treatment modalities and rationale explained. Literature review and discussion on the subject of non contiguous spine injury is presented in the paper.

The outcome of treatment with internal fixation for the bifacetal fracture dislocation of the lumbosacral spine was discussed along with conservative management of the cervical spine injury. He had no residual limb weakness but had persistent bladder dysfunction since this injury.

Non contiguous spine injury is a commonly missed injury and the case we describe is a highly unusual but probable pattern of injury that has to be kept in mind in dealing with these kinds of injuries.

This case presentation highlights the problem of thermal necrosis of the tibia following reaming, in a tibia with a narrow canal.

A 2 year follow up of a 19 yr old aspiring dancer, who had a closed low velocity fracture to her midshaft left tibia. This was treated with intramedullary nailing of the tibia. Difficulty encountered while reaming of the canal at the time of operation because of the narrowness of the canal. She subsequently had a refracture of the shaft of the tibia, above the united fracture after the removal of the intramedullary nail. This happened in the narrow isthmic part of the tibia proximal to the fracture and was confirmed to have avascularity with isotope bone scan. This subsequently showed no appreciable sign of healing.

Patient had renailing of the tibia with bone grafting and the fracture. Latest review shows the fracture to be consolidating.

Surgeons have to be aware of the dangers of narrow canal in tibia before intramedullary nailing and appropriate reamers to be used if the canal is too narrow.