Purpose: Chronic compartment syndrome of the forearm is considered to be exceptional but may be underestimated. Compartment syndrome of the upper limb is recognized but generally considered to be non-specific compared with acute Wolkmann syndrome. Chronic compartment syndrome, or “subacute compartment syndrome” is also well known but often associated with exertion of the lower limbs in athletes. The association of a compartment syndrome of the upper limb and a chronic compartment syndrome was just recently described since the first publication appears to be the paper by Tompkins in 1997. Scare reports have reported a few cases since then.

Material and methods: We report our personal experience with ten cases with a minimum follow-up of six months.

Results: Compared with the literature, the analysis of our series provides an explanation of the clinical, diagnostic, and therapeutic features of chronic exercise syndromes of the forearm.

Discussion: A better awareness of this pathological condition will probably enable earlier and more surgical care of these athletes who are handicapped by these syndromes well known in the motocross world as “forearm tetany” or “armpump””.

Purpose: Eary results of a prospective study of a homogeneous group of 45 patients treated by electrical stimulation of the posterior cords for refractory chronic pain subsequent to postoperative fibrosis demonstrated good results (function and pain relief) in 77% of patients with a mean follow-up of 51 months. We further examined the technique treating certain cases of post-surgical refractory chronic lumbar radiculaglia using spinal cord neurostimulation and posterior spinal restabilisation during the same procedure.

Material and methods: Results of a small series of eight patients, mean age 48 years were examined at a mean follow-up of 11 years. Five of the patients were manual labourers and five were occupational accident victims. All had a history of endocanal surgery (narrow lumbar canal, disc hernia). These eight patients had lumbar and radicular pain which were chronic and refractory to conservative treatment. The usual preoperative tests were: percutaneous epidural neurostimulation for radiculalgia by deafferentation and immobilisation test with a corset for lumbalgia. Chronic neurostimulation of the posterior cords was indicated if either test was positive. Metronic ITREL II or III was used. Posterior restabilisation was performed by arthrodesis with a posteriolateral graft, or for more recent patients, by dynamic lumbar neutralisation (Dynesys). Neurostimulation and posterior stabilisation were performed during the same operative procedure.

Results: This therapeutic association enabled four of the patients to resume their occupational activities. Two patients were retired. Radiculalgia: At last follow-up, antalgic effect of neurostimulation persisted for six patients. For one, radiculalgia recurred at eight years. For the last patient, despite rigorous preoperative selection, pain recurred early at two years. Lumbalgia: Improvement persisted at last follow-up in four of the eight patients. Lumbalgia recurred in three at eight to eleven years. This time corresponds to the usual duration of arthrodesis efficacy due to the development of a neo-junction, the reason for which we extened our indications for dynamic neutralisation. The last patient developed a neojunction at two years and underwent extension of the arthrodesis with good antalgesia at ten years.

Conclusion: Combining electrical stimulation and spinal restabilisation in the same procedure provides a real antalgesic effect for certain patients with postoperative lumboradicular pain. The quality of the results are less favourable for lumbalgia because the effect of the arthrodesis is less long-lasting. It is hoped that the new Synergy electrode, with promising effect on radiculalgia and lumbalgia and which is currently under evaluation, will meet its expectations.

Purpose: We report the clinical and radiological course in a continuous series of 194 patients treated by the same team between 1996 and 2001 for thoracolumbar fracture. Cotrel frame instrumentation and Boëhler corset immobilisation were used.

Material and methods: In this series of 65 women and 129 men, age range 16 – 77 years, we retained one year follow-up at least for inclusion in the study. More than 85% of the patients were retained for study and the final analysis concerned 150 patients who were contacted.

All patients were in Frankel class E. In compliance with the SOFCOT 1995 Symposium, the method described by Rosset and Laulin and the international classification described by Magerl were applied to pre-operative x-rays to search for the pathogenic mechanism involved. The radiological analysis was conducted on preoperative, immediate post-operative, 1-month, 3-month, and last follow-up x-rays. The course of spinal kyphosis and angular deformation of the trauma zone and the subjacent disc were analysed. In addition to the overall series, patients with limit therapeutic indications, according to the local kyphosis and trauma-induced regional angular deformation, were also studied.

Results: For the initial indication of choice, type A1 fracture, gain in reduction was minimal for the constraining treatment. For type A3 fractures, posterior displacement of the posterior wall was not a contraindication because the posterosuperior reduction could be achieved by ligamentotoxis in the majority of the cases The gain in correction of spinal kyphosis was greater in these patients. Nevertheless, for this type of fracture, spinal kyphosis greater than 15° was an implicit sign of a potential posterior distraction lesion where osteosynthesis might be indicated, especially since the USS fixator uses a parallel assembly and authorises short instrumentations.

Conclusion: The Boëhler technique is a safe, minimally invasive and low-cost method for the treatment of thoracolumbar spine fractures, which enabled 30% correction of the spinal kyphosis. This method retains its indications for type A fractures.

Purpose: The purpose of this work was to determine the role of orthopaedic treatment as a function of initial criteria of instability and potential risk of secondary restabilisation after healing of the common anterior vertebal ligament in patients with bipediculated C2 fractures and to compare the results of surgical treatment using CE pediatric fixation of C1-C3 fractures associated with C1-C3 graft to those with C2-C3 arthrodesis using posterior screw plate fixation with a pedicular screw in C2.

Material and methods: This was a retrospective analysis conducted in patients treated over a ten year period. There were 57 patients treated by two different orthopaedic surgery teams. There were 33 women and 24 mean, mean age 37 years with a maximum follow-up of 12 months. Clinical and radiographic findings were the same before treatment and at last follow-up. The surgical indication was for rupture of the common posterior vertebral ligament as assessed differently by two different surgical teams.

Results: Orthopaedic treatment was given to 65% of the patients (72% and 62% for the two teams). Clinical outcome in these patients was good or excellent in 69% and 79% resepectively for the two teams. Surgical treatment was given in 35% of the cases. Cervical CD fixation produced 100% fair clinical results and 40% very good and good radiographic results with the other 60% being acceptable. For the C2-C3 plate with a pedicular screw in C2, the clinical outcome was good or very good in 53% with 34% fair and poor results and 73% good and very good and 27% poor radiographic results.

Discusssion: This work demonstrated that indications or orthopaedic treatment can be extended, following the work by Roy-Cammille on the instability of these lesions introducting thus the notion of spontaneous anterior restabilisation due to healing of the common anterior vertebral ligament. For the choice of the technique, arthrodesis by cervical CD fixation remains a safe and sure technique despite the logical loss of C2-C3 rotation. Plate screw fixation with a C2 pedicular screw is more attractive but remains technically difficult.