The treatment of type-II traumatic spondylolisthesis of C2 remains controversial. We reviewed the outcome of 16 patients treated between 2001 and 2003.

As classified by Levine and Edwards, 14 patients sustained type-II fractures and two type-I injuries. There were no type-III injuries. All except one patient, who was injured playing rugby, were injured in motor vehicle accidents (four drivers, 10 passengers and one pedestrian). Eight patients had associated injuries. Thirteen patients were managed by means of a halo body jacket within 2 weeks of presentation for 5 to 9 weeks. One patient with a type-II injury was treated in an ABCO brace and those with type-I injuries in a Philadelphia collar.

All patients showed evidence of radiological union within 12 weeks (mean 7.5 weeks). Flexion/extension views revealed no instability. All patients regained full flexion and extension clinically, but five had some limitation of rotation. One patient removed the halo body jacket himself. There were no pin-tract or neurological complications. Mean follow-up time was 13.5 months (3 to 27). Four patients exhibited late disc space changes at C2/3 on radiographs.

Early patient mobilisation in a halo body jacket is an effective and safe management option for type-II C2 traumatic spondylolisthesis.

We retrospectively reviewed eight children with idiopathic chondrolysis (IC) of the hip and nine with atrophic tuberculosis (TB) of the hip treated over the 10 years 1990 to 1999. Both conditions present with a stiff hip and radiographic joint space narrowing. Our aim was to delineate clinical, radiological and histological differences between the two conditions, thereby obviating the need for biopsy in IC, which could worsen the prognosis.

In the IC group all patients were girls. Their mean age was 12 years (11.5 to 13). They presented with a flexion abduction and external rotation deformity of the hip. Chest radiographs were normal in all patients, and all except one had an ESR below 20. The Mantoux was negative in six of the eight. Radiographs showed joint space narrowing and osteopoenia, but the subchondral bony line remained present. Four of the eight had a synovial biopsy, which showed non-specific chronic synovitis. The cartilage looked pale and lustreless. In one hip the cartilage was biopsied and showed cartilage necrosis.

In the TB group, five of the nine patients were boys. The mean age was 7 years (5 to 13.5). The only constant hip deformity was flexion. Chest radiographs were normal in all patients. In all patients the ESR was below 20 and the Mantoux was positive. Hip radiographs showed osteopoenia with loss of the subchondral bony line. Peri-articular lytic lesions were present in all patients except one. Histology of synovial biopsy showed caseous necrosis in all hips, and seven of the nine had a positive culture for TB. Macroscopically the cartilage looked normal, and in one hip the cartilage biopsy was histologically normal.

We confirmed that in IC the joint space narrowing is due to cartilage necrosis. We postulate that in atrophic TB the loss of subchondral bone due to subchondral erosion gives the impression of joint space narrowing. We also concluded that IC was a diagnoses per se and not by exclusion, and that biopsy was not required.