Introduction: About 5–12 percent of scaphoid fractures are associated with other fractures, and approximately 1 percent of scaphoid fractures are bilateral.

Materials and Methods: Three hundred fifty patients sought treatment for established scaphoid non-union at the author’s department. All patients routinely underwent plain radiographs, taken with both hands in neutral position for preoperative measurement of scapholunate angle and scaphoid length. Unexpectedly however, radiological examination revealed a bilateral scaphoid Herbert type D2 pseudoarthrosis (24 waist) in 12 patients (5 females, 7 males with mean age 25 years, range 14 to 48). No patient was aware of the mechanism of controlateral injury or had previously complained of controlateral wrist pain. All patients received treatment for both sides. The scaphoid was exposed through a volar approach. The fracture was anatomically reduced and fixed with a Herbert screw. Iliac bone graft was used. Mean follow-up was 43 months (range, 25 to 68) using the modified Mayo wrist score.

Results: Fracture union was confirmed both clinically and radiographically and union rates were 96 percent. Mean union time was 7 months (range 4 to 12 months). Non-union occurred in 1 patient. According to the Mayo wrist score, excellent results were achieved in 17 cases, good in 6 and poor in 1.

Conclusion: Bilateral scaphoid pseudoarthrosis has a very rare incidence, and experience showed us that patients do not always complain of both sides. Routine pre-operative evaluation at our institution includes a set of comparative plain radiographs of the wrists and we strongly recommend this policy to avoid missing bilateral injuries.

Purpose: To study the pattern of neurological lesions and the frequency they occur in patients with cervical injuries. The relationship of these lesions with certain types of injuries and the cause of omjury.

Patients and methods: Between 1970–2001, 665 patients suffering a cervical injury were studied in our Department. There were 192 male and 73 female patients aged 42,3 years on average. Two hundred sixty-five of these cases (38,5%) were presented with neurological symptoms.The mean time of hospitalization was 43,45 days. The patients were classified according to the type and the level of injury. ASIA‘s functional classification was used (35,1% were ASIA A, 13,96% ASIA B, 10,57% ASIA C and 40,37% ASIA D). 194 were followed up for a mean period of 7 years. Conservative treatment was applied to 183 (69%) patients while 82 patients (31%) were treated operatively with anterior cervical fusion, posterior cervical fusion, or combined anterior and posterior fusion. Postoperatively, most of the patients with incomplete neurological lesion, were improved.

Conclusions: An analysis of our cases showed the following: a) There is a relationship between the type of neurological signs and the type of osseous or ligamentous injuries. b) There is relationship between type of osseous or ligamentous injury and severity of neurological lesion.. c) Burst fractures are the most severe fractures, followed by bilateral dislocations and tear-drop fractures. d) There is a relationship between mechanism of injury and severity of neurological lesion

Ulnar compression neuritis at the elbow level, known as the cubital syndrome, is one of the most common nerve entrapment syndromes. There are many treatment alternatives, such as conservative treatment, submuscular transposition, simple facial release, medial epicondylectomy and anterior subcutaneous transposition. The aim of the present study is to suggest the intramuscular transposition of the ulnar nerve for the cubital syndrome treatment.

With the technique based on flaps creation by “Z” lengthening of the flexorpronator muscules, the ulnar nerve is transferred in a well vascularizated area. Between 1992 and 2001, 76 patients were treated by anterior intramuscular transposition of the ulnar nerve. It was possible to follow up 27 patients, 19 males and 8 females. During the re-examination, the rough and thin grasping, the improved objective and subjective sings, as well as the return to the previous vocation, were reported. We make comparison with the international bibliography and correlation of the results to the age of the patients.

We recommend the anterior intramuscular transposition of the ulnar nerve for the cubital tunnel syndrome treatment, which is technically demanding, but provides a satisfactory functional outcome.

Diving injuries are the cause of devastating trauma, primarily affecting the cervical spine. The younger male population is more often involved in such injuries. This study describes our experience on diving injuries treatment and offers a long follow-up.

During a 31-year period (1970–2001) 20 patients, 19 male and one female have been admitted with cervical spine trauma following a diving injury. All admissions have been made between May and September. One patient was lost to follow-up. The mean age of the patients was 23 years (16–47). The lower cervical spine was involved in 13 patients; four patients had lesions in the middle and upper cervical spine, while one patient had combined lesions. The most commonly fractured vertebrae were C5 and C6. Fracture-dislocation was evident in 10 patients, while a teardrop fracture was diagnosed in six patients. Six patients were classified, as ASIA A upon admission and bladder control was absent in 12. Only four patients were treated surgically, two with iliac bone grafting alone, one with posterior plating and one with an anterior plate plus graft. The other patients with initial neurological deficit were treated conservatively, because of their rapid neurological improvement, their lesion being regarded as stable. Fourteen patients were treated conservatively with steroids and Crutchfield skull traction or halo vest, followed by the application of a Minerva or Philadelphia orthosis.

The mean follow-up was 11 years (6 mo to 23.8 years). Four patients in the ASIA A category died in the first month of their hospitalization (two of cardiac arrest, one from pulmonary embolism and one from respiratory infection) and two remained unchanged. Six patients with ASIA B and C improved neurologically and one remained unchanged. Nine patients had developed urinary tract infection and two had respiratory infections. Two out of the four operated on developed superficial trauma infection.

In conclusion, diving injuries of the cervical spine demonstrate a high mortality and morbidity rate. The initial neurological deficit may improve with appropriate conservative treatment. The indications for surgical management are post-traumatic instability and persistent or deteriorating neurologic deficit.