Introduction The management of cervical spine facet fractures, dislocations and subluxations in the literature is controversial. Many implants have been tested biomechanically and clinically. The overall biomechanical evidence points to greater stability with posterior constructs, however anterior surgery has practical advantages in terms of less dissection and local trauma than the posterior approach. The aim of this audit was to assess radiological results of facet joint fracture dislocations treated between January 2000 and August 2004. The audit was designed to examine the hypothesis that anterior fixation is inferior to posterior or combined anterior and posterior fixation.

Methods The clinical notes and radiological images of patients who present with a uni- or bifacet fracture dislocation during the study period were retrospectively reviewed. There were 21 patients treated during this period. 4 patients had incomplete radiological follow-up and were excluded. 12 Patients underwent anterior procedures, 3 posterior and 2 combined. Radiological follow-up included analysis of post-operative and final follow up x-rays. Failures were defined as evidence of nonunion, failure of metal ware, persisting kyphosis greater than 11 degrees or change in translation greater than 4 mm. Complications noted were 2 superficial infections, 1 psuedarthrosis 1 aspiration pneumonia, 1 ileus.

Results Overall 1 patient receiving anterior surgery developed a pseudarthrosis. This patient went on to develop fusion with posterior wiring and graft. Two patients developed wound infections following posterior wiring. All patients developed radiological fusion. Statistically there was no difference in radiological failure between anterior, posterior or combined anterior and posterior fusion.

Discussion There is insufficient evidence to reject the null hypothesis, anterior plating is inferior to posterior wiring or combined anterior and posterior procedures, and neither can the alternative be accepted. Better biomechanical results have been reported for posterior instrumentations and some authors have reported high rates of radiological failure with anterior fixation. However the anterior approach is associated with fewer complications in the literature6. The complicated nature of the facet fracture and the accompanying ligament injuries require patients to be assessed on an individual basis and treated as such.

Microfracture is a stem cell stimulation technique to promote the healing of full thickness articulate cartilage defects

Sixty-six patients have undergone microfracture for full thickness articulate cartilage defects over a five year period. All procedures were performed by one surgeon following the technique of Steadman. All patients were under 46, had an isolated chondral lesion, had a stable well aligned knee and were a minimum of one year post surgery.

Patients were evaluated with a preoperative and follow up IKDC score, WOMAC score, KOOS Score, Tegner activity level and SF 36, VAS pain scores and overall knee function score. Failure was determined by the need for a secondary chondral procedure.

Nine patients failed. Thus the overall success rate was 86%. The failure rate was higher with larger lesions.

There was a significant improvement in IKDC score, WOMAC score, KOOS Score, Tegner activity level and SF 36, VAS pain scores and overall knee function score.

Microfracture has a good success rate in the short to medium term with isolated full thickness articular cartilage lesions in the stable well aligned knee.