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.

Closed manipulation of long bone fractures is often a difficult problem. Muscles and soft tissues along with gravity, acting along the fracture fragments, can cause complex displacement and deformity at the fracture site. At the same time surgeons have to rely on human assistants to manipulate and realign these fractures. This depends a lot on their individual skills and furthermore human assistants are prone to fatigue and are liable to imprecise movements. A robotic device has precision, accuracy, and steadiness along with the ability to be programmed. The purpose of this study is to conceptualize a device, which can aid orthopaedic surgeons to manipulate long bone fractures.

Extensive literature search was done using the Internet and conventional resources, to find recent developments in the use of robotics in trauma and fracture surgery. Different models of robots were considered and finally a parallel robot of the Stewart platform type was considered to be of the design that will be more compatible with an orthopaedic operating environment.

Computer aided design and graphics modelling of the robot was done and range of motion and force it can generate was calculated. The prototype that was built had six degrees of freedom and enough force and range of motion to reduce and manipulate long bone fractures. The actual controlling interface of the robot through a PC was established.

It is possible to build a robot for manipulating long bone fractures. Further research is being done to focus on the integration of the robot to fluoroscopic images and designing the correct attachment tools for the extremities.

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.

Thirty patients with chronic pyogenic or tuberculous arthritis of the hip treated by Girdlestone's excision arthroplasty were reviewed two to seven years after operation. There was marked or complete relief of pain in 29, control of infection in 27, squatting and sitting cross-legged was possible in 27, and 16 were able to stand on the operated limb. Overall results were good in 16, fair in nine, and poor in five. Tuberculous disease was not reactivated and the use of traction for 12 weeks and a weight-relieving caliper for 12 months after operation helped to reduce the shortening to an average of 3.8 centimetres. Excision arthroplasty is considered a sound operation to restore the ability to squat and sit cross-legged.