The unstable burst fracture.

Sixteen patients with "unstable" burst fractures of the thoracolumbar junction were treated with a modified posterolateral decompression and Harrington rod instrumentation. Preoperative computed tomography (CT) could assess the midsagittal diameter of the spinal canal and accurately localize the site of neural impingement. A surprisingly large proportion of cases had CT-demonstrated posterior element fractures which were missed using conventional radiographic modalities. The surgical goal was to provide the optimal environment for neurologic recovery. All 12 patients with neurologic deficits improved postoperatively, including five of eight patients with conus medullaris lesions who had full recovery. One-stage decompression-stabilization reduces the incidence of progressive kyphosis, neurologic deterioration, and mechanical back pain common in both conservative treatment and with wide laminectomy.

Fracture separation of the coracoid process associated with acromioclavicular dislocation: conservative treatment--a case report and review of the literature.

Complete acromioclavicular dislocation associated with fracture separation of the base of the coracoid process is uncommon. This is a report of a 51-year-old man with severe emphysema and limited physical demands in whom the acromioclavicular dislocation and coracoid process fracture were treated conservatively with sling immobilization and early motion and exercises. Good power and full, painless range of motion with minimal symptoms was observed at 6 months follow-up. The strong coracoclavicular ligaments, rather than rupture, may avulse the coracoid process near its base and with disruption of the acromioclavicular joint may allow complete dislocation of the clavicle. A satisfactory result may be obtained without operative reduction of either the acromioclavicular joint or the coracoid process.