Evolution of the Cross-Sectional Area of the Osseous Lumbar Spinal Canal across Decades: A CT Study with Reference Ranges in a Swiss Population.

Spinal canal dimensions may vary according to ethnicity as reported values differ among studies in European and Chinese populations. Here, we studied the change in the cross-sectional area (CSA) of the osseous lumbar spinal canal measured in subjects from three ethnic groups born 70 years apart and established reference values for our local population. This retrospective study included a total of 1050 subjects born between 1930 and 1999 stratified by birth decade. All subjects underwent lumbar spine computed tomography (CT) as a standardized imaging procedure following trauma. Three independent observers measured the CSA of the osseous lumbar spinal canal at the L2 and L4 pedicle levels. Lumbar spine CSA was smaller at both L2 and L4 in subjects born in later generations (p < 0.001; p = 0.001). This difference reached significance for patients born three to five decades apart. This was also true within two of the three ethnic subgroups. Patient height was very weakly correlated with the CSA at both L2 and L4 (r = 0.109, p = 0.005; r = 0.116, p = 0.002). The interobserver reliability of the measurements was good. This study confirms the decrease of osseous lumbar spinal canal dimensions across decades in our local population.

[Update on humeral shaft fractures]. / Mise au point sur les fractures diaphysaires de l'humérus.

Humeral shaft fractures are relatively common, representing up to 5% of all fractures. Conservative management is the treatment of choice for most humeral shaft fractures and offers good functional and union outcomes. Age and oblique fractures of the proximal third are two risk factors for non-union. Surgical indication threshold should be lower for patients with these factors. Functional outcomes and union rates after plating and intramedullary nailing are comparable, but the likelihood of shoulder complications is higher with intramedullary nailing. Finally, there is no advantage to early exploration of the radial nerve even in case of secondary radial nerve palsy.

Les fractures de la diaphyse humérale sont relativement fréquentes et représentent jusqu'à 5 % des fractures. Le traitement conservateur par brace est le traitement de choix pour la majorité des fractures. Il permet un taux élevé de consolidation et est associé à de bons résultats fonctionnels. L'âge ainsi que les fractures obliques du tiers proximal sont deux facteurs de risque de pseudarthrose en présence desquels une prise en charge chirurgicale doit être plus facilement envisagée. Lorsqu'ils sont indiqués, l'ostéosynthèse par plaque et l'enclouage centromédullaire offrent des taux de consolidation et des résultats fonctionnels équivalents, avec cependant un risque de problème d'épaule plus important après enclouage. Finalement, l'exploration chirurgicale immédiate du nerf radial n'est pas recommandée, même en cas de parésie secondaire à la réduction de la fracture.