Existing predictive signs as available in current literature may miss potential proximal thoracic (PT) curve deterioration and shoulder imbalance, following selective main thoracic (MT) curve correction in adolescent idiopathic scoliosis (AIS). The present study is an attempt to evaluate and complement these signs, through a retrospective study of 56 AIS patients who underwent correction and fusion from 1986 till 2003 with follow-up 4-16 years. Forty-nine had fusion of MT curve, 7 of MT and PT. Cotrel-Dubousset instrumentation in 45, Luque in 12. Preoperative data: MT 50 degrees (40 degrees -80 degrees), PT 25 degrees (0 degrees -50 degrees), shoulder elevation from -4 cm (right) to 2 cm (left), clavicle angle from -14 degrees to 5 degrees , PT bending correction from 0 to 100% and T1 tilt from -15 degrees to 14 degrees . We introduced the first rib index (FRI), i.e., the difference between the diameter of right and left first rib arch as a percentage of the sum of both diameters, averaging from -22.7 to 14.3%. (Minus signs refer to or predict right, while positive left shoulder elevation.) Evaluation included all predictive parameters as related principally to postoperative left shoulder elevation > or =1 cm, patient satisfaction and surgeon fulfillment. Postoperative correction MT curve 53% (23-83%) and PT 35% (0-100%). One progressive paraplegic started 40 min following normal wake-up test. Immediate decompression, full recovery. Three cases with wound infection recovered after late removal of instrumentation. Loss of correction > or =10 degrees in five. Fifteen had postoperative persisting left shoulder elevation > or =1 cm. Seven of these expressed dissatisfaction. Statistically FRI proved valuable predictive factor always in combination with previously described signs. We concluded that a postoperative left shoulder elevation >/=2 cm is a potential cause of dissatisfaction and may be prevented with thorough validation of all predictive signs, principally the FRI.

A prospective study of 141 patients with 143 tibial shaft fractures has been carried out; 102 fractures were closed and 41 open. All the patients were treated by Ender's nailing and early weight-bearing. The average healing time was 15.2 weeks. There were no cases of bone infection and complications were minimal, the commonest being slight malalignment. Using this method, rapid restoration of bone continuity was achieved, combined with almost normal limb function during treatment.

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Endometriosis constitutes a benign condition, occurring in 10%–12% of menstruating women. Bowel involvement is estimated to occur in 5%–12% with the rectosigmoid region involved in up to 90% of these cases. We present the case of a 45‐year‐old Caucasian female patient with rectosigmoid endometriosis.