Purpose of the study: Available epidemiological data on hand and wrist tumours are scarce and sometimes discordant. In our unit, these tumours are managed conjointly by hand surgeons and tumour specialists. We conducted an epidemiological study of 624 tumours treated from 1980 to 2008.

Material and methods: The recruitment used three methods: diagnostic coding in the database, analysis of discharge letters, study of tumour registries. All hand and wrist tumours treated surgically in our unit were included retrospectively. Exclusion criteria were: patients aged less than 15 years and/or managed in the paediatric surgery unit; poorly identified cases; recurrences.

Results: The study population included 624 tumours (375 female and 249 male). Mean age was 48 years (range 16–94). Eight tumours were malignant: 4 skin, 3 soft tissue, 1 bone metastasis of a primary renal tumour. Soft tissue tumour concerned 525 patients (84.1% of the study population). Respectively, 71 tumours concerned bone and 28 skin. There were 221 synovial cysts. The bone tumours exhibited a harmonious distribution for age and gender with a peak from 35 to 50 years and a sex ratio of 1/1. There were 43 chondromas found at all ages, mainly in long bones.

Discussion: Our series is the third largest reported. A review of the literature identified the eight largest studies available. For 6452 tumours, 81.7% concerned soft tissues, 13% skin, 4.7% bone tissue. These lesions occurred at all ages with female predominance (60%). Malignant tumours were found in 4.4% of the cases. Exclusion of the paediatric cases and the retrospective nature of the data collection were the main biases of this work.

Conclusion: Data on 624 hand and wrist tumours were in agreement with published work. Tumours involved mainly soft tissues. Synovial cysts predominated. Chondromas accounted for 70% of the bone tumours. Malignant tumours were rare (2.9%). For suspect cases, we recommend referral to a specialised centre for the management of malignant tumours of the hand. A pluridisciplinary analysis is indicated to adapt the diagnostic and therapeutic strategy.

Purpose: Classifications of fractures of the thoracolumbar spine are theoretically designed to help make therapeutic decisions. Three classifications (J. Laulan, F. Denis, F. Magerl) were compared to assess reproducibility for use by a surgery team.

Material and methods: The classifications were described during a SOFCOT symposium in 1995. Four observers examined 60 files reading them twice at a 1 month interval. The files included plain radiographs (AP and lateral view) and a scanner series and were read in random order. Intra- and interobserver concordance were measured with the kappa method.

Results: Intra- and interobserver reproducibility was good for the classification proposed by F. Denis (kappa = 0.6229 and 0.0795) for classification groups but was weak for subgroups (kappa = 0.028 and 0.571). Reproducibility was moderate for the classification proposed by J. Laulin (interob-server kappa = 0.460, intraobserver kappa = 0.541). The Magerl classification produced low to negligible reproducibility for classification groups and subgroups (intra- and interobserver kappa = 0.138 to 0.0343).

Discussion: Because of its low to negligible reproducibility, the Magerl classification would be difficult to use in clinical practice to make coherent therapeutic decisions or for scientific research to analyze series of fractures treated using this classification. The reproducibility of the F. Denis classification was good for groups but low for subgroups that include fractures resulting from different mechanisms requiring radically different treatment strategies. This is a good classification system for descriptive work but can lead to treatments poorly adapted to the causal mechanism of the fracture. The reproducibility of the J. Laulan classification is moderate but each group in this classification corresponds to fractures caused by the same mechanism. Therapeutic indications determined with this system would be more coherent.