bluuebunny/crossref_metadata_2025 huggingface dataset:
THE HEALING OF FRACTURES OF THE LOWER END OF THE RADIUS
Authors: Sevitt S.
Published: February 2018

1. The processes of repair and union were studied in six fractures of the lower end of the radius, ranging in age from ten days to five and a half months.

2. The major pathway to union is medullary, through the proliferation around the fracture of vascular granulation tissue with osteogenic power. This invades and then bridges the fracture and is followed by the laying down of trabeculae of new bone.

3. Success depends on the growth of new capillaries across the fracture line, some of which mature and re-establish the meduilary circulation.

4. Indriving of the lateral cortex of the proximal fragment into the distal spongy medulla at the time of injury (in Colles's fractures) permits bridging between proximal periosteal and distal meduliary callus. Otherwise periosteal proliferation plays only a subsidiary role in union.

5. Fissure fractures of the lower articular surface were frequent and they also healed by the invasion of granulation tissue proliferating in the medulla nearby.
THE EFFECT OF FROZEN IRRADIATED BONE HOMOGRAFTS ON THE HEALING OF DEFECTS IN THE MANDIBLE AND FEMUR OF THE RAT
Authors: Cleaton-Jones P. E. , Retief D. H. , Maier G.
Published: February 2018

1. The effects of frozen irradiated homogenous bone grafts on the healing of circumscribed defects in the mandibles and femora of forty albino rats have been studied.

2. The grafts were well tolerated by the host animals and did not appear in any way either to stimulate or to inhibit osteogenesis. The rate of healing of the defects containing the homografts compared favourably with that of the control defects.
BONE GRAFTS AND CHRONIC OSTEOMYELITIS
Authors: de Oliveira José C.
Published: February 2018

1. In the treatment of chronic osteomyelitis the most troublesome factor is the infected bone cavity. This is seldom obliterated spontaneously by bone regeneration. The number of procedures designed to fill the cavity, since the beginning of the century, show how much it troubles the surgeon.

2. The use of bone grafts in the treatment of chronic osteomyelitis has been studied. One hundred and twenty cases are reviewed (the largest series in the literature), the follow-up being between two and ten years. The most common lesion was a bone cavity, with or without a sequestrum.

3. Treatment must include the removal of infected soft tissues as well as sclerosed bone, and must be done under appropriate antibiotic control. The value of cancellous bone grafts in filling infected cavities in the metaphysio-epiphysial regions is especially emphasised.

4. The results were gratifying, only four relapses occurring in 120 cases.
THE PATTERN OF BONE AND CARTILAGE DAMAGE IN THE RHEUMATOID KNEE
Authors: Chaplin D. M.
Published: February 2018

1. Fifty knees affected by rheumatoid arthritis were studied in detail at synovectomy.

2. The destructive lesions found were relatively constant and are described in detail.

3. Cartilage lesions were much more common than was expected radiologically.

4. The pattern described suggests that articular cartilage is destroyed by contact with diseased synovial membrane but protected by contact with another cartilaginous surface.
ILIACUS HAEMATOMA
Authors: Mukherjee Sadhan Kumar
Published: February 2018

1. Two cases of iliacus haematoma occurring after injury in otherwise healthy individuals are reported.

2. Both cases were complicated by infection of the haematoma, but both patients made a full recovery after operation.
ARTICULAR CARTILAGE: A REVIEW AND SCANNING ELECTRON MICROSCOPE STUDY
Authors: Clarke Ian C.
Published: February 2018

1. The fibrillar networks of adult human articular cartilage, taken from femoral and acetabular specimens, have been systematically examined by scanning electron microscopy. The internal structures revealed by rupturing the tissue were compared with published findings from transmission electron microscope studies.

2. Though this technique demonstrated the internal fibrillar appearance of cartilage to a remarkable degree, it had several attendant limitations. On final drying, specimens generally exhibited shrinkage which varied within wide limits; this could have altered the internal architecture to some extent. In addition, the rupturing technique, which at the time of this investigation was the only satisfactory method of revealing the fibrillar cartilage structure, may well have had a great influence on the fibril orientations.

3. The fibrils revealed no characteristic collagen periodicity and were considerably thicker than those observed by transmission electron microscopy. It is suggested that a coating of mucin on the collagen fibrils might account for this.

4. At low magnifications the torn layers in the fractured surfaces extended radially from the calcified zone and turned obliquely at or near the articular surface to merge with the distinctly layered superficial zone, thus forming arcade-like structures. That these were not artefacts produced by the fracturing technique was shown by their similarity to the classical arcade pattern of light microscopy. However, the factor which governed the direction of these planes of weakness, be it collagen, mucopolysaccharides or cells, could not be satisfactorily determined.

5. At higher magnifications only three regions of distinct fibrillar organisation could be identified: 1) a surface layer consisting of a random fibrillar network; 2) a superficial zone composed of layers of fibrillar network, intersecting and overlapping in planes parallel to the surface; and 3) elsewhere below the superficial zone a network of virtually random fibrils which extended to the calcified region with apparently little variation in thickness or density. There was little variation from this pattern even in aged fibrillated specimens.

6. At the lower magnification range the scanning electron microscope has revealed the arcade pattern described by light microscopy, while at the higher magnifications the fibrillar organisation as seen by scanning electron microscopy correlated well with the concepts developed by transmission electron microscopy, that is, a random network of fibrils overlaid at the articular surface by a membrane-like system of bundled fibrils.

7. A possible role in the transmission of joint forces is outlined for the above fibrillar organisation.
THE SEMITENDINOSUS TENODESIS FOR RECURRENT DISLOCATION OF THE PATELLA
Authors: Baker R. H. , Carroll N. , Dewar F. P. , Hall J. E.
Published: February 2018

1. Semitendinosus tenodesis with adequate lateral release for recurrent dislocation of the patella has a high success rate and a low complication rate.

2. The technique of operation is simple.

3. Its particular application is in the young patient before epiphysial closure, although it can give good results in the older patient.
ARTHROGRAPHY OF THE KNEE BEFORE AND AFTER SYNOVECTOMY FOR RHEUMATOID ARTHRITIS
Authors: Taylor A. R. , Ansell B. M.
Published: February 2018

1. In twenty-five patients with rheumatoid arthritis of the knee examined by contrast arthrography certain typical features were encountered. These consisted of enlargement of the suprapatellar pouch and loss of the normally smooth outline of the joint cavity because of nodular filling defects. In some cases less definite filling defects were seen, due to loose fibrinous deposits, particularly in popliteal cysts.

2. This method of assessment of the results of synovectomy of the knee correlated well with the clinical findings. The more satisfactory the clinical result the more normal the arthrograph. Patients who had recurrence of pain, swelling and tenderness in the knee showed arthrographic findings similar to those before operation.
CRYPTOGENIC METASTASES IN UGANDA AFRICANS
Authors: Templeton A. C. , Hutt M. S. R. , Dodge O. G.
Published: February 2018

1. Secondary tumours in bone are common in Uganda.

2. Of the five tumours which often give rise to bone metastases in Europe—breast, bronchus, thyroid, prostate and kidney—only the kidney is an unimportant site in Uganda, its place being taken by hepatocellular carcinoma.

3. Most primary bone tumours occur around the knee whereas tumours ofthe skull, vertebrae and head of femur are very likely to be secondary. The thyroid was the most likely primary site for secondary tumours in women. In men the liver, bronchus and prostate were common primary sites.
WEIGHT-BEARING AREAS IN THE HUMAN HIP JOINT
Authors: Greenwald A. S. , Haynes D. W.
Published: February 2018

1. A specially designed loading apparatus and dyeing technique have been used to demonstrate the weight-bearing areas in fifty-one normal adult hip joints.

2. Under loads and positions typical of the stance phase of walking the entire articular surface of the acetabulum is involved in weight-bearing. This contact area is reproduced on the femoral head, and its position determined by the attitude of the femur to the acetabulum.

3. With loads typical of the swing phase, the dome of the acetabulum and corresponding areas on the femoral head are not involved in weight-bearing.

4. The results are compared with the conclusions of previous investigators and their possible significance with regard to joint degeneration is discussed.
HOMOCYSTINURIA AND MARFAN'S SYNDROME
Authors: Brenton D. P. , Dow C. J. , James J. I. P. , Hay R. L. , Wynne-Davies Ruth
Published: February 2018

1. Skeletal and other clinical features in twenty-three patients with homocystinuria have been compared with those in sixteen patients with Marfan's syndrome.

2. The two diseases are clinically similar but florid arachnodactyly and scoliosis are commoner in Marfan's syndrome, whereas widening of epiphyses and metaphyses of long bones is a distinctive feature of homocystinuria.

3. Patients with homocystinuria frequently have osteoporosis at a young age with a high incidence of vertebral involvement including biconcavity and flattening. Patients with Marfan's syndrome do not have osteoporosis and may have excessively tall vertebrae.

4. Mental retardation and thrombosis are common in homocystinuria and uncommon in Marfan's syndrome.

5. Homocystinuria is most probably inherited as an autosomal recessive and Marfan's syndrome as an autosomal dominant.

6. The two diseases should be differentiated because of the thrombotic risk in homocystinuria, and also because in this disease there is a possibility of treating the biochemical defect.

7. Although patients with homocystinuria may present to the orthopaedic surgeon with osteoporosis, severe genu valgum or scoliosis, the disease is an uncommon cause of these defects.
THE ROLE OF ARTHROSCOPY IN THE MANAGEMENT OF DISORDERS OF THE KNEE
Authors: Jackson Robert W. , Abe Isao
Published: February 2018

1. A critical analysis of the findings in 200 knees examined by arthroscopy at least one year previously has been carried out to assess its value in the management of a wide variety of disorders.

2. Arthroscopy is a practical and valuable procedure with minimal associated morbidity or complications.

3. The increased accuracy of diagnosis helps to avoid unnecessary operations and to base methods of treatment on a better knowledge of the pathology.
HIP INSTABILITY IN PATIENTS WITH MYELOMENINGOCELE
Authors: Rueda J. , Carroll N. C.
Published: February 2018

1. The problem of paralytic hip instability has been studied in a series of twenty-one patients brought to a spina bifida clinic.

2. Thirty iliopsoas tendon transfers were done in an attempt to reduce deformity and improve hip stability.

3. At the time of review, ten of these hips were stable and twenty were unstable. Ten hips were improved by operation, and one hip was worse. The other nineteen remained the same.

4. All of the children except one were capable of walking with an orthotic device.

5. Some of the complexities of the problem of paralytic hip instability in the patient with myelomeningocele are discussed.
SCREW FIXATION IN THE MANAGEMENT OF THE FRACTURED CARPAL SCAPHOID
Authors: Maudsley Roy H. , Chen S. C.
Published: February 2018

1. A modification of the McLaughlin technique of lag screw fixation of the fractured scaphoid is described.

2. Fifty-six patients operated upon between 1956 and 1966 have been reviewed and their fractures classified under the headings recent, delayed union and non-union.

3. Plaster casts were avoided and early return to work encouraged; 95 per cent did so within two months.

4. Of twenty-two recent fractures, including three perilunar trans-scaphoid dislocations, nineteen united; of fifteen showing delayed union, eight united: and of nineteen cases of non-union, only two united.

5. The function of the wrist in the seventeen cases of persistent non-union stabilised by lag-screw was surprisingly good; only one patient has required arthrodesis to date.

6. The indications and contra-indications for the operation are discussed.
RADIAL TUNNEL SYNDROME
Authors: Roles N. C. , Maudsley R. H.
Published: February 2018

1. Resistant cases of tennis elbow are explained on the basis of an entrapment neuropathy of the radial nerve and its branches.

2. An operation is described to explore these nerves through an anterior muscle-splitting incision.

3. Thirty-eight elbows in thirty-six patients have been operated on with improvement in all.
REDUCTION OF ACUTELY SLIPPED UPPER FEMORAL EPIPHYSIS
Authors: Casey Brian H. , Hamilton Henry W. , Bobechko Walter P.
Published: February 2018

1. The results of thirty-five acutely slipped upper femoral epiphyses, treated from 1950 to 1969, are presented. Avascular necrosis of the femoral head occurred in five cases.

2. Skin traction with medial rotation, followed in three to four days by internal fixation, without further manipulation, is recommended so that this iatrogenic complication may be avoided.
HIP ASSESSMENT: A COMPARISON OF NINE DIFFERENT METHODS
Authors: Andersson Gunnar
Published: February 2018

1. The various methods of assessing the results of hip arthroplasties have been investigated.

2. The different results obtained by using different methods are very significant.

3. The importance of achieving a generally agreed assessment is obvious.
CYSTIC ANGIOMATOSIS OF BONE
Authors: Boyle W. J.
Published: February 2018

1. Three cases of cystic angiomatosis of bone are presented and the literature is reviewed.

2. The typical radiological appearances are described and illustrated.

3. The diagnosis must be confirmed by biopsy, and it is essential that the bone removed should be from an involved rib.

4. The prognosis is dependent upon extraskeletal visceral involvement and is not influenced by radiotherapy or chemotherapy. Splenectomy may improve the chance of survival when the spleen is the only viscus involved.
INJURIES OF THE TARSO-METATARSAL JOINTS
Authors: Wilson D. W.
Published: February 2018

1. Twenty-two feet injured at the tarso-metatarsal level are reviewed.

2. Experiments with eleven cadaveric feet are reported.

3. The injuries are caused by forced plantar-flexion combined with rotation in most cases. Crushing of the foot alone often does not produce dislocation.

4. A classification is suggested.

5. The results of various treatments in this small series are presented. It is concluded that anatomical reduction is important, achieved if necessary by operation and internal fixation.
ISOLATED TRABECULAR FATIGUE FRACTURES IN THE FEMORAL HEAD
Authors: Todd R. C. , Freeman M. A. R. , Pirie C. J.
Published: February 2018

1. The femoral head has been examined in specimens taken from cadavers, patients suffering subcapital fracture of the femoral neck and patients undergoing total replacement arthroplasty for osteoarthrosis and rheumatoid arthritis.

2. Lesions have been seen, some of which appear to be uniting fatigue fractures of individual trabeculae.

3. It is suggested that excessive cyclical loading, sometimes leading to fatigue fractures, may represent a fundamental pathological process of general importance in the evolution of certain skeletal and articular diseases.
WOUND HEALING AFTER OPERATIONS ON PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: Garner Richard W. , Mowat Alastair G. , Hazleman Brian L.
Published: February 2018

1. The incidence of failure of wound healing by primary intention due to infection, haematoma and gaping of wound edges, has been compared in 100 patients with rheumatoid arthritis and in 100 matched controls following a variety of orthopaedic operations.

2. There were thirty-one cases of failure of wound healing in the patients with rheumatoid arthritis and sixteen in the controls (P< ·02). There was no significant difference in the numbers of infected wounds or in those in which a haematoma developed. However, there was a significant excess of wound edge separation in the rheumatoid patients (thirteen) compared with the controls (four) (P< ·05).

3. The problems of wound healing were minor since there was no difference in the mean number of days ±1 standard deviation to wound healing between the patients: l6·6±7·5 days; and the controls: 15·2±7·9 days.

4. There was no correlation between duration or severity of rheumatoid disease and wound healing.

5. There was no difference in wound healing between patients with sero-positive and seronegative disease.

6. Forty-nine patients received corticosteroid therapy in small dosage. This was associated with an increased incidence of wound infection. Treatment for more than three years was associated with a significant increase in the mean number of days to wound healing.

7. The results are discussed in the light of the increased incidence of infection in several sites in patients with rheumatoid arthritis and of the effect of corticosteroid therapy on wound healing in man and experimental animals. It is suggested that more marked abnormalities might have been expected, and that these findings may need to be considered in the future surgical management of such patients.
DIPHOSPHONATES
Authors: Graham R. , Russell G. , Smith Roger
Published: February 2018

1. The phosphonates are simple chemical compounds containing P-C-P bonds which are resistant to the action of naturally occurring phosphatases and pyrophosphatases. They inhibit the formation and dissolution of apatite crystals in vitro and prevent ectopic mineralisation and bone resorption in animals.

2. In man one diphosphonate (EHDP) has been shown to reduce the excessive turnover of bone in Paget's disease and also appears to slow the mineralisation of ectopic bone matrix in myositis ossificans progressiva.

3. The possible uses of the diphosphonates in bone disorders with excessive resorption and in ectopic mineralisation are being further investigated.
ARTHRODESIS OF THE CARPO-METACARPAL JOINT OF THE THUMB
Authors: Carroll Robert E. , Hill Norman A.
Published: February 2018

1. A technique of arthrodesis of the trapezio-metacarpal joint of the thumb is described. Primary fusion was achieved in thirty-six of thirty-nine cases.

2. Compensatory movement at the adjacent joints permits a good range of thumb movement.

3. Trapezio-metacarpal arthrodesis is the operation of choice for patients under fifty with isolated osteoarthritis of this joint. It is also useful for stabilising the thumb in patients with paralysis of the thumb when adequate muscles for transfer are not available.
FORCES UNDER THE FOOT
Authors: Stott J. R. R. , Hutton W. C. , Stokes I. A. F.
Published: February 2018

1. A method is described for measurement of the vertical load carried by different areas of the foot while walking barefoot. The results of tests on fourteen subjects, seven with some foot abnormality, are reported.

2. The results show that the load carried by the normal midfoot is low. Measurements in this area could be useful in the quantitative assessment of some foot abnormalities.

3. Considerable variation between individuals is seen in the distribution of vertical load across the forefoot. The metatarsal bones do not necessarily carry loads in proportion to their size.
CHONDROCYTE MULTIPLICATION IN OSTEOARTHRITIC ARTICULAR CARTILAGE
Authors: Rothwell Alastair G. , Bentley George
Published: February 2018

1. Twelve trephine specimens of articular cartilage and subchondral bone taken from six fresh osteoarthritic femoral heads were incubated in a medium containing tritiated thymidine, and autoradiographs were prepared from serial sections five microns thick.

2. Scattered labelling of chondrocytes in sections from four of the six femoral heads was demonstrated. No more than four labelled cells were seen in any one section. About half were found in typical chondrocyte clusters.

3. The implications of this evidence of chondrocyte multiplication with regard to the repair of damaged articular cartilage are discussed.
ACUTE TRAUMATIC DISLOCATION OF A CONGENITALLY DYSPLASTIC HIP
Authors: Raine G. E. T.
Published: February 2018

An eight-year-old girl who suffered a traumatic dislocation of a congenitally dysplastic hip is described. No other such case is recorded in the literature.
THE RELATIONSHIP BETWEEN DEGENERATIVE CHANGES AND LOAD-BEARING IN THE HUMAN HIP
Authors: Bullough Peter , Goodfellow John , O'Connor John
Published: February 2018

1. A predictable pattern of degeneration occurs on both the femoral head and the acetabulum and this pattern is age dependent.

2. The degenerative areas on the femoral head are related to habitual non-use.

3. The hip is shown to be anatomically incongruent, and the dome of the acetabulum, a predictable area of degeneration, is shown also to be an area of habitual non-use.

4. The possible relationships between age-dependent degenerative changes and senile degenerative joint disease is discussed and the importance of changing geometry stressed.
THE ELBOW IN ARTHROGRYPOSIS
Authors: Williams Peter F.
Published: February 2018

1. The possibilities in the treatment of the elbow in arthrogryposis are discussed.

2. The role of tricepsplasty to gain movement, and of triceps transfer to obtain power are outlined and the results obtained in the surgical treatment of twenty-three elbows are analysed.
A CONTROLLED TRIAL OF IMMEDIATE AND DELAYED CLOSURE OF MYELOMENINGOCELE
Authors: Smyth B. T. , Piggot J. , Forsythe W. I. , Merrett J. D.
Published: February 2018

1. A controlled trial of ninety-nine patients with myelomeningocele has shown that immediate closure did not result in any significant (at P<0.05) reduction in mortality or alteration in muscle power.

2. If required, closure of the back may be delayed for forty-eight hours after birth or longer to allow a detailed clinical assessment of the infant.

3. The muscle power in the lower limbs is a useful guide to prognosis both in relation to mortality and the incidence of hydrocephalus.

4. Mortality is greatest in the first year of life.

5. In the urinary tract the commonest anomaly is neurogenic bladder. Other congenital anomalies were not more common than in children generally.
A MODIFIED TENDON TRANSFERENCE FOR RADIAL NERVE PARALYSIS
Authors: Said Galal Z.
Published: February 2018

1. A modified technique of tendon transference for irreparable damage of the radial nerve is described. The tendon of the pronator teres is transferred to the two radial extensors of the wrist and to the tendon of extensor carpi ulnaris.

2. The method succeeds in preventing radial deviation on attempted dorsiflexion of wrist and helps to provide a powerful grip.
MULTIPLE BONE LESIONS CAUSED BY AVIAN-BATTEY MYCOBACTERIA
Authors: Ellis Wray
Published: February 2018

1. A case of multiple bone lesions in a patient infected by Avian-Battey bacillus is reported.

2. It is suggested that the prognosis in future Heaf-negative cases may be improved by studies of the cellular response to the infection.
THE INTERRELATIONSHIPS BETWEEN BONE MINERAL AT DIFFERENT SKELETAL SITES IN MALE AND FEMALE CADAVERA
Authors: Aitken J. M. , Smith C. B. , Horton P. W. , Clark D. L. , Boyd J. F. , Smith D. A.
Published: February 2018

1. Sections were cut from the third metacarpal, the radius, the femur and the third lumbar vertebra of thirty-four male and twenty-one female cadavera. The mineral content of these different specimens was measured by ashing and the relationships between the quantity of bone mineral present at these sites were examined.

2. In the females the whole bone density and mineral/unit length at both the midshaft metacarpal and the midshaft radius correlated significantly with the whole bone density at all the other sites.

3. In the males these correlations were much less significant and no significant correlation was found between the whole bone density of either the metacarpal midshaft or the radial midshaft and that of the third lumbar vertebra or the distal femur, although a highly significant correlation was found between those of the distal femur and the lumbar vertebra.

4. It is suggested that in women, measurements of either mineral/unit length or whole bone density of both the midshaft metacarpal and radius provide useful information on the whole bone densities at other sites throughout the skeleton. This work was supported by the Scottish Hospital Endowments Research Trust, the National Fund for Research into Crippling Diseases and G. D. Searle and Co. Ltd., High Wycombe.
THE FAT EMBOLISM SYNDROME
Authors: Gurd Alan R. , Wilson R. I.
Published: February 2018

1. A distinction must be made between the fat embolism syndrome, a clinical entity, and fat embolism demonstrated pathologically, which may be found after death following fracture with no prior evidence of the syndrome.

2. One hundred cases of the syndrome encountered over a period of four years have been studied in detail and the diagnostic criteria have been defined. These include one major feature, four minor features and fat macroglobulaemia.

3. Sixteen of the patients died–eight from severe pulmonary insufficiency of the syndrome, eight from other traumatic causes.

4. The prevention of shock is the best measure for prevention of the syndrome. The role of proteases in the production of shock and the place of protease inhibition in treatment of the syndrome are briefly discussed.

5. For the established case the aim of treatment is to ensure an adequate pressure of arterial oxygen.
THE FIBRINOLYTIC ENZYME SYSTEM AFTER TRAUMA AND IN PATIENTS WITH FAT EMBOLISM
Authors: Rennie A. M. , Ogston D. , Cooke R. J. , Douglas A. S.
Published: February 2018

The changes in a number of haemostatic factors after fractures of the tibia or femur were compared with those observed in patients with fat embolism complicating such fractures. After fractures uncomplicated by fat embolism there was a rise in the fibrinogen, α1-antitrypsin and serum activation inhibitor. The plasminogen level and platelet count initially fell, but later increased to above the initial levels. Patients whose fractures were complicated by fat embolism had the same pattern of changes but quantitatively greater.
PATHOLOGICAL CHANGES IN A CASE OF PERTHES' DISEASE
Authors: McKibbin B. , Ráliš Z.
Published: February 2018

1. The findings in a femoral head obtained at necropsy on a boy aged nine suffering from Perthes' disease are described.

2. The findings revealed that there had been avascular necrosis of the epiphysis followed by revascularisation and healing, and there was evidence to suggest a second episode of infarction.

3. The findings provide strong support for the suggestion that Perthes' disease is the result not of one but of more than one episode of major infarction.
INTRASPINAL ENTEROGENOUS CYST ASSOCIATED WITH SPONDYLOLISTHESIS AND SPINA BIFIDA OCCULTA
Authors: Page R. E.
Published: February 2018

1. An enterogenous cyst lying in the cauda equina opposite the third lumbar vertebra, and associated with spina bifida occulta of the fifth lumbar vertebra and spondylolisthesis of the fifth lumbar on the first sacral vertebra, is described in a man aged thirty-five suffering from chronic low back pain and sciatica.

2. Current embryological theories concerning the formation of intraspinal enterogenous cysts from primitive gut cells are further substantiated by the features of this case.
THE LAMINECTOMY MEMBRANE
Authors: LaRocca Henry , Macnab Ian
Published: February 2018

1 . Standard lumbar laminectomy was performed at multiple levels in thirty dogs, and manipulations were carried out in the spinal canal to observe their effects on periradicular adhesion formation. The canal was scarified, packed with Gelfoam, or treated with three varieties of Silastic membranes. The results were serially assessed from three days to twelve weeks by gross observation, nerve conduction studies, histological examination of transverse sections of the spine, myelin study of lumbar roots and micropaque study of the arterial supply to the roots.

2. The results were consistent biologically. The principal source of scar is dorsally in the fibrous tissue elements of the erector spinae muscle mass. This scar, the laminectomy membrane, covers the laminectomy defect and extends into the canal bilaterally to adhere to the dura and nerve roots.

3. Gelfoam does not contribute to scar formation, but instead acts as an effective interposing membrane. Silastic membranes are capable of providing protection against nerve root adhesions without interfering with the anatomical or physiological integrity of the nerves.

4. Certain clinical implications of the study are discussed.
DISLOCATION OF THE CERVICAL SPINE WITH CORD COMPRESSION IN RHEUMATOID ARTHRITIS
Authors: Meijers K. A. E. , Van Beusekom G. Th. , Luyendijk W. , Duijfjes F.
Published: February 2018

1. The treatment is described of a consecutive series of fourteen patients suffering from rheumatoid arthritis causing a slip of the cervical vertebrae, mainly at the C.1-2 level, and a cord lesion.

2. The importance of a change of symptoms and signs in these patients, especially the occurrence of the so-called "alarm signs", is stressed.

3. In twelve patients the combination of this kind of cervical instability with a cord lesion was treated by fusion, most frequently of occiput to C.2 and 3.

4. In the eleven patients who survived the operation the results with a follow-up period of one to eight years are considered highly gratifying.

5. Technical details and various problems associated with treatment are discussed.
SLIPPED FEMORAL CAPITAL EPIPHYSIS OCCURRING DURING GROWTH HORMONE THERAPY
Authors: Rennie William , Mitchell Nelson
Published: February 2018

1. A case is reported of a girl aged fifteen with growth hormone deficiency who developed a slip of the left femoral capital epiphysis at the age of seventeen during human growth hormone therapy.

2. The epiphysiolysis is regarded as iatrogenic.
TOURNIQUET PARALYSIS WITH PROLONGED CONDUCTION BLOCK
Authors: Rudge Peter
Published: February 2018

1. Electro-physiological studies have been made in a case of "tourniquet paralysis" of the upper limb produced by the application of a pneumatic cuff.

2. The results indicate that an important part of the persistent paralysis was caused by local conduction block at the level of application of the cuff.

3. The value of electro-physiological studies in such cases is stressed.
ANTIBIOTIC THERAPY OF CHRONIC POST-TRAUMATIC OSTEOMYELITIS
Authors: Hierholzer G. , Rehn J. , Knothe H. , Masterson J.
Published: February 2018

1. The dominant role of pathogenic staphylococci in surgical infections has been confirmed by positive isolations in 89·9 per cent of a wide variety of lesions in a hospital infective unit. Of 150 staphylococci isolated, 147 were sensitive to fusidic acid, two were slightly sensitive and only one was resistant.

2. Fusidic acid was administered as sodium fusidate to 100 patients with staphylococcal infections (including seventy-two with chronic post-traumatic osteomyelitis). Sterile swabs were achieved in seventy-seven of these patients and in the remaining twenty-three a change of flora was detected.

3. Bone samples were taken at operation from twenty-nine patients with chronic osteomyelitis who had been treated for at least five days with fusidic acid. Depending on dosage, the mean fusidic acid concentrations were 7·3 and 9·8 micrograms per gram. Corresponding levels in non-inflammatory bone samples from thirty-one patients were, depending on the duration of treatment, 12·3, 2l·3 and 25·4 micrograms per gram. The fusidic acid levels in cancellous bone were almost twice as high as those in compact bone.

4. The relevance of these findings to the use of fusidic acid therapy as an adjunct to surgical management of chronic osteomyelitis is discussed.
ADAMANTINOMA OF THE TIBIA
Authors: Braidwood A. S. , McDougall A.
Published: February 2018

Two cases of adamantinoma of the tibia are reported. The first patient has survived twenty years after above-knee amputation and shows no sign of recurrence. The second patient shows no evidence of recurrence two and a half years after amputation through the knee.

The clinical picture of the tumour is described and the theories of histogenesis are outlined.
CONGENITAL PSEUDARTHROSIS AND BOWING OF THE FIBULA
Authors: Dooley B. J. , Menelaus M. B. , Paterson D. C.
Published: February 2018

1. The cases of four children who presented with bowing or pseudarthrosis of the fibula only, are described.

2. There is a gradation in the severity and significance of this condition. There may be fibular bowing without fibular pseudarthrosis; fibular pseudarthrosis without ankle deformity; fibular pseudarthrosis with deformity but without the late development of tibial pseudarthrosis; or fibular pseudarthrosis with the late development of tibial pseudarthrosis.

3. Proper management is dependent on a knowledge of this range of conditions.
THE EFFECT OF HYPERBARIC OXYGEN ON THE TRANSPLANTATION OF EPIPHYSIAL GROWTH CARTILAGE IN THE RABBIT
Authors: Calderwood J. W.
Published: February 2018

1. As previous experiments with autogenous transplantation of epiphysial growth plates have given limited success, a study was carried out on two groups of rabbits, one of which was given hyperbaric oxygen post-operatively in an attempt to improve the results.

2. Sixty-four New Zealand white rabbits had the distal ulnar growth plate transplanted from left to right and vice versa, giving a total of 128 transplants.

3. In the group of thirty-two rabbits given hyperbaric oxygen 48 per cent of the transplants were regarded as successful when examined histologically six weeks after operation, while in the control group the figure was 28 per cent.

4. This investigation suggests the clinical use of hyperbaric oxygen to improve the results of transplantation of growth cartilage.
EQUINUS DEFORMITY DUE TO HAEMANGIOMA OF CALF MUSCLE
Authors: Sutherland A. D.
Published: February 2018

Joint deformity secondary to extensive haemangiomatous involvement of the soft tissues has been well described and is easy to diagnose. If the haemangioma is small, localised and within the belly of a muscle the diagnosis is more difficult. In equinus deformity of obscure aetiology localised calf tenderness may be the only diagnostic sign. Three children with equinus deformity caused by a small haemangioma in the calf muscles were treated by simple excision with satisfactory results.
RESULTS OF TREATMENT OF SPINAL TUBERCULOSIS BY " MIDDLE-PATH" REGIME
Authors: Tuli S. M.
Published: February 2018

The efficacy of modern drugs in the treatment of tuberculosis of the spine has been evaluated by a personal follow-up for three to ten years. Operation on the vertebral lesion was done only for those patients with or without neural complications who failed to respond favourably to drug therapy and rest. Thus absolute indications for operation were present in only 6 per cent of cases without neural involvement and in 60 per cent of patients with neural deficit. Of the patients who responded to drug therapy alone, only 19 per cent revealed increase of kyphosis by more than 10 degrees. The diseased area showed radiological evidence of osseous replacement in 29.6 per cent of cases, of fibro-osseous union in 50 per cent and of fibrous replacement in 202 per cent. The overall results of this regime compare favourably with those of radical operation. It is suggested that freatment should in the first place be by modern antitubercular drugs.
A NEW LOOK AT OSTEOGENESIS IMPERFECTA
Authors: Bauze Robert J. , Smith Roger , Francis Martin J. O.
Published: February 2018

In a clinical, radiological and biochemical study of forty-two patients from Oxford with osteogenesis imperfecta, it was found that patients could be divided simply into mild, moderate and severe groups according to deformity of long bones. In the severe group (seventeen patients) a family history of affected members was uncommon and fractures began earlier and were more frequent than in the mild group (twenty-two patients); sixteen patients in the severe group had scoliosis and eleven had white sclerae; no patients in the mild group had white sclerae or scoliosis. Radiological examination of the femur showed only minor modelling defects in patients in the mild group, whereas in the severe group five distinct appearances of bone (thin, thick, cystic and buttressed bones, and those with hyperplastic callus) were seen. The polymeric (structural) collagen from skin was unstable to depolymerisation in patients in the severe group, but normal in amount, whereas the reverse was found in the mild group. This division according to long bone deformity may provide a basis for future research more useful than previous classifications.
A STUDY OF THE "CAPSULAR" SHADOW IN DISORDERS OF THE HIP IN CHILDREN
Authors: Brown Ian
Published: February 2018

Displacement and blurring of the soft-tissue shadows about the hip has been described in several conditions, particularly in transient synovitis. A study was made between such displacements and the posture commonly adopted by an "irritable hip". Examination of radiographs of normal hips, and of those in cases of transient synovitis and Perthes' disease showed that the appearance of "capsular swelling" is related to the position of lateral rotation and abduction. This was confirmed by anatomical dissections of the lateral plane, which appears to be an intermuscular plane lying anterior to the hip, and an explanation is given for the blurring which may accompany its lateral displacement. "Capsular swelling" appears to be a radiological artefact.
PHOSPHATE COMPOUNDS IN BONE SCANNING
Authors: Hughes S. P. F. , Jeyasingh K. , Lavender P. J.
Published: February 2018

Bone scanning with radioactive isotopes has been used to study a wide variety of disorders. Recently certain phosphate compounds, labelled with technetium, have been used as bone scanning agents. The comparative merits of three technetium-labelled phosphate compounds currently available for bone scanning–pyrophosphate, tripolyphosphate and ethylhydroxydiphosphonate (EHDP) have been compared in rabbits. Each substance was injected into ten rabbits and blood was withdrawn at regular intervals. The animals were killed at four hours and the blood and tissue samples were assayed for radioactivity. The results show that EHDP has a more rapid blood clearance than the other two agents, with a resultant improvement in the bone to soft-tissue ratio. Of the three substances investigated technetium-labelled EHDP was the best and might allow the technique of scanning to be used on a wide scale for the general study of bone and its pathology.
COBALT TOXICITY AFTER McKEE HIP ARTHROPLASTY
Authors: Jones D. Anthony , Lucas H. Keith , O"Driscoll Michael , Price C. H. G. , Wibberley B.
Published: February 2018

The significance of cobalt as a cause of symptoms after McKee hip arthroplasty is discussed. Seven patients are described in whom such arthroplasties became unsatisfactory after periods varying from nine months to four years. Six of these patients were cobalt-positive but nickel-and chrome-negative on patch testing. Macroscopic and histological necrosis of bone, muscle and joint capsule around the prostheses was found in five patients whose hips were explored. The symptoms were progressive pain, a feeling of instability, and in two cases spontaneous dislocation. Radiological features included acetabular fracture, bone resorption, loosening and dislocation of the prosthesis. Increased cobalt concentrations (determined by atomic absorption spectrophotometry) in the urine of four patients and in a variety of tissues in one patient are presented. Patch testing is recommended in the investigation of patients with troublesome McKee hip arthroplasties.
EWING'S TUMOUR
Authors: Macintosh D. J. , Price C. H. G. , Jeffree G. M.
Published: February 2018

Forty-seven histologically confirmed cases of Ewing's tumour are reported, with typical age, sex and skeletal distributions. The disease-free survival curves are like those for osteosarcoma of corresponding types of bone, but with higher mortality. The two-year disease-free survival rates were 24 per cent for tumours of long bones and 5 per cent for those of other bones. Osseous metastases were most frequent, although the lung was the commonest single site involved. There were secondary deposits in lymph nodes in nine patients, possibly also in four more with mediastinal enlargement. Although initially radiosensitive, one-third of tumours recurred locally, almost always with the appearance of metastases. Neither whole bone irradiation nor high dosage alone ensures complete control of the primary tumour, and it is suggested that recently reported improved results of treatment should be attributed to adjuvant multi-drug chemotherapy. Inadequate control of the primary tumour diminishes the chance of survival and for some sites radical operation merits reconsideration.
NIEVERGELT-PEARLMAN SYNDROME WITH IMPAIRMENT OF HEARING
Authors: Murakami Yukitomo
Published: February 2018

Three cases of the Nievergelt-Pearlman syndrome occurring in a family are presented. In addition to the major features of the syndrome (symphalangism, carpal fusion, atypical club foot with massive tarsal fusion, and congenital dislocation of the head of the radius), all three patients exhibited conductive deafness, which had not been recorded in previous reports. The clinical findings strongly suggested that the loss of hearing was due to fusion of the ossicles of the middle ear.
THE INCIDENCE AND PATTERN OF KNEE INJURY ASSOCIATED WITH DISLOCATION OF THE HIP
Authors: Gillespie W. J.
Published: February 2018

A retrospective survey of 135 posterior dislocations and fracture-dislocations of the hip was carried out in order to define the pattern of associated knee injuries. Thirty-five patients had sustained a significant injury to the knee, of which twenty-five were clearly attributable to a direct blow on the front of the knee (fractured patella, traumatic chondromalacia, fractures of femoral and tibial condyles) and ten were compatible with valgus, yams or rotational forces (medial, lateral and cruciate ligament tears). The second type of injury has not been widely recognised but it is important that it should not be overlooked.
DORSAL DISLOCATION OF THE FIRST METATARSO-PHALANGEAL JOINT
Authors: Giannikas A. C. , Papachristou G. , Papavasiliou N. , Nikiforidis P. , Hartofilakidis-Garofalidis G.
Published: February 2018

The anatomy of the first metatarso-phalangealjoint and of dorsal dislocation of the phalanx are described. As with similar lesions in the hand, closed reduction is impossible because of interposition of the volar plate. Open reduction is essential and should be performed as soon as possible after the injury.
FRACTURES OF THE CALCANEUS WITH DISPLACEMENT OF THE THALAMIC PORTION
Authors: Soeur Robert , Remy Robert
Published: February 2018

The thalamus is the part of the calcaneus that supports the posterior articular facet and continues forward, becoming thinner towards the groove of the sinus tarsi. The main displacements after fracture depend on 1) a primary fracture line dividing the bone into anterior and posterior fragments, and 2) a semilunar fragment in the thalamic region. In the operation advised the sinus tarsi is exposed and the semilunar fragment is reduced by rotation in the opposite direction and is fixed to the medial fragment (the sustenaculum tali not being displaced) by a transverse Kirschner wire. The two main fragments are fixed by an antero-posterior wire. Plaster is applied and is retained for twelve weeks. Weight-bearing is not permitted for the first four weeks. There were no major complications in fifty-eight operations. The anatomical results were good: restoration of the tuber-joint angle by reduction of the semilunar fragment was maintained. The functional results were very satisfactory: permanent disability was slight or mild.
INTERTROCHANTERIC OSTEOTOMY FOR OSTEOARTHRITIS OF THE HIP
Authors: Olsson Sven S. , Goldie Ian F. , Irstam Lars K. H.
Published: February 2018

A radiological review of two groups of intertrochanteric osteotomies of the femur for primary osteoarthritis of the hip has been made. Each group originally consisted of forty-one hips. In one group a Wainwright straight V-spline without compression had been used for fixation, and In the other group an AO angled plate with compression. The time for bony union was equal in the two groups but the incidence of non-union was lower in the AO group. Regression of cysts and of bone sclerosis was more frequent in the Wainwrlght group, possibly as a consequence of the greater medial displacement and varus angulation.
MORPHOLOGICAL CHANGES IN THE ARTICULAR CARTILAGE AFTER MENISCECTOMY
Authors: Lutfi A. M.
Published: February 2018

The medial meniscus was resected from the right knees of twelve young grivet monkeys that were killed at intervals of twenty-one to 252 days after operation. The knees operated upon and the control knees were investigated radiologically and histologically. Degenerative changes occurred in the medial femoral and tibial condyles. At first there was loss of cells from the superficial layer of the articular cartilage, with a marked decrease in the acid mucopolysaccharide content of the matrix. The chondrocytes in the deeper layer of the non-calcified zone proliferated to form clones before finally degenerating. The acellular cartilage showed splitting, and with progress of the degenerative process there was thinning and erosion of the cartilage. Eventually there was complete loss of articular cartilage with thickening and exposure of the subchondral bone. These degenerative changes were confined to a small area of the articular cartilage and had occurred despite regeneration of the meniscus. The rest of the cartilage looked normal. It is concluded that articular cartilage deprived of the protection of a meniscus may undergo arthritic changes.
Metaphysial dysostosis (Jansen type). Report of a case with long follow-up
Authors: Kikuchi S , Hasue M , Watanabe M , Hasebe K
Published: February 2018

A case of the Jansen type of metaphysial dysostosis, followed for fifteen years from childhood to the age of nineteen, is reported. Radiographs taken at five years revealed the characteristic metaphysial changes in all the tubular bones, especially those of the hands and feet. The acetabular and glenoid areas, the costochondral junctions and the sternal ends of the clavicles were also involved. Radiographs taken at nineteen years, however, showed only marked deformities, which shows that the involvement of the metaphyses can regress by the end of growth. Biopsy of the lower end of radius at the age of twelve revealed changes in the growth plate or physis, especially in the zone of resting cartilage. This finding suggests that cellular function in this zone is disturbed by some unknown mechanism. Hence, the term physial dysostosis may be more accurate than metaphysial dysostosis.