bluuebunny/crossref_metadata_2025 huggingface dataset:
PRIMARY INSTABILITY OF LUMBAR VERTEBRAE AS A COMMON CAUSE OF LOW BACK PAIN
Authors: Morgan Francis P. , King Thomas
Published: February 2018

1. Primary lumbar vertebral instability or "pseudo-spondylolisthesis" varies from about 3 millimetres to 1Â·7 centimetres, and is perhaps the commonest radiological sign associated with lumbo-sacral pain after the third decade of life. It was observed in 28Â·6 per cent of 500 consecutive cases of lumbo-sacral pain. The next commonest cause is gross disc degeneration, which is a late result of instability.

2. The secondary instability that may accompany a nuclear prolapse or osteoarthritis is excluded from this discussion.

3. This lumbar instability is an early sign of "incipient disc degeneration," occurring before narrowing of the disc space, sclerosis of the epiphysial rings, or osteophyte formation becomes evident. The instability in the lower lumbar region is caused by incomplete radial posterior tears, usually between the fourth and fifth lumbar vertebrae; and in the upper lumbar region from anterior concentric fissures or slits between some of the lamellae of the annulus fibrosus.

4. As shown radiologically, lumbar instability is commonest between L.4-5 and is rare between L.5 and sacrum because the facets between L.5-S.1 normally face forwards and backwards and thus resist anterior sliding.

5. The usual direction of antero-posterior sliding in the case of the upper four lumbar vertebrae is posteriorâthat is, the upper vertebra is displaced backwards on the one immediately below it during full extension in the erect position. The displacement tends to disappear on forced flexion, which may cause anterior displacement. On the other hand, the reverse displacement may exist between the fifth lumbar vertebra and the sacrum.

6. Operative treatment by bone grafting is a last resort in carefully selected individuals. After operation the patient rests in bed for three months without rigid splinting. Bone grafting is best for a localised lesion (affecting only one disc); it is generally not advisable if more than two discs are involved.

7. The results in thirty patients treated by spinal fusions showed that 70 per cent had no pain and resumed work, l3Â·3 per cent had improvement and resumed work, and l6Â·7 per cent were worse or no better.
FATIGUE FRACTURES OF THE LOWER TIBIA AND FIBULA IN THE SAME LEG
Authors: Murray David S.
Published: February 2018

1. A case is described of fatigue fractures occurring in the lowest thirds of the right tibia and fibula simultaneously.

2. The fibular fracture was a runner's fracture.

3. The tibial fracture was ascribed to the application of a below-knee walking plaster to treat the fibular lesion.

4. Both fractures were slow in uniting.

5. The fractures occurred in a rapidly growing youth but no clinical evidence of an endocrine dysfunction was found.
INCOMPLETE SPINAL CORD INJURIES
Authors: Taylor R. G. , Gleave J. R. W.
Published: February 2018

1. Twenty-seven patients with a Brown-SeÌquard syndrome resulting from trauma have been studied, fourteen of the left side of the cord and thirteen of the right. There were sixteen gunshot wounds and eleven closed injuries.

2. The prognosis for recovery is much better than the initial catastrophic nature of the symptoms and signs would indicate.

3. The pattern of recovery is discussed in detail and the long and rather tedious course of the treatment is indicated.

4. Spasticity on the side worse affected still presents a difficult problem, but a less severe one than that presented by flaccid paralysis.
METAPHYSIAL FRACTURES IN INFANCY
Authors: Weston W. J.
Published: February 2018

1. Three cases of metaphysial fractures in infants are described. Obstetrical trauma was probably responsible in two cases, and in the third case direct injury was admitted by the parents.

2. These fractures are associated with bone destruction and periosteal new bone formation in the metaphyses. They are important because they can be confused with syphilis, tuberculosis, scurvy, osteomyelitis and neoplasm.

3. The fractures respond to conservative treatment and usually heal rapidly in a matter of weeks.
POTT'S PARAPLEGIA IN THE NIGERIAN
Authors: Jones B. S.
Published: February 2018

1. The results of treatment of 115 patients with Pott's paraplegia during a six and a half year period are reviewed.

2. The indications for operative interventionâin particular antero-lateral decompressionâ according to the duration, grade and type of paraplegia, are discussed.

3. No attempt has been made to justify the treatment of individual patients in the series, some of whom would undoubtedly have benefited from earlier operation; but lessons are pointed and conclusions drawn from the results, good and bad.
SPINAL TUBERCULOSIS IN SOUTHERN NIGERIA
Authors: Konstam Peter G. , Konstam Sheila T.
Published: February 2018

1. In Nigeria, among the sites affected by tuberculosis of bones and joints there is especial frequency in the lumbo-thoracic junction from the tenth thoracic to the fourth lumbar vertebrae.

2. Outstanding in the pattern of the disease in adults is a tendency in certain patients to ossification of the spinal ligaments.

3. An ambulatory out-patient reÌgime is described. So far it has promised well.
HYPOPHOSPHATASIA
Authors: Dickson W. , Horrocks R. H.
Published: February 2018

1. A case of hypophosphatasia in a boy who sustained a fractured left femur is described.

2. The literature is reviewed, and the reported cases are found to fall into severe, moderately severe and mild forms.

3. The diagnostic features of the disease are the radiological picture, which resembles that of rickets, very low serum alkaline phosphatase, and excessive phosphoethanolamine excretion in the urine.

4. Other clinical features may be a failure to thrive in early infancy, premature loss of deciduous teeth, hypercalcaemia and renal damage.

5. The function of alkaline phosphatase in bone metabolism in relation to this disease has been discussed.
DIAPHYSO-EPIPHYSIAL RESECTION FOR BONE TUMOUR AT THE KNEE
Authors: D'aubigneÌ R. Merle , Dejouany J. P.
Published: February 2018

1. An operation to re-establish the continuity of the bone after resection of tumours of the lower end of the femur or upper end of the tibia is described.

2. Sound bony union may be obtained, allowing walking with weight bearing after three to four months.

3. The combination of a massive tibial or femoral graft (Juvara procedure) with an intramedullary nail, a massive homogenous graft, and fixation of the patella to the autograft to accelerate its revascularisation. has given constant and rapid bony union in five cases.

4. This possibility gives real value to wide resection in the treatment of severe cases of giant-cell tumours. especially those that are recurrent. osteolytic or suspect of malignancy.

5. Its value in the treatment of sarcoma cannot be assessed in so short a series.
NOTES ON A RARE CASE OF ESSENTIAL OSTEOLYSIS
Authors: Branco Francisco , da Silva Horta J.
Published: February 2018

1. A case of essential osteolysis, progressing for thirteen years and involving the right femur and pelvis of a boy who was thirteen years old at the time of onset, is presented.

2. The histological appearance of fragments of bone and soft tissue removed from the affected thigh is described.

3. No evidence that might throw light on the etiology of the disease was obtained from biochemical investigations or from the histological studies.

4. None of the many lines of treatment that were tried had any effect upon the progress of the disease.
TRANSPOSITION OF GLUTEUS MAXIMUS, TENSOR FASCIAE LATAE AND ILIO-TIBIAL BAND FOR PARALYSIS OF LATERAL ABDOMINAL MUSCLES IN CHILDREN AFTER POLIOMYELITIS
Authors: Axer Anatol
Published: February 2018

1 . An operation for strengthening the lateral abdominal muscles in children after poliomyelitis is described. It consists of transposition of the proximal part of the gluteus maximus, the tensor fasciae latae and the ilio-tibial band ("the pelvic deltoid" of Henry) to a chosen rib.

2. The results of this operation in eight consecutive cases of paralytic scoliosis, pelvic obliquity and thoraco-pelvic instability are assessed.

3. A "strong" motor allows the child to lift the pelvis against gravity, whereas with a "weak" motor the child is unable to do so efficiently. However, even a "weak" musculotendinous tendinous unit helps invariably in restoring the thoraco-pelvic stability, just as a weak "hamstring-into-patella" transplant stabilises the knee.

4. Those motors (gluteus maximus with or without tensor fasciae latae) that contract vigorously and move the free end of the ilio-tibial band for at least three centimetres on direct faradic stimulation with a bipolar electrode during the operation become ultimately strong and most efficient.

5. The unreliability of the clinical test of tensor fasciae latae in small children is discussed, and the advantage of using the gluteus maximus as the motor for the musculo-tendinous unit is emphasised.

6. Using the proximal half (or less) of the gluteus maximus for strengthening the lateral abdominal muscles does not seem to affect appreciably the strength of hip extension. This phenomenon may be explained with reasonable probability by the existence of a twofold insertion of that muscle.
PAROSTEAL OSTEOGENIC SARCOMA OF BONE
Authors: Weston W. J. , Reid J. D. , Saunders J. H.
Published: February 2018

1 . A case of parosteal osteoma with histologically low-grade sarcomatous areas is described.

2. Arteriography revealed abnormal arteries, the histological appearances of which are described.

3. Vascular shunts indicative of low-grade malignancy were also seen.

4. Reasons are given for accepting the view that this lesion is a tumour, originally benign, but liable to the development of low-grade malignancy.
A AND B ANTIGENS IN HUMAN BONE TISSUE
Authors: Weinberg Haim , Makin Myer , Nelken David , Gurevitch Joseph
Published: February 2018

1 . Sloughing of homogenous skin grafts and clouding of corneal transplants have been shown to be due to antigen-antibody reaction; antigens A and B have been demonstrated in human epidermis and corneal tissue; and anti-red-cell agglutination has been observed in dogs after homogenous bone transplantation. Human bone was therefore examined in thirty-three experiments to determine the presence or absence of A and B antigens.

2. The bone was separated into hard cortical bone, hard washed cancellous bone and soft-tissue washings of bone.

3. Adsorption experiments showed that A and B antigens are absent from cortical bone. A and B antigens are present in cancellous bone.
TRANSPLANTATION IMMUNITY IN BONE HOMOGRAFTING
Authors: Chalmers John
Published: February 2018

1 . Fresh bone autografts to a muscle bed in the rat gave rise to vigorous new bone formation from about the fourth day. The graft took the form of a hollow ossicle with central bone marrow at eighteen days: it became progressively more regular in outline and was still present at six months.

2. Fresh bone homografts produced two separate phases of new bone formation–early and late. In the early phase non-lamellar woven bone appeared at about the fourth day, continued to grow until eight days, and subsequently died. It arose from osteogenic cells of the homograft. In the late phase, which developed in relation to a few grafts after four weeks, the new bone was lamellar in character, and remained closely applied to the graft surface. Evidence is presented that this bone arose by metaplasia of the host connective tissues at the graft site. There was a local inflammatory response to the bone homograft.

3. Both phases of homograft new bone formation were abolished if the animal was prepared by a skin homograft from the same donor four weeks before, but not if four months elapsed between the two grafting procedures.

4. Freeze-dried bone homografts did not give rise to the early phase of homograft new bone but produced a few examples of the late phase after five months. The inflammatory response was less intense with freeze-dried homografts than with fresh homografts.

5. Skin homografts three weeks after fresh bone homografts from the same donor underwent an early rejection at five to six days.

6. Skin homografts three weeks after freeze-dried bone homografts from the same donor had a mean survival time of twelve days, which was significantly longer than the mean survival time of l0·9 days in normal rats.
OSTEOTOMY OF THE CALCANEUM FOR PES CAVUS
Authors: Dwyer F. C.
Published: February 2018

1 . A new surgical approach to the treatment of pes cavus is suggested. The operation consists in a subcutaneous division of the contracted plantar fascia and correction of the varus deformity of the heel by removing a wedge from its lateral aspect. It is submitted that, by approaching the deformity from behind and overcoming the varus of the heel, the foot is rendered plantigrade and that thereafter weight bearing exerts a corrective influence which results in progressive improvement of the deformity. The operation is essentially a prophylactic one and, for the best results, it should be performed before there is gross structural deformity and while active growth is still taking place.

2. Even in patients over the age of fourteen, improvement is obtained by doing nothing more than this simple operation. In the presence of fixed deformity of the forefoot, as encountered in older patients, inversion is corrected by removing a lateral wedge from the calcaneum and the cavus by taking a dorsal wedge from the tarso-metatarsal region. This has the double advantage of producing good correction of deformity, while at the same time preserving movement at the mid-tarsal-subtalar joint. Fixed clawing of the toes will require appropriate corrective treatment, but if the toes are malleable the simple effect of weight bearing on the plantigrade foot produces gradual correction.
OBSERVATIONS ON THE AMBULANT CORRECTION OF THORACIC SCOLIOSIS AND KYPHOSIS WITH PARTICULAR REFERENCE TO THE EXPERIMENTAL USE OF HYDROSTATIC PRESSURE
Authors: Bremner R. A.
Published: February 2018

1 . The theoretical requirements for optimal correction of thoracic scoliosis and kyphosis are discussed, and observations are made on the limitations of methods in current use for their ambulant correction.

2. The experimental use of hydrostatic pressure in an endeavour to satisfy these clinical requirements is described.

3. It is suggested that the use of hydrostatic pressure as the source of corrective force has considerable advantages, and that, with refinements, the techniques described may prove a useful addition to rigid mechanical methods of correction.
THE RADIOGRAPHIC CHANGES IN PERTHES' DISEASE
Authors: O'Garra J. A.
Published: February 2018

1. The progressive radiographic changes in twenty-five patients suffering from Perthes' disease of the hip are described.

2. The prognostic value of lateral views of the hip is emphasised, and the present concepts of pathogenesis in the light of recent observations are discussed.
CONGENITAL DYSPLASLA OF THE HIP
Authors: Leffmann Rudolf
Published: February 2018

1. Eighty infants with congenital dysplasia of the hip, diagnosed before walking began, are reviewed.

2. The clinical and radiographic features of congenital dysplasia are described.

3. A dysplastic hip may either become normal spontaneously, or it may deteriorate to the state of true dislocation.

4. Treatment is discussed.
AN ANOMALOUS EXTENSOR INDICIS MUSCLE
Authors: Jones B. Victor , Ipswich R. N.
Published: February 2018

1. A case is described in which the extensor indicis tendon was replaced by a short muscle arising from the soft tissues on the dorsum of the wrist.

2. The patient complained of pain in the hand after heavy use. This was considered to be due to constriction of the muscle by the extensor retinaculum. Division of the retinaculum was followed by a considerable improvement in his symptoms.
THE NORMAL VASCULAR SUPPLY OF THE VERTEBRAL COLUMN IN THE GROWING RABBIT
Authors: Amato V. P. , Malta Sliema , Bombelli R.
Published: February 2018

The blood supply of the vertebral column of the rabbit has been studied. A description of the embryological development of the blood supply is followed by a description of the blood vessels supplying the adult vertebra.
THE EFFECT OF CRUDE PAPAIN ON THE EPIPHYSIAL CARTILAGE OF LABORATORY ANIMALS
Authors: Hulth Anders , Westerborn Olle
Published: February 2018

The present investigation has shown that crude papain can be used to produce rapid changes in the epiphysial cartilage of various young laboratory animals (rabbits, mice, rats, guinea pigs and cats).

1. Single injections of crude papain produce profound changes in the epiphysial cartilage. These changes disappear within a few days. They are radiographically visible as a narrowing of the epiphysial plates. Histologically, the formation of bony trabeculae in the primary spongiosa is found to be arrested.

2. Repeated injections of crude papain cause permanent damage to the epiphysial cartilage, often with bony closure. Consequently, the longitudinal growth of the injected animals, when compared to the controls, is found to be retarded or permanently arrested, and there may be severe bony deformity.

3. Using inactivated crystalline papain, we have been able to produce changes in the epiphysial cartilage identical with those caused by the injection of crude papain.

4. The injection of crude papain is dispelled by the addition of cysteine, but retains its full strength if hydrogen peroxide is added.
CALCIFICATION IN VITRO AND PHOSPHATASE ACTIVITY
Authors: Burger Martin , Sobel Albert E.
Published: February 2018

The alkaline phosphatase activity of pre-osseous tibial cartilage of rachitic bone stored in the deep freeze for two weeks at -25 degrees centigrade was only slightly less than that of fresh controls from the same animals. The deep frozen pre-osseous tissue did not calcify in in vitro calcifying media containing either inorganic phosphorus or organic phosphate ester. The fresh controls calcified equally well in both media. In addition, after deep-freeze storage the tissue hydrolysed the organic phosphate to the same degree as did the fresh tissue.

Bones heated at 65 degrees centigrade will calcify in vitro after calcium chloride treatment despite the destruction of phosphatase activity.

It appears unlikely that a relationship exists between alkaline phosphatase and the minimal system required for calcification of pre-osseous cartilage in vitro. These findings do not exclude the possibility that alkaline phosphatase plays some critical role in vivo.
ARTHROPLASTY OF THE KNEE
Authors: Shiers L. G. P.
Published: February 2018

1. The results of twenty-eight "hinge" arthroplasties of the knee are described.

2. Failure was most often due to breaking of the prosthesis.

3. The design of the prosthesis has been modified as a result of experience in cases of mechanical failure.

4. The results suggest that with the use of the modified hinge good results may be obtainable in three out of four cases.
VERTEBRAL GROWTH AND ITS MECHANICAL CONTROL
Authors: Roaf Robert
Published: February 2018

1. Some of the factors responsible for vertebral growth have been discussed.

2. In kyphosis and scoliosis it is important to prevent progressive epiphysial damage.

3. In selected cases of progressive scoliosis, epiphysiodesis on the convex side will correct unequal growth.

4. The technique of spinal epiphysiodesis is described and the results that may be expected are discussed.
A MODIFIED LAMBRINUDI OPERATION FOR DROP FOOT
Authors: Bényi Paul
Published: February 2018

A modified Lambrinudi arthrodesis is described which has given excellent results in forty-two out of the forty-four operations for the severest types of club foot.
A DIRECT LATERAL APPROACH TO THE LATERAL COMPARTMENT OF THE KNEE JOINT
Authors: Bruser D. M.
Published: February 2018

A description is given of a direct approach to the lateral compartment of the knee with the joint fully flexed. This approach has been found useful for excision of cysts of the lateral cartilage, but is also applicable to excision of the lateral cartilage for tear.
CHARNLEY STABILISATION OF THE HIP
Authors: Mortens J. , Jensen E.
Published: February 2018

The results of Charnley stabilisation of the hip in forty-three patients observed for one to four and a half years are reported. The operation readily produced a bony fusion in young patients and also in some of the older ones. Fibrous ankylosis, with or without some movement in the joint, gave an excellent result. Even when a pseudarthrosis or a stress fracture occurred, the clinical result often showed a definite improvement. Only three patients did not benefit from the operation, though none of these showed any significant increase in their disability.
ULNAR DIMELIA
Authors: Harrison R. G. , Pearson M. A. , Roaf Robert
Published: February 2018

Three cases of ulnar dimelia, one in an adult, are described and reference is made to earlier reported cases. The etiology of the condition is discussed.
OSTEOSCLEROSIS AFTER INTERMITFENT ADMINISTRATION OF LARGE DOSES OF VITAMIN D IN THE RAT
Authors: Storey E.
Published: February 2018

When large daily doses of vitamin D were administered to rats endochondral growth was inhibited and bone resorption occurred; later in the process uncalcified matrix (osteoid) like that seen in rickets formed on trabecular margins. When vitamin D was given only for a short period and then discontinued, little resorption of bone was seen during the withdrawal period and wide seams of osteoid material appeared which eventually calcified in an irregular manner. When normal endochondral growth was resumed a wide transverse band of dense bone with enclosed cartilaginous cores was left in the marrow cavity. If, after a few days, a second large dose of the vitamin was given resorption again occurred and calcification of osteoid material was accelerated, the first microscopic sign being a dense, wide, granular, deeply staining line at the junction of the bone and new osteoid. After a second withdrawal period a second layer of osteoid formed; eventually another transverse band appeared in the metaphysis. If this hypervitaminosis D cycle (+4 -12) was continued rats continued to form new bone with relatively little remodelling, so that after three such cycles bones became dense and hard.

Histological study showed that little marrow cavity remained in either skull, vertebrae or epiphyses and a dense mass of bone enclosing cartilage cores filled the metaphysial part of the long bones. In addition, ankylosis ofteeth, calcification of spinal ligaments and widespread metastatic calcification were present.

When hypervitaminosis D cycles (+1 -12, +1 -21) were adjusted to produce minimal resorptive changes a wide range of bone change was observed. This varied from uniform dense metaphysial bone containing abnormal cartilage matrix arranged in longitudinal striations, dense transverse bands parallel to the epiphysial cartilage, to remnants of dense trabeculae extending into the marrow cavity.

Bone changes in osteopetrosis structurally closely resembled the induced bone changes in the rat. It is concluded that an important mechanism in the production of osteopetrosis is an accentuated rhythm of bone change like that shown experimentally to be produced in these animals. It is emphasised that these changes are but part of a range of bone disorders associated with abnormalities of cycles of resorption and deposition of bone, the type of change differing with the nature of the cycles.
ANALYSIS OF FORCES PRODUCING FRACTURES OF THE PROXIMAL END OF THE FEMUR
Authors: Hirsch Carl , Frankel Victor H.
Published: February 2018

1. If a vertical load is applied to the head of the femur parallel to its shaft, the upper cortex is stretched and the lower cortex is compressed. The neck breaks from the upper subcapital border to the lesser trochanter. This type of fracture is rarely found clinically.

2. If a compressive force is applied to the area between head and greater trochanter while the head is loaded vertically, a transverse fracture of clinical appearance is produced. If this axial pressure acts along the part of the neck above the central axis a subcapital comminuted fracture results. If the pressure acts below the central axis the result is a transcervical fracture.

3. Strain gauge experiments have shown that axial compression within the upper segment of the neck is produced by the abductor muscles of the hip. Adductor muscles produce a low axial compression. It is suggested that muscular action at the time of injury influences the type of fracture produced by the injury.
SIMULTANEOUS POSTERIOR DISLOCATION OF BOTH SHOULDERS
Authors: Shephard Edmund
Published: February 2018

A case of simultaneous posterior dislocation of both shoulders, occurring in an epileptiform fit, is described. Manipulative reduction succeeded after five days, and full function was gained.
NEUROPATHIC JOINTS IN DIABETES
Authors: Degenhardt Donald P. , Goodwin Martin A.
Published: February 2018

Two cases of neuropathic joints in diabetes mellitus are described. The condition, though rare, must be kept in mind in diabetes with neuropathy. With proper control of the diabetes and supportive measures to the joints the prognosis is relatively good.
CARPO-METACARPAL DISLOCATION
Authors: Shephard Edmund , Solomon D. J.
Published: February 2018

Four cases of carpo-metacarpal dislocation are described. In one case all five metacarpals of one hand were involved.
THE BLOOD SUPPLY OF THE FEMORAL NECK AND HEAD IN RELATION TO THE DAMAGING EFFECTS OF NAILS AND SCREWS
Authors: Brodetti Alfredo
Published: February 2018

1. Sixteen injected specimens of human femoral heads and necks, in which a nail or screw had been inserted, were examined.

2. The possibility exists that the fixing agent may interfere with the blood supply of the femoral head. The likelihood of this occurrence is not great.

3. The position of the fixing agent in which vascular damage is least likely is the central area or "neutral zone" of the femoral neck and head.
CELL DIVISION IN ENDOCHONDRAL OSSIFICATION
Authors: Kember N. F.
Published: February 2018

1. The pattern of tritiated thymidine labelling in the cells of the epiphysial cartilage and metaphysis of the tibia in the rat is described for intervals of one hour to twenty-eight days after injection.

2. The region of dividing cells is defined and evidence given for a zone of reserve cells at the top of the cartilage columns.

3. The difficulties of quantitative grain count studies are discussed, and some approximate values are given for the generation time and mitotic cycle periods of the cartilage plate cells.

4. Some further evidence is given about the life cycles of the osteoblast and the osteoclast.
CALCAREOUS DEPOSITS ABOUT THE METACARPO-PHALANGEAL JOINTS
Authors: Pollen A. G.
Published: February 2018

1. Previous reports of calcareous deposits about the metacarpo-phalangeal joints are reviewed, and four further cases are described.

2. The clinical features are described, with reference to the possibility of erroneous diagnosis.

3. Conservative treatment is recommended.
INTRATHECAL SPINAL TUMOUR AS A CAUSE OF COCCYDYNIA
Authors: Houlding R. Neville , Matheson A. T.
Published: February 2018

1. Coccygeal pain in a young man, persisting for ten years in all and for seven years after partial removal of the coccyx, was shown to be due to an intrathecal tumour of the cauda equina.

2. Removal of the tumour, which was found to be an ependymoma, gave complete relief.
ASSESSMENT OF VERTEBRAL OSTEOPOROSIS BY RADIOGRAPHIC AND CHEMICAL METHODS POST-MORTEM
Authors: Caldwell R. A. , Collins D. H.
Published: February 2018

1. Radiological, chemical and histological examinations have been made of the lumbar vertebral bodies in 100 necropsies on patients dying in a general hospital, with a view to determining the range of variation of calcium content and radiographic density in normal and osteoporotic bone.

2. Radiographs were made of sagittal mid-line vertebral body slabs uniformly one centimetre in thickness, and the radiographic density of these specimens was measured in relation to an aluminium step-wedge of one to ten units. Radio-opacity of different vertebrae ranged from four to ten units. The specimen radiographs also clearly revealed the trabecular structure and the lateral profile of the bones.

3. Calcium was chemically estimated and expressed as weight of the element per unit volume of the whole bone mass (that is, of anatomical bone including soft marrow tissue). It ranged from 38 to 102 milligrams per cubic centimetre of bone. In 75 per cent of the cases the range was 50-84 milligrams per cubic centimetre. High calcium values were mostly encountered in young adults, and the calcium per unit volume tended to diminish with age; but a wide range of calcium was still encountered in the older subjects and a better correlation with age was achieved by radiographic density. Both calcium content and radiographic density tended to be higher in the male than in the female bones at all ages.

4. The results of both calcium and radiographic density showed a smooth distribution curve, though skewed through the inclusion in the series of more older people with less mineralised bones; the absence of a double peak in these curves suggests that the examinations were made on a homogeneous population and does not indicate a separate pathological group of osteoporotic subjects.

5. Arbitrary standards must be used to distinguish osteoporotic from normal bones, since neither radiological measurement or chemical assay, nor histological assessment, reveals a point at which the two groups can be separated. In the present series it seemed to us satisfactory to regard as abnormal all bones showing a radiographic density of five or less step-wedge units, and by this standard nineteen of the 100 cases (eight male, eleven female) were deemed to be osteoporotic. Histological examination excluded other forms of bone rarefaction.

6. The regression of calcium on the density measurements proved to be statistically significant and was not affected either by age or by the number of days in bed during the last illness. A small difference between the sexes was apparent, there being slightly less calcium in female than in male bones of equal radiographic density. Provided this is taken into account, the radiographic density scale can be used to predict the calcium content of vertebral bone specimens and should prove a rapid and accurate method in a survey of osteoporosis in post-mortem room material.
THE MECHANICAL DISTURBANCES RESULTING FROM LUMBAR DISC SPACE NARROWING
Authors: Jonck L. M.
Published: February 2018

1. In this investigation one was impressed by the close relationship that exists between the constituent parts of the intervertebral discs and the surrounding supporting structures. The part that is responsible for the maintenance of a co-ordinated balance between these structures, and hence for the effective mechanism of the spine, is the nucleus pulposus.

2. The cruciate arrangement of the annulus fibrosus is related to spinal function, and the angle of intersection of consecutive laminae of the annulus fibrosus is more or less constant.

3. In the Bantu it was found that the interspinous and supraspinous ligaments differ from the classical descriptions given in anatomical text-books.

4. The movements taking place between two vertebrae are comparable to those of a rocking-horse.

5. Narrowing of a disc is a progressive process which is the result of the disturbances in the balance between the components of the force to which a disc is subjected. The process is initiated by the loss of nucleus pulposus content.

6. With the approximation of two adjacent vertebrae a disturbance of the relations of the structures in the intervertebral foramen was noted. On anatomical grounds, when a disc is narrowed it appears that the most likely structures to cause pressure on the nerve root are not the disc itself, but the superior articular processes with their overlying ligamentum flavum.
AVASCULAR NECROSIS AFTER SLIPPING OF THE UPPER FEMORAL EPIPHYSIS
Authors: Lowe H. G.
Published: February 2018

1. Avascular necrosis of the bony epiphysis or necrosis of the articular cartilage of the hip joint–without bony necrosis–can occur after a slipped upper femoral epiphysis.

2. In avascular necrosis of the bony epiphysis the prognosis depends upon the degree of revascularisation that occurs and upon survival of the articular cartilage. The articular cartilage can survive and a good functioning hip result especially if aided by mobilisation without weight bearing.

3. The prognosis after necrosis of the articular cartilage is poor. This complication occurs more often when conservative treatment is used.

4. A certain number of hips will show poor results no matter what treatment is used.

5. Nutrition of the articular cartilage is probably by the synovial fluid.

6. Strong traction may damage the soft-tissue structure of the hip joint.

7. It is not advisable to perform an osteotomy soon after a slip of the epiphysis. It is better to wait until good function is assured in the joint.
TIBIAL OSTEOTOMY FOR OSTEOARTHRITIS OF THE KNEE
Authors: Jackson J. P. , Waugh W.
Published: February 2018

1. The results are presented of upper tibial osteotomy carried out in ten patients for osteoarthritis of the knee associated with lateral deformity.

2. The operation is indicated when there is severe pain, valgus or varus deformity, and a range of flexion of at least 90 degrees.

3. In every case pain has been relieved, and recovery of movement after operation has been easy.
THE ROLE OF SPINAL AND ABDOMINAL MUSCLES IN THE PATHOGENESIS OF SCOLIOSIS
Authors: Zuk Tomasz
Published: February 2018

It is concluded that the development of scoliosis is due to muscle imbalance, the weaker muscles being on the convex side of the curve. It is suggested that the increased electrical activity in the muscles on the convex side is secondary to the scoliosis, being part of the body's attempt to compensate for the curvature.
KELLER'S ARTHROPLASTY MODIFIED
Authors: Thomas F. Brian
Published: February 2018

1. A modification of the Keller's arthroplasty is described, in which one of two types of distractor–intramedullary wire and external staple–is used to maintain normal length of the great toe for three weeks after operation.

2. The results of the modified operation are analysed. They appear to show that the use of a distractor can be expected to produce an improved end result and to aid post-operative wound healing.

3. The possible reasons for the improvement in results are discussed.

4. The intramedullary wire and the external staple are compared with respect to ease of introduction, effectiveness in maintaining distraction and end results.
MUSCLE ACTION AND THE SHAPE OF THE FEMUR
Authors: Brookes M. , Wardle E. N.
Published: February 2018

1. Femoral neck deformities that developed in patients under clinical observation are described.

2. Experiments made on ten decalcified femora produced similar deformities.

3. The two sets of observations are correlated and discussed with reference to the role of muscular imbalance in the causation of deformities of the femoral neck.
CAUSES AND TREATMENT OF NON-UNION IN FRACTURES OF THE RADIUS AND ULNA
Authors: De Buren N.
Published: February 2018

1. The age of the patient has no influence on the incidence of non-union in fractures of the forearm in adults.

2. The degree of displacement of the fracture is an important factor in non-union, and is related to the violence of the injury.

3. Fractures of one bone unite better than fractures of both bones, and this is due to the stabilising effect of the intact bone.

4. Open and comminuted fractures have a much higher incidence of non-union.

5. The lowest incidence of non-union, allowances being made for other significant factors, was in cases treated conservatively; and after that in cases treated by plating followed by immobilisation in plaster.

6. Plating without subsequent immobilisation in plaster is a method to be abandoned, but there is some advantage in waiting for ten days, until post-operative oedema has been absorbed, before applying the plaster.

7. In cases in which several factors predisposing to non-union are present in the same patient, it seems justifiable to supplement plating by cancellous onlay strips as a primary procedure.

8. In cases of non-union the cancellous insert graft described by Nicoll succeeded in 94·5 per cent of the cases, many of which were exceptionally difficult problems. In 75 per cent union occurred within four months of grafting.

9. The restoration of mobility, either after union of the fracture or after grafting operations, was never a serious problem in the present series.
CHONDROECTODERMAL DYSPLASIA
Authors: Ellis R. W. B. , Andrew J. Douglas
Published: February 2018

Since this paper was submitted for publication three additional reports have appeared, two of which represent typical examples of the syndrome. Husson and Parkman (1961) reported the case of a female infant dying at the age of four months with chondroectodermal dysplasia, obliteration of the upper labiogingival sulcus, and congenital heart disease. The heart lesions included anomalous pulmonary venous return, single atrium and a persistent left superior vena cava. There was no known consanguinity. In reviewing the cardiac lesions described in chondroectodermal dysplasia they include another case with anomalous pulmonary venous return described by Darling, Rothney and Craig (1957), which also showed chondroectodermal dysplasia and polydactyly, though details of the extracardiac malformations are not given. Nabrady (1961) described a four-year-old Hungarian girl with ectodermal defects involving the teeth and nails but not the hair, polydactyly, distal shortening of the extremities producing dwarfing, and typical radiological appearances of the long bones. There was presumptive evidence of a septal defect of the heart. There was no consanguinity, but the mother was considered to show a "forme fruste" of the condition. A necropsy report by Meitner (1961) of a newly born premature infant with multiple congenital malformations of organs of ectodermal, mesodermal and endodermal origin is of interest because these malformations included extreme polydactyly of hands and feet, absence of nails, chondrodysplasia, and trilocular heart. In many respects, however, the case is atypical of chondroectodermal dysplasia.
THE PROSTHETIC MANAGEMENT OF A CASE OF ESSENTIAL OSTEOLYSIS
Authors: Vitali M.
Published: February 2018

1. A case of essential osteolysis previously reported in this Journal is recalled briefly and its subsequent course is outlined.

2. A successful prosthesis is described which has enabled the patient to lead a relatively normal life.
SPINAL DYSRAPHISM
Authors: James C. C. Michael , Lassman L. P.
Published: February 2018

1. A syndrome resulting from congenital lesions affecting the spinal cord and cauda equina, associated with spina bifida occulta, is described.

2. The syndrome consists of a progressive deformity of the lower limbs in children. One foot and the same leg grow less rapidly than the other. The foot develops a progressive deformity which begins as a cavo-varus and becomes a valgus one. Both lower limbs may be affected. There may be progression to sensory loss, trophic ulceration, disturbance of function of bowel and bladder and even paraplegia.

3. Methods of investigation including myelography are described.

4. Exploration of the spinal cord has been undertaken in twenty-four patients so affected. Extrinsic congenital lesions causing traction or pressure or a combination of traction and pressure on the spinal cord have been found in twenty-two of these.

5. In two-thirds of the patients some degree of improvement has followed operation.
ACUTE HAEMATOGENOUS OSTEOMYELITIS
Authors: Gilmour William N.
Published: February 2018

1. A series of 328 cases of acute haematogenous osteomyelitis in children is analysed.

2. In the first group ofseventy-seven cases from 1944 to 1950 penicillin gave excellent results.

3. After 1950 the disease took on new characteristics in terms of frequency, severity and age incidence, with the appearance of a staphylococcus resistant to penicillin: 251 cases are recorded from 1951 to 1960.

4. The importance of the early assessment ofthe disease into degrees of severity is emphasised as the surgeon's guide in his form of management.

5. The value of operative decompression is discussed.

6. The frequent and dire consequences of hip joint involvement are analysed and draillage of the hip joint is described.
SPONTANEOUS DISAPPEARANCE OF NEUROBLASTOMA WITH MATURATION TO GANGLIONEUROMA
Authors: Eyre-Brook A. L. , Hewer T. F.
Published: February 2018

A three-month-old girl presented with a massive abdominal tumour arising from the right lumbar region. Microscopic examination of a biopsy specimen showed a typical neuroblastoma. No treatment was given except that necessary symptomatically for paralysis caused by compression of the cauda equina. Spontaneous regression was accompanied by maturation to a small ganglioneuroma, found at necropsy examination at the age of ten years. Death was from urinary infection due to a persistent neurogenic bladder.
THE TOURNIQUET IN SURGERY
Authors: Klenerman L.
Published: February 2018

The history of surgery is to a large extent written around the record of its technical advances. A pneumatic tourniquet is a humble instrument, when compared with many of the more complicated mechanical devices in the modern operation theatre. Nevertheless, it has played a significant role in making possible the precise operations of present-day orthopaedics. Simple tool though the tourniquet may be, its application carries many potential dangers, and it should only he entrusted to skilled hands.
RETROSTERNAL DISLOCATION OF THE CLAVICLE
Authors: McKenzie Jean M. M.
Published: February 2018

1. Two patients with retrosternal dislocation of the clavicle are reported.

2. A method of closed reduction is described.

3. Diagnosis, and the interpretation of oblique radiographs of the sternoclavicular joint, are described.
THE EFFECT OF IMPLANTING VARIOUS SUBSTANCES INTO ARTIFICIALLY CREATED CIRCUMSCRIBED DEFECTS IN RAT FEMURS
Authors: Melcher A. H. , Irving J. T.
Published: February 2018

1. The effect of implanting heterogenous anorganic bone, homogenous organic bone, autogenous compact bone from the iliac crest, and autogenous bony callus into circumscribed defects in the femur of albino rats of the Wistar strain is described.

2. Neither heterogenous anorganic bone nor homogenous organic bone appeared to induce new bone formation in a healing defect.

3. Some of the osteogenic cells of autogenous callus implants survived transplantation to a bone defect and gave rise to new bone formation. This did not occur when compact bone from autogenous iliac crest was implanted.

4. Implants of autogenous callus, autogenous compact bone, homogenous organic bone and heterogenous anorganic bone all impeded the normal development of host bone trabeculae in a healing bone defect, seemingly because they acted as physical barriers to the proliferating host callus. None of the implant materials appeared to suppress the healing reaction ofthe host.

5. Implanted homogenous organic bone was removed and replaced by host bone more quickly than was implanted heterogenous anorganic bone, and it appears to be the better material for grafting into bone defects.

6. Autogenous callus or autogenous cancellous bone is a superior implant material to autogenous compact bone and is the bone graft material of choice.

7. The absorption of all the implant materials used in this investigation was associated with the presence of multinucleated giant cells.

8. The activity of multinucleated giant cells may be influenced by the organic matrix of the material which is to be absorbed.

9. Except when fresh autogenous callus was implanted into the defects, the rate of healing in the grafted defects was slower than that in the control defects. In the defects grafted with fresh autogenous callus the healing rates of the control and grafted defects were the same.
AN UNUSUAL CASE OF METAPHYSIAL DYSPLASIA
Authors: Theodorou S. D. , Adams J.
Published: February 2018

1. A case of metaphysial dysplasia observed for eleven years is reported.

2. Only one case with similar features has previously been reported.

3. The literature on the subject is reviewed.
CLICKING ELBOW FROM A TORN ANNULAR LIGAMENT
Authors: Wightman J. A. K.
Published: February 2018

A case of "clicking elbow" is described in which at operation the clicking appeared to be due to a"bucket handle" type of lesion of the annular ligament. Excision of the separated part of the ligament abolished the clicking.
STUDIES IN THE TRANSPLANTATION OF BONE, V. The Capacity of Fresh and Treated Homografts of Bone to Evoke Transplantation Immunity
Authors: Burwell R. Geoffrey
Published: February 2018

1. Experiments to examine the antigenicity of homologous bone tissues in rats are reported. The tissues studied included fresh marrow-free cortical bone blocks and chips, fresh, boiled, frozen and freeze-dried marrow-containing iliac bone, fresh iliac bone devoid of marrow, and fresh red marrow.

2. The various tissues were transplanted from hooded to Wistar rats. Three weeks later a skin graft from each donor was transplanted to its respective host to detect the presence of transplantation immunity, which was indicated by the early rejection of the skin graft.

3. Homografts of fresh cortical bone evoked transplantation immunity indicating that it contained transplantation antigens which were also in the skin.

4. Homografts of fresh marrow-containing iliac bone also evoked transplantation immunity, which was shown to be caused by the red marrow.

5. Fresh iliac homografts devoid of marrow did not elicit transplantation immunity. This suggests that iliac bone tissue may not contain transplantation antigens or that the small amount of iliac bone inserted was insufficient.

6. Microscopy of the grafts, removed after three weeks, showed that the inflammatory infiltrations around the bone homografts and autografts were not very different, but that the amount of new bone formed was different. The autografts produced a lot of new bone, the homografts only a little.

7. It is suggested that the immune response evoked in the host by the foreign graft impairs the formation of new bone by fresh homografts of cortical blocks, cortical chips and marrow-containing iliac bone.

8. The impairment of new bone formation by homografts of marrow-free iliac bone is discussed. Such bone grafts fail to evoke detectable transplantation immunity. Why these grafts do not form more new homologous bone than the other homografts studied, is not clear.

9. Homografts of boiled and frozen iliac bone do not evoke any detectable change in the sensitivity of the host to donor tissue.

10. Homografts of freeze-dried marrow-containing iliac bone elicit a slight but significant prolongation of the survival of skin homografts. The implication, in terms of modern immunological theory, is that in such grafts certain tissue antigens still persist.
ISCHIO-PUBIC "OSTEOCHONDRITIS"
Authors: Byers Paul D.
Published: February 2018

1. A child with so-called ischio-pubic osteochondritis is reported from whom the affected ramus was resected. The features observed in the resected specimen were those of a normal closing epiphysis.

2. The literature is reviewed with emphasis on other children who had biopsies and on large scale radiographic surveys of normal children.

3. The conclusions are that the changes in the ischio-pubic synchondrosis cannot justifiably be called osteochondritis, and that they require further investigation, which can most profitably be done at necropsy.
SURGICAL TREATMENT OF SPASTIC "THUMB-IN-PALM" DEFORMITY
Authors: Matev Ivan
Published: February 2018

The technique described aims to eliminate the drawbacks of the commonly accepted operative procedures for correction of the spastic "thumb-in-palm" deformity without fusion of the thumb. In all seven patients followed up for one and a half to two years after operation the thumb regained a functional position, being held out of the palm together with the metacarpal without hyperextension of the metacarpo-phalangeal joint.