bluuebunny/crossref_metadata_2025 huggingface dataset:
PARTIAL SYNOVECTOMY IN THE TREATMENT OF TUBERCULOSIS OF THE KNEE
Authors: Wilkinson M. C.
Published: February 2018

The infrequency of serious cartilage destruction in the joints of children makes it probable that the majority will recover with antibiotic and constitutional treatment alone, especially if a joint biopsy is performed. Synovectomy for children should therefore be reserved for those whose knees remain swollen and warm, even after antibiotic therapy, or whose range of movement does not show signs of returning. Exploration of such joints may show that pannus is wholly or partly covering the cartilage and that it is soft and pitted. Removal of the pannus allows better nutrition of the cartilage. The number of children who require arthrodesis in the future should be very small.

Adults who respond well to antibiotic and constitutional treatment may also recover without surgery, except biopsy, but for patients with more severe disease the need for an alternative to arthrodesis exists. The choice between synovectomy–better called joint clearance –can often only be made after the joint has been opened. The choice between the two operations has always been fully discussed with the patient before the operation. The results enumerated in this paper suggest that arthrodesis may only need to be performed for patients with severe disease, often involving the bony articular surfaces, and that joints may recover function even when there has been partial destruction of cartilage.
FIBROUS DYSPLASIA OF BONE
Authors: Stewart Marcus J. , Gilmer W. Scott , Edmonson Allen S.
Published: February 2018

1 . Twenty patients with fibrous dysplasia, confirmed histologically, are reported and discussed in regard to classification, etiology, pathogenesis and treatment. The various fibrous or fibrocystic lesions of bone are characterised briefly for purpose of contrast, and the position of fibrous dysplasia in this heterogeneous collection is suggested.

2. The classification of fibrous dysplasia based on the degree of skeletal involvement is used, and the diagnostic, therapeutic and prognostic implications of this classification emphasised. The authors endorse the opinion that fibrous dysplasia is a developmental defect. Clinical, histological and radiographic evidence is presented to point to the distinct evolution of the monostotic lesions, to which a positive and aggressive approach is recommended.
OSTEOTOMY OF THE NECK OF THE FIRST METATARSAL IN THE TREATMENT OF HALLUX VALGUS
Authors: Gibson John , Piggott Harry
Published: February 2018

1. Correction of hallux valgus by spike osteotomy of the neck of the first metatarsal is described, and the results in eighty-two feet are presented.

2. A high proportion of satisfactory results can be obtained, but great care is needed in both selection and technique.

3. The ideal case is one of moderate deformity, without degenerative arthritis, and with symptoms referable to increased width of the forefoot; the operation should not be performed in cases with obvious degenerative change, nor when metatarsalgia is a prominent symptom.

4. It is important to displace the metatarsal head as far laterally as possible, and vital to avoid dorsal angulation or displacement.

5. It is suggested that enough is now known about the natural evolution of hallux valgus and the results of some operations for prophylactic surgery to be undertaken in carefully selected cases.
NAIL AND GRAFT ARTHRODESIS OF THE HIP
Authors: Gardiner T. B.
Published: February 2018

The Brittain V-arthrodesis is a satisfactory procedure for osteoarthritis of the hip. It is particularly suitable for elderly patients when the range of hip flexion is less than 60 degrees. If the four deaths are excluded, two-thirds of the patients secured a sound bony fusion. This occurs slowly. All but one of the patients who survived for three years or more after operation had a sound bony fusion. It is evident that the operation, given time, yields a high rate of sound bony fusion in the hip. It seems likely that use of the McLaughlin nail plate would prevent the one serious complication, namely fracture of the shaft of the femur through or immediately below the drill hole made for the fibular graft.
STUDIES IN THE TRANSPLANTATION OF BONE IV. The Immune Responses of Lymph Nodes Draining Second-set Homografts of Fresh Cancellous Bone
Authors: Burwell R. Geoffrey
Published: February 2018

1. The response of the first regional lymph node to a homograft of fresh iliac cancellous bone inserted subcutaneously into the rabbit's ear three weeks after the introduction of a similar graft from the same donor into the same ear has been investigated in thirty rabbits. Fifteen rabbits which received second-set autografts of cancellous bone have also been studied.

2. The insertion of second-set homografts of fresh marrow-containing cancellous bone evokes an immune secondary response in the lymph nodes draining the grafts.

3. The increase in weight of the first regional lymph nodes on the side receiving second-set homografts is more rapid and of greater magnitude than that of nodes draining first-set homografts of cancellous bone. Second-set autografts evoke weight changes in the draining nodes similar to those in nodes draining first-set autografts of cancellous bone.

4. The histological changes which occur in the lymph nodes draining the second-set homografts (secondary response) are described and compared with those occurring in lymph nodes draining first-set homografts of cancellous bone (primary response).

5. In the primary response the distribution of large and medium lymphoid cells is throughout an activated sector of the cortex of the lymph node (Burwell and Gowland 1961), but in the secondary response these cells are found peripherally within the activated sector of the node. In both the primary and the secondary responses large and medium lymphoid cells are found in the medullary trabeculae of the lymph nodes.

6. The differences between the primary response of lymph nodes draining a tissue homograft (cancellous bone) and the primary response of lymph nodes draining classical antigens, and reported by other workers, are described.

7. Knowledge concerning the inflammatory response in the tissues of the host surrounding homografts of fresh cortical and cancellous bone implanted into animals previously sensitised to tissue from the respective donor is reviewed.

8. The late phase of new bone formation by homografts of fresh cancellous bone is discussed in the light of immunological studies.
INTRA-ARTICULAR ARTHRODESIS OF THE DISINTEGRATED TUBERCULOUS HIP JOINT
Authors: Gawne D. W.C. , Fung G. S.
Published: February 2018

1. The results of treatment of twenty-five disintegrated tuberculous hips by excision, arthrodesis and anti-tuberculous drugs are reported.

2. The methods used are described.

3. Sound healing and bony fusion was obtained in all but three of the twenty-five hips treated.
SKELETAL CHANGES IN ENDEMIC FLUOROSIS
Authors: Singh Amarjit , Dass Ramji , Hayreh Sohan Singh , Jolly S. S.
Published: February 2018

1. The skeletal changes in endemic fluorosis are described from an area of the Punjab where the fluorine content of water and soil is very high.

2. A detailed description of a fluorotic skeleton is given, with its various anthropometric measurements.

3. The vertebral changes demonstrated the pathogenesis of the neurological complications observed in this condition.
DISPLACEMENT OF THE RUPTURED ULNAR COLLATERAL LIGAMENT OF THE METACARPO-PHALANGEAL JOINT OF THE THUMB
Authors: Stener Bertil
Published: February 2018

1. The pathological anatomy of total rupture of the ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb has been studied at operation in thirty-nine patients.

2. It has been found that the ligament, when ruptured distally (the most usual type) is often displaced so that the ulnar expansion of the dorsal aponeurosis–here referred to as the adductor aponeurosis–becomes interposed between the ruptured end of the ligament and the site of its attachment on the phalanx; the ligament gets folded over to a greater or lesser extent and the ruptured end sticks out beyond the proximal edge of the adductor aponeurosis. Such displacement of the ligament with interposition of the adductor aponeurosis was found in twenty-five of the thirty-nine cases. The ligament may also be displaced without the adductor aponeurosis being interposed (with a gap between the ruptured end and the site of itsattachment on the phalanx).

3. Variations in the pathological anatomy are illustrated by more detailed descriptions of nine cases. In one of these the adductor aponeurosis had got caught between the two surfaces of the joint, and in another the adductor aponeurosis was found ruptured as well as the ulnar collateral ligament.

4. On the basis of dissection studies on forty-two fresh post-mortem specimens, a rational explanation is given of the pathological anatomy.

5. The results of the present investigation on clinical and anatomical material provide a strong argument in favour of operative treatment for total rupture of the ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb.

6. Aspects of diagnosis and operative technique are discussed.
ACUTE STREPTOCOCCAL GANGRENE
Authors: Cotter P. W. , Morris J. B.
Published: February 2018

1. A case of acute streptococcal gangrene is discussed against the known background of the disease.

2. In management, stress is laid upon the necessity for early adequate surgery, backed by adequate supportive therapy.
THE ANTERIOR CAPSULAR MECHANISM IN RECURRENT ANTERIOR DISLOCATION OF THE SHOULDER
Authors: Moseley H. F. , Övergaard B.
Published: February 2018

1 . The concept of the capsular mechanism of the shoulder joint with regard to recurrent anterior dislocation of the shoulder has been defined and a survey of the literature presented.

2. An anatomical, including an embryological, investigation of shoulder joints with special reference to the structure and function of the glenoid labrum and to the variations in the arrangement of the gleno-humeral ligaments and the synovial recesses of the anterior capsular mechanism is reported. The labrum, which is generally believed to be a consistent, fibrocartilaginous structure, is shown to be a redundant portion of capsular tissue and a continuation of the capsule as it attaches to the osseous glenoid rim. The fibrocartilaginous element is confined to a small transition zone at the capsular attachment in the great majority of cases. The great variability in the arrangement of the gleno-humeral ligaments and synovial recesses is stressed, and it is shown that an anterior pouch of variable size is present when the middle gleno-humeral ligament is attached to the scapular neck and not to the labrum.

3. The basic lesions of the anterior capsular mechanism found at operation for recurrent anterior dislocation of the shoulder in twenty-five consecutive cases using a modified Bankart procedure with a standard anterior approach to the joint are reported, and the findings are correlated with the results of the anatomical investigation. In most cases the lesions were found to be of the Bankart type with or without avulsion of the periosteum of the scapular neck. In four cases, however, the soft-tissue attachment to the anterior glenoid rim was intact; in those cases a large synovial pouch was present and the middle gleno-humeral ligament was either not discernible or it arose from the scapular neck. In all cases a postero-lateral notch on the humeral head was palpable and laxity of the subscapularis could be demonstrated. When measured, the joint capacity was always greatly augmented.

4. The present work shows, from a basic standpoint, that Bankart's original idea that the recurrent state was due to the failure of healing of the fractured fibrocartilaginous glenoid labrum is no longer tenable.

5. Finally, the anomalous attachment or the insufficient development of the middle gleno-humeral ligament in certain cases of recurrent anterior shoulder dislocation is shown to provide the anatomical basis for the recurrent state in these cases; this is the weak area in the antero-inferior part of the capsule which has been described in the literature for the past hundred years. Thus we have returned to the original view of Hippocrates.
THE EFFECTS OF FROSTBITE IN CHILDHOOD
Authors: Bigelow D. R. , Ritchie G. W.
Published: February 2018

1. Frostbite in a child may be severe enough to destroy the cartilage cells of the epiphysial plate of a digit, and produce clinical deformity.

2. Both the direct effect of the freezing itself and the vascular changes secondary to such frostbite appear to cause necrosis of the growing epiphysis with destruction of the epiphysis and disappearance of the epiphysial line or plate. The disappearance of the epiphysial plate is obvious, but whether the epiphysis itself is actually destroyed and disappears or simply fuses with the metaphysis is a question now being studied.

3. It is suggested that the deformities may be helped by interphalangeal fusion of severely involved joints in the position of function, and phalanges that become angled into varus or valgus may be improved by open wedge osteotomy or epiphysiodesis of the side of the epiphysis still functioning.
FRACTURES AND DISLOCATIONS OF THE CERVICAL SPINE
Authors: Beatson T. R.
Published: February 2018

1. Experimental radiological and mechanical studies on a cadaveric cervical spine are reported.

2. A series of fifty-nine dislocations and fracture-dislocations of the cervical spine is reviewed.

3. The methods of reduction and indications for operation are discussed.
PLASTIC TREATMENT OF THE MUSCLES AND BONE IN AMPUTATION SURGERY
Authors: Dederich Rolf
Published: February 2018

1. Musculoplastic stump correction is a method of physiological preparation of all the elements of the stump–muscles, bone, vessels and nerves–so as to establish the best relations between them. It removes the cause of existing circulatory disorders by creating active muscular movements.

2. In all cases stump pains, even those of causalgic character, have been eliminated. We attribute this to the attainment of normal muscular tension, and we believe that many phantom sensations and pains are caused by cramped and retracted muscles.

3. Active muscular work produces increased arterial inflow, as has been shown by arteriography, and also eliminates venous stasis in the end of the stump by restoration of the muscle pump mechanism.

4. Stumps prepared in the way described become painless and warm and their muscles become strong.
REHABILITATION OF RESPIRATORY FUNCTION AFTER POLIOMYELITIS
Authors: Stevenson F. Harwood , Wilson A. B. Kinnier , Bottomley A. H. , Airey D. M.
Published: February 2018

1. A series of patients with respiratory paralysis after anterior poliomyelitis is reported.

2. The examination routine is described and its value discussed.

3. Details are given of methods of respiratory rehabilitation and of the various pitfalls encountered, with suggestions for their avoidance.

4. The rates of recovery of vital capacity (and percentage of the expected vital capacity) in adults and children are analysed and compared with the rates given by Sharrard for nonrespiratory individual muscles in treated patients. It is shown that during the first year treated patients tend to recover approximately 3 to 4 per cent of their expected vital capacity per month rather than to regain any definite proportion of their current vital capacity.
RUPTURE OF THE TENDO CALCANEUS
Authors: Hooker C. H.
Published: February 2018

1. The clinical aspects of fifty-six patients with rupture of the tendo calcaneus are discussed, and the mechanism of injury is described.

2. Operative repair of the rupture is considered with a study of the results in twenty-eight patients.
AINHUM
Authors: Aggarwal N. D. , Singh Hardas
Published: February 2018

1. This case, in a girl, is the fourth case of ainhum to be reported from India.

2. The disease began in the big toe and later involved all the toes of the left foot.
TRANSIENT SYNOVITIS OF THE HIP JOINT IN CHILDREN
Authors: Adams J. A.
Published: February 2018

1. Transient synovitis is an acute, and at times exudative, condition of the synovial membrane.

2. There is no particular association with injury or with upper respiratory infection.

3. The course is short and benign with complete resolution. The occasional hip with chronic or recurrent symptoms can be distinguished from Legg-Perthes' disease by the shorter history, normal radiographs and the complete resolution.

4. There is no evidence that transient synovitis leads to avascular changes in the femoral head.
EXPERIENCES WITH THE THOMPSON QUADRICEPSPLASTY
Authors: Hesketh K. T.
Published: February 2018

Ten cases of Thompson's quadricepsplasty for stiffness of the knee after thigh injuries are discussed, with particular reference to points in the operation and after-treatment.
CHRONIC NON-SPECIFIC TENDOVAGINITIS OF TIBIALIS POSTERIOR
Authors: Williams Robin
Published: February 2018

1. Fifty-two patients with chronic tendovaginitis of the tendon of the tibialis posterior have been reviewed. With one exception the changes were regarded as non-specific.

2. Twelve patients in whom conservative treatment failed were treated by division of the tendon sheath, with complete relief in eleven.
OBLIQUE DISPLACEMENT OSTEOTOMY FOR HALLUX VALGUS
Authors: Wilson J. N.
Published: February 2018

1. An oblique displacement osteotomy of the distal third of the first metatarsal is described for the correction of adolescent hallux valgus.

2. No fixation of the fragments is necessary, stability depending upon displacement in the over-corrected position for two weeks.

3. A follow-up of twenty-five operations has shown only one failure, from recurrence of the deformity. There have been no complications.
STUDIES IN THE TRANSPLANTATION OF BONE VI. Further Observations Concerning the Antigenicity of Homologous Cortical and Cancellous Bone
Authors: Burwell R. Geoffrey , Gowland G. , Dexter F.
Published: February 2018

1. The antigenicity of homologous cortical and cancellous bone has been investigated in eighty-four rabbits.

2. The primary immune responses which occur in lymph nodes draining homografts of fresh tissues (Burwell and Gowland 1961, 1962) have been used as a histological indicator of the antigenicity of fresh homologous cortical bone freed from soft tissues.

3. The secondary immune responses which occur in lymph nodes draining homografts of fresh marrow-containing iliac bone (Burwell 1962a, b) have been used also as a histological indicator of the antigenicity of homografts of 1) fresh cortical bone freed from soft tissues, 2) fresh marrow-free iliac bone, and 3) mairow-containing iliac bone treated by boiling, freezi ng, freeze-drying and merthiolate solution.

4. It is found that whereas fresh homologous cortical bone fails usually to produce cytological evidence of a primary response in the regional lymph nodes, fresh homologous cortical bone chips inserted into the drainage areas of lymph nodes sensitised previously to donor ..tissue evoke constantly cytological evidence of a secondary response.

5. Fresh homologous marrow-free iliac bone inserted into the drainage areas of lymph nodes sensitised previously to donor tissue does not produce detectable evidence of a secondary response.

6. Homografts of boiled marrow-containing iliac bone do not elicit a secondary response in lymph nodes previously sensitised to donor tissue.

7. Previous work has shown that homografts of frozen (–20 degrees Centigrade) marrow-containing iliac bone do not evoke a primary response in lymph nodes draining such grafts. In the present work it is shown that similar frozen homografts inserted into the drainage areas of lymph nodes previously sensitised to donor tissue evoked a secondary response in three of six lymph nodes.

8. Homografts offreeze-dried marrow-containing iliac bone fail usually to evoke a secondary response in lymph nodes sensitised to donor tissue.

9. Homografts of marrow-containing iliac bone treated by immersion in merthiolate solution before being inserted into the drainage areas of lymph nodes previously sensitised to tissue from the donor elicited a secondary response in three of five lymph nodes.

10. Knowledge concerning the antigenicity offresh and treated homologous bone is discussed in the light of recent work.
PLANTAR PRESSURES AND TROPHIC ULCERATION
Authors: Bauman J. H. , Girling J. P. , Brand P. W.
Published: February 2018

1. With the object of perfecting the design of footwear for feet anaesthetic from leprosy, pressures on the soles of feet during walking were measured with transducers sufficiently thin to be worn inside ordinary shoes.

2. It was found that anaesthetic feet without deformity or muscle imbalance did not produce significantly higher pressures than normal feet during barefoot walking on a flat surface. The pressure distribution under drop feet with active posterior tibial muscles differed from normal, with increased pressure under the lateral forefoot and decreased pressures elsewhere.

3. Loss of toes or function of the toes results in high, sharp pressure peaks under the anterior end of the foot during push-off. In deformed feet these pressures are usually concentrated at one or two small areas.

4. In anaesthetic feet the prevention of trophic ulceration largely depends on the even distribution of pressure over the sole of the foot.

5. Moulding by carefully placed arch supports or metatarsal bars effectively redistributes plantar pressure.

6. A shoe with a rigid sole pivoting on a rocker near the centre of the foot most effectively reduces pressures under the forefoot of shortened, deformed feet.

7. We recommend the use of insoles made of microcellular rubber (approximately 1 5 degrees shore).

8. The importance of studying each deformed foot for areas of high pressure before fitting shoes is stressed; a pressure-indicating footprint is satisfactory for this purpose.
SPINAL DEFORMITIES IN NEUROFIBROMATOSIS
Authors: Laws J. W. , Pallis C.
Published: February 2018

1. Neurofibromatosis is a disease involving both neuro-ectodermal tissues and mesodermal elements. In the past it has usually been assumed that the mesodermal abnormalities were secondary to the neuro-ectodermal ones. For example, skeletal deformities were considered to be caused by local neurofibromata.

2. It is becoming increasingly recognised that in neurofibromatosis there may be abnormal development of bone without any local abnormality of neuro-ectodermal origin. Study of our patients confirms this view. Considerable deformity of vertebral bodies was demonstrated at sites where there was no evidence of any neurofibroma or other soft-tissue change. At other sites apparent erosion of bone was associated with the formation of a local meningocele.

3. The findings in this small series of patients with neurofibromatosis suggest that the scalloping of the vertebral bodies, deformity of pedicles and widening of the intervertebral foramina are usually caused by dysplasia of bone and may be associated with a local meningocele.
INFERIOR TIBIO-FIBULAR DIASTASIS TREATED BY CROSS SCREWING
Authors: Smith M. G. H.
Published: February 2018

1. Twenty-three patients were treated by cross screwing for diastasis of the tibia and fibula in fractures at the ankle.

2. It is suggested that limitation of ankle dorsiflexion after this treatment was caused by the presence of a mechanical block to dorsiflexion by spur formation at the margins of tibia and talus.

3. An ordinary bone screw controlled the diastasis satisfactorily in twenty patients.

4. The screw did not interfere with movement at the inferior tibio-fibular joint because bone resorption about that part of the screw in the fibula allowed a small range of movement.

5. Discomfort from the screw was relieved by its removal.
AN UNUSUAL SYMMETRICAL DISTAL LIMB DEFORMITY IN SIBLINGS
Authors: Blockey N. J. , Lawrie J. H.
Published: February 2018

We describe two siblings with congenital growth defects of the distal limb bones and their progress over four years. They bear some resemblances to a boy described in 1958 by Solonen and Sulamaa and to a father and his three sons described in 1944 by Nievergelt.
THE BEHAVIOUR OF BLOOD VESSELS AFTER EXPERIMENTAL TRANSPLANTATION OF BONE
Authors: Kingma M. J. , Hampe J. F.
Published: February 2018

1. The behaviour of various types of cortical bone graft has been studied in rabbits by histological and injection techniques.

2. The results suggest that penetration of the graft by blood vessels plays an important part in the incorporation of autogenous and homogenous grafts.

3. Autogenous and homogenous grafts are both incorporated–the latter more slowly than the former–but heterogenous grafts are rejected. The reasons for this rejection are discussed.
PRIMARY AND SECONDARY DISLOCATION OF THE SCAPHOID BONE
Authors: Thompson T. Campbell , Campbell Rolla D. , Arnold William D.
Published: February 2018

1. Nine cases of disturbance of the relationship between the scaphoid and the radius and between the scaphoid and the lunate bones are described.

2. Persistent dislocation of the scaphoid bone may follow reduction of perilunar dislocations or of other dislocations of the proximal row of the carpus. It may be obvious, as in waist-deep dislocation, or may be solely a rotational dislocation which may be difficult to diagnose.

3. Uncorrected rotational dislocation of the scaphoid bone caused significant disability in six of seven cases.

4. Aids to the diagnosis of this condition are described and a vigorous approach to the problem of correction is advocated.

5. The experience of other workers in this field is reviewed and discussed.
PRIMARY INTRASPINAL TUMOURS: THEIR CLINICAL PRESENTATION AND DIAGNOSIS
Authors: Da Roza A. C.
Published: February 2018

1. An analysis has been made of the clinical features and investigations in ninety-five cases of primary intraspinal tumours.

2. Loss of muscle power was the commonest symptom, and was often ignored until late in the course of the disease.

3. Two-thirds of the patients had no pain in the spinal region, although five of these had either extensive growths or radiographical evidence of bone erosion by tumour.

4. One-third of the patients had urinary symptoms, and two of them had acute retention initially attributed to prostatic obstruction.

5. In eighteen cases posture and gait were abnormal. The case histories of five of these patients are recorded, and they emphasise the importance of recognising lumbar spasm and hamstring tightness in young patients as signs of a cauda equina neoplasm.

6. All patients had some detectable sensory, motor, or reflex changes, and these were mostly bilateral.

7. Radiography, and cerebrospinal fluid manometry and analysis, were helpful in establishing the diagnosis.

8. Hysteria should not be diagnosed until all efforts have been made to prove otherwise.
INTERNAL FIXATION FOR UNSTABLE ANKLE FRACTURES
Authors: Denham R. A.
Published: February 2018

Two hundred and thirty-two ankle fractures were treated in the orthopaedic department of the Royal Portsmouth Hospital between 1959 and 1960. Seventy-one fractures treated by internal fixation with screws have been seen at follow-up examination. Results show that open reduction, secure and accurate internal fixation and early movement without plaster or other splintage is a treatment which in most cases has been followed by a short convalescence, few post-operative complications, and a painless ankle and with good function.
HYPERTROPHY OF THE PALMARIS LONGUS MUSCLE
Authors: Ashby B. Sterry
Published: February 2018

A case of unilateral hypertrophy of the palmaris longus muscle in a girl of thirteen is described, associated with "simian" hands and feet and unusually coarse skin of the trunk. Symptoms of median nerve compression were relieved by excision of the muscle.
AVASCULAR NECROSIS AND REVASCULARISATION OF THE FEMORAL HEAD AFTER INTRACAPSULAR FRACTURES
Authors: Sevitt S.
Published: February 2018

1 . The arterial pattern and the histological features in the femoral head and neck were studied at necropsy in twenty-five specimens with intracapsular fractures. An improved visual-arteriographic method employing barium sulphate dyed with Prussian blue was used. Twenty-three of the fractures were from a few days to twenty-four weeks old and two were seven and ten years old. Nineteen had been nailed or nail-plated.

2. The results were divided into four groups according to the state of the femoral head. In the first group, four heads were histologically viable and had a normal vascular pattern; in the second group, four showed partial avascular necrosis with part of the head retaining a normal blood supply; in the third group, ten had avascular necrosis in all or most of the head and showed little or no revasculanisation; and in the fourth group, seven showed extensive revascularisation of grossly necrotic heads. Total or subtotal capital necrosis had occurred in 64 per cent and total or partial necrosis in 84 per cent of the specimens. The results indicated that interruption of the retinacular vessels was the cause of gross necrosis; and that in most cases an intact blood supply through the ligamentum teres cannot keep more than a part of the head alive when the other vessels are cut off. Occasionally the ligamentum teres is torn by the nail, or though intact, its blood supply is interrupted. This accounts for completion of avascular necrosis in most cases with total capital necrosis. Viability of the subfoveal area from an intact supply through the ligamentum teres was the main source of revascularisation after capital necrosis. Other sources–from across a uniting fracture line, from growth of soft tissue round the head and neck and from other small viable foci in the head and neck–were much less important and the degree of revascularisation was generally limited. Revascularisation was accompanied by fibrocellular invasion of the marrow, differentiation of cells and the formation of oil cysts whereby the necrotic fat is removed; but bony reconstitution was limited.

3. Six fractures were uniting and another had united by bone making an overall union frequency of 50 per cent considering only the nailed fractures older than two weeks. Four of them (57 per cent) showed total or subtotal capital necrosis. In fractures older than two weeks the frequency of union among the eleven nailed fractures with avascular necrosis was 36 per cent, and it was 100 per cent among the three nailed ones with viable or substantially viable heads. Necrosis of the neck side of the fracture was unrelated to non-union because it soon becomes invaded by fibrovascular tissue and new bone.

4. Fibrosis was the basis of union when the head was dead but examination of older fractures at necropsy is needed to assess the long-term results of revascularisation and union. The clinical desirability or otherwise of capital revascularisation after necrosis also needs to be studied.
POSTERIOR ILIOPSOAS TRANSPLANTATION IN THE TREATMENT OF PARALYTIC DISLOCATION OF THE HIP
Authors: Sharrard W. J. W.
Published: February 2018

1. The indications for and technique of posterior iliopsoas transplantation are described with particular reference to paralytic dislocation and subluxation of the hip in children.

2. Experience of 150 operations in ninety-five patients and of the long-term results of forty-one operations are given.

3. Reduction of the dislocation has been maintained in every case even when there was complete paralysis of all gluteal muscles.

4. All the children are able to walk without the aid of hip splintage.
FAMILY STUDIES AND THE CAUSE OF CONGENITAL CLUB FOOT
Authors: Wynne-Davies Ruth
Published: February 2018

1. The family history of, and associated congenital abnormalities in, patients with talipes equinovarus, talipes calcaneo-valgus and metatarsus varus living in Devonshire has been studied.

2. The chances of any individual having one of these deformities is approximately one per 1,000 in each case.

3. If one child in a family has the deformity, the chances of a second having it are one in thirty-five for talipes equinovarus and one in twenty for talipes calcaneo-valgus and metatarsus varus.

4. The male relatives of the female patients with talipes equinovarus are at particular risk.

5. It is suggested that the cause of club foot is partly genetic and partly environmental, from a factor acting on the foetus in the uterus.

6. The classification of associated congenital abnormalities leads to the suggestion that the genetic factor in talipes equinovarus and talipes calcaneo-valgus relates to defective formation of connective tissue.
THE MANAGEMENT OF STOVE-IN CHEST
Authors: Williams Grant
Published: February 2018

1. A course of treatment is suggested for patients with stove-in chests based on experience with seven patients, only one of whom died from his injury.

2. The literature on this subject is reviewed and it is suggested that treatment may be undertaken by an accident surgeon without recourse to intermittent positive pressure respiration inmost instances.
FRACTURES AT THE BASE OF THE FIRST METACARPAL BONE
Authors: Griffiths J. C.
Published: February 2018

1. A large proportion of fractures were poorly reduced in this series either because the method used was inadequate or because it was inexpertly applied. At first it was thought that immobilisation in plaster gave adequate fixation but it was impossible to be certain that the reduction was not sometimes lost in the interval between manipulation and the check radiograph taken immediately after plaster had been applied. This suggested that in some cases fixation might be lost early although late redisplacement was not seen.

2. The late subjective results in patients with unreduced fractures were good, but there was some loss of thumb mobility partly due to varus deformity of the metacarpal bone and partly due to incomplete compensation for generalised stiffness in and around the joint.

3. Since loss of movement caused little disability and joint involvement rarely produced symptoms due to osteoarthritis, it seems doubtful whether the use of complex methods of treatment is justifiable.

4. Women seem to be predisposed to painful symptoms at the carpo-metacarpal joint of the thumb whether they occur after fracture or in association with non-traumatic osteoarthritis of the joint.
TORSION OF THE INFRAPATELLAR FAT PAD
Authors: Coleman H. M. , Simmons E. H. , Barrington T. W.
Published: February 2018

1. Three patients are reported in whom a sudden acute internal derangement of the knee was caused by torsion of a pedunculated portion of the infrapatellar fat pad.

2. The symptoms and signs are described.

3. The pathological changes and the pathogenesis are discussed.
BONE TUMOURS AND THEIR ENZYMES
Authors: Jeffree Grace M. , Price C. H. G.
Published: February 2018

1. Alkaline and acid phosphatase, non-specific esterase and beta-glucuronidase have been estimated and demonstrated histochemically in a series of bone tumours and allied lesions, of which ten were osteogenic sarcomata, ten were giant-cell lesions, eleven were fibroblastic lesions and seven were tumours of cartilage.

2. Osteogenic sarcoma was found to be characterised by high levels of alkaline phosphatase, with rich staining for this enzyme in the tumour cells. Similar high levels of alkaline phosphatase were found in other bone-forming lesions, such as fibrous dysplasia, a giant-cell sarcoma with osteogenic matrix, and fracture callus.

3. Giant-cell lesions were characterised by high levels of acid phosphatase, and intense staining for this enzyme in the osteoclasts. These cells were also found to be rich in non-specific esterase (as shown by the alpha-naphthyl acetate method) and in beta-glucuronidase, but almost or entirely lacking in alkaline phosphatase. High levels of alkaline phosphatase were not found in giant-cell lesions except in relation to osteogenic matrix.

4. Fibroblastic tumours were characterised by moderate levels of all four enzymes, with little or no staining for phosphatases in the tumour cells; non-specific esterase was generally present in a proportion of the cells.

5. In certain lesions intermediate stages in the differentiation of fibroblasts to osteoblasts were found, notably in fibrous dysplasia, in which the biochemical change preceded the histological. In such lesions high total levels of alkaline phosphatase were found.

6. Cartilaginous tumours were characterised by low levels of all four enzymes, and little histochemical staining except in hypertrophied cells in areas of ossification.

7. It was found in general that the enzyme distributions in these neoplasms and other lesions reflected the findings in comparable reactive and growing normal tissues.
LONG-TERM FOLLOW-UP OF COLLES'S FRACTURE
Authors: Smaill G. B.
Published: February 2018

1. A five-year follow-up of forty-one patients who sustained Colles's fractures was made.

2. The objective results were not so satisfactory as the subjective, but overall there seems to be no reason to depart from the present methods of managing these injuries by manipulation and immobilisation in plaster.

3. Colles's belief that in time the patient would regain full painless function irrespective of how the fracture was treated seems to be vindicated.
ANTERIOR INTEROSSEOUS NERVE PALSY
Authors: Fearn C. B. d'A. , Goodfellow J. W.
Published: February 2018

An isolated palsy of the anterior interosseous nerve of the forearm is described in a boy aged nine. It was cured by surgical division of a constricting fibrous band in the forearm.
COSTAL CHONDRITIS
Authors: Elson R. A.
Published: February 2018

1. Two cases of costal chondritis are presented. The special features and treatment of this condition are described and the literature is reviewed.

2. Early diagnosis and energetic treatment of costal chondritis obviates serious morbidity.

3. Treatment with antibiotics is of value in curing the condition before cartilage necrosis has occurred and in controlling the spread of infection to neighbouring tissues.

4. Excision of all necrotic cartilage is essential for cure, if cartilage necrosis has occurred.

5. Secondary infection with organisms of low virulence, notably pseudomonas pyocyanea, is nowadays the commonest cause of chronicity.
ANTERIOR INTERBODY FUSION OF THE LUMBAR SPINE
Authors: Sacks Sidney
Published: February 2018

1. At the present stage of our experience, when 150 patients have been analysed over a period of five years, the conclusion has been reached that anterior interbody fusion in the lower lumbar spine is a procedure which should be added to our surgical armamentarium for use in selected cases.

2. Patients suffering from chronic intervertebral disc degeneration whose main symptoms are recurrent incapacitating backache derive the most benefit from this procedure.

3. When used as a salvage operation in patients who have had previous unsuccessful laminectomy or posterior fusion, good results can be expected.

4. In patients with spondylolisthesis anterior interbody fusion should be confined to cases in which the vertebral bodies have not slipped forward more than one-third.
SCOLIOSIS AND NEUROFIBROMATOSIS
Authors: Scott J. C.
Published: February 2018

1. Analysis of eighty-one patients with neurofibromatosis showed that sixty-two (76 per cent) had café-au-lait markings; 12 per cent had significant spinal deformity.

2. Thirty-three examples of spinal deformity in neurofibromatosis showed a wide variety of patterns and severity of the adult curve. There was no evidence that there was any recognisable pattern of scoliosis in neurofibromatosis. No evidence was discovered to suggest that any acquired local abnormality of bone contributed to the deformity.

3. Some of the severe deformities showed a pattern similar to that seen in the congenital sco1ioses, and this might be the link between the neurofibromatosis and the spinal deformity.
THE SCALENUS MEDIUS BAND
Authors: Bonney George
Published: February 2018

1. Thirteen instances of compression of the lower trunk of the brachial plexus at the thoracic inlet are described.

2. In each case the cause of compression was an aponeurotic band passing from the seventh cervical transverse process to the first rib.

3. The symptoms, physical signs, radiological features and findings at operation are described.

4. Satisfactory results followed removal of the band.

5. The anatomical arrangements are compared with those of the "normal" thoracic outlet and with those obtaining in cases of "vascular" thoracic outlet syndrome.
HYDATID DISEASE OF THE LUMBAR VERTEBRAE
Authors: Fitzpatrick S. C.
Published: February 2018

1. A thirty-two-year-old man has been under treatment for twelve years for primary hydatid disease of the body of the third lumbar vertebra.

2. The second lumbar vertebra became involved, as were the soft tissues over a wide area, but the spinal canal was not affected.

3. A hydatid cyst was found in the left lung.

4. Management included stabilisation of the spine by bone graft, desensitisation to hydatid antigen, removal of the diseased vertebral bodies, pedicles and processes, the use of saturated solution of sodium chloride as a scolicide and the dilation of secondary ureteral strictures.

5. The patient, although not cured, has been enabled to "live with his disease" to earn his living and enjoy tennis and swimming.
HYDATID DISEASE OF THE INNOMINATE BONE
Authors: Parker Douglas , Chapman Robert
Published: February 2018

1. A case of hydatidosis of the innominate bone is described.

2. The disease was treated by local resection combined with instillation of supersaturated salt solution.

3. The disease appears to have been arrested and the functional result is good.

4. The lethal effect of supersaturated salt solution on the parasite is stressed.

5. The experience of other workers in the field of hydatid disease is described.
THE CLINICAL APPLICATION OF EXTERNALLY POWERED ARTIFICIAL ARMS
Authors: McKenzie D. S.
Published: February 2018

I have tried to describe the functional attainments of amputees using conventional prostheses. I have outlined the work we have been doing on pneumatic arms for infants and children. I have discussed some of the practical problems in applying pneumatic and myo-electric systems to adults. The inescapable conclusion that one must reach is that two basic clinical requirements must be met before really significant advance is made in this field. Firstly, we must find a method of providing sensory information from the prosthesis. Secondly, we must find a way of utilising more control sites. So far we have only been able to make use of direct movements or myo-electric signals. In the high level bilateral subjects more controls are required than appear to be available. Capener has suggested, in more than one discussion that I can recall, the possibility of using the voice and I have no doubt that a subject could be trained to reserve certain frequencies for prosthetic controls. It may be that we will have to think along some such lines as this.
HENDON PNEUMATIC POWER UNITS AND CONTROLS FOR PROSTHESES AND SPLINTS
Authors: Wilson A. B. Kinnier
Published: February 2018

1. The Hendon motor and the Hendon valve are described.
DEVELOPMENT OF EXTERNALLY POWERED UPPER EXTREMITY ORTHOTIC SYSTEMS
Authors: Engen Thorkild J.
Published: February 2018

1. Orthotic systems for the upper limb are described.

2. Two patients are described to illustrate the value of the systems.
CLOSED INJURIES OF THE ILIAC ARTERIES
Authors: Stiles P. J.
Published: February 2018

1. Three cases of traumatic thrombosis of the iliac arteries and one case of a false aneurysm of the internal iliac artery following closed injuries are described.

2. Results of the treatment of these cases are discussed.
INTRA-UTERINE AMPUTATIONS AND ANNULAR LIMB DEFECTS IN SINGAPORE
Authors: Pillay V. K. , Hesketh K. T.
Published: February 2018

1. Forty cases of congenital constriction bands are reported and certain patterns of abnormality and their management are discussed.

2. Attention is drawn to the relative frequency with which this condition occurs in the Malays of Singapore.
THE TREATMENT OF MALUNITED ANTERIOR MONTEGGIA FRACTURES IN CHILDREN
Authors: Bell Tawse A. J. S.
Published: February 2018

1. Six cases of malunited anterior Monteggia fracture have been treated, five of them successfully, by open reduction and reconstruction of the orbicular ligament by turning down a slip from the triceps tendon.

2. One relapse occurred after a slight injury; this was because of an unsuitable triceps tendon.

3. A slip from the triceps tendon has retained reduction of the head of the radius in a patient with congenital dislocation of the radial head.
SMITH'S AND BARTON'S FRACTURES
Authors: Ellis James
Published: February 2018

1. A method of treating Smith's fracture and Barton's anterior fracture-dislocation of the wrist by internal splintage is described.

2. The application of a special buttress plate fixed to the lower anterior aspect of the radius is advocated; no external splintage is used.
COMPLICATIONS AFTER PARATHYROIDECTOMY
Authors: Davies D. R. , Friedman M.
Published: February 2018

1. Convulsions causing fractures complicated the post-operative course of two patients after parathyroidectomy.

2. One patient with primary hyperparathyroidism and osteitis fibrosa developed tetany which was controlled with difficulty with the usual measures to correct hypocalcaemia. The convulsion occurred during hypomagnesaemia. This seemed the main immediate cause of symptoms and was easily corrected when recognised.

3. The second patient had been subjected to total parathyroidectomy for treatment of renal glomerular osteodystrophy. The complications were entirely due to hypocalcaemia and the usual treatment was inadequate until oral aluminium hydroxide was given.

4. Further experience shows that aluminium hydroxide can be a valuable addition to other measures for dealing with hypocalcaemia due to the "hungry bones" phenomena.
ADAMANTINOMA OF THE TIBIA
Authors: Donner R. , Dikland R.
Published: February 2018

1. A case of adamantinoma of the tibia was followed radiographically for seventeen years before a biopsy was performed. During this time there was an increase in size of the tumour and a gradual transformation of radio-opaque into polycystic areas.

2. Biopsy revealed a peculiar osteoid-like differentiation of the epithelial tissue.
MUSCLE REGENERATION IN EXPERIMENTAL ANIMALS AND IN MAN
Authors: Allbrook David , Baker W. de C. , Kirkaldy-Willis W. H.
Published: February 2018

1. Direct injury to skeletal muscle results in fragmentation and necrosis of muscle fibres, though this is patchy in distribution.

2. The sarcolemmal basement membranes form the interface along which fibre regeneration takes place.

3. Phagocytosis of disorganised sarcoplasm is an essential prelude to the reconstitution of severely damaged fibres.

4. Regeneration of injured muscle begins with proliferation of basophilic cells probably originating from muscle satellite cells. After a few days typical myoblast nuclear chains are present. By a week following injury the chains of myoblasts have formed myotubes, which possess myofibrils and sarcomeres.

5. By twelve days in the monkey and by eighteen days in man the muscle fibre regenerative process shows many new fibres which have not reached a mature diameter.

6. Much collagen may be formed in the tissue space at the site of injury. It appears that as the muscle fibres increase in diameter the collagen decreases in extent.

7. In the monkey by three weeks the muscle at the fracture site appears normal. This is also true in the specimens examined at four, six and twelve weeks.

8. In the monkeys the injured limb was immediately used to run and jump. A parallel intense and early activity of muscle and joints was a cardinal point in the management of this series of fracture patients. The clinical results were satisfactory.

9. It is concluded that in both the monkey and in man, given active limb movements, permanent and functionally useful muscle regeneration occurs following soft-tissue injury associated with a bone fracture.