bluuebunny/crossref_metadata_2025 huggingface dataset:
POSTERIOR INTEROSSEOUS NERVE PARALYSIS CAUSED BY A GANGLION AT THE ELBOW
Authors: Bowen T. Llewellyn , Stone K. H.
Published: February 2018

1. A case of posterior interosseous nerve palsy from compression in the supinator muscle by what appeared to be a simple ganglion is described.

2. Surgical decompression led to an effective cure.

3. The course of the nerve through this muscle invites compression.

4. Rotation of the forearm, especially with super-added deformity of the limb, may increase the compresssion.
FIBROGENESIS IMPERFECTA OSSIUM
Authors: Baker S. L. , Dent C. E. , Friedman M. , Watson Lyal
Published: February 2018

1. A clinical, radiological and histological description of a patient with fibrogenesis imperfecta ossium is given. We think that this is the first case in which diagnosis has been made during the life of the patient.

2. The disease is characterised by a defect in the formation of the collagen fibres of the bone matrix. There is also a failure of normal calcification of the matrix, giving rise to the appearance of wide "osteoid" seams. When examined with the polarising microscope and when stained with Gomori's reticulin stain the collagen fibres can be seen to be grossly deficient and abnormal.

3. The patient presented at the age of fifty-four years with bone pain and multiple fractures. The only biochemical abnormality detected in the plasma was an elevated alkaline phosphatase. He was also in negative calcium balance.

4. Treatment with vitamin D2, later changed to dihydrotachysterol, appears to have produced clinical, biochemical and radiological improvement. It appears that a direct action of the vitamin on the abnormal bone collagen must be postulated, in addition to its known actions on the calcifying mechanisms.

5. An unusual feature of the case was the slow development of a total unresponsiveness to large doses of vitamin D2, in spite of a markedly elevated level of vitamin D in the plasma. There was later a response to a much smaller dose of dihydrotachysterol, which is being maintained to date.
THE ETIOLOGY AND TREATMENT OF CONGENITAL DISLOCATION OF THE KNEE
Authors: Katz M. P. , Grogono B. J. S. , Soper K. C.
Published: February 2018

Five knees with congenital dislocation were explored. The cruciate ligaments were found to be absent or hypoplastic. The results obtained by reconstructing an anterior cruciate ligament appear to be good. On the basis of dissections of foetal knees we believe that the cruciate ligaments are the main structures preventing an anterior dislocation of the knee in early foetal life; this deviation from the adult pattern is due to the bony configuration of the foetal knee. We therefore postulate that the basic defect in congenital dislocation of the knee is an absence or hypoplasia of the cruciate ligaments.
NAIL-PATELLA SYNDROME WITH ILIAC HORNS AND HEREDITARY NEPHROPATHY
Authors: Darlington D. , Hawkins C. F.
Published: February 2018

1 . Necropsy and dissection findings of a man of fifty-two who died from nail-patella syndrome are recorded.

2. The significance of the iliac horns are discussed and the literature concerning their development is reviewed.

3. Other anomalies are reviewed and the incidence of hereditary nephropathy is discussed.

4. The genetic origin ofthe syndrome is outlined but the involvement of such varying tissues remains unexplained.
LOWER CERVICAL RHEUMATOID SUBLUXATION WITH TETRAPLEGIA
Authors: Hopkins J. S.
Published: February 2018

1. Four patients with tetraplegia from rheumatoid subluxation occurring in the lower cervical spine are described and the common features are noted.

2. Compression appeared to be responsible for the cord damage, although it was not necessarily directly related to vertebral subluxation. The lesions causing the compression were varied.

3. Forcible attempts to reduce vertebral subluxation may be harmful. Two patients were improved by posterior decompression.

4. A suggested programme for the treatment of such patients is outlined.
RESULTS OF TREATMENT OF 100 CONGENITALLY DISLOCATED HIPS
Authors: Somerville E. W.
Published: February 2018

1. The results of the treatment of 100 congenitally dislocated hips out of 102 treated consecutively are reported.

2. The follow-up has been from five to fifteen years and the treatment of all has been the same.

3. The importance of adequate growth potential which determines the future development of the hip is stressed.
ISCHAEMIA COMPLICATING CLOSED TIBIAL AND FIBULAR SHAFT FRACTURES
Authors: Owen R. , Tsimboukis B.
Published: February 2018

1. The frequency of variable degrees of ischaemia of soft tissue in closed tibial and fibular shaft fractures is emphasised.

2. Two cases with ischaemia of calf musculature are described.

3. A follow-up study of 100 cases of closed tibial shaft fractures is analysed; ten patients were found to be affected.

4. The anatomical and pathological changes are discussed.

5. A plea is made for early surgical exploration in cases manifesting signs of ischaemia.
OSTEOMALACIA–A COMMON DISEASE IN ELDERLY WOMEN
Authors: Chalmers J. , Conacher W. D. H. , Gardner D. L. , Scott P. J.
Published: February 2018

1. The clinical features, diagnosis and treatment of osteomalacia are discussed in relation to thirty-seven recently recognised cases. It is suggested that this disease is not uncommon in elderly women, among whom it is liable to be confused with senile osteoporosis. Osteomalacia may be distinguished by, firstly, the history, in which persistent skeletal pain of long duration and muscular weakness are typical of osteomalacia, but not of osteoporosis in which transient episodes of pain usually associated with a fracture are more characteristic. There is a high incidence of previous gastric surgery in the osteomalacia patients. Secondly, the physical examination shows skeletal tenderness in osteomalacia but this is not a particular feature of osteoporosis. A shuffling "penguin gait" suggests osteomalacia. Thirdly, the biochemistry shows a low plasma calcium and phosphate, and raised alkaline phosphatase levels commonly in osteomalacia but these are usually normal in osteoporosis. Reduced twenty-four-hour urinary calcium is characteristic of osteomalacia but not of osteoporosis. Fourthly, radiology will show diminished bone density which is common to both diseases, but if the changes are more marked in the peripheral bones than in the axial skeleton osteomalacia is suggested; the opposite is typical of osteoporosis. Skeletal deformity without fracture suggests osteomalacia, as do stress fractures and greenstick fractures in the elderly. Looser's zones are diagnostic of osteomalacia in which they are the most important radiological feature. Finally, histology will show the presence of excess osteoid tissue in undecalcified sections of bone in osteomalacia. This may be the earliest and most sensitive index of the disease and biopsy is indicated in all doubtful cases.

2. The etiology is discussed and it is suggested that a dietary deficiency of vitamin D, limited exposure to sunlight and mild degrees of malabsorption may all be important either alone or in combination. No satisfactory explanation is offered for the predominant female incidence.

3. A practical method of treatment is given and the dangers of uncontrolled administration of vitamin D indicated.

4. Treatment of osteomalacia is rapidly and consistently successful, and well justifies a thorough screening of all elderly patients presenting with weakness, skeletal pain, pathological fractures or with diminished radiographic density of bone.
UNION OF INTERTROCHANTERIC OSTEOTOMIES
Authors: Green J. P.
Published: February 2018

1. Fibrous union of an osteotomy occurred in only 3 per cent of osteotomies done during a four-year period.

2. Delayed union sometimes gives rise to pain on bearing weight while union is in progress, and non-union is usually associated with disabling pain.

3. The most significant factors predisposing to delayed or fibrous union are inefficient fixation and excessive displacement. A high or very oblique osteotomy may also have an adverse effect upon the rate of bony union.
FAMILIAL SLIPPED UPPER FEMORAL EPIPHYSIS
Authors: Rinnie A. M.
Published: February 2018

1. During the past twenty-five years there have been admitted to this orthopaedic service twelve children or adolescents having a close relative who previously or subsequently developed slipped upper femoral epiphysis. This represents an incidence of approximately 7 per cent.

2. There is some evidence that the incidence is considerably higher.

3. In addition to those with close relations also with slipped epiphysis, two patients had parents with osteoarthritis of the hip.

4. I believe, therefore, that in slipped upper femoral epiphysis there is evidence of a genetic defect. This is probably due to a recessive gene of low penetrance. The frequency in this region is high because the north-east of Scotland has very definite geographical boundaries and the rural, agricultural population, from which the majority of these cases were drawn, has formed until recently a stable community likely to show a greater than average incidence.
TRAUMATIC DISLOCATION OF THE TIBIALIS POSTERIOR TENDON AT THE ANKLE
Authors: Nava B. E.
Published: February 2018

1. A case of traumatic forward dislocation of the tibialis posterior tendon at the ankle is described.

2. A possible mechanism of the injury is suggested.
OSTEOPOROSIS AND FRACTURE OF THE FEMORAL NECK IN THE SOUTH AFRICAN BANTU
Authors: Solomon L.
Published: February 2018

1. Senile osteoporosis is one of the common causes of morbidity in old people. Its distribution in European and American populations has been deduced from epidemiological studies of its major complications, such as fractures of the vertebrae and the femoral neck. Although there has been some evidence that different population groups differ in their susceptibility to this condition, no demographic study of its prevalence in the white and Bantu races has previously been made.

2. The present paper describes an epidemiological study of femoral neck fractures in the Bantu population of Johannesburg, covering the years 1957-63. The cases were analysed by age and sex, the type of trauma and the level of the fracture. The number of fractures was related to the population at risk; the fracture incidence was expressed both as an age-specific rate and as a standardised rate and compared with fracture rates in European populations. It was found that the fracture rate in the elderly Bantu is less than one-tenth of that in Western European populations, and that males and females are affected equally. It was concluded that senile or post-menopausal osteoporosis is much less pronounced in the Bantu than in white populations.

3. The relationship of these findings to endocrine changes, calcium balance and racial factors is discussed. It is suggested that senile osteoporosis is not caused by a simple calcium deficiency but may be related to an imbalance between calcium intake, absorption and excretion, or a failure of the complex mechanism which normally controls this balance. Whatever the immediate cause, however, race plays an important part in determining the onset and distribution of the condition.
FAMILIAL (IDIOPATHIC) SCOLIOSIS
Authors: Wynne-Davies Ruth
Published: February 2018

1. Idiopathic scoliosis is a familial condition.

2. The findings suggest either dominant or multiple gene inheritance, but a larger series is needed before a firm conclusion can be drawn.

3. The infantile and adolescent types of scoliosis seem to share the same basic etiology, because their families contain instances of each.

4. Infants with resolving scoliosis have affected relatives in the same proportions as in the main group, suggesting this is a mild form of the same disorder.

5. In this series all infants seen with scoliosis under one year of age had plagiocephaly, which was usually transient.

6. Mental defect and epilepsy are the commonest findings associated with scoliosis.

7. In adolescent scoliosis the age of the mother is significantly raised by comparison with the expected figure for the normal population.
ABNORMAL ARRANGEMENT OF THE LOWER LUMBAR AND FIRST SACRAL NERVES WITHIN THE SPINAL CANAL
Authors: Keon-Cohen Bryan
Published: February 2018

1. Four cases of abnormal arrangement of the lower lumbar and sacral nerves within the spinal canal are reported.

2. In all four cases the presentation was like that associated with acute lumbar disc protrusion, though in only two cases was a protrusion found at operation.

3. The significance of the findings is discussed and the findings are compared with those in the eighteen other recorded cases.
QUADRICEPS CONTRACTURE
Authors: Williams Peter F.
Published: February 2018

1. Previous reports of the role of the quadriceps in producing limitation of movement or dislocation of the patella have tended to implicate one particular part of the complex. Experience gained in thirty-five quadricepsplasties in children has shown that all parts of the quadriceps (except vastus medialis) and the ilio-tibial band also may play a part and that each of these must be attended to if a satisfactory result is to be obtained.

2. A simple technique of operation is described and illustrated.

3. Since this paper was prepared, a patient showing features of particular interest has been seen and treated.
RECURRENT DISLOCATION OF THE SUPERIOR TIBIO-FIBULAR JOINT
Authors: Owen Robert
Published: February 2018

1. Two patients with recurrent dislocation of the head of the fibula are described.

2. The difficulties in diagnosis are discussed.
PRIMARY OSTEOARTHRITIS, VENOUSIENGORGEMENT AND OSTEOGENESIS
Authors: Brookes M. , Helal B.
Published: February 2018

1. The venographic findings in clinical primary osteoarthritis are described.

2. Experimental venous engorgement, of the knee joint and of healing fibular fractures, results in accelerated bone formation and disturbed cartilage formation.

3. Changes in pH, ppCO2, and PPO2 are indicated as the chemical means by which chondrogenesis and osteogenesis can be altered.

4. It is suggested that chronic venous stress in joints is a causal factor in primary osteoarthritis.
CLINICAL EXAMINATION AND URINARY OESTROGEN ASSAYS IN NEWBORN CHILDREN WITH CONGENITAL DISLOCATION OF THE HIP
Authors: Thieme W. T. , Wynne-Davies Ruth , Blair H. A. F. , Bell E. T. , Loraine J. A.
Published: February 2018

1. Twenty-one cases of congenital dislocation of the hip were found on examination of 1,881 consecutive neonates on the first day of life, giving an incidence of eleven per 1,000 live births.

2. Insignificant high-pitched "clicks" were noted in 10 per cent of newborn children.

3. Conversion of half of the patients with hip dislocation to normal occurred during the first post-natal week.

4. Joint laxity was not a feature of the newborn with congenital dislocation of the hip.

5. Oestradiol, oestrone and oestriol were estimated in twenty-fourhour urine samples collected from sixteen patients with congenital dislocation of the hip and nineteen matched controls during the first six days of life. No significant differences in oestrogen output between the two groups were found.

6. The hypothesis that congenital dislocation of the hip is a result of an inborn error of oestrogen metabolism in the newborn is not supported.
DEVELOPMENT OF A SURGICALLY IMPLANTED MYO-TELEMETRY CONTROL SYSTEM
Authors: Tucker F. R. , Scott R. N.
Published: February 2018

1. The difficulties of obtaining myo-electric signals from the muscles in amputation stumps are discussed.

2. The requirements of a myo-telemetry system which could be implanted are discussed.

3. A description is given of a new approach to the problem in which the electrical unit is contained in an inert plastic and fitted into the bone in the amputation stump, using an external power source.
THE LONG-TERM REACTION OF BONE TO SELF-CURING ACRYLIC CEMENT
Authors: Charnley J. , Follacci F. M. , Hammond B. T.
Published: February 2018

1. A study is reported of 190 femora in 174 patients in whom self-curing acrylic cement had been present in the medullary cavity of the upper end of the femur for the fixation of an endoprosthesis for an average period of four years.

2. The bone remained radiologically normal in 81 per cent of cases.

3. Improvement in the thickness of the cortex from pre-existing atrophy was noted in 2·6 per cent.

4. In 4·7 per cent the bone showed some atrophy after insertion of the cement. This exceeded 10 per cent in only two cases. All were originally osteoporotic from polyarthritis; all were satisfactory as regards the arthroplasty itself, and the atrophy could usually be explained by disuse resulting from the state of the opposite lower extremity, or the knee on the same side.

5. In 9·4 per cent there was fusiform hypertrophy of the femoral cortex, the bony texture remaining normal. This appearance was considered physiological and benign.

6. In 2·2 per cent there were changes for which the most likely explanation is chronic non-suppurative osteitis, though no collateral evidence of infection was found.

7. In 44·8 per cent there was a thin line of condensation in the cancellous bone demarcating the outer limits of the cement. This is considered to be physiological and not to indicate failure of immobilisation.

8. In 37·2 per cent there was slight resorption of the cut surface of the calcar femorale. This is considered to be physiological and to confirm the efficacy of weight transmission by cement lower down in the medullary cavity.
MANIPULATIVE REDUCTION IN SLIPPED UPPER FEMORAL EPIPHYSIS
Authors: Fairbank T. J.
Published: February 2018

This series, albeit consecutive and unselected, is very small; conclusions must therefore be tentative. The results do however suggest that the dangers of late manipulative reduction properly performed may have been exaggerated. Attempted without undue force it proved a harmless procedure, often successful even in cases of long duration. When it succeeds, the results in slips of unacceptable degree are at least as good as those following the more major surgical procedures, which can thus be avoided. Even when the displacement is minor its correction should on theoretical grounds at least decrease the prospects of later osteoarthritis. The only absolute contra-indication is a fused epiphysial plate. The degree of slip and above all the duration of symptoms should not preclude an attempt at manipulative reduction.
THE ANATOMY OF UNCORRECTED CLUB FEET
Authors: Swann Malcolm , Lloyd-Roberts G. C. , Catterall A.
Published: February 2018

1. We have considered torsional deformity in club feet and conclude that medial torsion does not occur in the tibia.

2. It is suggested that in uncorrected feet the hindfoot with the ankle mortise is laterally rotated.

3. We have discussed the cause, prevention and consequences of spurious correction by lateral rotation.

4. The "bean-shaped foot" seems an appropriate description of the final deformity as it is commonly seen.
THE GROWTH OF BONE AUTOGRAFTS IN RABBIT EAR CHAMBERS
Authors: Ezra-Cohn H. E. , Bullough Peter G. , Trueta J.
Published: February 2018

1. A method is described for the in vivo and in vitro study of osteogenesis by implanting a modified transparent chamber in half lop-eared rabbits (as originated by Sandison 1928). This method allows the daily observation and photography of the developing bone and the study of its intimate connection with the vascularity of the area.

2. The osteogenetic potential of a variety of substances can also be investigated by this method. The tissue in the chamber can easily be prepared for its final examination by optical and electron microscopy and by other laboratory techniques.
COMPRESSION OF THE DEEP PALMAR BRANCH OF THE ULNAR NERVE
Authors: Hayes J. R. , Mulholland R. C. , O'Connor B. T.
Published: February 2018

1. A case of compression of the deep branch of the ulnar nerve is described.

2. Anatomical evidence is presented that the reason for the special liability of the deep branch to be compressed by ganglia in this region is its relationship to a ligamentous band which passes from the pisiform bone to the hamate superficial to the deep branch of the ulnar nerve.

3. This band, though constant, has not been well recognised.
A REVIEW OF LONG-TERM RESULTS OF ARTHRODESIS OF THE FIRST METATARSO-PHALANGEAL JOINT
Authors: Fitzgerald J. A. W.
Published: February 2018

1. One hundred cases of arthrodesis of first metatarso-phalangeal joint have been reviewed after a post-operative interval of at least ten years.

2. Seventy-seven per cent of patients were completely satisfied with the late results ; only 9 per cent were dissatisfied.

3. The two major factors leading to poor results were found to be malposition of the arthrodesis, and interphalangeal osteoarthritis.

4. The ideal position for fusion is considered to be in at least 20 degrees of valgus, preferably between 20 and 30 degrees ; between 20 and 40 degrees of dorsiflexion ; and most importantly, neutral rotation.

5. The precise operative technique is not important provided it maintains the position obtained at operation until the arthrodesis is sound.
CONSEQUENCES OF AVASCULAR NECROSIS OF THE FEMORAL HEAD IN RABBITS
Authors: Rösingh G. E. , Steendijk R. , Van den Hooff A. , Oosterhoff J.
Published: February 2018

1. In two-month-old rabbits the femoral heads were made necrotic by transecting the ligament of the femoral head and applying a ligature around the femoral neck. The animals were killed at different periods, from six hours to twenty-one weeks after the operation. The changes in the femoral heads were studied histologically, microradiographically and radiographically.

2. In the first three weeks the necrotic bone marrow was penetrated by granulation tissue in which cellular differentiation gradually developed. Subsequently large quantities of new bone were deposited on the dead trabeculae. This led to an increase in the bone volume at the expense of the marrow volume; this increase coincided with an increase in the radiographic density (sclerosis) of the femoral head. The new bone tissue was attached to the necrotic trabeculae by a specific cement line and showed the features of woven bone. At a later stage lamellar bone was deposited. From six weeks on a normal bone-marrow ratio was gradually restored with concomitant radiographic loss of sclerosis.

3. It is suggested that mechanical weakening of the femoral head is the consequence of this late post-operative restoration of the normal pre-operative bone-to-marrow ratio, the new bone trabeculae being mechanically inferior because of the presence of woven bone and cement lines. This weakness may initiate collapse and deformation of the revascularised femoral head.
FREE DIGITAL TRANSFER
Authors: Cobbett J. R.
Published: February 2018

1. A single case is presented in which the great toe was transferred in one stage to replace an amputated thumb : microvascular techniques were used to anastomose the appropriate vessels.

2. The operative and post-operative complications are described and the final successful result noted.

3. The place of the operation in the future of thumb replacement is briefly discussed.
DISLOCATION OF THE HEAD OF THE RADIUS ASSOCIATED WITH FRACTURE OF THE UPPER END OF THE ULNA IN CHILDREN
Authors: Theodorou S. D.
Published: February 2018

I. Five cases of dislocation of the head of the radius associated with fracture of the upper end of the ulna in children are reported. It is important that fractures of the upper end of the ulna, especially those with some varus deformity in children, should arouse suspicion of the possible co-existence of a dislocation of the head of the radius.

2. The association of the injury to the elbow with a fracture of the lower end of the radius and ulna in three of our cases indicates the necessity for keeping in mind the possibility of this combination.

3. Closed reduction seems to be the best method of treatment.

4. Our five cases were seen during a period ofonly three years. We therefore believe that this injury is not as unusual as appears from the literature.
TOTAL DISLOCATION OF THE CUBOID BONE
Authors: Drummond Denis S. , Hastings David E.
Published: February 2018

1. A case of total dislocation of the cuboid bone without fracture is described. This is an uncommon injury and to our knowledge has not previously been reported.

2. Its rarity is explained in the light of the structural anatomy and function of the foot.

3. A mechanism of injury is postulated and a method of reduction and fixation described.
THE TREATMENT OF FLEXION CONTRACTURES OF THE KNEE IN POLIOMYELITIS
Authors: Conner Alan N.
Published: February 2018

1. Methods of correcting flexion contractures of the knee following poliomyelitis fail if posterior subluxation of the tibia is allowed to occur.

2. Careful serial manipulations will give straight, congruous joints in younger patients. Posterior capsulotomy does not facilitate correction.

3. Supracondylar femoral osteotomy is indicated in children over fifteen and in adults, although sometimes arthrodesis of the knee is necessary.
ALLOTRANSPLANTATION OF JOINTS
Authors: Volkov M.
Published: February 2018

Joint allotransplantation has a place in the treatment of joints destroyed by operation or disease. It is hoped that the results will improve with increasing knowledge of immunological mechanisms and with improvements in methods of internal fixation.
INSTILLATION-SUCTION TECHNIQUE IN CHRONIC OSTEOMYELITIS
Authors: Taylor A. R. , Maudsley R. H.
Published: February 2018

1. A technique of closed instillation-suction for the treatment of chronic bone infection is described in which infected bone is first exposed and all necrotic material removed. Three perforated drainage tubes are inserted, and brought out through the skin some distance from the wound. The perforated parts of the tubes are laid close to the infected area and the wound closed in layers. Two of the tubes are connected to a drip bottle containing antibiotic solution, and the third to a continuous suction pump. Closed continuous instillation-suction is thus established, and has been maintained for up to six weeks.

2. The results in twelve cases are presented, two-thirds of which showed clinical resolution of the infection.
HISTOLOGICAL STRUCTURE OF HUMAN FLUOROTIC BONES
Authors: Jit Indar , Chawla L. S. , Chhuttani P. N.
Published: February 2018

1. Fluorotic bones and exostoses obtained from the skeletons of two subjects with advanced fluorosis have been examined microscopically.

2. The cortical bone showed normal, regular Haversian systems with normal canaliculi and lacunae. The exostoses also exhibited normal, regular Haversian systems but at places the reabsorption tunnels were large.

3. Special stains failed to show osteoid tissue either in the fluorotic bones or in their exostoses.
MASSIVE OSTEOLYSIS
Authors: Kery L. , Wouterst H. W.
Published: February 2018

Two cases of massive osteolysis of the lower extremities are reported. In one case a second lesion occurred in the opposite tibia and the process stopped after early total resection.
A VACUUM SPLINT FOR USE IN ORTHOPAEDIC OPERATIONS
Authors: Povey R. W.
Published: February 2018

1. The principle of the vacuum splint is described.

2. A simple, cheap operating splint has been found useful to replace sandbags and other supports.

3. Applications to commonly practised orthopaedic operations are discussed.
THE MANAGEMENT OF LOWER LIMB PHOCOMELIA
Authors: Lamb D. W. , Simpson D. C. , Pirie R. B.
Published: February 2018

1. Experience with the McLaurin swivel walker for children with bilateral phocomelia of the lower limbs is described.

2. Modifications to the prosthesis and the method of fitting in stages are recorded.
BENIGN CHONDROBLASTOMA OF BONE
Authors: Sirsat M. V. , Doctor Vatsala M.
Published: February 2018

A case of malignant transformation of a benign chondroblastoma of the tibia in a fifteen-year-old boy is reported. The tumour was not irradiated at any time during the course of the disease. The tumour showed a typical appearance of benign chondroblastoma at the first operation. It recurred repeatedly after curettage, and finally emerged as a highly malignant undifferentiated sarcoma. In spite of amputation the patient died nine years after the onset of the disease with an enlarged liver and inguinal lymph nodes.
TREATMENT OF MOBILE FLAT FOOT BY DISPLACEMENT OSTEOTOMY OF THE CALCANEUS
Authors: Koutsogiannis E.
Published: February 2018

1. Thirty-four cases of calcaneal osteotomy for mobile flat foot in nineteen patients are reviewed.

2. The function was markedly improved in seventeen of the nineteen patients.

3. The operation was successful in correcting the valgus deformity of the heel in thirty of the thirty-four feet. it was less successful in improving the longitudinal arch, especially when the flat foot deformity was severe.
COMPLETE REMOVAL OF THREE VERTEBRAE FOR GIANT-CELL TUMOUR
Authors: Stener Bertil , Johnsen Odd E.
Published: February 2018

1. A twenty-six-year-old woman was paraplegic because of a benign giant-cell tumour which had destroyed the body of the twelfth thoracic vertebra completely and the bodies of the eleventh thoracic and first lumbar vertebrae partially. The tumour had expanded into both pleural cavities and displaced the aorta forward and to the left. The extent and topography of the tumour were evaluated before operation by angiography. The function of the spinal cord had not been improved significantly by laminectomy. It was therefore decided to attempt extirpation of the tumour by removing all remaining parts of the three vertebrae involved.

2. After the removal of the tumour, only the spinal cord with the thecal sac bridged the gap between the tenth thoracic and second lumbar vertebrae. The gap was bridged with struts of cortical bone from both tibiae and with two strong plates, all secured with steel wire. The metal was removed five months later because it had become loose. Gradual shortening and angulation of the spine then occurred, together with progressive resorption of the cortical grafts. Nevertheless, the operation restored the function of the spinal cord; the patient regained ability to walk and full control of the bladder.
TOTAL SPONDYLECTOMY IN CHONDROSARCOMA ARISING FROM THE SEVENTH THORACIC VERTEBRA
Authors: Stener Bertil
Published: February 2018

1. A forty-nine-year-old man had a chondrosarcoma arising from the body of the seventh thoracic vertebra. The tumour protruded into the mediastinum and also into the spinal canal where it displaced the spinal cord.

2. At operation all the seventh thoracic vertebra and parts of the sixth and eighth were removed together with the tumour. The thoracic spine was reconstructed by inserting two iliac bone-blocks between the cut bodies of the sixth and eighth vertebrae and by wiring two strong "A. O." plates to the transverse processes of the third to the sixth and the eighth to the tenth vertebrae.

3. The patient was nursed in a plaster-of-Paris bed for three and a half months.

4. One year and three months after operation, the patient was walking and well, with no signs of recurrence or metastasis. Radiographs showed that a block-vertebra had been created from the iliac grafts and the two cut vertebrae.
DEGENERATION OF JOINTS IN HAEMOPHILIACS UNDER TREATMENT BY MODERN METHODS
Authors: van Creveld S. , Hoedemaeker Ph. J. , Kingma M. J. , Wagenvoort C. A.
Published: February 2018

1. Four joints of three young haemophiliacs who died in traffic accidents have been examined.

2. All patients had received prompt specific treatment for intra-articular and other haemorrhages.

3. Major macroscopic and histological changes were seen in the joints, but these changes were not quite so severe as those described before the days of specific treatment.

4. The possibilities of preventing articular changes and of minimising the effect of blood in the joints are discussed.
ATHLETIC ACTIVITY IN ADOLESCENCE AS AN ETIOLOGICAL FACTOR IN DEGENERATIVE HIP DISEASE
Authors: Murray R. O. , Duncan Catherine
Published: February 2018

1. In a previous investigation, approximately 40 per cent of so-called "primary" degenerative disease or osteoarthritis of the hip appeared to have been the result of an abnormal joint mechanism caused by minimal epiphysiolysis in adolescence. Males were affected much more commonly than females. The residual abnormality of this disturbance, recognised radiologically, was termed the "tilt deformity" of the femoral head.

2. Three groups of young adult males, with different athletic backgrounds, have now been examined to assess the incidence of this abnormality and its relationship to athletic regimes. The condition was found to be more common in subjects who had been engaged in more active regimes and was also related statistically to a history of "growing pains". The deformity is compared with the gross disturbance of adolescent epiphysiolysis or slipped epiphysis, which is believed basically to be caused by chronic stress.

3. Degenerative disease of the hip of this type has a geographical and racial distribution corresponding to the degree of interest in and encouragement of competitive athletic activities. Many cases are therefore postulated to be the direct result of a minor and usually asymptomatic disturbance of this type, attributable to excess activity during adolescence.
INTERCONDYLAR T-SHAPED FRACTURES OF THE HUMERUS
Authors: Brown R. F. , Morgan R. G.
Published: February 2018

1. A review of ten cases of T-shaped intercondylar fractures of the humerus treated with a sling and early movement is presented.

2. The method and the results are discussed and some comparison is made with other series.

3. This method of treatment has certain advantages and the results are reasonable in comparison with those of other methods.
TALECTOMY FOR EQUINOVARUS DEFORMITY IN ARTHROGRYPOSIS AND SPINA BIFIDA
Authors: Menelaus M. B.
Published: February 2018

1. The indications for talectomy in the treatment of equinovarus deformity in arthrogryposis multiplex congenita and spina bifida are discussed.

2. The technique of the operation is described, with variations which may be necessary in special circumstances.

3. The results of forty-one operations are analysed.

4. It is concluded that the operation has a useful place in the management of equinovarus deformity in arthrogryposis multiplex congenita and spina bifida, especially between the ages of one and five years.
COMPRESSION OF THE DEEP PALMAR BRANCH OF THE ULNAR NERVE BY AN ANOMALOUS MUSCLE
Authors: Jeffery A. K.
Published: February 2018

1. A case of compression of the deep palmar branch of the ulnar nerve by an accessory abductor minimi digiti muscle is described.

2. The morphology of abnormal muscles in the hypothenar region is discussed.

3. Five previously reported cases of ulnar nerve compression at the wrist by an anomalous muscle are reviewed.

4. When symptoms are produced by an anomalous hypothenar muscle, they seem to be related to the anatomical site of the muscle and the presence of muscle hypertrophy. Occupational factors may be important in producing this hypertrophy.
THE SCAPHO-CAPITATE FRACTURE SYNDROME
Authors: Monahan P. R. W. , Galasko C. S. B.
Published: February 2018

1. A case of the scapho-capitate fracture syndrome is described.

2. At operation the proximal fragment of the capitate bone was found to have rotated on a transverse and not on a vertical axis.
PROSTHETIC REPLACEMENT OF A CHONDROSARCOMA OF THE UPPER END OF THE FEMUR
Authors: Bingold A. C.
Published: February 2018

A case of excision of a chondrosarcoma of the upper end of the femur with replacement by a prototype internal prosthesis has been followed for eighteen years.
PROXIMAL AVULSION OF THE ILIACUS WITH PARALYSIS OF THE FEMORAL NERVE
Authors: Green J. P.
Published: February 2018

1. The case of a girl aged sixteen years who avulsed the iliacus muscle from the ilium during a gymnastic exercise is reported.

2. The lesion was complicated by paralysis of the femoral nerve from pressure by the haematoma. Recovery occurred after decompression.

3. Reports of similar cases from the literature are reviewed.
CONGENITAL DISLOCATION OF THE HIP
Authors: MacKenzie Ian G.
Published: February 2018

1. A scheme was started in 1960 with the object of ensuring that the hips of all babies born in the North-Eastern Region of Scotland were examined shortly after birth.

2. 1,671 children with suspected abnormalities have been seen during the ensuing ten years, and the findings are discussed.

3. Clinical examination is essential. Radiographic examination of the newborn is not necessary and may be misleading, but it does prove that some hips with limited abduction but no instability are in fact dislocated.

4. Treatment is not started when the diagnosis is made shortly after birth. The children are re-examined at three weeks, when spontaneous recovery has occurred in about half. The others, whether they show instability or only limitation of abduction of the hips, are treated in a simple splint until they are three months old. Any residual stiffness is an indication for further splintage.

5. The first radiographs are taken when the children are three months old, and no child is discharged until the radiographs show that the upper femoral epiphyses have appeared and are in normal position.

6. We appreciate that we are treating some children who would have recovered spontaneously, but we do not know how to distinguish them. There is no evidence that splintage harms a hip.

7. Eighty-six children (5 per cent of the total) needed operation usually because the diagnosis was missed at birth.

8. Children with familial joint laxity or genu recurvatum should be examined especially carefully for associated hip abnormality.

9. The incidence of abnormality of the hips at birth is about one in fifty live births.
VENOUS ENGORGEMENT AND INTRAOSSEOUS HYPERTENSION IN OSTEOARTHRITIS OF THE HIP
Authors: Arnoldi Carl C. , Linderholm Hêkan , Müssbichler Herbert
Published: February 2018

1. In fifteen patients with unilateral osteoarthritis of the hip bilateral measurements of the intraosseous pressure of the femoral neck and determination of femoral vein pressure were done simultaneously. These pressure examinations were followed by bilateral intraosseous phlebography of the proximal part of the femur.

2. In a second series of fifteen patients the intraosseous pressures of the femoral head and neck were measured simultaneously before operation for osteoarthritis.

3. The pressure in the femoral vein was equal on the two sides. The intraosseous pressure in the femoral neck was always higher in the arthritic hip than on the unaffected side. In hips with osteoarthritis the pressure in the femoral head was higher than the pressure in the neck.

4. Intraosseous phlebography indicated a state of intramedullary venous engorgement in osteoarthritis. The normal channels for venous drainage from the femoral head and neck were not visible in the phlebographs from the arthritic side. Instead, drainage took place through descending intramedullary vessels to the trochanteric region and down into the femoral shaft. The emptying of intraosseous contrast material from the arthritic hip was delayed.

5. The phlebographs indicated that the abnormally high intraosseous pressure observed in osteoarthritis is caused by a high resistance to flow across the cortex of the proximal part of the femur.

6. The aching rest pain typical of severe osteoarthritis was noted only in patients with intraosseous femoral neck pressure above 40 millimetres of mercury, an indication that this type of pain is caused by intramedullary hypertension. The decrease of arteriovenous pressure difference, caused by increase of resistance to venous outflow, is probably accompanied by disturbances of nutritive flow. This "venous ischaemia" may play an important role for the structural changes of cancellous bone in osteoarthritis.
FLEXOR MUSCLE SLIDE IN THE SPASTIC HAND
Authors: White W. F.
Published: February 2018

1. A study has been made of thirty-two patients who had had operations for their spastic hands.

2. In twenty-seven a flexor muscle slide was done, either by itself or in association with an arthrodesis of the wrist. The rationale of the operation is discussed.

3. The first muscle slide was done in 1959 and the average follow-up was seven and a half years.

4. Selection is crucial : drive, usually coupled with intelligence, is essential for success.

5. Operation is not a replacement for physical therapy. The object is to make rehabilitation easier. The flexor muscle slide, in carefully chosen cases, may play a significant part in achieving this.
THE MANAGEMENT OF HYDATID DISEASE OF BONE AND JOINT
Authors: Booz M. K.
Published: February 2018

1. Twelve cases of hydatid disease of bone seen in Kuwait over the last ten years are reported. Ten of the twelve patients were Bedouins.

2. Seven cases were followed up and the results of treatment are discussed.

3. Curettage, formalin swabbing and bone grafts were used as the treatment of choice.

4. There may be a place for a conservative approach in some cases ; one such case reported here has been followed up for ten years.

5. The problem of prevention, especially in a Bedouin area, is briefly discussed.
SURGICAL TREATMENT FOR DERANGEMENT OF THE LUMBAR SPINE
Authors: Newman P. H.
Published: February 2018

1. Some of the more common and obvious clinical syndromes arising from mechanical and degenerative derangements of the lumbar spine are defined.

2. Some principles in the selection of cases for surgical treatment are discussed and it is stressed how small a part operative intervention plays in the overall problem of low back derangement.

3. Details of surgical technique in the eight types of syndrome are described from past experience in the author's clinic, but not without recognition of the fluidity of this comparatively new field and its continuing evolution.
PROBLEMS ASSOCIATED WITH THE USE OF THE KNEE-CHEST POSITION FOR OPERATIONS ON LUMBAR INTERVERTEBRAL DISCS
Authors: Alexander J. P.
Published: February 2018

1. The knee-chest position offers the surgeon excellent conditions for operations on lumbar intervertebral discs.

2. Hypotension on resumption of the prone or supine position is common: it is influenced by the anaesthetic technique, the physical state of the patient, the operation time and the extent of surgical bleeding.

3. The hypotension is thought to be due to poor perfusion of the lower limbs while the patient is in the knee-chest position.
EFFECTS OF STRETCHING THE TIBIAL NERVE OF THE RABBIT
Authors: Lundborg GÖRan , Rydevik BjÖRn
Published: February 2018

1. Stretching of the tibial nerve cut 2 centimetres above the ankle has been the subject of an experimental study in rabbits.

2. The effects on intraneural microcirculation, on vascular permeability, and on the barrier function of the perineurium have been analysed with the aim of determining the extent to which a divided nerve can be stretched without interfering with the process of repair.

3. The results obtained may prove valuable for understanding basic mechanisms and for establishing certain important limitations when end-to-end suture of a nerve trunk is performed under some degree of tension in man.
RECOMBINED GRAFTS OF BONE AND MARROW
Authors: Salama R. , Burwell R. Geoffrey , Dickson I. R.
Published: February 2018

1. This paper reports a histological study of the fate of sheep and calf cancellous bone grafts impregnated with autologous red marrow of Wistar rats and implanted intramuscularly as composite xenograft-autografts for two to twelve weeks. It also includes some biochemical estimations of certain types of sheep and calf bone used to prepare these composite grafts.

2. Only one of 223 devitalised bone xenografts implanted without autologous marrow formed new bone; in contrast 216 of 223 transplanted with marrow formed new bone.

3. The new bone formed by the composite grafts is derived from the autologous marrow. There was no evidence for an inductive effect upon the marrow of the various types of xenograft bone studied as described previously for allograft bone (Burwell 1966).

4. The highest score of new bone formation was found in composite grafts based on fully deproteinised sheep iliac bone prepared at Oswestry. Statistically this score was significantly higher than those registered by composite grafts prepared from intact (frozen and freeze-dried), decalcified (frozen and freeze-dried) and Kiel sheep bone, and by Kiel and Oswestry calf bone (Table II).

5. The histological evidence reported suggests that the high score with the sheep Oswestry composite grafts is because Oswestry bone is feebly immunogenic, if at all; and that such feeble or absent immunogenicity permits more marrow cells to differentiate into osteoblasts and lay down new bone without impediment.

6. The lower scores of new bone formation in most of the undeproteinised composite grafts of sheep origin–intact frozen, intact freeze-dried and Kiel–are attributed to residual immunogenicity within the organic material of the donor bone, because each type evoked the formation of mature plasma cells.

7. The Kiel bone grafts appeared to evoke less of a plasma cell reaction and may be less immunogenic than the intact and decalcified bone xenografts.

8. The sheep Oswestry CXA's formed significantly more new bone than did the calf Oswestry CXA's. This difference may be due to the different physical properties of the bone obtained from old sheep compared with the bone obtained from a young calf.
ATLANTO-AXIAL FRACTURE-DISLOCATIONS
Authors: Fried Larry C.
Published: February 2018

1. Ten consecutive cases of acute atlanto-axial fracture dislocation were treated by posterior C.1-C.2 fusion.

2. In eight cases there was significant redislocation warranting further therapy.

3. Operative fusion together with prolonged firm immobilisation are recommended only after a trial of conservative therapy.
OSTEOMALACIA IN ELDERLY PATIENTS WITH FRACTURE OF THE FEMORAL NECK
Authors: Jenkins D. H. R. , Roberts J. G. , Webster D. , Williams E. O.
Published: February 2018

1. Seventy-four patients over the age of seventy with either subcapital or intertrochanteric fracture have been investigated for evidence of osteomalacia. To establish an index of suspicion the incidence of biochemically defined osteomalacia has been compared with quantitative histology in this group.

2. Whereas no significant difference in the incidence of the disease was noted in the comparison of subcapital with trochanteric fracture groups, there was a high incidence of osteomalacia overall. Furthermore, a subclinical form of the disease appears to exist.

3. The relevance of these observations is discussed with particular reference to the established diagnostic criteria of the condition.
GANGLIA OF THE FLEXOR TENDON SHEATHS IN THE HAND
Authors: Matthews Phillip
Published: February 2018

1. The features of ganglia of the flexor tendon sheaths of the hand are described.

2. A high incidence in typists is discussed in relation to etiology and pathogenesis.

3. The suggestion is made that needle rupture is the method of choice, with surgical excision in case of recurrence.
OSTEOTOMY OF THE CALCANEUS AND CONCOMITANT PLANTAR STRIPPING IN CHILDREN WITH TALIPES CAVO-VARUS
Authors: Dekel S. , Weissman S. L.
Published: February 2018

1. Thirty-three children with thirty-eight feet affected by a cavo-varus deformity and treated by calcaneal osteotomy with concomitant stripping of plantar muscles were reviewed two to ten years after operation.

2. Out of twenty-six patients who were over eleven years old at the time of the review, fourteen (with eighteen feet) did not need any further treatment. In three other patients the deformity had recurred to a slight degree but did not warrant tarsal reconstruction. In the remaining nine patients the recurrence was marked and necessitated tarsal reconstruction.

3. The combined procedure is of value when there is progressive deformity in children too young for tarsal reconstruction.