bluuebunny/crossref_metadata_2025 huggingface dataset:
EXISTENCE AND INCIDENCE OF OSTEOID IN OSTEOARTHRITIC FEMORAL HEADS
Authors: Batra H. C. , Charnley J.
Published: February 2018

1. Specimens are described in which osteoid was seen in undecalcified bone sections prepared from a number of osteoarthritic femoral heads.

2. It was localised mostly in the pressure segments.

3. The reason for the presence of this osteoid is not well understood and the possibilities of local histochemical changes and/or cellular metaplasia are discussed.
SUBACUTE HAEMATOGENOUS OSTEOMYELITIS
Authors: King D. M. , Mayo K. M.
Published: February 2018

1. Sixty-seven patients with subacute haematogenous osteomyelitis are reported.

2. The benign nature of the disease is noted.

3. The clinical types of infection are reported, with regard to the site of the lesion.

4. The treatment is described.
SYME'S AMPUTATION
Authors: Baker G. C. W. , Stableforth P. G.
Published: February 2018

1. All traceable Syme amputees attending the Edinburgh limb centre have been seen and reviewed. They number sixty-seven. Forty had amputations twenty-five or more years before.

2. There are seventy-one surviving stumps. One has failed.

3. Records of all the below-knee amputees reveal five further failures of Syme stumps. The causes of failure are discussed.

4. Problems in the Syme stump are rare after the first year. The early difficulties are discussed.

5. We conclude that a patient with Syme's amputation can expect his stump to give a lifetime of service.
MAJOR INJURIES OF THE TALUS
Authors: Kenwright J. , Taylor R. G.
Published: February 2018

1. Fifty-eight major injuries in the region of the talus were reviewed regarding treatment, incidence of complications and long-term results.

2. The prognosis for simple fractures of the head, neck or body was good, as was that for dislocations of the midtarsal and peritalar joints.

3. The prognosis for fracture-dislocations of the neck and body was better than has been frequently reported. It was related to the degree of initial trauma. A good result occurs only if accurate reduction is effected and maintained. Fixation with a Kirschner wire is a useful method of maintaining the reduction after unstable fracture-dislocations.

4. Avascular necrosis occurred only in the more severe injuries and its incidence was related to the degree of initial displacement. The late results were better than have been previously described. The condition is best treated conservatively by protection from weight-bearing until revascularisation is well advanced.

5. A case with an unusual pattern of fracture of the neck of the talus is described following a plantar-flexion inversion injury.
SOLITARY EOSINOPHILIC GRANULOMA IN BONE
Authors: Fowles J. V. , Bobechko W. P.
Published: February 2018

1. Forty patients with solitary eosinophilic granuloma of bone from the Hospital for Sick Children, Toronto, have been reviewed. They had clinical and laboratory findings similar to those reported by others except for the erythrocyte sedimentation rate, which was raised in nearly half the patients tested.

2. Radiographs in all cases showed the lesion to be osteolytic. In the skull and cervical spine there was no bony reaction ; in the thoracic and lumbar spine the typical picture of Calvés disease was produced; in long bones the cortex commonly showed endosteal erosion and periosteal reaction.

3. In one patient the lesion progressed so rapidly that the body of a cervical vertebra was destroyed within ten days.

4. The differential diagnosis includes sarcoma. Biopsy is essential.

5. All the patients improved regardless of the treatment they received. Complications were due either to the site of the lesion or to its treatment.

6. Expansion of the lesion after biopsy indicates a more widespread manifestation of histiocytosis X.
SURGICAL RELIEF FOR SPASTIC TETRAPLEGIA DUE TO CERVICAL CORD COMPRESSION
Authors: Fuller David J.
Published: February 2018

1. A case of cervical cord compression due to a congenital anomaly of the arch of the axis, treated successfully by decompressive laminectomy twenty-six years after the onset of symptoms, is described.

2. The significance of bony abnormalities of the cervical spine as a treatable cause of spastic tetraparesis is stressed.
ARTHROGRYPOSIS MULTIPLEX CONGENITA
Authors: Gibson D. A. , Urs N. D. K.
Published: February 2018

1. Eighty-two patients out of 114 with arthrogryposis seen at the Hospital for Sick Children, Toronto, during the period of 1950-65 have been studied, and the literature has been reviewed.

2. Arthrogryposis is considered to be caused by a failure of normal development.

3. Respiratory infection in the first five years is the major hazard to life. If these children survive the first five years, the expectation is that they will reach maturity and find a place in the community.

4. Children with upper limb involvement develop remarkably good function which can be improved by carefully planned operations.

5. Operation has a much larger place in the treatment of affected lower limbs.

6. Three out of four children with lower limb involvement can be enabled to walk if tile need for repeated operation is accepted.

7. Excision of the talus is a useful operation in the management of club foot ill arthrogryposis.

8. Early treatment is more effective than late ill controlling deformity and improving function.
PES CAVUS AND LYMPHOEDEMA
Authors: Jackson B. T. , Kinmonth J. B.
Published: February 2018

1. Two patients with bilateral pes cavus and lymphoedema are reported. Lymphography confirmed the existence of lymphatic insufficiency in both cases. In both there was evidence of hereditary factors in the etiology.

2. This familial syndrome appears not to have been previously reported.
THE STRENGTH OF THE MENISCI OF THE KNEE AS IT RELATES TO THEIR FINE STRUCTURE
Authors: Bullough Peter G. , Munuera Luis , Murphy Joseph , Weinstein Allan M.
Published: February 2018

1. The orientation of collagen fibres of the menisci of the knee has been demonstrated by polarised light microscopy.

2. As might be supposed from its fibre structure, the ultimate tensile strength of the meniscal tissue is dependent upon the axis of loading.

3. The tensile strength of the meniscus is similar to that of articular cartilage.
CONGENITAL PSEUDARTHROSIS OF THE CLAVICLE
Authors: Gibson D. A. , Carroll N.
Published: February 2018

1. Thirteen cases of congenital pseudarthrosis of the clavicle conforming to the classical picture are presented, together with five cases of pseudarthrosis occurring for various other reasons, and nine cases of congenital pseudarthrosis that form a special group because there was a strong family history.

2. Treatment, if desired by the patient, is easy, but should be deferred until the age of four or five years.

3. The etiology remains obscure. Our embryological study does not support the theory that the clavicle normally develops from two ossification centres that may fail to coalesce. Although in thirteen of our patients there was no family history of pseudarthrosis, there was another group of nine patients who presented a strong family history, and it seems certain that in some instances congenital pseudarthrosis of the clavicle can be transmitted genetically.
CONGENITAL PSEUDARTHROSIS OF THE CLAVICLE
Authors: Owen Robert
Published: February 2018

1. Thirty-three cases of congenital pseudarthrosis of the clavicle are presented.

2. The lesions all occurred in the right clavicle and are thought to be due to abnormal intrauterine development rather than non-union of birth fractures.

3. Methods of treatment are reviewed. Excision and bone grafting is favoured.
AMYLOIDOSIS OF BONE
Authors: Axelsson U. , Hallen A. , Rausing A.
Published: February 2018

Two cases of skeletal amyloidosis are described. In one the disease existed for many years, progressively destroying several vertebral bodies. There was no evidence of chronic infection, myelomatosis or cancer. In the other case myelomatosis was the primary disease but the first manifestation was a cystic tumour of the humerus. Not until several years later did typical bone lesions and Bence-Jones protein reveal the true nature of the disease.
CONGENITAL ARTERIOVENOUS FISTULA WITHIN THE TIBIA
Authors: Walker Geoffrey
Published: February 2018

1. A case of arteniovenous fistula within the tibia of a girl is described.

2. Removal and replacement of a large part of the tibial diaphysis was followed by "re-formation" of the bone.

3. The literature of the condition is reviewed.
DUPUYTREN'S CONTRACTURE
Authors: Honner Richard , Lamb D. W. , James J. I. P.
Published: February 2018

1. The results in 138 hands operated on for Dupuytren's contracture are analysed and compared with those in other series.

2. Contracture ofthe metacarpo-phalangeal joint can be expected to respond well to operation, whereas the outlook in the case of contracture of the proximal interphalangeal joint is generally poor.

3. The reasons for this difference are examined.

4. The advantages of early operation for contracture of the proximal interphalangeal joint are stressed.
FRACTURES OF THE DENS [ODONTOID PROCESS]
Authors: Schatzker Joseph , Rorabeck Cecil H. , Waddell James P.
Published: February 2018

1. Thirty-seven cases of fracture of the dens have been studied.

2. The incidence of non-union was high: 64 per cent after apparently adequate closed treatment.

3. Possible causes of the high incidence of non-union have been studied : attention is drawn to the effect of displacement and to that of posterior displacement in particular.

4. Non-union of the dens with potential instability at the atlanto-axial joint is not acceptable in a patient who expects to lead a normal active life.

5. Atlanto-axial fusion is the method of choice in the treatment of instability ; once that has been secured, pseudarthrosis of the dens is no longer significant.
RECURRENT SUBLUXATION OF THE PATELLA ON EXTENSION OF THE KNEE
Authors: Dandy D. J.
Published: February 2018

1. Eight patients are described in whom the patellae subluxated laterally on every extension of the knee. This is an unusual type of recurrent subluxation. It may recover completely, or remain symptom-free for many years, or increase in severity so that the patient seeks treatment for relief of pain and joint effusion, or progress to frank dislocation.

2. Each patient was examined and the probable causes were analysed. The bayonet deformity was present in twelve of the sixteen knees. A new observation is made on the relationship of tibial crest and tubercle in this condition.
BILATERAL APLASIA OF THE TIBIA, POLYDACTYLY AND ABSENT THUMB IN FATHER AND DAUGHTER
Authors: Pashayan H. , Fraser F. C. , McIntyre J. M. , Dunbar J. S.
Published: February 2018

1. A family is reported in which tibial aplasia with polydactyly of hands and feet and absent thumbs occurred in a father and daughter.

2. The evidence suggests the existence of an autosomal dominant mutant gene that causes absent thumbs and manual polydactyly, with or without varying degrees of tibial hypoplasia and pedal polydactyly.
RADIAL PALSY FOLLOWING MUSCULAR EFFORT
Authors: Lotem M. , Fried A. , Levy M. , Solzi P. , Najenson T. , Nathan H.
Published: February 2018

1. Three cases of paralysis of the radial nerve after intensive muscular effort in extension of the elbow are described. Clinical and electrophysiological evidence is recorded.

2. There was motor and sensory affection of varying degree and extent in the distribution of the radial nerve.

3. The type of lesion in each case was that of neurapraxia, and rapid spontaneous recovery occurred in each case.

4. The level of the lesion was in the arm, below the origin of the branches to the triceps.

5. The cause of the lesion was thought to be compression by a fibrous arch related to the lateral head of the triceps.

6. The cases are discussed in relation to other instances of compression of nerves by fibrous arches, and an explanation is advanced for spontaneous recovery.
INTRA-ARTICULAR RHEUMATOID NODULES OF THE KNEE
Authors: Chamberlain M. Anne
Published: February 2018

1. Eight patients with rheumatoid arthritis had an intra-articular nodule in one or both knees causing mechanical symptoms.

2. The nodule was on the lateral side of the knee and interfered with walking. It caused a click and painful instability of the knee at about 15 degrees of flexion.

3. Surgical excision of the nodule, which was attached to the synovial membrane, abolished the symptoms.
POLYMYALGIA RHEUMATICA
Authors: Mowat Alastair G. , Camp A. Virginia
Published: February 2018

1. Polymyalgia rheumatica is a disease of unknown cause, manifested by severe pain and stiffness of the muscles of the shoulder and pelvic girdles, which may be accompanied by a variety of other systemic symptoms.

2. Twenty-three patients with this condition are reviewed.

3. The difficulties of diagnosis, especially when presenting as an orthopaedic problem, are discussed.
OSTEOID OSTEOMA OF THE SKULL
Authors: Prabhakar B. , Raja Reddy D. , Dayananda B. , Rao G. Raghava
Published: February 2018

1. A case of osteoid osteoma of the skull is reported, with characteristic clinical, radiological and pathological features.

2. Osteoid osteoma of the skull has not previously been reported.
SCIATIC NERVE PARALYSIS FOLLOWING ANTICOAGULANT THERAPY
Authors: Leonard M. A.
Published: February 2018

1. A case of complete sciatic palsy complicating anticoagulant therapy is presented.

2. A brief review of the possible pathogenesis is made and the importance of early recognition and treatment of the syndrome is emphasised.
SYNOVECTOMY OF THE KNEE IN JUVENILE RHEUMATOID ARTHRITIS
Authors: McMaster Michael
Published: February 2018

1. Opinion is divided as to the value of synovectomy of the knee in juvenile rheumatoid arthritis.

2. Between 1964 and 1970 thirty synovectomies of the knee were performed in twenty-seven children, who have now been kept under review for one to eight years. Three have required a second operation.

3. The operative findings at various stages are presented and discussed, with special reference to the effect on growth of the limb.

4. Synovectomy is a useful procedure which should be reserved for cases where effusion persists despite nine months of conservative treatment and performed before signs of bone erosion appear.
PSEUDOMALIGNANT OSSEOUS TUMOUR OF SOFT TISSUE
Authors: Chaplin D. M. , Harrison M. H. M.
Published: February 2018

1. Two cases of pseudomalignant osseous tumour of soft tissue are reported and added to the nineteen cases in the literature.

2. The clinical and histological features are described and distinguished from myositis ossificans, osteogenic sarcoma in soft tissue and parosteal fasciitis.

3. In one case the non-malignant nature of the lesion has been confirmed by its spontaneous regression.
CONGENITAL DIASTASIS OF TIBIO-FIBULAR MORTISE
Authors: Tuli S. M. , Varma B. P.
Published: February 2018

1. Two cases of congenital diastasis of the inferior tibio-fibular mortise are described.

2. No previous description of this condition has been found in the literature.

3. it is suggested that the cause is osteochondrosis of the distal tibial epiphysis associated with a club foot.
ENZYME ACTIVITY IN ARTICULAR CARTILAGE AFTER SYNOVECTOMY OF THE KNEE IN THE RABBIT
Authors: Galway Robert D. , Cruess Richard L.
Published: February 2018

Subtotal synovectomy was performed in the knee joints of New Zealand white rabbits. The changes noted in the articular cartilage as manifest by decreased metachromatic staining of the matrix were considered to indicate matrix degradation caused by the altered joint environment. The documentation of the enzyme changes suggests that the histological alteration in the articular cartilage noted after synovectomy may be mediated through the activation of endogenous chondrocyte lysozomal enzymes, particularly cathepsin and acid hydrolases.
MOTION STUDIES OF THE LUMBAR SPINE
Authors: Pennal George F. , Conn Garson S. , McDonald Glen , Dale Gordon , Garside Henry
Published: February 2018

1. This is a preliminary report of an attempt to determine an objective reference point or "point of motion" during flexion and extension of the lumbar spine.

2. The method described uses superimposition of lateral radiographs taken in flexion and extension with the patient standing.

3. In seventy-eight radiographically normal subjects with no symptoms a "point of motion" was determined for each of the lowest three disc levels. At each level these points clustered within a specific zone approximately 2·5 centimetres square. Sixty-four per cent fell within a square centimetre.

4. In a comparative study of twenty-four patients with confirmed pathology, the "point of motion" fell outside the larger zone at the level of pathological change in 65 per cent of the disc levels.

5. The determination of the "point of motion" is a special technique for studying spinal motion. Its role as a diagnostic and prognostic aid in assessing patients with back pain is the subject of continuing study.
SCOLIOSIS AFTER THORACOPLASTY
Authors: Loynes R. D.
Published: February 2018

1. The results of 243 thoracoplasty operations are discussed. It was found that scoliosis developed in over 99 per cent of cases and that the curve was convex towards the side of operation. The angle of curvature correlated closely with the number of ribs removed.

2. If the head, neck and tubercle of the rib and the transverse process of the corresponding vertebra were all removed the degree of scoliosis was increased, whereas if a thoracoplasty was performed with apicolysis and embedding of the scapula the spinal deformity was less. Possible explanations for these phenomena are discussed.

3. No evidence was found to support the theory of causation by imbalance between the paired "pneumatic cylinders" (lungs and thoracic cage) supporting the thoracic spine.

4. The scoliosis was found to progress for many years; some factors influencing this course are discussed.

5. No correlation was found between the age of the patient at the time of thoracoplasty and the degree of subsequent scoliosis, but severe spinal deformity can arise even in older adults.
CORRECTION OF ROTATIONAL MALUNION OF A PHALANX BY METACARPAL OSTEOTOMY
Authors: Pieron A. P.
Published: February 2018

1. Rotational deformity of a finger caused by malunion of a phalangeal fracture has been corrected by metacarpal osteotomy.

2. Because of the anatomical arrangement of the metacarpo-phalangeal joint this method gives good control of the distal phalanges.

3. Division through the metacarpal rather than through the phalanx avoids adhesions in the flexor and extensor mechanisms and in the joints of the fingers, allows early mobilisation and is an easier procedure.
A MODIFIED TECHNIQUE FOR STABILISING THE SPASTIC THUMB
Authors: Lam S. J. S.
Published: February 2018

1. A modified method of stabilisation of the thumb of the spastic hand is described whose rigidity overcomes the difficulty of maintaining a good position while fusion is proceeding.

2. The method seems to have a place in the management of suitably selected patients with severe spastic thumb-in-palm.
CHIARI OSTEOTOMY FOR ACETABULAR DYSPLASIA IN YOUNG SUBJECTS
Authors: Colton C. L.
Published: February 2018

1. The results of Chiari pelvic osteotomy have been examined two to six years after operation in a group of eighteen patients with persisting acetabular dysplasia in the second and third decades.

2. The analysis suggests that for a good clinical result it is essential to create a relationship of the new outer acetabular lip to the original lip so that the CE angle is between 20 and 40 degrees and the roof angle is between 10 degrees below and 20 degrees above the horizontal.

3. This may be achieved by a pelvic osteotomy immediately above the joint capsule, angled 10 degrees upwards and inwards and displaced by 50 per cent of the pelvic thickness.

4. Details of the operative technique using a Smith-Petersen approach are presented.
MICROVASCULAR SURGERY IN ORTHOPAEDICS AND TRAUMATOLOGY
Authors: Tamai Susumu , Sasauchi Nobuyuki , Hori Yoshihide , Tatsumi Yoshitaka , Okuda Hisao
Published: February 2018

1. The history of microvascular surgery is reviewed; the necessary instruments and the technique of suture are described.

2. Modern trends in the experimental and clinical applications in orthopaedic surgery and traumatology are discussed.

3. The authors emphasise the usefulness of this technique in tissue transplantation and in the reconstruction of microvascular injuries of the musculoskeletal system.
THE NATURAL HISTORY OF THE RHEUMATOID METACARPO-PHALANGEAL JOINT
Authors: McMaster Michael
Published: February 2018

1. One hundred and twenty-six metacarpo-phalangeal joints affected by rheumatoid arthritis were studied macroscopically at either synovectomy or arthroplasty.

2. The sites and extent of the initial erosion corresponded with the sites and size of the synovial pouches.

3. The areas of cartilage degeneration were related to the degree of flexion, ulnar deviation and subluxation of the proximal phalanx on the metacarpal head.

4. The routine radiographic findings were not a true reflection of all the pathological changes within the joint.

5. It is suggested that by encouraging joint movement and preventing deformity the degree of cartilage degeneration may be diminished.
ARTHROPLASTY OF THE FOREFOOT IN RHEUMATOID ARTHRITIS
Authors: Barton N. J.
Published: February 2018

1. The results of arthroplasty of the forefoot in thirty-eight patients with polyarthritis have been analysed in detail. Sixty-five feet had been operated on by one of three different techniques–Kates-Kessel-Kay, Fowler or Clayton–though sometimes with modifications.

2. The subjective results were remarkably good. The patients were completely satisfied with forty-two operations, satisfied in most respects with twenty-one, and dissatisfied with only two.

3. The commonest cause of persistent pain was prominence of one metatarsal stump; great care must be taken at the time of operation to ensure that the metatarsals are trimmed to equal length.

4. The objective results were less satisfactory. The lateral four toes were usually functionless, the gait was never normal and the walking distance was still restricted, though often by other factors. The operation, therefore, should be carried out only in patients with severe pain and disability.

5. A comparison of the results of the three different techniques of operation showed no major differences.
THE NAIL-PATELLA SYNDROME
Authors: Valdueza A. Fidalgo
Published: February 2018

1. Three families with the characteristic changes of the nail-patella syndrome are reported. In addition to the well established bone and nail defects they had soft-tissue contractures, web formation around the elbows and muscular hypoplasias. The literature on soft-tissue changes is reviewed and their importance emphasised.

2. Asymmetrical joint development is considered to be a characteristic feature of the syndrome.

3. The incidence of renal disease in our families is recorded.

4. The literature on the basic defect is reviewed. The likelihood of a primary alteration in connective tissue chemistry is considered.
THE USE OF SPLINTAGE IN THE MANAGEMENT OF PARALYTIC DISLOCATION OF THE HIP IN SPINA BIFIDA CYSTICA
Authors: McKibbin B.
Published: February 2018

1. A specially designed splint is described with which it is possible to maintain the reduction of a paralytic dislocation in a child with spina bifida cystica. The results of its use in a series of thirteen cases are recorded.

2. It is suggested that all such children presenting in the first year of life, in whom the power of the flexor and adductor muscle groups is preserved, should be treated initially in this way until the prognosis for the individual can be accurately assessed.

3. The theoretical implications of the findings are discussed.
AMPUTATION IN OSTEOSARCOMA
Authors: Sweetnam Rodney
Published: February 2018

1. The question whether amputation for lower femoral osteosarcoma should be by disarticulation of the hip or through the upper femur to leave a stump is discussed.

2. Sixty-eight such patients are reviewed. Thirty were treated by disarticulation and thirty-eight by through-femur amputation.

3. There was a 16 per cent incidence of stump recurrence after through-femur amputation, but none after disarticulation. Comparison of survival was not conclusive.

4. Disarticulation of the hip is advised.
A REVIEW OF EXCISION OF THE TRAPEZIUM FOR OSTEOARTHRITIS OF THE TRAPEZIO-METACARPAL JOINT AFTER TWENTY-FIVE YEARS
Authors: Gervis W. H.
Published: February 2018

Thirty years' experience of excision of the trapezium for osteoarthritis of the trapeziometacarpal joint has shown that this simple operation is entirely satisfactory.
EXCISION OF THE DISTAL END OF THE ULNA IN RHEUMATOID ARTHRITIS
Authors: Rana N. A. , Taylor A. R.
Published: February 2018

1. The results of excision of the distal end of the ulna in eighty-six wrists of seventy patients suffering from rheumatoid arthritis are presented.

2. There was relief of pain in 93 per cent and restoration of full rotation in 87 per cent.

3. Further destructive changes of the radio-carpal joint were seen in 85 per cent, but these did not affect the good clinical results.
LONG-TERM CONSEQUENCES OF STABLE FRACTURES OF THE THORACIC AND LUMBAR VERTEBRAL BODIES
Authors: Young M. H.
Published: February 2018

1. The late consequences of stable fractures of the thoracic and lumbar spine have been assessed in a series of workmen. The incidence of symptoms has been recorded and an attempt made to assess the degree of associated incapacity.

2. It has been found that most patients continue to have some symptoms attributable to the back injury and that approximately one in five of the patients who attended for review was partially or completely incapacitated as a consequence of such symptoms.

3. The persistence of symptoms was found to be unrelated to the severity of fracture, to its level, to the presence of radiological evidence of degenerative change, or to the age of the patient.

4. Persistent symptoms were found more commonly in those patients who had received more treatment. The implications of this observation are discussed.
PARTIAL COSTECTOMY AS A COSMETIC OPERATION IN SCOLIOSIS
Authors: Manning C. W. , Prime F. J. , Zorab P. A.
Published: February 2018

It is suggested that the operation of partial costectomy is so beneficial psychologically to some young scoliotic patients that it is worth the very small physiological cost demonstrated here in patients who found their "hump" sufficiently embarrassing to curtail their normal social life.
A METAPHYSIAL ABNORMALITY
Authors: Kilburn Peter
Published: February 2018

1. A case is reported of a twelve-year-old boy showing normal stature and severe genu valgum.

2. The radiological and histological features suggested metaphysial dysostosis, possibly of the Schmid type.
FRACTURE OF THE NECK OF THE RADIUS WITH MEDIAL DISPLACEMENT OF THE HEAD
Authors: Ghawabi M. H. El
Published: February 2018

1. Three cases of fracture of the neck of the radius with medial displacement of the head are described.

2. It is proposed that such injuries be classified into two types: 1) displacement of the radial head without dislocation of the elbow; and 2) displacement during posterior dislocation of the elbow.
ANTERIOR FUSION OF THE SPINE FOR INFECTIVE LESIONS IN ADULTS
Authors: Kemp H. B. S. , Jackson J. W. , Jeremiah J. D. , Cook Josephine
Published: February 2018

1. The results of treatment of 117 tuberculous and fourteen other types of infection of the spine in adults by anterior fusion and chemotherapy have been reviewed.

2. It is suggested that anterior fusion is justified because: a) it permits isolation of the organism, and hence the determination of drug sensitivities and appropriate chemotherapy; b) removal of the diseased tissue and the stabilisation of the affected segment by iliac bone grafts can be effected, leading to rapid healing by bony fusion with little further collapse; c) rehabilitation of the patient is hastened; and d) the incidence of reactivation is probably diminished.
CONGENITAL CLUB FOOT
Authors: Waisbrod Hanan
Published: February 2018

1. An anatomical study of congenital club foot in various stages of foetal development is presented, and the literature is reviewed.

2. The most striking finding was deformity of the talus and in particular a change in its angle of declination.

3. That deformity was present in feet whose deformity could not be corrected by gentle manipulation; it was absent in feet whose deformity could be so corrected.

4. Abnormality of the tendon and insertion of the tibialis posterior muscle was found in most cases.

5. Speculations are advanced concerning the nature and cause of the talar deformity.
STATIC AND DYNAMIC PROBLEMS IN SPASTIC CEREBRAL PALSY
Authors: Reimers Jørgen
Published: February 2018

1. Analysis of the static and dynamic conditions in spastic cerebral palsy leads to the conclusion that contractures of the hip, knee and ankle should be released from above downwards, and that the full benefit is obtained only when all contractures have been corrected.

2. Only when these joints are mobilised by removal of the significant contractures is the spastic patient able, despite other handicaps, to sit, stand and walk with the least hindrance and the least cosmetic fault.

3. In our Danish experience, inadequate or poor results from the orthopaedic surgery of cerebral palsy are mainly due to the fact that patients with contractures are operated on too little and too late, or not in the correct sequence.
PLANTAR PRESSURES IN HEALTHY CHILDREN AND IN CHILDREN WITH MYELOMENINGOCELE
Authors: Hay Malcolm C. , Walker Geoffrey
Published: February 2018

1. It has been shown in fifty normal feet that the perpendicular static plantar pressures rise by about 35 per cent between the ages of five years and maturity.

2. It is very likely that similar increases in plantar pressures occur between two and five years of age.

3. The plantar pressures in seventy-eight feet of children with spina bifida were with a few exceptions substantially higher than those of normal children of the same age. It is likely that this is so, at least in part, because the feet of children with spina bifida are smaller than normal.

4. This increase in perpendicular static pressure during growth must be relevant in the production of trophic foot ulceration.

5. The existence and importance of "flail deformity" as a factor producing areas of increased pressure and ulceration in anaesthetic feet is postulated.
ENTRAPMENT NEUROPATHY OF THE SURAL NERVE
Authors: Pringle Robert M. , Protheroe Keith , Mukherjee Sadhan K.
Published: February 2018

1. Four cases of sural nerve entrapment lesions in the ankle and foot are reported.

2. All the patients gained complete relief of symptoms following neurolysis.

3. The presence of a ganglion in relation to the sural nerve in the ankle and foot is a helpful sign in the diagnosis of this condition.
DISPLACED SUPRACONDYLAR FRACTURES OF THE ELBOW IN CHILDREN
Authors: Fowles J. V. , Kassab M. T.
Published: February 2018

Displaced extension supracondylar fractures of the elbow 1. One hundred and ten children were treated by reduction and stabilisation by two pins inserted laterally at an angle of 30 degrees to one another.

2. The complications before and after treatment included fifteen nerve lesions in thirteen patients. The ulnar nerve was involved on one occasion only. Solitary radial nerve injuries occurred with postero-medial displacement of the distal fragment, while median nerve and brachial artery injuries were associated with postero-lateral displacement. All the lesions recovered spontaneously.

3. There were no ischaemic complications after treatment, despite the ligation of one ruptured brachial artery.

4. The average stay in hospital was four days, compared with twenty days for thirty-two other patients treated in traction because of gross oedema.

5. Of eighty patients seen six months to five years after the fracture, seventy (or 87·5 per cent) had excellent or good results, seven patients with marked varus deformities had fair results, and two patients had poor results with very stiff elbows.

Displaced flexion fractures 1. The clinical features, complications and treatment of seventeen cases are described.

2. There were no complications involving the median or radial nerves or the brachial artery, but three patients had a lesion of the ulnar nerve.

3. Nine children had closed reduction and fixation by two lateral percutaneous pins.

4. Reduction was difficult and the results poor compared with extension fractures. Closed reduction failed in one-third of the children, and the functional and cosmetic results were unsatisfactory in over half the patients reviewed.
TRAUMATIC DISLOCATION OF THE RADIUS AT THE ELBOW
Authors: Wiley J. J. , Pegington John , Horwich J. P.
Published: February 2018

1. Isolated dislocation of the radius at the elbow occurs most commonly as a pronation injury, associated with slight elbow flexion and a varus strain. Disruption of the radio-ulnar articulation occurs primarily because of tearing of the annular ligament, which is the most important reinforcing structure of this joint. The tensing of the interosseous membrane through neutral into supination, and consequently the approximation of the radius to ulna, supports the recognised supination manoeuvre to reduce such an injury.

2. It is suggested that this injury may be more common than previously appreciated. It may be not diagnosed, it may be over-diagnosed as total dislocation of the elbow, or it may be belatedly diagnosed as a congenital dislocation of the radial head.
THE EXPERIMENTAL INDUCTION OF LOCALISED SKELETAL TUBERCULOUS LESIONS AND THEIR ACCESSIBILITY TO STREPTOMYCIN
Authors: Tuli S. M. , Brighton Carl T. , Morton Harry E. , Clark Larry W.
Published: February 2018

1. Chronic tuberculous osseous lesions were induced consistently in eight- to ten-week-old unvaccinated guinea-pigs by the insertion of Gelfoam impregnated with mycobacterium tuberculosis into the metaphysial region through a drill hole in the distal part of the femur. Typical tuberculous lesions developed by three weeks and many of them were followed for twelve weeks or more.

2. This experimental model establishes a reliable method of producing a localised lesion at a predetermined site without early death of the animal. The model is sufficiently similar to the human lesion, and may offer a reliable system for further investigations.

3. It was observed that streptomycin penetrates readily into tuberculous osseous lesions. The concentration of streptomycin found in the tuberculous lesion after a single intramuscular injection was much higher than the concentration considered sufficient to have an inhibitory effect on the human type of mycobacterium tuberculosis.
FRACTURE MANAGEMENT IN PATIENTS WITH HAEMOPHLLIA
Authors: Feil Edward , Bentley George , Rizza Charles R.
Published: February 2018

1. The management of fractures in five patients with haemophilia is described: two patients had antibodies to antihaemophilic globulin.

2. The principles of management of injured haemophilia patients are described, as are the special problems in patients with antibodies to AHG.

3. Stability of the fragments must be achieved to prevent the hazards of displacement of the fracture, recurrent bleeding and pseudotumour formation which may threaten viability of the limb.

4. Stabilisation of potentially unstable fractures can be achieved at the onset by internal fixation. Plaster casts should be reserved for stable fractures or fractures occurring in young children.
STRESS FRACTURE OF THE FUSED LUMBO-DORSAL SPINE IN ANKYLOSING SPONDYLITIS
Authors: Yau Arthur C. M. C. , Chan R. N. W.
Published: February 2018

1. The aetiology of a destructive lesion through a former interspace in a spine fused by ankylosing spondylitis is reviewed.

2. From the findings in three patients treated by anterior spinal fusion, evidence was obtained to show that a stress fracture, originating posteriorly between two fused spinous processes, leads to a pseudarthrosis between two vertebral bodies that may simulate a tuberculous lesion.

3. If spinal fusion is indicated, the anterior approach is recommended, both for direct observation of the lesion and to achieve sound union.
INCIDENCE OF INTERDIGITAL CLAVUS
Authors: Gillett H. G. Du P.
Published: February 2018

1. An investigation of interdigital clavus or corn does not support the opinion that it is found most often in the web of the fourth interspace.

2. Most occur in that interval, but less than a third involve the web.

3. The commonest site is the area of impingement of the distal interphalangeal joint of the fifth toe on the proximal interphalangeal joint of the fourth.
INFANTILE IDIOPATHIC SCOLIOSIS
Authors: Wynne-Davies Ruth
Published: February 2018

An attempt has been made to determine the aetiological factors in infantile idiopathic scoliosis from a clinical, genetic and epidemiological survey of 134 infants, ninety-seven of whom developed a curve in the first six months of life. Plagiocephaly was present in all cases; mental retardation occurred in 13 per cent of males with progressive scoliosis; congenital dislocation of the hip occurred in 3.5 per cent of cases and congenital heart disease in 2.5 per cent; and inguinal hernia was found in 7.4 per cent of males. Approximately 3 per cent of parents and 3 per cent of sibs had the same deformity, thirty times the general population frequency for the Edinburgh area. Other positive findings included an excess of breech presentations and of premature, low birthweight males, and a preponderance of curves developing in the winter months. Infants with progressive scoliosis tended to have older mothers and to come from poorer families. Only three children, all with resolving scoliosis, habitually lay prone in early infancy, in marked contrast to North American infants where this posture is usual. The almost complete absence of infantile idiopathic scoliosis in North America is noted and it is thought that the two facts may be related. The aetiology is likely to be multifactorial, with a genetic tendency to the deformity which is either "triggered off" or prevented by external factors.
EXPERIMENTAL SCOLIOSIS IN PRIMATES
Authors: Robin Gordon C. , Stein Haim
Published: February 2018

An attempt to produce scoliosis in young baboons by excision of the heads of ribs failed in thirteen growing animals observed for up to a year after operation. Other investigators have failed to produce scoliosis in primates by similar and other techniques that had successfully produced scoliosis in quadruped animals. The possible reasons for this are discussed, especially in the light of clinical trials that are being carried out with techniques transposed from the quadruped experimental animal to the scoliosis clinic.
QUADRILATERAL SHAPED BRIMS MADE FROM HIGH-DENSITY POLYETHYLENE FOR LONG LEG CALIPERS
Authors: Fulford G. E. , Cairns T. P.
Published: February 2018

Quadrilateral shaped brims made of high-density polyethylene have been used with satisfactory results on more than 120 patients who needed ischial-bearing long leg calipers. At first the fitting technique was the same as that used for thigh amputees. Subsequently it has been possible to fit most patients from a range of pre-formed brims. The properties of high-density polyethylene allow the caliper side irons to be riveted directly to the brim which, with the use of ready-made brims, allows a patient to be fitted rapidly with a comfortable and effective caliper.
A RADIOLOGICAL STUDY OF FRACTURES OF ACRYLIC CEMENT IN RELATION TO THE STEM OF A FEMORAL HEAD PROSTHESIS
Authors: Weber Frans A. , Charnley John
Published: February 2018

The incidence and prognostic significance of fractures of acrylic cement related to the stem of a femoral head prosthesis in total hip replacement are examined. These fractures are demonsfrated when the cement has been rendered radio-opaque by the addition of barium sulphate. One and a half per cent of the radiographs of 6,649 patients showed these fractures, which were sometimes associated with subsidence of the prosthesis. Fracture of the cement was usually evident at the six-month post-operative review, if it occurred at all. This radiological complication was devoid of symptoms in the majority of cases and tended to occur in patients with excellent functional recovery. In a minority of patients pain in the thigh during the first six months seemed likely to be explained by this fracture. Slight subsidence of the prosthesis in the cement bed appeared to result in a new and final position of stability. The prognosis was very good; only when separation of the fracture exceeded about 4 millimetres was the prognosis doubtful, in which case a chronic deep infection might be suspected. Possible mechanical and structural causes of fracture of the cement are discussed.
STIMULATION OF BONE GROWTH BY PERIOSTEAL STRIPPING
Authors: Jenkins D. H. R. , Cheng D. H. F. , Hodgson A. R.
Published: February 2018

periosteal stripping in the long lower limb bones of thirty children with shortening after poliomyelitis was performed. All have been followed up for five years. A relative increase in length attributable to the periosteal stripping procedure was seen in the majority. The conclusions are that this simple procedure is indicated in minor degrees of limb inequality in growing children, but that the haphazard response precludes any accurate estimation of the final outcome of such a procedure.
GIANT CHONDROMAS ARISING FROM THE RIBS
Authors: Pandey S.
Published: February 2018

Chondromas may arise from the ribs but seldom grow to giant size. In a series of twenty-one cases, four giant tumours were encountered. Three were treated by excision without leaving a significant defect of the chest wall or impairment of respiration; the fourth was examined by biopsy. No evidence of malignant change was discovered in these four large tumours.
Hip dysplasia in the African Bantu
Authors: Roper A
Published: February 2018

Dysplasia of the hip is almost unknown in the Bantu peoples of Africa, except in cases of arthrogryposis and in those with partly European ancestry. Evidence is produced to show that the importance of intrinsic genetic factors in hip dysplasia far outweighs that of the extrinsic factors. These are of great importance only if allowed to act on a hip in which genetic factors have already determined dysplasia. Evidence is also produced to contradict the theory that the "piggyback" carrying method used by Bantu mothers is the reason for the immunity from dysplasia of the hip. The absence of "primary" osteoarthritis of the hip is noted, and the range of hip disorders leading to "secondary" osteoarthritis in the adult African is compared with that in the adult European. Three patients are described, one in each of the groups mentioned above, the third having an isolated "typical" congenital dislocation of one hip. The methods of study used were enquiry into obstetric history and into carrying methods, and arthrography to confirm clinical findings. The experience of other surgeons working in Africa is recorded.
The pelvic osteotomy of Chiari: an anatomical study of the hazards and misleading radiographic appearances
Authors: Benson MK , Evans DC
Published: February 2018

The medial displacement osteotomy of Chiari has an established place in the management of older children and adults with severe hip dysplasia. The results claimed for the operation are, however, variable. There have also been reports of sciatic nerve lesions. In this study ten cadavers were operated upon. Chiari osteotomy was performed upon five, and five acted as controls. The hemipelvis was removed from each cadaver; each specimen was deep-frozen and sectioned transversely. The distance of the sciatic nerve from the nearest bony point was measured in each section and the results were recorded graphically. A further radiographic and photographic study was performed to determine whether apparent displacement at the osteotomy might be misleading. The conclusion was drawn that the sciatic nerve is angulated at the osteotomy and further endangered by the risk of bone splintering at the sciatic notch. The radiographic study suggested that some poor clinical results may be explained by a radiological artefact, because there is a tendency for the osteotomy to hinge posteriorly at the sciatic notch opening anteriorly like a book. Radiographs may suggest excellent medial displacement whereas in fact the femoral head is very poorly covered.
Muscle imbalance in the aetiology of scoliosis
Authors: Fidler MW , Jowett RL
Published: February 2018

At the apex of an idiopathic scoliotic curve there is a greater proportion of "slow twitch" muscle fibres in multifidus on the convex as compared to the concave side. To determine whether this represents a primary muscular imbalance relevant to the aetiology of idiopathic scoliosis or merely a secondary change, the lengths of multifidus on opposite sides of the curve were measured. Multifidus is shorter on the convex side. This is consistent with the theory of primary muscular imbalance, in which the more tonically acting muscle with its higher proportion of "slow twitch" fibres contracts and shortens as the deformity is produced. The paradox of multifidus being shorter on the convex rather than on the concave side is explained by consideration of its action.
Treatment of fractures of the femoral neck by replacement with the Thompson prosthesis
Authors: D'Arcy J , Devas M
Published: February 2018

The case histories of 361 subcapital fractures of the femoral neck in 354 patients treated by primary replacement with the cemented Thompson prosthesis were reviewed, and 156 survivors were seen at follow-up. The average age was eighty-one years. Three hundred and thirty fractures occurred in women and thirty-one in men. The antero-lateral approach to the hip was used at all operations because it allows immediate and unrestricted mobilisation after operation. It is considered that this method is the best treatment in the rehabilitation of elderly patients after high femoral neck fractures, because of its low morbidity and high success rate in returning the geriatric orthopaedic patient to independence. The results after an average of just over three years were available for 161 hips in 156 patients studied at follow-up. Of these, 132 (82 per cent) were satisfactory. Most of the unsatisfactory results were in patients under seventy-five years of age. Out of the whole group of 361 hips treated the important early complications were wound infections in seventeen hips 4-7 per cent), all of which resolved, and dislocation in seven hips (2 per cent). Forty-six patients (12-9 per cent) died during the first four weeks after operation, their average age being eighty-five. One hundred and seventy-one patients (47-4 per cent) were discharged from hospital within under four weeks of the operation. Acetabular erosion and loosening are shown to be the important later complications. Three patients had late sepsis.
Pseudoarthrosis after spinal fusion for scoliosis
Authors: McMaster MJ , James JI
Published: February 2018

A series of 246 patients with scoliosis and attempted fusion had exploration performed six months later in order to detect and treat any pseudarthrosis at an early stage and so prevent subsequent loss of correction. Bilateral or unilateral pseudarthroses occurred in 25 per cent and were of three types--definite, hairline and doubtful. Single unilateral pseudarthroses accounted for 6 per cent and were of little if any clinical significance. The hairline pseudarthroses could not be seen radiologically and were easily missed at exploration. In general the pseudarthroses were least common in the more rigid parts of the spine and in curves which by nature of their aetiology or long duration had become most rigid. Neither the initial severity of the curve nor the degree of correction obtained before the initial attempted fusion had any apparent effect on the incidence. Follow-up for an average of four years has shown that a pseudarthrosis is of little significance with regard to the ultimate result provided it is recognised early and repaired.