bluuebunny/crossref_metadata_2025 huggingface dataset:
RESIDUAL ADDUCTION OF THE FOREFOOT IN TREATED CONGENITAL CLUB FOOT
Authors: Lowe L. W. , Hannon M. A.
Published: February 2018

1. Seventy-three congenital club feet in fifty-one children have been reviewed between the ages of four and fourteen years to determine the incidence of residual adduction ofthe forefoot.

2. A radiological method of measuring metatarsus varus, based on the naviculo-metatarsal angle, is described.

3. On clinical examination 52 per cent of the feet had residual adduction of the forefoot, and metatarsus varus was present in 74 per cent of these.

4. There was no residual adduction in 48 per cent but only 45 per cent of these showed normal radiographic features. In the remainder various forms of spurious correction were seen.

5. For early treatment, detachment of the origin of the abductor hallucis muscle is recommended at the time of extended posterior release, with tenotomy of the tendon of insertion as an additional measure.
ANTERIOR APPROACH TO SCOLIOSIS
Authors: Dwyer A. F. , Schafer Michael F.
Published: February 2018

1. The equipment used in the correction of scoliosis by the anterior route is described.

2. The important points in surgical technique are emphasised.

3. The results of operation on fifty-one patients are analysed.

4. Attention is drawn to the high rate of fusion, the stability of correction, and the brevity of the period of convalescence.
THE EFFECT OF HIGH FEMORAL OSTEOTOMY ON OSTEOARTHRITIS OF THE HIP
Authors: Byers Paul D.
Published: February 2018

1. Osteotomy for osteoarthritis of the hip induces a fibrin layer over the exposed bone which forms the basis of a fibrocellular protective mantle that can differentiate towards cartilage.

2. The process is accompanied by bone remodelling, which reduces sclerosis, resolves osteolytic foci and, in company with bone formation in the fibrous mantle, restores the subchondral plate.

3. Many important aspects of the pathogenesis of osteoarthritis and of its partial repair by osteotomy remain to be elucidated.
ULTRA-STRUCTURE, IN VITRO CULTIVATION AND METABOLISM OF CELLS ISOLATED FROM ARTHRITIC HUMAN BONE
Authors: Bard D. R. , Dickens M. J. , Edwards J. , Smith Audrey U.
Published: February 2018

1. Methods for culturing cells isolated from slices of arthritic human or normal mammalian cancellous bone are described.

2. The capacity of the cultured cells to take up and hydroxylate labelled proline has been investigated.

3. Sections of the partially decalcified bone and of the isolated cells have been examined by transmission electron microscopy.

4. The possible significance of the results and observations are discussed. We are deeply grateful to Dame Janet Vaughan, who very kindly read this manuscript and made several valuable suggestions and criticisms. We are much obliged to Dr Sylvia Fitton-Jackson for her advice on the techniques of tissue culture and for giving us the composition of her chemically defined medium. Dr Palfrey kindly allowed one of us, M. J. Dickens, to learn transmission electron microscopy in his department at St Thomas's Hospital Medical School under the expert tuition of Mr G. Maxwell. Mr R. Hockhan and Mr M. Hepburn of the University of Surrey Structural Studies Unit helpfully instructed in the operation of the transmission electron microscope. Our special thanks are due to Mr E. P. Morris for his competent and enthusiastic technical assistance.
THE INCIDENCE OF MALIGNANT PRIMARY BONE TUMOURS IN RELATION TO AGE, SEX AND SITE
Authors: Larsson Sven-Erik , Lorentzon Ronny
Published: February 2018

1. The incidence of osteogenic sarcoma, chondrosarcoma and Ewing's sarcoma in relation to age, sex and site is analysed in a study of 832 malignant primary bone tumours diagnosed in Sweden in 1958-68. The results are compared with those in other series.

2. The adolescent incidence peak for osteogenic sarcoma is caused by tumours localised to the long bones of the lower limb. The peak incidence occurs at a mean age of twelve years for girls and sixteen years for boys and is associated with the maximum growth velocity for the adolescent growth spurt.

3. Ewing's sarcoma, showing no sex difference with regard to its incidence peak, seems not to be associated with bone growth.

4. In the adult, the incidence of osteogenic sarcoma parallels that of chondrosarcoma, thus showing a successive increase with increasing age. In Sweden, where Paget's disease is uncommon, the incidence of osteogenic sarcoma over the age of thirty is only one-third of that during adolescence.

5. In osteogenic sarcoma and chondrosarcoma but not in Ewing's sarcoma, the characteristic predominance of males over females is valid only for localisations to the long bones of the lower limb, the pelvis and the spinal column and not for other sites. Internal factors such as age, sex, bone growth and maturation and also weight-bearing seems to be of importance in modifying the response of the tissue to a causative external factor, like a common virus.
POSTERIOR PSOAS TRANSFER AND HIP INSTABILITY IN LUMBAR MYELOMENINGOCELE
Authors: Parker Barrie , Walker Geoffrey
Published: February 2018

Seventy-two posterior psoas transfer operations performed in forty-four children with lumbar myelomeningocele were reviewed one to eight years after operation in an attempt to assess its value. Muscle charting, an objective recording of the child's walking ability, and radiographic examination of the hips were done. Hip stability was improved: 49 per cent were stable at the time of psoas transfer and 94 per cent at review. Functional results depended mainly on the level of neurological activity present: 57 per cent of the children had an acceptable functional result. Usually, posterior psoas transfer should be done as soon after the age of nine months as the child's condition will allow. Over the age of two years it should be restricted to children with activity in the third and fourth segments of the lumbar cord.
LINK ARTHROPLASTY OF THE METACARPO-PHALANGEAL JOINTS
Authors: Devas Michael , Shah Vipin
Published: February 2018

Link arthroplasty is a system of joint replacement in which the joint is left almost intact with no great removal of bone. It is based on a two-piece self-locking hinge slotted into the metacarpal head and phalangeal shaft. The operation is simple and no special instruments are needed. The preliminary follow-up of fifty-four metacarpo-phalangeal joint replacements showed thirty-five good and sixteen fair results.
INJURIES OF THE MIDTARSAL JOINT
Authors: Main B. J. , Jowett R. L.
Published: February 2018

Injuries involving the midtarsal joint, which are frequently misdiagnosed, have been studied to clarify the mechanism, classification and treatment. The necessity for routine antero-posterior, lateral and oblique radiographs is emphasised. Seventy-one injuries have been classified according to the direction of the deforming force : medial, longitudinal compression, lateral, plantar and crush types are described. Included in the medial and lateral types is a hitherto undescribed tarsal rotation or " swivel" injury. The mechanism whereby longitudinal compression causes fractures of the body of the navicular is described, and two varieties having different prognoses are defined : one due to purely longitudinal compression and the other due to longitudinal compression with a medial component.

The results of treatment have been assessed clinically and radiologically. Reduction, open if necessary, with internal fixation, is recommended for displaced fractures : primary arthrodesis is not indicated. For severe persistent symptoms from medial and longitudinal force injuries triple arthrodesis is recommended, and from lateral force injuries, calcaneo-cuboid arthrodesis.
FAMILIAL SCOLIOSIS
Authors: Robin Gordon C. , Cohen Tirza
Published: February 2018

Scoliosis Clinic and the Department of Human Genetics, Hadassah University Hospital, Jerusalem Scoliosis appeared in fifteen members of a family in three generations. The eight members examined showed an idiopathic type of scoliosis. Father-to-son transmission occurred more than once. Although at first appearance transmission of the scoliosis is as an autosomal dominant trait, the concept of polygenic inheritance, as has been shown in previous population studies, could also explain the inheritance in this family
LATE RESULTS OF TRANSFER OF THE TIBIAL TUBERCLE FOR RECURRENT DISLOCATION OF THE PATELLA
Authors: Hampson W. G. J. , Hill P.
Published: February 2018

The authors wished to determine the late results of the Hauser operation, with special reference to the development of osteoarthritis. Predisposing factors associated with recurrent dislocation of the patella were also investigated. Thirty-five patients with forty-our surgically treated knees attended for review, ten to twenty-fve (aerage sixteen) years after operation. Two patients had subsequently undergone excision of the patella. Ten patients gave a family history of recurrent dislocation of the patella and seven patients showed generalised joint laxity. Pain was present in eight knees before operation and was present in thirty-three knees (75 per cent) at the time of review. Patellar crepitus was present in thirty-seven out of forty-two knees (88 per cent) at review. Osteoarthritis was present in thirty out of forty-two knees (70 per cent). The incidence increases with time since operation and the present age of the patient. It is concluded that the Hauser operation prevents further dislocation but does not prevent the development of osteoarthritis. It is possible that a simple soft-tissue operation which effectively prevents dislocation might achieve the same results.
FLAT FOOT
Authors: Jones B. S.
Published: February 2018

The pathogenesis of flat foot and its operative correction for severe cases are reviewed. The importance of the medial plantar fascia in maintaining the structural integrity of the foot is emphasised. Reinforcement of an incompetent plantar fascia by separating the inner half of the calcaneal tendon and attaching it to the neck of the first metatarsal has given results in three patients that were satisfactory at two, six and seven years later.
THE PATHOLOGICAL BASIS FOR SKELETAL SCINTIGRAPHY
Authors: Galasko C. S. B.
Published: February 2018

Skeletal scintigraphy, which has now been established as a useful and accurate method of detecting early skeletal metastases and assessing their response to treatment, has been investigated for its pathological basis.

Histological examination of several hundred necropsy specimens, from sixty-eight patients who died from malignant disease, showed a significant increase of osteoid and immature woven bone in the presence of metastatic cancer.

Tumour-cell suspensions of the VX2 carcinoma were injected into the medullary cavity or on to the periosteal surface of the ilia or tibiae of New Zealand white rabbits. A combination of bone destruction and new bone formation, similar to the autopsy material, was seen. There were at least two mechanisms for the new bone production. Initially, intramembranous ossification was seen in the fibrous stroma surrounding the tumour. Once the cortex was involved and cortical bone destruction had occurred, large amounts of woven bone resembling fracture callus were laid down. The new bone had a markedly increased avidity for boneseeking isotopes, indicating why skeletal scintigraphy was useful.

A further twenty rabbits, in whose ilia the VX2 carcinoma was growing, were treated by local irradiation. When treatment was successful the tumour was destroyed, the production of new bone ceased, and the lesion lost its increased avidity for bone-seeking isotopes, indicating that skeletal scintigraphy could be used to assess the response of skeletal metastases to therapy.
A STUDY ON THE EFFECTS OF PARTICULATE METALS OF ORTHOPAEDIC INTEREST ON MURINE MACROPHAGES IN VITRO
Authors: Rae T.
Published: February 2018

This is part of a larger study designed to investigate the action of particulate metals of orthopaedic interest on tissues. Damaging effects were determined by cytological examination and the assay of two enzymes. Lactic dehydrogenase (LDH) if released into the supernatant indicates a damaged cell membrane; decreased intracellular levels of glucose-6-phosphate dehydrogenase (G6PD) indicates a lowered phagocytic capacity of the cells. Soluble and wear products around implanted prostheses could facilitate late infections by impairing local reactions to bacteria. Particulate cobalt, nickel and cobalt-chromium alloy were found to damage the cells and to cause LDH release. G6PD was found to have a lower activity in the cells exposed to these materials. In contrast, titanium, chromium and molybdenum were well tolerated by macrophages and had no effect on the distribution and activity of either enzyme. The solubility of these metals in the culture medium was also measured.
SYNOVIAL REGENERATION AND ARTICULAR CARTILAGE CHANGES AFTER SYNOVECTOMY IN NORMAL AND STEROID-TREATED RABBITS
Authors: Bentley George , Kreutner Albert , Ferguson Albert B.
Published: February 2018

Little is known of the effects of synovectomy on articular cartilage. In order to investigate this matter, anterior synovectomy of the knee was performed in thirty-five normal adult rabbits and in thirty-five which were given 25 milligrams of hydrocortisone intramuscularly each week afterwards. The animals were killed at intervals from four to 110 days after synovectomy. Histological examination of the regenerating synovium in both groups showed complete structural and functional regeneration by eighty days in the first group and a delay in regeneration in the steroid group. 35Sulphur autoradiographs of the articular cartilage of femoral and tibial condyles revealed surface fibrillation and chondrocyte death in 23 per cent of normal knees after eighty days but only 1·8 per cent of knees of animals receiving hydrocortisone. Thus synovectomy in a healthy joint may have an unfavourable effect on the physiology of cartilage by alteration of synovial composition and hyaluronate content in normal joints. Systemically-administered hydrocortisone may reduce this harmful effect in normal cartilage.
ABDUCTION CONTRACTURE OF THE HIP IN CHILDREN
Authors: Shen Young-Shung
Published: February 2018

Nine cases of abduction contracture of the hip in children from contracture of the gluteus maximus muscle are reported. Division of the aponeurosis gluteus maximus over the greater trochanter always permitted full adduction.
THE USE OF FOOTPRINTS IN ASSESSING THE RESULTS OF OPERATIONS FOR HALLUX VALGUS
Authors: Henry A. P. J. , Waugh W. , Wood Harlow
Published: February 2018

One hundred and seventy feet have been reviewed after operations for hallux valgus; eighty-five had had arthrodesis of the first metatarso-phalangeal joint and eighty-five had had Keller's operation. Footprints were made in order to assess the patterns of weight-bearing on the big toe and on the lesser metatarsal heads. After arthrodesis the big toe bore weight in 80 per cent compared with 40 per cent after Keller's operation. The ability to bear weight on the big toe is related to the presence of metatarsalgia and excessive weight bearing on the lesser metatarsal heads. These complications were seen more commonly after Keller's operation (particularly when more than one-third of the phalanx had been excised) than after arthrodesis.
SPINAL FUSION WITH FREE PERIOSTEAL GRAFTS AND ITS EFFECT ON VERTEBRAL GROWTH IN YOUNG RABBITS
Authors: Ritsilä V. , Alhopuro S.
Published: February 2018

The effect of early fusion on growth of the spine has been studied in rabbits. Free periosteal grafts from the tibia were transplanted either posteriorly between the spinous and articular processes or postero-laterally between the articular and transverse processes. Sound bony fusion was achieved in both the thoracic and the lumbar spine. Spinal fusion caused local narrowing and wedging of the intervertebral spaces, followed by retardation of growth and wedging of the vertebrae. A progressive structural scoliosis developed after unilateral postero-lateral fusion and a lordosis developed after posterior fusion.
14C-GLUCOSE AND 35S-METABOLISM OF PIG EPIPHYSIAL CARTILAGE AND ITS VARIATIONS AFTER OSTEOTOMY
Authors: Beckmann Jürgen , Rodegerdts Udo , Buddecke Eckhart
Published: February 2018

on in vitro incubation of articular and epiphysial cartilage of the ulna of the domestic pig 70 to 80 per cent of [U-14C] glucose was metabolised to 14C-lactate, but cartilage of the epiphysial plate produced up to five times as much 14C-CO2 as articular cartilage, and the specific radioactivity of 14C (or 35S)-chondroitin 4 (6)-sulphate isolated from epiphysial cartilage (following 35S-sulphate incorporation) was about twice as high as that of articular cartilage. Six weeks after an osteotomy on both sides of the proximal epiphysial plate of the left ulna, the glucose uptake, lactate production, and the specific radioactivity of the glycosaminoglycans displayed no significant differences when compared with those of the corresponding epiphysial plate of the control right ulna, whereas a 50 per cent increase in the oxidation of 14C-glucose to 14c-co2 was observed.
Coxa plana: a radiological comparison of the rate of healing with conservative measures and after osteotomy
Authors: Marklund T , Tillberg B
Published: February 2018

Subtrochanteric osteotomy has been reported to interrupt the destructive phase of coxa plana and speed up the rate of healing. The aim of this investigation was to test the validity of these statements. The material comprised twenty-five patients treated by osteotomy and thirty-three patients treated by support in a Thomas's splint. For every patient the extent of the radiological changes was estimated and plotted against time as a percentage of the normal epiphysial volume. The graph so obtained represents the rate of destruction and re-ossification, as well as the maximum involvement of the epiphysis. The curves for each group of patients were superimposed in a graph with all the minima coincident in time. The two patterns of curves are closely similar. It was confirmed statistically that the rates of destruction and re-ossification did not differ between the two groups. The results afford no evidence that osteotomy interrupts the disease or speeds up healing.
A controlled study of the indications for and the results of femoral osteotomy in Perthes' disease
Authors: Lloyd-Roberts GC , Catterall A , Salamon PB
Published: February 2018

We have considered the reasons for securing containment of the femoral head in Perthes' disease and have reviewed briefly the methods used. The present investigation describes the outcome in a controlled series of forty-eight hips treated by containment by femoral varus-rotation osteotomy in selected patients. In assessing the results we have emphasised that controls are essential, and for this purpose we have used two comparable groups, one untreated and the other treated by methods other than containment. The same factors were considered in assessment--namely age, duration, group, and the presence or absence of "at risk" signs. The results were graded similarly as good, fair and poor in all groups. We have concluded that containment by femoral osteotomy is the treatment of choice in patients with "at risk" signs provided that severe deformity has not already occurred. There is no evidence that treatment of any kind favourably influences the course of the disorder in the remainder. Although this is predominantly a radiological study some clinical features are discussed.
Excision arthroplasty of the hip
Authors: Haw CS , Gray DH
Published: February 2018

The results of excision arthroplasty on forty hips in thirty-two patients have been studied by personal review. The mean follow-up was ten years and the results were graded in the Lazansky system. The outcome was fairly predictable, most patients achieving a fair to good result. The patients were satisfied with the operation in unilateral cases as a secondary operation, but it was generally unsatisfactory as a primary procedure or when performed bilaterally. Pain relief was satisfactory, and previously infected hips achieved sound wound and bone healing. Half could walk with no aid or one stick. No correlation could be found between the radiological appearances and the quality of the result.
Strontium 87mSr bone scanning for the evaluation of total hip replacement
Authors: Feith R , Slooff TJ , Kazem I , van Rens TJ
Published: February 2018

In a series of seventeen patients with unilateral osteoarthritis of the hip a scintiscanning follow-up study was made before and after total hip replacement for the assessment of the normal course of the 87mSr-scintiscan. In another series of twenty-eight patients with total hip replacement a photoscan was made as a supplement for the diagnosis of loosening of one or both components of a total hip implant. In most of these cases it proved to be a useful method, especially when clinical and raidological examination was inconclusive. It is concluded that up to six months after operation increased osteoblastic activity exists; the scintiscan became normal after that time. 87mSr scintiscanning offers a safe and simple technique for the assessment of the success and stability of total hip arthroplasty. It is also a useful aid for the early detection of loosening and infection. The procedure can help in the differential diagnosis of complaints after total hip replacement.
Restoration of muscle balance of the foot by transfer of the tibialis posterior
Authors: Williams PF
Published: February 2018

A new technique of tibialis posterior transfer is described which has been used in a wide variety of conditions producing muscular imbalance in the foot. The results in eighty-five feet are reviewed in terms of range of motion, power and voluntary control of the transfer. The effect of the transfer on shoe wear, on the necessity for bracing and on the child's or his parents' assessment of the results are used to allocate an overall evaluation of the operation. Recommendations on the indications for the operation are given.
Malignant osteoblastoma
Authors: Schajowicz F , Lemos C
Published: February 2018

The clinical, radiographic and pathological features are described of eight cases of a bone tumour which we propose to classify as "malignant osteoblastoma". It presents the characteristics of genuine osteoblastoma but of an aggressive pattern, with more abundant and often plump hyperchromatic nuclei, greater nuclear atypia, and numerous giant cells of osteoclastic type. This rare tumour is regarded as the malignant counterpart of osteoblastoma and appears to be only locally aggressive. It should be separated from conventional osteosarcoma not only because of its peculiar histological pattern, but also because of its different clinical and radiological features and better prognosis. Thus seven of the eight patients were alive and free of disease from one and a half to eleven years after the initial surgical treatment, which in only two cases included amputation. Excision or block resection is the preferred method of treatment.
Patello-femoral joint mechanics and pathology. 1. Functional anatomy of the patello-femoral joint
Authors: Goodfellow J , Hungerford DS , Zindel M
Published: February 2018

Cadaver knee joints were mounted so that life-like forces of weight-bearing were simulated. The patello-femoral contact areas were defined under load throughout the range of movement by the dye method. During movement from extension to 90 degrees of flexion a band of contact sweeps across the patella from inferior to superior pole, but the odd facet makes no contact. At about 135 degrees of flexion separate medial and lateral contact areas form, the medial one limited to the odd facet. From extension to 90 degrees of flexion the patella holds the quadriceps tendon away from the femur, but in further degrees of flexion an extensive "tendo-femoral" contact area forms. Between 90 degrees and 135 degrees of flexion the patella rotates and the ridge between the medial and odd facets engages the femoral condyle. The odd facet is shown to be a habitual non-contact area and the ridge to be subject to high load, observations which correlate with cartilage lesions described in Part 2 of the paper.
Radial club hand with absence of the biceps muscle treated by centralisation of the ulna and triceps transfer. Report of two cases
Authors: Menelaus MB
Published: February 2018

Two children with radial club hand and absence of the biceps muscle were treated by centralisation of the ulna into the carpus and triceps transfer. The two operations were performed only a short time apart so that the period between the procedures could be used to stretch the triceps and to enable the children to adapt to an altered position of the wrist and to mobility of the elbow at one step and following a single period of plaster immobilisation. It is very likely that function is better than it would have been had the condition remained untreated. Before operation the children had only a crude hook function of the hand against the forearm and could not bring the hand to the mouth. Even if function is not much improved, the improvement in appearance is considerable and is by itself sufficient to justify the procedures.
An experimental model of osteoarthritis; early morphological and biochemical changes
Authors: McDevitt C , Gilbertson E , Muir H
Published: February 2018

An experimental model of osteoarthritis resulting from laxity of the joint was induced in eighteen mature dogs (at least two years old) by sectioning the anterior cruciate ligament of the right knee (stifle) with a stab incision, the left knee providing a control. A sham operation was also performed in three other dogs, in which a stab incision was made but the ligament left intact. The dogs were killed at various intervals from one to forty-eight weeks later. Morphological changes in bone, cartilage, synovial membrane and joint capsule were examined in all the joints and biochemical changes in the cartilage of three dogs killed after two, eight, and sixteen weeks. All the changes resulting from the operation progressed with time and became indistinguishable from those found in three dogs with natural osteoarthritis of the knee. There were no changes in the joints which had sham operations. As the time of onset is known, this experimental model in a larger species enables a study to be made of the biochemical as well as the morphological changes in the early stages of osteoarthritis.
A technique of correction and internal fixation for scoliosis
Authors: Resina J , Alves AF
Published: February 2018

This report describes a technique for the correction and fusion of scoliosis with the aid of a flexible metal rod that is fixed by wires under tension to the bases of the spinous processes on the convex side of the curve at a number of points. The results in a series of 100 cases are reported. In the last seventy patients, the average correction at one month was 51 per cent, and after two years 45 per cent. In these seventy cases the incidence of pseudarthrosis was 5-7 per cent.
Diffusion of antibiotics from acrylic bone-cement in vitro
Authors: Hill J , Klenerman L , Trustey S , Blowers R
Published: February 2018

The diffusion of Fucidin, gentamicin, and clindamycin from acrylic cement was tested in an in vitro system. The activity of Fucidin was very short-lived and only against gram-positive organisms; gentamicin inhibited gram-positive and gram-negative organisms for twenty-two and eleven days respectively; clindamycin had significant action only against gram-positive organisms and retained some activity for fifty-six days. We suggest that the destruction of organisms in the tissues is more likely to be achieved by topical and intravenous administration of antibiotics during the operation than by incorporation of antibiotic in the cement.
Conformity in condylar replacement knee prosthesis
Authors: Walker PS , Hsieh HH
Published: February 2018

Experiments were carried out to determine the optimum conformity between the femoral and tibial condyles in condylar replacement knee prostheses. Wear tests and observations from removed prostheses indicated that both high and low conformity produced characteristic abrasion and fatigue. Partly conforming condyles provided stability under load-bearing but allowed laxity to occur. Fixation to resist the various forces on the tibial components was enhanced by a short central intramedullary peg. Partial conformity is proposed as the optimum configuration between femoral and tibial components.
The natural history and management of congenital short tibia with dysplasia or absence of the fibula
Authors: Hootnick D , Boyd NA , Fixsen JA , Lloyd-Roberts GC
Published: February 2018

Forty-three patients with unilateral congenital short tibia with partial or complete absence of the fibula are reviewed. The factors influencing the degree of leg shortening at maturity are considered. Serial radiographic measurements of leg length in fourteen patients covering an average observation period of 9-3 years support the hypothesis that the relative difference in growth between the two limbs remains remarkably constant. By estimating the percentage difference between the normal and abnormal leg lengths on the first measurable radiograph it is therefore possible to predict the likely shortening at maturity. This method of prediction allows the surgeon to make the decision to proceed to Syme's amputation or to the use of an extension prosthesis at about one year of age when the child starts to walk.
The vascularity and remodelling of subchondrial bone and calcified cartilage in adult human femoral and humeral heads. An age- and stress-related phenomenon
Authors: Lane LB , Villacin A , Bullough PG
Published: February 2018

A quantitative study of the vascularity and a qualitative study of the remodelling of the calcified cartilage and subchondral bone end-plate of adult human femoral and humeral heads were performed with respect to age. In the femoral head the number of vessels per unit area was found to fall 20% from adolescence until the seventh decade and in the humeral head 15% until the sixth decade. Thereafter an increase was noted in the femur but none in the humerus. More vessels were present at all ages in the more loaded areas of the articular surfaces: 25% more for the femur and 15% more for the humerus. The degree of active remodelling by endochondral ossification declined 50% from adolescence until the seventh decade in the femoral head, and 30% until the sixth decade in the humeral head, rising thereafter to levels comparable to those found at young ages. More remodeling was noted in the more loaded areas at all ages.
Benign osteoblastoma as a cause of osteomalacia. A report of two cases
Authors: Yoshikawa S , Nakamura T , Takagi M , Imamura T , Okano K , Sasaki S
Published: February 2018

Two patients, a Japanese man and woman both aged eighteen, developed symptoms and signs of osteomalacia over a period of five years. Each of them had a benign osteoblastoma, one in the right fourth metacarpal and the other in the uppermost third of the right humerus. Resection of the tumours without any treatment by vitamin D resulted in rapid cure of the osteomalacia. Attempts to prove a phosphaturic humoral substance or vitamin D antagonist in the osteoblastoma of the humerus were unsuccessful, probably due to prompt excretion from the tumour cells.
The results of early operation in talipes quino-varus. A preliminary report
Authors: Main BJ , Crider RJ , Polk M , Lloyd-Roberts GC , Swann M , Kamdar BA
Published: February 2018

The results of operation performed within the first six months of life upon seventy-seven resistant club feet are presented. The indications for and the rationale of early operation are discussed. Particular attention has been paid to the relationship between the age at operation and the outcome more than four years later; the results were greatly superior when operation was undertaken early. Two surgical techniques are compared, the postero-medial release proving better than a simple posterior release. The relationship between clinical and radiological assessment is discussed, and also the influence of the results reported upon future practice.
Systemic disturbance from Thompson's arthroplasty: a age-matched and sex-matched controlled retrospective survey
Authors: Sikorski JM , Millar AJ
Published: February 2018

The records of 107 patients with displaced subcaptial hip fractures treated by Thompson's femoral head replacements have been reviewed to determine the mortality and certain aspects of systemic morbidity. Comparison was made with a group, matched exactly for age and sex, in which intertrochanteric fractures were treated by nail-plate fixation. The patients treated by Thompson's arthroplasty were further subdivided into two groups: one in which methylacrylic cement was used, and one in which it was not used. We found no difference in the mortality of the patients undergoing replacement arthroplasty and nail-plate fixation. Similarly there was no difference in the incidence of cerebrovascular incidents and myocardial infarction after operation. There was a higher incidence of transient cardiac failure following Thompson's arthroplasty. Hypotension during the operation occurred irrespective of whether cement was used; nor was the use of cement associated with increased mortality. However, it seems that methylacrylic cement does contribute to the cardiac failure that may occur after Thompson's arthroplasty.
The muscles in club foot--a histological histochemical and electron microscopic study
Authors: Isaacs H , Handelsman JE , Badenhorst M , Pickering A
Published: February 2018

In talipes equino-varus the diminished bulk of the calf muscle suggests a neuromuscular defect. Accordingly, biopsies were taken from the postero-medial and peroneal muscle groups, and occasionally from abductor hallucis, in sixty patients mostly under the age of five years; 111 were studied histochemically and histologically, and a further fifty-three by electron-microscopy. Histochemical anomalies were revealed in ninety-two specimens; the muscle fibres in the other nineteen varied in size but were abnormal at the ultramicroscopic level, as were all specimens examined with the electron microscope. Evidence of neurogenic disease was seen in most instances and was more obvious in the older patients. The pattern of abnormality was similar in both muscle groups. It is thought that shortening of the postero-medial muscles may result from a small increase of fibrosis due to minor innervation changes occurring in intra-uterine life. There is evidence that immobilisation, stretching or relaxation of muscles does not account for the anomalies observed. This study of the extrinsic muscles in talipes equino-varus indicates a dominant neurogenic factor in its causation.
The osteoninductive property of decalcified bone matrix. An experimental study,
Authors: Tuli SM , Singh AD
Published: February 2018

Demineralised homologous bone-matrix implant was used to bridge a large circumferential osteoperiosteal gap in the diaphysis of the ulna of rabbits. Periodic observations of the graft were made clinically, radiologically, histologically and by tetracycline fluorescence up to forty-two weeks. By the twelfth week after operation 81 per cent of the animals revealed bone formation in the implant and complete bridging of the gap. The new bone was laid on the surface and in the substance of the matrix, suggesting that the inductive principle was acting locally. The bone, once formed, remodelled to the texture of a mature tubular bone and did not undergo absorption during a long follow-up period. Demineralise bone-matrix proved to be a highly osteoinductive and readily osteoconductive material. The graft did not evoke any appreciable local foreign-body or immunogenic reaction. The high degree of success in bridging massive bone defects justifies further serious studies and hopes for a useful substitute for massive autologous bone grafts.
Points in the technique of recementing in the revision of an implant arthroplasty
Authors: Greenwald AS , Narten NC , Wilde AH
Published: February 2018

When aseptic failure of the bond between the cement and the prosthesis of a total joint replacement occurs, complete removal of the cement has been advocated before the insertion of a new prosthesis. The present study questions this practice. Both laboratory tests on variously prepared specimens of cement and clinical experiences demonstrate that recementing over old cement is a practical alternative if the technique employed includes the removal of blood from the old cement surface, rasping of this surface and the early application of fresh cement.
Mechanics of the knee and problems in reconstructive surgery
Authors: Denham RA , Bishop RE
Published: February 2018

Static force transmission at the knee is analysed using measurements from radiographs showing the position of the line of body weight and also the bones of the knee in their correct orientation during function. With this technique it is possible to suggest values for a variety of forces acting at the knee. During function the degree of knee flexion is not as important as the angle that the thigh makes with the vertical. The tension in the extensor mechanism is not the same above and below the patella. Failure to recognise these two features results in fundamental errors. The patella, the effects of patellectomy and of forward displacement of the attachment of the patellar ligament are discussed. The importance of the transmission of force in the coronal plane is emphasised with particular reference to total knee replacement. It is suggested that small errors of geometry, as seen in the anteroposterior radiograph, can produce large changes of load.
ICLH arthroplasty of the knee: 1968--1977
Authors: Freeman MA , Todd RC , Bamert P , Day WH
Published: February 2018

The essentially satisfactory results from the ICLH implant as used until 1975 were marred by examples of loosening and sinking of the tibial implant, by patellar pain of varying severity, by wear of the tibial implant caused by fragments of cement and by failure consistently to control the alignment of the leg. This report describes the methods now being used to overcome these complications and gives an account of the success so far achieved.
The characteristics of acetabular cups worn in the human body
Authors: Dowling JM , Atkinson  , Dowson D , Charnley J
Published: February 2018

In laboratory tests, the ultra-high molecular weight polyethylene used for the acetabular cups of Charnley hip prostheses has a very low wear rate against steel. In the body radiographic measurements indicate that the polyethylene wears more rapidly. In order to investigate this higher wear rate, the sockets of acetabular cups removed at post-mortem have been examined using optical and electron microscopy. It has been shown that a socket wears predominantly on its superior part and that this is a direct consequence of the orientation of the cup in the body and the direction of loading of the hip. In the worn region the femoral head in effect bores out a new socket for itself, a process which is visible with the naked eye after approximately eight years. Electron microscopy shows that the predominant wear mechanism is adhesion, but after about eight years the appearance of surface cracks suggests that surface fatigue is taking place in addition to this. Laboratory wear tests have shown that pure surface fatigue is not sufficient to account for the high clinical wear rate. Other deformation processes are suggested and discussed with regard to the higher clinical wear rate.
Aneurysmal bone cysts of the spine
Authors: Hay MC , Paterson D , Taylor TK
Published: February 2018

Aneurysmal bone cysts are uncommon lesions, especially in the spine. Seventy-eight cases have been previously documented in the English literature and an additional fourteen cases are now reported. There is a definite predilection for the lumbar region and the neural arch is the part of the vertebra most commonly affected. It is recommended that treatment should consist of total excision or when this is not possible, curettage. Radiotherapy should be reserved for those few cases where operation is inadvisable.
Progression in idiopathic scoliosis: A preliminary report of a possible mechanism
Authors: Lloyd-Roberts GC , Pincott  , McMeniman P , Bayley IJ , Kendall B
Published: February 2018

Recent surveys have shown that idiopathic structural scoliosis of mild degree is generally not progressive. We will propose a mechanism which may be responsible for deterioration in the few. It has been observed that the spinal cord, although displaced towards the concavity, does not rotate in company with the vertebrae, thus exposing the emerging nerve roots to the effects of traction and possibly of entrapment. We suggest that progression occurs when the neuraxis is unable to adjust to the change in the anatomy of vertebral column. Our proposition is based upon our findings in a complete spinal column obtained from a baby with structural scoliosis. Support is provided by intercostal angiography, and by observations upon normal anatomy, the pathological anatomy of mature scoliotic spines and the anatomy of contrived scoliosis in normal spines. Although our histological and electrophysiological investigations are incomplete we can demonstrate a significant increase in degenerate cells in the dorsal root ganglia at the apex on the convex side. Lack of suitable necropsy material prevents us from confirming our observations so that our report is inevitably preliminary. We enter a plea that careful examination of the neuraxis be undertaken whenever a specimen of a scoliotic spine becomes available.
Charnley low-friction arthroplasties of the hip in rheumatoid arthritis. A study of the complications and results of 378 arthroplasties
Authors: Colville J , Raunio P
Published: February 2018

During the years 1971 to 1975, 378 Charnley low-friction arthroplasties of the hip were performed on 278 patients with rheumatoid arthritis. The average age at operation was thirty-nine years. The follow-up time ranged from one to six years (mean two and a half years). Forty per cent of patients were receiving steroids at the time of operation. The most common complications were loosening of the prosthesis (3.4%), perforation of the femoral cortex and fracture. Deep infection occurred in 0.7%, dislocation in 0.7%, and thromboembolic episodes in 1.3%. Ninety-five per cent of patients were free of pain at follow-up compared to 84% who were severely handicapped by pain before operation. In addition, the increased mobility in 98.5% of patients and their improved independence makes hip replacement a recommendable procedure in these patients.
Peroneal spastic flat foot. Its treatment by osteotomy of the os calcis
Authors: Cain TJ , Hyman S
Published: February 2018

A series of patients treated by osteotomy of the os calcis for the relief of peroneal spastic flat foot is reviewed. The late results have been evaluated, and the literature reviewed. It is suggested that this is an effective method of treatment which has advantages over tarsal fusions.
An analysis of residual deformity in club feet submitted to early operation
Authors: Main BJ , Crider RJ
Published: February 2018

The contributions made by metatarsus primus varus, medial subluxation of the navicular, and angulation of the neck of the talus to the residual deformity in treated club feet were assessed from radiographs. Their relation to the appearance of the feet, to the age of the patient, to the results of operations, and to the age at the time of the first operation were investigated. Lateral rotation of the ankle and flattening of the talus were also studied. Medial subluxation of the navicular was found to be the most important factor influencing both the appearance of the feet and the lateral rotation of the ankle. Relocation of the talonavicular joint correlated with the success of operative treatment; and the timing of the primary operation determined the degree of relocation which could be achieved. Metatarsus primus varus and angulation of the talus were of little importance. Increased emphasis is given to the need for early relocation of the talonavicular joint.
Pyogenic non-tuberculous spinal infection: an analysis of thirty cases
Authors: Digby JM , Kersley JB
Published: February 2018

Thirty patients with non-tuberculous pyogenic osteomyelitis of the spine are reported in all of whom the diagnosis was confirmed bacteriologically, histologically or serologically. The clinical and radiological features and investigations are analysed. Back pain, localised to the level involved, was the predominant symptom. The erythrocyte sedimentation rate was raised in all cases, and a characteristic sequence of radiological features is described.
The management of progressive infantile idiopathic scoliosis
Authors: McMaster MJ , Macnicol MF
Published: February 2018

Twenty-seven children with progressive infantile idiopathic scoliosis have been reviewed after long-term management. Twenty-two children had single thoracic curves which were diagnosed at an early age and treated in a modified Milwaukee brace until the age of ten years when the spine was corrected and fused. The mean correction after operation was 40 per cent of the initial degree of curvature seen in early childhood before treatment. Solid spinal fusion led to a further moderate loss in correction due to bending of the fusion mass before the spine became stable several years later. Five children had double structural curves and were treated only in a brace. This provided less satisfactory control of these curves but because of the minimal cosmetic deformity, extensive spinal fusion was avoided.
An electromyographic investigation of subluxation of the patella
Authors: Mariani PP , Caruso I
Published: February 2018

An electromyographic investigation of patients with subluxation of the patella has been carried out on the parts of the extensor apparatus which actively contribute to the alignment of the patella, both before and after the operation to correct this disorder. The electromyographic pictures have revealed a sharp fall in the activity of the vastus medialis, with full recovery to normal values after a corrective operation. Even if the aligning function of the patella is altered by a variety of factors, the present study confirms the importance of the vastus medialis in the pathogenesis of malalignment of the extensor mechanism.
The stress-tenogram in the diagnosis of ruptures of the lateral ligament of the ankle
Authors: Evans GA , Frenyo SD
Published: February 2018

The stress-tenogram is a radiological technique for the investigation of injuries to the lateral ligament of the ankle, and combines the information previously provided by inversion and anterior stress radiographs, and the peroneal tenogram. It is designed to differentiate between stable and unstable ankles, and between isolated ruptures of the anterior talofibular ligament and combined tears of the anterior talofibular and calcaneofibular ligaments. A high degree of diagnostic accuracy has been confirmed at operative repair in a group of thirty-two patients.
The treatment of congenital vertical talus
Authors: Fitton JM , Nevelos AB
Published: February 2018

Operative correction of congenital vertical talus in nine feet in six patients is described. The operation consists of the comprehensive lengthening of the tendons in the foot and full peritalar release without excision of the navicular; it is performed through a dorsal transverse incision.
A study of stump growth in children with below-knee amputations
Authors: Christie J , Lamb DW , McDonald JM , Britten S
Published: February 2018

The growth of the stump has been studied in eighteen children with below-knee amputations. Measurements were available shortly after operation and later at skeletal maturity. It was found that all patients achieved less than expected growth and that the reduction was greater in those patients who had had amputation for congenital deformity.