bluuebunny/crossref_metadata_2025 huggingface dataset:
GREENSTICK FRACTURE OF THE UPPER END OF THE ULNA WITH DISLOCATION OF THE RADIO-HUMERAL JOINT OR DISPLACEMENT OF THE SUPERIOR RADIAL EPIPHYSIS
Authors: Wright P. R.
Published: February 2018

1. Five cases of greenstick fracture of the upper end of the ulna with dislocation of the radio-humeral joint are described.

2. Although the direction of angulation of the fracture and the corresponding displacement of the upper end of the radius may be lateral, medial or anterior, it is suggested that all five cases form a group in which the mechanism of injury is essentially the same. This mechanism is considered to be a fall on the outstretched hand with the forearm held in supination.

3. The complications of the injury are described.
CHEMICAL AND HISTOCHEMICAL STUDIES ON THE ORGANIC CONSTITUENTS IN FRACTURE REPAIR IN RATS
Authors: Udupa K. N. , Prasad Guru Charan
Published: February 2018

1. The process of repair after fracture of the humerus of the growing rat has been studied by histological, histochemical and biochemical methods.

2. Both periosteal and surrounding mesenchymal cells take part in the process of repair.

3. The primary framework of collagen bridging the gap is mainly formed by the mesenchymal cells, while calcification and ossification of the framework is largely a function of the periosteum.

4. The mucopolysaccharide content rises rapidly in the first week after injury, and is followed by a rise in the collagen content during the second week. The deposition of calcium phosphate during the third and fourth weeks causes an apparent fall in the collagen content during that period. The collagen content tends to return to normal during the phase of remodelling in the fifth and sixth weeks.

5. The tensile strength of the healing bone bears a close relation to its collagen content.
STUDIES IN THE TRANSPLANTATION OF BONE VII. The Fresh Composite Homograft-Autograft of Cancellous Bone
Authors: Burwell R. Geoffrey
Published: February 2018

1. Previous immunological studies have shown that homografts of fresh marrow-free iliac bone are only weakly, if at all, antigenic.

2. In view of this finding an attempt was made to produce a foreign bone graft capable of forming new bone as readily as an iliac autograft by the following method. Living cells of high osteogenic potential and of autologous type were introduced into the graft by combining homologous fresh marrow-free iliac bone with the animal's own red marrow to form a fresh composite homograft-autograft of cancellous bone.

3. Such fresh composite homograft-autografts were inserted into a muscular site in Wistar rats and removed for microscopical examination at intervals of one to seven days and at two, six and twelve weeks after transplantation.

4. It is found that bone and marrow together as a fresh composite homograft-autograft form considerably more new bone than do either of the components of the graft transplanted separately. Homografts of fresh marrow-free iliac bone form, in general, a small amount of early phase and late phase new bone. Autografts of red marrow transplanted alone to a muscular site formed new bone in thirteen to thirty experiments (43 per cent).

5. The stimulus to osteogenesis, and the cellular source of osteoblasts, in marrow autografts is discussed in the light of present knowledge. The concept is suggested that after its transplantation there develops in marrow an inductive system leading to osteoblastic differentiation and bone formation. It is proposed that the necrosis of a portion of a marrow graft liberates osteogenic substances which are taken up by primitive wandering cells derived from littoral cells lining the vascular sinusoids of the surviving portions of the marrow which are induced, thereby, to differentiate as osteoblasts.

6. The cellular source of osteoblasts in a fresh composite homograft-autograft of cancellous bone is discussed. It is deduced that the new bone is derived mainly from the contained marrow of the graft, by mechanisms similar to those leading to osteoblastic differentiation in transplanted autografts of marrow.

7. The stimulus to the greater formation of new bone by fresh composite autograft-homografts than by autografts of marrow transplanted alone is discussed. Two explanations are suggested: 1) a more extensive necrosis of marrow in a composite homograft-autograft than in marrow transplanted alone; and 2) an inductive effect of bone upon marrow.

8. The new bone formed by autografts of fresh marrow-containing iliac bone, it is concluded, is derived not only from osteoblasts on the surfaces of the grafted bone but also from primitive wandering cells derived from littoral cells lining the vascular sinusoids of the surviving portions of its marrow.

9. Mechanisms which may play a role in the histogenesis of woven bone are discussed.

10. The significance of the relation of bone and marrow is considered briefly in the light of knowledge concerning the venous patterns of bone and marrow.
RE-FRACTURE OF THE SHAFT OF THE FEMUR
Authors: Seimon L. P.
Published: February 2018

1. A series of twenty-one cases of re-fracture of the femoral shaft has been examined and analysed.

2. Liability to re-fracture may be increased if the original injury is caused by great violence, but it does not seem to be affected by the method of primary treatment.

3. Over 60 per cent of the re-fractures were avoidable. In some, re-fracture was caused by premature institution of vigorous mobilisation; in others, warning cracks were visible on radiographs before re-fracture.

4. In the remaining patients re-fracture appears to be unpredictable and unavoidable.

5. Re-fracture is best treated by the simplest methods.
MALIGNANT CHANGE IN FIBROUS DYSPLASIA
Authors: Riddell D. M.
Published: February 2018

A brief review of the literature on malignant change occurring in fibrous dysplasia is given and a further case of a sarcoma arising in a patient with polyostotic fibrous dysplasia is reported.
THE JUXTA-EPIPHYSIAL VESSELS IN THE LONG BONES OF FOETAL RATS
Authors: Brookes M. , Landon D. N.
Published: February 2018

1. The results of the present investigation indicate that in the foetal rat the juxta-epiphysial vascular bed consists of a dense irregular network of sinusoids in direct contact with the growth cartilage, supplied by end-arteries, and drained by a profusion of metaphysial sinusoids.

2. The circulation is a closed one–that is, the endothelium is unbroken in its continuity and microhaemorrhages do not occur against the cartilage.

3. It is possible that juxta-epiphysial endothelial cells or their derivatives are chondrolytic, and that they participate directly, together with other mesenchymal derivatives, in the removal of cartilage as a preparatory stage in enchondral bone formation.
FRACTURES OF THE TIBIAL SHAFT
Authors: Nicoll E. A.
Published: February 2018

1. A series of 705 fractures of the tibia is reviewed, 674 of which were treated conservatively.

2. The factors most conducive to delayed or non-union are initial displacement, comminution, associated soft-tissue wound and infection. The extent to which these are combined in any fracture determines its "personality" and its inherent propensity for union.

3. Eight fracture types are differentiated based on the above "personality rating." The incidence of delayed union or non-union varies from 9 per cent in the most favourable type to 39 per cent in the least favourable. Infection raises the incidence to 60 per cent. Comparative statistics which fail to recognise these differences can be entirely misleading.

4. Continuous traction does not retard union.

5. The results of conservative treatment are analysed with regard to union, deformity, stiff joints and contractures and the conclusion is reached that no case has yet been made out for internal fixation as the method of choice in the treatment of this fracture.
TREATMENT OF FOREARM FRACTURES IN ADULTS WITH PARTICULAR REFERENCE TO PLATE FIXATION
Authors: Nevile Burwell H. , Charnley Arnold D.
Published: February 2018

1. A simple method of internal fixation of adult forearm fractures which gives consistent good results is necessary because the closed method of treatment is of limited application.

2. Open reduction of fractures without rigid internal fixation gives a high proportion of non-union and poor results.

3. Rigid internal fixation with standard plates and screws has been shown to give a low incidence of non-union in this series.

4. A three and a half inch long plate with six screws is suitable for most fractures, but if there is moderate or severe comminution, or if there is a segmental fracture, longer plates and more screws should be used to provide sound fixation.

5. Severely comminuted fractures with large avascular bone fragments should have the addition of a bone graft at the time of the plating operation in order that union may be assured. Thin strips of iliac bone are preferred.

6. Rigid plating is considered to be the most satisfactory treatment for open fractures.

7. Immobilisation of the limb after operation is not necessary and is undesirable if the fixation is rigid.

8. The functional results of this treatment are good and seemingly better than those achieved by other methods.

9. Serious complications of the plating operation are few and avoidable.
TALIPES EQUINOVARUS
Authors: Wynne-Davies Ruth
Published: February 2018

1. A long-term follow-up of eighty-four patients with talipes equinovarus is reported.

2. A detailed examination was made to ascertain the nature of the residual deformity and assess the function of the deformed foot.

3. Radiographic technique in infants and adults is described.

4. Results showed that: 1) In many cases there was a dysplasia of the whole limb. 2) The dysplasia was no more marked in the patients treated in the early 1930's by multiple forceful under anaesthetic, than in the more recent patients treated by gentler means. 3) Nearly half the cases had only a false correction of the deformity in that the foot was "broken" at the talo-navicular level, leaving the heel in inversion, although the forefoot was plantigrade.

5. The posture of patients with laterally rotated hip joints is related to the fixed inverted heel.

6. Clinical assessment correlated with radiographic appearances shows clearly the near impossibility of a good foot resulting from a false correction.
CONTRACTURE OF THE QUADRICEPS MUSCLE
Authors: Gunn D. R.
Published: February 2018

1. Contracture of parts of the quadriceps muscle is not uncommon and is often accompanied by tightness of the ilio-tibial tract. It is suggested that this may follow intramuscular injections.

2. Recurrent dislocation of the patella can be a consequence of this muscle contracture.

3. Division of the ilio-tibial tract and lengthening of the fibrotic elements of the quadriceps can prevent further dislocation and restore good function.
THE BONDING OF PROSTHESES TO BONE BY CEMENT
Authors: Charnley John
Published: February 2018

1. The use of acrylic cement in bonding femoral head prostheses to bone is described.

2. No sign of deterioration of the bond between the cement and bone has been seen in histological preparations up to three and a quarter years after operation, and no harmful effects have been recognised, or suspected, in 455 patients in whom it has been used.

3. The technique is considered justifiable in elderly patients where the medullary canal is large and the cortex of the femur is thin and brittle.
FRACTURE OF THE MANUBRIUM STERNI
Authors: Helal B.
Published: February 2018

1. Three cases of fracture of the manubrium are described.

2. Two of these cases are very unusual in showing fracture of the manubrium caused by indirect violence.

3. The literature is reviewed and methods of treatment are discussed.

4. The mechanism of fracture of the sternum by indirect violence is discussed.
TRANSCERVICAL FEMORAL FRACTURE
Authors: Brown J. T. , Abrami G.
Published: February 2018

1. A review of 195 patients with displaced intracapsular fractures of the femoral neck treated by a sliding nail-plate appliance has been presented.

2. The highest failure rate was evident in fractures in women over seventy-five with Grade 4 displacement.

3. The effect of various concomitant factors has been analysed in relation to the end results.

4. Observations have been made on avascular necrosis, its incidence amongst the failures and its association with late segmental collapse after fracture union.
EXOSTOSIS FORMATION AFTER TRAUMATIC AVULSION OF THE ANTERIOR INFERIOR ILIAC SPINE
Authors: Irving M. H.
Published: February 2018

Two cases are described of exostosis of the anterior inferior iliac spine after traumatic avulsion of the apophysis at this site by the rectus femoris muscle.
SPONTANEOUS BILATERAL RUPTURE OF THE CALCANEAL TENDON DURING STEROID THERAPY
Authors: Melmed E. P.
Published: February 2018

1. This case is presented to illustrate two etiological factors in tendon rupture occurring in one patient.

2. The rupture of the long head of the biceps brachii muscle appears to have been of acute traumatic origin.

3. Bilateral simultaneous rupture of the calcaneal tendons is rare, but it seems probable that the cortico-steroid therapy was the etiological factor in this case.

4. It has been suggested that degeneration in the tendon is caused by ischaemia, secondary to hypertrophy of the tunica media and narrowing of the medium calibre blood vessels. Betamethazone could possibly have aggravated, or may even have caused these changes, and the periarteriolar changes found in the biopsy specimen would tend to support this theory.
VERTEBRAL FRACTURES IN WEST AFRICANS SUFFERING FROM TETANUS
Authors: Davis P. R. , Rowland H. A. K.
Published: February 2018

1. Radiography of the spines of thirty-three West African patients recently recovered or dead from tetanus revealed vertebral fractures in nineteen. These fractures occurred most frequently in the fourth to eighth thoracic vertebrae.

2. The spines of 111 Nigerians from the same area of West Africa were examined, measurement of the areas and shape of the vertebral bodies carried out, and the proportional incidence of articular shelves and laminar spicules was calculated.

3. The upper mid-thoracic vertebral bodies are relatively long and narrow and have but little greater cross-sectional area than those immediately above them; possessing no neural arch supports to sustain longitudinal compressive forces in flexion, they are at greatest hazard during tetanic spasms.

4. Analyses of these factors and of the clinical features, together with experimental observations drawn from the literature, are used to explain the prevalence of upper mid-thoracic vertebral fractures as a complication of tetanus in West Africans, and in particular the greater degree of compression and higher incidence found in children.

5. Vertebral fracture is not usually an important complication of tetanus; it causes little pain, does not prolong the illness, gives rise to no permanent disability and has no effect on the mortality.
TREATMENT OF DISPLACED SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN IN FULL EXTENSION AND SUPINATION
Authors: El-Sharkawi A. H. , Fattah H. Abdel
Published: February 2018

1. A method of treatment of displaced supracondylar fractures of the humerus in children by manipulative reduction and fixation in plaster in full extension of the elbow and supination of the forearm is described.

2. The method is easy, safe and requires a short period of hospitalisation. The carrying angle at the elbow can only be recorded, controlled and maintained when the elbow is extended and the forearm is fully supinated. Thus cubitus varus can be avoided.

3. The results of treatment in seventy-two displaced fractures treated by this method are reported.

4. Treatment by other methods is reviewed.
THE FUNCTION OF FIBROCARTILAGINOUS FRACTURE CALLUS
Authors: Urist Marshall R. , Wallace Theodore H. , Adams Thompson
Published: February 2018

1. Autografts, isografts and homografts of fibrocartilaginous callus were observed in the anterior chamber of the eye in rats. Proliferation of cartilage ceased, endochondral ossification followed, and the end-product was a new and complete ossicle with a cortex and a marrow cavity. The size and shape of the ossicle was determined by the size and shape of the sample of callus. Thus the callus in the eye performed the function of a cartilage model like that of the developing epiphysis or a healing fracture of a long bone.

2. Fibrocartilaginous callus, heavily labelled with 3H-thymidine, was transplanted to the eye twenty-four hours after the last injection, when there was little if any radioactive thymidine circulating in the blood. A few small chondrocytes with labelled nuclei persisted in the cores of new bone trabeculae, but the largest part of the labelled callus was resorbed and replaced by unlabelled new bone.

3. Homografts of labelled callus produced the same results as autografts at twenty-five days, but between twenty-five and forty-five days the donor cells were destroyed by the immune response of the host.

4. Isogenous transplants in host rats treated with 3H-thymidine between nine and thirteen days, when the callus was invaded by new blood vessels, produced many osteogenetic cells with labelled nuclei and made it possible to trace the origin of the new bone. The label appeared in the progenitor cells within twenty-four hours. While remaining thereafter in progenitor cells, it appeared also in osteoclasts (or chondroclasts) and osteoblasts in forty-eight to seventy-two hours, and in osteocytes in ninety-six to 120 hours. Chondrocytes did not proliferate and were not labelled in the eye.

5. Homogenous transplants in host rats treated with 3H-thymidine between five and one days before the operation also produced new bone, but contained no labelled osteoprogenitor or bone cells after twenty-five days in the eye. At forty-five days the donor tissue had been destroyed by the immune response of the host.

6. Devitalised callus was encapsulated in inflammatory connective tissue and scar. When the dead callus was absorbed by the capillaries of the host new bone formation by induction produced a scanty deposit as a delayed event in a few instances.

7. Irrespective of whether it originated in the donor or the host, a connective-tissue cell type that proliferated rapidly and became labelled with 3H-thymidine was identified as a progenitor cell. Differentiation and specialisation as osteoprogenitor cells occurred after the growth of blood vessels into the interior of the callus, and developed inside of excavation chambers in cartilage. Except that the interaction of the donor tissue and host cells leading to new bone formation by induction takes place in the interior of the excavation chamber, the biophysico-chemical mechanism is unknown.
VASCULARISATION OF BONE GRAFTS IN THE ANTERIOR CHAMBER OF THE EYE
Authors: Deleu J. , Trueta J.
Published: February 2018

In this study the direct relationship between the type of bone implant used, the vascular reaction caused to the host and the revascularisation of the implant has been studied. It was found that the best graft was that which was the most rapidly and permanently vascularised. Not only was the biological affinity between the graft and the bed important, but the structural facilities offered by the implant for the "penetration" by the host vessels were also of paramount importance. Thus small, fresh, cancellous bone grafts offered the best chance of rapid incorporation provided they were not crushed to the point of making vascular progress difficult. The findings from this investigation so strongly suggest that the rapid revascularisation of the bone grafts was because of an end-to-end anastomosis of the vessels of the host with those in the implant that it seems justified to consider that the best bone graft is that which is richest in vessels. Apart from a recent short paper by Graf (1960), we have not found this assertion before. It is this which seems to make the fresh, autogenous, cancellous implant so superior to all others.

We believe that any new material for bone grafts should be tested by the technique described here. The material which one day may replace fresh, autogenous, cancellous implants will have to show the same readiness to vascular penetration, vascular osteogenesis and vascular permanency that at present is exhibited only by the cancellous autograft.
SUBTROCHANTERIC OSTEOTOMY IN THE TREATMENT OF PERTHES' DISEASE
Authors: Axer A.
Published: February 2018

1. A rationale of subtrochanteric osteotomy with derotation and varus angulation in the treatment of Perthes' disease is suggested.

2. Three months after operation the child returns to a normal unrestricted life.

3. The anatomical results in twelve such operations with an average follow-up of two years and five months are presented. In five children the results were "very good," in four "good," in one "fair" and in one "bad."

4. These results seem to compare favourably with those observed after conservative treatment of two, three or more years duration.
LATE THROMBOSIS OF THE FEMORAL ARTERY COMPLICATING FRACTURE OF THE FEMUR
Authors: Roper B. A. , Provan J. L.
Published: February 2018

1. A case of femoral artery occlusion after fracture of the femur occurring several days after internal fixation with a medullary nail is described.

2. Arterial reconstruction was undertaken seventeen days after the internal fixation, twenty-seven days after the injury, with restoration of flow and recovery of the limb.
IDIOPATHIC NECROSIS OF THE FEMORAL HEAD IN ADULTS
Authors: d'Aubigné R. Merle , Postel M. , Mazabraud A. , Massias P. , Gueguen J.
Published: February 2018

1. Idiopathic necrosis of the femoral head is generally considered to be a rare disease but it appears to be rather frequent in France in view of the fact that 139 cases were recorded in the orthopaedic clinic of Hôpital Cochin between 1959 and 1963. Ninety cases treated by operation have been analysed in this paper. Men are nearly exclusively affected between the ages of eighteen and seventy, with the highest incidence between thirty and fifty years of age. Both hips are affected in 52 per cent of cases.

2. The etiology is unknown, but steroid therapy was noted in 36 per cent of the cases and some history of slight injury in 30 per cent. The sudden onset of pain in half the cases suggests the obliteration of one of the blood vessels supplying the femoral head.

3. Radiographs are often normal at the time of onset of the symptoms but later they show increased density of the head localised to the antero-superior aspect, and later still collapse of this weight-bearing region. The extent of the lesion appears to be determined from the very beginning rather than to be progressive. The superior joint space is never reduced and may in fact be widened.

4. Pathological examination of the head and neck confirms necrosis of the cancellous bone and the integrity of the overlying cartilage, but shows deep to the necrotic region a highly reactive zone characterised by hypervascularity and raised metabolism. These features have been demonstrated by injection of the blood vessels and also by the uptake of phosphorus 32 and by the succino-deshydrogenase test.

5. In six cases microscopic vascular lesions were found in the antero-lateral pedicle of the femoral head.

6. The high degree of activity of the tissue deep to the necrotic zone gives some hope for revascularisation of the necrotic segment. For this reason protection from pressure may be the way to prevent dramatic collapse of the head. Rest, medical treatment and freedom from weight bearing, however, do not achieve adequate protection. Varus or rotation osteotomy of the femoral neck not only gives relief from pain but appears to prevent collapse of the femoral head.

7. When destruction of the head has already taken place good results may be expected from the insertion of a metallic prosthesis, provided the acetabulum is sound. The results are less favourable when the acetabulum has been altered by secondary arthritic change, and arthrodesis may have to be considered if the disease is unilateral or when a prosthesis has been successfully inserted on the other side.
A NEW METHOD OF HIP FUSION USING AN INTRAMEDULLARY NAIL
Authors: Onji Yutaka , Kurata Yotaro , Kido Hikaru
Published: February 2018

1. A method of hip fusion with the aid of a straight intramedullary nail through the ilium and the femur is presented.

2. If properly done, no external fixation is necessary and the patient can be allowed up with crutches ten days after the operation.

3. The method has been used on eighteen hips between 1958 and 1960. There was one case of delayed union due to faulty technique and one case of exacerbation of an old tuberculous infection. Otherwise the follow-up study of the patients revealed good bony fusion in all cases, with no pain in the back or knee.
GIANT-CELL TUMOURS AND ANEURYSMAL BONE CYSTS OF THE SPINE
Authors: Verbiest H.
Published: February 2018

1. Five cases of involvement of vertebrae by growths classified as giant-cell tumours, and two cases of involvement by tumours classified as aneurysmal bone cysts are described.

2. The periods of observation after operation in the benign cases were in three cases six years, in one ten years and in one twenty-one years.

3. In one case malignant transformation developed four and a half years after operation and one patient, in whom a sacral tumour was already malignant at the time of operation, died five months later.

4. Four patients showed significant involvement of vertebral bodies.

5. The problems related to the removal of a vertebral body and the measures taken to stabilise the spine are discussed.
THE HISTOLOGICAL APPEARANCES OF LATE SEGMENTAL COLLAPSE OF THE FEMORAL HEAD AFTER TRANSCERVICAL FRACTURE
Authors: Catto Mary
Published: February 2018

1. A study of late segmental collapse in twelve femoral heads shows that it may not develop until two and a half years after the fracture.

2. Until the articular surfaces had collapsed the patients usually had no symptoms. The fractures were united and there was no obvious radiographic evidence of ischaemic necrosis.

3. There was histological evidence that the whole of the femoral heads had been necrotic at one time. The term late segmental collapse is more appropriate than late segmental necrosis.

4. The blood vessels of the ligamentum teres played little or no part in revascularisation which, when it occurred, was almost entirely across the fracture line.

5. In only one femoral head was revascularisation approaching completion and apparently continuing. In the other eleven much of the head remained necrotic and the process appeared to have halted.

6. An increase in radiological density was caused by new bone laid down on unresorbed necrotic trabeculae and was most prominent behind the line of revascularisation when the process had halted.

7. Trabecular collapse was evident within dead bone. In ten of the femoral heads it occurred in the subchondral region and in four just beyond the junction of reossified and dead bone.

8. Osteoarthritic changes occurred in the cartilage covering revascularised bone at the periphery of the head, especially when collapse was severe.
THE MANAGEMENT OF INFECTION AFTER KÜNTSCHER NAILING OF THE FEMUR
Authors: Wilson J. N.
Published: February 2018

1. Seven cases of infection following medullary nailing of the femur have been studied.

2. Points in the diagnosis of nail track infection are emphasised, especially periosteal reaction.

3. It is felt that a sinograph is an essential part of the investigation and can be useful to assess progress.

4. The principles of treatment of established nail track infection are: adequate drainage of the fracture site; dependent drainage of the whole track by draining the pocket at the lower end; the use of instillation tubes to irrigate the nail track with antibiotics. Once the fracture is stable and the nail track adequately treated by local and general antibiotics the nail should be removed. It is not considered necessary to wait for bony union before removal of the nail.
OSTEOSARCOMA IN ENCHONDROMATOSIS (OLLIER'S DISEASE)
Authors: Braddock G. T. F. , Hadlow V. D.
Published: February 2018

1. A patient of sixty-eight suffering from enchondromatosis (Ollier's disease) is described.

2. A malignant tumour developed in the region of the lesser trochanter of the femur. Histological investigation established that it was an osteosarcoma.

3. Other features of interest are the radiographic appearance of Ollier's disease at an advanced age, and the presence of subcutaneous subcostal and retroperitoneal haemangiomata.
A METHOD OF ASSESSING CORRECTION IN CLUB FEET
Authors: Beatson T. R. , Pearson J. R.
Published: February 2018

We suggest that, after an initial course of treatment in the accepted manner by gentle manipulations without anaesthetic, followed by splinting for a period of three or four months, the talo-calcaneal index should be measured on radiographs taken in the standard positions described.

Should the correction be inadequate–that is, should the talo-calcaneal index be under 40 degrees even though clinically the foot appears corrected–further treatment should immediately be undertaken.
RESTORATION OF PREHENSION AFTER SEVERE MUTILATIONS OF THE HAND
Authors: Tubiana Raoul , Stack H. Graham , Hakstian Robert W.
Published: February 2018

1. Prehension is a complex mechanism for which both movement and sensation are required.

2. Two basic grips are considered: the digital pinch and palmar grasp, which are simpler expressions of the precision grip and the power grip. For the digital pinch the minimum requirement is a thumb or a reconstructed thumb, and a finger to which it can oppose. For palmar grasp mobile fingers are necessary so that they can wrap round the object grasped.

3. The restoration of prehension is considered under the following headings: mutilation of the fingers; mutilation of the thumb; and mutilation of both together.

4. The various methods of reconstruction are described that are appropriate to each type of mutilation, so as to provide restoration of length, mobility and sensation.

5. The indications for the various main methods to compensate for loss of the thumb are discussed. These methods include pollicisation and osteoplastic repair with neurovascular island flap.
MASSIVE OSTEOARTICULAR BONE GRAFTS
Authors: Ottolenghi Carlos E.
Published: February 2018

1. Seven cases of massive osteoarticular transplant for conditions affecting major joints are described. In one case the whole femur was replaced.

2. The transplants were well accepted, though there was a varying degree of absorption of bone and necrosis of articular cartilage.

3. The functional results were very satisfactory, and movements of joints were well preserved. 4. In these cases recurrence of the original disease was not seen.

5. Such operations are still in an experimental stage, but they are likely to have a permanent place in treatment in certain carefully selected cases.
SUPRACONDYLAR SPUR OF THE HUMERUS
Authors: Kessel Lipmann , Rang Mercer
Published: February 2018

Symptoms due to a supracondylar spur of the humerus, although rare, are common enough to make it the subject of routine examination of a patient with pain and disturbance of sensibility of the hand. It can mimic the carpal tunnel syndrome; it may produce ulnar nerve symptoms. Irritation or compression of either the brachial artery or, if there is a high division of it, the ulnar artery, may cause episodes of ischaemic pain in the forearm. The clinical features of a supracondylar spur causing symptoms are: symptoms of median nerve compression; forearm claudication; a palpable spur about two inches above the medial epicondyle; and disappearance of the radial or ulnar pulse on full extension and supination of the forearm.
SURGICAL TREATMENT OF PULMONARY METASTASES FROM PRIMARY TUMOURS OF BONE
Authors: Sweetnam Rodney , Ross Keith
Published: February 2018

1 . A series of twelve patients with solitary lung metastases from primary tumours of bone is reviewed. There were seven osteosarcomas, two chondrosarcomas, two fibrosarcomas and one malignant chondroblastoma. In each patient the lung desposit was resected.

2. Four patients have so far died from the disease. The average survival of the others since pulmonary resection is six years and seven months.

3. It is suggested that the results of pulmonary resection in carefully selected patients with solitary pulmonary metastases fully justify the procedure.

4. Careful investigation to ensure as far as possible that the metastasis is solitary, and a "waiting period" in case others should develop, are essential if unnecessary surgery is to be avoided. A waiting period of three months is recommended.
TARSAL TUNNEL SYNDROME
Authors: Lam S. J. S.
Published: February 2018

1. The tarsal tunnel syndrome is a clinical entity and is probably more often encountered than is recognised.

2. The cause is unknown but is probably like that responsible for the carpal tunnel syndrome. Experimental evidence suggests that the sensory symptoms in both these conditions are due to localised ischaemia of the nerve within the fibro-osseous tunnels, and that later structural changes are responsible for motor paralysis.

3. Relief of symptoms is complete if decompression of the posterior tibial nerve is performed before the onset of motor involvement.
INTRA-ARTICULAR SURGERY FOR DEGENERATIVE ARTHRITIS OF THE KNEE
Authors: Insall J. N.
Published: February 2018

1. The technique of the intra-articular surgery employed by the late Mr K. H. Pridie for osteoarthritis of the knee is described.

2. The results of sixty-two operations in sixty patients are analysed. The results in forty-eight knees (77 per cent) were pleasing to the patient. Forty knees (64 per cent) were rated as good at review.

3. The operation is most suitable for relatively active healthy people whose disability warrants a comparatively painful operation and lengthy rehabilitation.

4. The operation was most successful for relieving pain and improving stability. Functional improvement was less.

5. Results were remarkably permanent. The knees showed little tendency towards further deterioration.

6. Most of the bad results were associated with removal of the patella. A possible technical reason for this has been discussed.
UNRECOGNISED DISLOCATION OF THE HIP IN FRACTURES OF THE FEMORAL SHAFT
Authors: Helal B. , Skevis X.
Published: February 2018

1. The combination of femoral shaft fracture with dislocation of the hip in the same limb has been recorded in eighty-one patients since 1823.

2. A further fourteen cases are reported.

3. In over half the cases the hip dislocation was diagnosed late or not at all, and this error has occurred more often in modern times. The reasons for this are outlined.

4. The diagnostic physical signs of hip dislocation in the presence of a femoral shaft fracture are described.

5. The mechanism, sequels and treatment of this combined injury are discussed.
OSTEOSARCOMA OCCURRING IN OSTEOGENESIS IMPERFECTA
Authors: Klenerman L. , Ockenden B. G. , Townsend A. C.
Published: February 2018

1. Two girls with non-familial osteogenesis imperfecta who subsequently developed osteosarcoma of the femur are described. One is of special interest in that there were multiple bone metastases.

2. It is suggested that the tumours arose spontaneously and were not related to the underlying bone disorder.

3. Because of the relative frequency of hyperplastic callus formation in osteogenesis imperfecta it is most important that adequate biopsy material of any suspicious lesion is examined because the early clinical picture may be indistinguishable from a tumour.
FUNCTION AFTER RECONSTRUCTION OF SEVERED LONG FLEXOR TENDONS OF THE HAND
Authors: McKenzie A. R.
Published: February 2018

1. The case notes of 140 patients with a total of 297 severed long flexor tendons in the thumb and fingers have been analysed.

2. Fifty-seven patients in whom tendon reconstructive surgery was performed have been examined and the results have been recorded by three methods.

3. Methods of assessing finger and tendon function are reviewed and discussed. Accuracy and precision in tendon repair should be followed by an accurate and precise evaluation of tendon, joint and finger function.

4. A method of assessing the function is described. This is expressed as a percentage of the function of the uninjured contralateral finger.
CHONDROMALACIA PATELLAE
Authors: Crooks L. Mackenzie
Published: February 2018

1. It is suggested that abruptness of the condylar ridges on the femur plays a major role in the etiology of chondromalacia patellae. The medial condylar ridge is always abrupt in these cases, and indeed in many knees with no evidence of chondromalacia patellae. The lateral condylar ridge is rarely abrupt.

2. The short-term results of forty operations for reduction of femoral ridges in thirty-eight patients, with preservation of the patella in thirty-two cases, are satisfactory.
FRACTURE-DISLOCATION OF THE SHOULDER
Authors: Dewar F. P. , Yabsley R. H.
Published: February 2018

The case is reported of a fracture-dislocation of the shoulder, treated by an operation based upon a principle advanced by Moore in 1948. An excellent radiological and functional result was observed five and a half years after the injury.
BLOOD SUPPLY OF THE HUMAN PATELLA
Authors: Scapinelli Raffaele
Published: February 2018

1. A study has been made of the blood supply of the human patella. There are two main systems, one penetrating the middle third of the anterior surface and the other entering the lower pole of the bone behind the patellar ligament.

2. The relationship between these findings and the complication of avascular necrosis of the upper fragment of the patella after fracture is discussed. Forty-one cases of necrosis after operation have been studied and notes made on the pathological, clinical and radiological evolution of the condition. Whatever the severity of the ischaemic necrosis the prognosis was not substantially affected and good function was observed in all knees six months after injury.

3. The surgical implications of the vascular anatomy are discussed. It is pointed out that surgical intervention may damage the blood vessels entering the anterior surface of the bone and that circumferential repair of patellar fractures may strangle the vessels in their peripatellar course.

4. If removal of one-half of the patella after a transverse fracture is indicated, vascular studies indicate that the upper fragment should be removed.
CONGENITAL VERTICAL TALUS
Authors: Eyre-Brook Arthur L.
Published: February 2018

1. Four cases of true congenital vertical talus are described; in three of the four cases there were other major deformities of the skeleton. All were treated by open operation; the operation sacrificed part of the substance of the navicular bone, which was placed between the forepart of the calcaneus and the head of the talus.

2. The results five to ten years after operation show that stable reduction was maintained without any further treatment. They suggest, however, that more of the navicular bone could have been removed or that the whole navicular might be excised, at least in the more severe deformities.

3. Congenital vertical talus resembles club foot (equino-cavo-varus) in that difficulty in reduction and in maintenance of the reduction results from the tension in the medial pillar of the foot. Easing of the tension can result in recurrence of the dislocation or, alternatively, a reversal of the deformity.
THE RECOGNITION AND TREATMENT OF CONGENITAL FLAT FOOT IN INFANCY
Authors: Silk F. F. , Wainwright Denys
Published: February 2018

1. Eleven cases of congenital flat foot were studied, five of which are illustrated.

2. Ten of these cases were treated in infancy and followed for at least three years. In two cases the follow-up period was ten years and fifteen years.

3. An essential component of the deformity is equinus of the calcaneus, and treatment consisted of correction of the forefoot deformity by repeated manipulation, followed later by elongation of the calcaneal tendon and capsulotomy of the ankle.

4. The importance of recognising the deformity and beginning treatment in infancy is stressed.
CONGENITAL VERTICAL TALUS IN INFANCY
Authors: Harrold A. J.
Published: February 2018

1. Eight cases of congenital vertical talus in infancy are reported. The principal differential diagnosis at this age is from talipes calcaneo-valgus.

2. The deformity is primarily a dorsal dislocation of the talo-navicular joint.

3. Closed reduction can be achieved if treatment begins at birth. Open reduction is indicated for the deformity uncorrected by the age of three months.
WRINGER INJURIES OF THE HAND
Authors: Matev Ivan
Published: February 2018

1. In a series of seventy-one patients with wringer injuries of the hand three basic types of lesion were observed: a) denuding of part of or the entire hand, usually accompanied by avulsion of the distal phalanges; b) small lacerated wounds with wide detachment of surrounding skin and frequent fractures; c) multiple cut injuries of digits or the entire hand with skin avulsions.

2. Treatment was guided by the following principles: a) improvement of blood supply in regions of impaired nourishment; b) stable primary fixation of bones with Kirschner wires; c) primary wound closure through free skin grafting with maximal utilisation of available flaps.

3. Surgical technique as applied in various typical cases is outlined.
INLAY BONE GRAFTING FOR NON-UNION OF THE SCAPHOID BONE BY THE ANTERIOR APPROACH
Authors: Dooley B. J.
Published: February 2018

Cancellous inlay bone grafting for delayed union or non-union of the scaphoid bone gives good results in most cases (Table IV). The operation is easy, does not require radiological control and does not damage the dorsal arterial plexus. The indications for the operation are twofold: firstly for patients complaining of disabling symptoms in the wrist joint with an established pseudarthrosis of the scaphoid bone, with neither arthritic changes nor severe avascularity of the proximal fragment; and, secondly, for delayed union in recent fractures despite adequate immobilisation. Union may still occur if conservative treatment is continued further, but because this may take up to eighteen months (during which time most patients would be unable to work), operation is a reasonable alternative.

In this series two scaphoid fractures united after operation with some collapse of the proximal fragment. This probably resulted from removal of too much bone (preliminary to inlaying the graft) from an already small fragment with a poor blood supply.

The operation can be performed even in the presence of a small proximal fragment and gave a satisfactory result in two out of three such cases.
INTRAOSSEOUS GANGLIA
Authors: Seymour N.
Published: February 2018

The features of two cases of intraosseous ganglion in the lower tibia are described.
HOMOTRANSPLANTATION OF ARTICULAR CARTILAGE AND ISOLATED CHONDROCYTES
Authors: Chesterman P. J. , Smith Audrey U.
Published: February 2018

1. Techniques are described for homografting intact or partly digested hyaline cartilage or isolated chondrocytes on to cancellous bone in rabbits.

2. Material which had been cooled to and thawed from -79 degrees Centigrade either in the presence or absence of the protective substance dimethyl sulphoxide was grafted in the same way. In control experiments samples were boiled before grafting.

3. Necropsies were performed at intervals varying from two to twenty-six weeks later and the graft sites were removed, fixed and decalcified. Paraffin sections were stained histologically.

4. Freshly isolated chondrocytes or chondrocytes which had been frozen in the presence of dimethyl suiphoxide formed new matrix within two weeks and did not succumb to a homograft reaction. By the sixth week they had become aligned in columns surrounded by well stained matrix. There were signs oferosion by invading capillaries and osteoblasts, but no lymphocytes were seen. By the twelfth week invasion by trabeculae of newly formed bone was well advanced and by the twenty-sixth week the grafts were difficult to find although there had been no sign at any stage of an immunological reaction.

5. New matrix was also formed in homografts of hyaline cartilage which had been treated with papain or with papain and collagenase. After freezing in the presence of dimethyl sulphoxide, small areas ofthe grafts seemed to contain living cells which had formed new matrix. Other areas were disintegrating.

6. The homografts of intact cartilage showed a variety of appearances suggesting that the old matrix was gradually leached out and that chondrocytes liberated in vivo formed a new matrix.

7. Intact or partly digested cartilage which had either been frozen without dimethyl suiphoxide or boiled disintegrated and was rapidly replaced by bone after grafting.

8. When specimens of partly digested cartilage or isolated chondrocytes were homografted On to sites denuded of cartilage on the articular surface of the rabbit humeral head, nodules of fresh cartilage were formed. They were embedded in fibrous tissue derived, presumably, from marrow cavities opened up at the time of operation.
TRAUMATIC SPONDYLOLISTHESIS OF THE AXIS
Authors: Cornish Brian L.
Published: February 2018

1. The clinical experience of fourteen cases of traumatic spondylolisthesis of the axis is described.

2. Evidence is presented which suggests that vertical compression and extension forces are frequently involved.

3. Treatment is based on recognition of the deforming force and its extent.

4. Primary treatment of unstable lesions by the coronally placed bone dowel of Barbour allows early stabilisation and long-term security.

5. The increased antero-posterior diameter of the axis explains the low incidence of spinal cord damage.

6. Skull traction is considered illogical in that it runs parallel in effect to the most deadly form of judicial hanging.

7. Secondary stability following injury may allow continuing force to fracture the spine at other levels.

8. The paradox of an extension injury between the second and third cervical vertebrae and a "flexion" injury at a lower level is discussed.
THE CONSERVATIVE TREATMENT OF BENNETT'S FRACTURE-SUBLUXATION OF THE THUMB METACARPAL
Authors: Pollen Andrew G.
Published: February 2018

1. The treatment of Bennett's fracture is reviewed and the relative merits of conservative and operative treatment is considered.

2. A closed method of treatment is described and a series of thirty-one patients so treated is analysed. There were twenty-nine successful results.

3. It is urged that conservative treatment is the method of choice, and that operative measures should be reserved for the occasion when closed methods have failed.
THE RESULTS OF OPERATIONS FOR DISORDERS OF THE HIP CAUSED BY POLIOMYELITIS
Authors: Parsons D. W. , Seddon H. J.
Published: February 2018

1. The treatment of contractures at the hip secondary to poliomyelitis by Soutter's muscle slide or by Yount's fasciotomy gives excellent results. So does high femoral osteotomy, but it is not superior to the other two and should therefore be kept in reserve as a supplementary operation for the completion of correction of a deformity so gross as not to be wholly remediable by division of the soft parts.

2. Subluxation of the hip occurs only if the paralysis comes on during the first eighteen months of life and is a product not of severe paralysis but of unbalanced and often slight weakness of muscles. Correction of the invariable valgus deformity of the femoral neck by osteotomy is followed by relapse; acetabuloplasty too is unreliable. The most promising remedy seems to be some form of acetabuloplasty combined with transplantation of an iliopsoas of adequate strength into the greater trochanter. The indications for arthrodesis are few, but the results of this operation are good.

3. In the few patients with abductor weakness and little else the dipping gait may be abolished by iliopsoas transplantation.