bluuebunny/crossref_metadata_2025 huggingface dataset:
THE ROLE OF CAPSULAR CHANGES IN OSTEOARTHRITIS OF THE HIP JOINT
Authors: Lloyd-Roberts G. C.
Published: February 2018

1. The synovial membrane and capsule in osteoarthritis of the hip have been studied in twenty-five cases. Dissections have been made on fresh cadavers to establish the normal structure and function of these tissues at different ages.

2. Fragments of bone and cartilage were found beneath the synovial surface in twenty-three cases of the twenty-five cases of osteoarthritis.

3. The source of these fragments is the degenerate articular surfaces.

4. The fibrosis of the synovial membrane and capsule follows the synovial hyperplasia which accompanies the phagocytosis of these fragments.

5. A similar histological picture has been produced by injecting fragmented cartilage into the knee joints of rabbits. The injected fragments are found beneath the surface, and synovial hyperplasia is followed by subsynovial fibrosis.

6. The greatest amount of this joint debris is found in the lowest part of the joint cavity.

7. The joint capsule is particularly sensitive to traction.

8. All parts of the capsule are tight in extension, which is the weight-bearing position.

9. Fibrotic shortening of the capsule in the lowest part of the joint cavity explains many of the symptoms and signs of the disease: pain is caused by an attempt to stretch the capsule; muscle spasm occurs in the muscles supplied by the sensory nerves of this part of the capsule; extension, medial rotation and abduction, which tighten this area, are lost first; progressive shortening causes deformity in the opposite direction, namely flexion, lateral rotation and adduction; the loss of extension causes a more rapid wearing of articular cartilage on weight bearing; subperiosteal new bone is formed on the under-surface of the neck of the femur.

10. The symptomatology is discussed.
IDIOPATHIC SCOLIOSIS
Authors: James J. I. P.
Published: February 2018

The evolution of an idiopathic scoliosis is determined by the site of the primary curve and by the age of onset. It is significant that thoracic primary curves are commonly severe and the early onset of this curve accentuates this feature. Early operation based on prognosis is practised but sufficient time has not yet elapsed to justify any conclusions.
THE CHEMOTHERAPY OF ORTHOPAEDIC TUBERCULOSIS
Authors: Stevenson F. Harwood
Published: February 2018

Streptomycin and the newer antibiotics have already belied the pessimistic agnosticism of 1947. In certain instances, notably in disease of the knee and hip and in some cases with draining sinuses, it appears that they are sufficient to produce a quiescence which may be a cure. For the rest it remains to map out in detail what has in part been explored. In particular it is essential to confirm how far antibiotics enable surgeons to treat tuberculosis upon the basic principles applicable to other infections of bone without fear of secondary infection: where there is diseased bone, to remove it: where there is pus, to relieve the tension and evacuate it. The surgeon fears not so much the infection itself as the inability of the tuberculous soil ordinarily to deal with secondary infection. With the control of the diseased soil the risk should be no greater than that of any other surgery of bone.

The early case and the advanced case; age and site of disease; these and other variables must subdivide basic method. What is the best application of the new "combined operation" to a child of three with thoracic Pott's disease and a globular abscess? What is the wisest plan for a man of forty with old disease in his lumbar vertebrae and discharging sinuses? We begin to see what we could do. At the present the question still remains: What should we do?
THE SURGICAL CORRECTION OF MANDIBULAR PROTRUSION AND RETRUSION
Authors: Henry T. Cradock
Published: February 2018

1. The technique of correction of mandibular protrusion and retrusion by osteotomies through the rami of the mandible is described and illustrated.

2. The best age for the operation, and the factors that might favour or prevent relapse, are discussed.

3. Illustrative cases are described.
THE TRAUMATIC ANATOMY AND TREATMENT OF ACUTE ACROMIO-CLAVICULAR DISLOCATION
Authors: Horn J. S.
Published: February 2018

1. The lesions chiefly responsible for persistent pain and weakness after acromio-clavicular dislocations are tears of the trapezius and deltoid muscles.

2. These tears cannot be adequately treated except by open operation.

3. There are often physical barriers making closed manipulative reduction impossible.

4. Open reduction and repair of torn ligaments and muscle is advocated for manual workers.
A RADICULAR SYNDROME FROM DEVELOPMENTAL NARROWING OF THE LUMBAR VERTEBRAL CANAL
Authors: Verbiest H.
Published: February 2018

1. A clinical condition is described in which there are symptoms of compression of the caudal nerve roots on standing or walking, but not at rest. Seven cases are reported.

2. Myelography showed a block in the lumbar region in every case.

3. At operation narrowing of the spinal canal in part of its lumbar course was found.

4. The nature of the abnormality is discussed. It is suggested that the narrowing is due to encroachment on the spinal canal by the articular processes.
FRACTURE-DISLOCATION OF THE TROCHLEA
Authors: Potter C. M. C.
Published: February 2018

1. Two cases of fracture-dislocation of the trochlea are described. One case was complicated by complete ulnar nerve palsy.

2. The injury is caused by direct force applied to the point of the elbow, or it may be associated with posterior dislocation of the joint.

3. Open reduction is recommended, the fragment being held in position by soft-tissue sutures alone.

4. Four other cases mentioned in the literature are reviewed.
HYPERPARATHYROIDISM WITH INCREASED BONE DENSITY IN THE AREAS OF GROWTH
Authors: Adam A. , Ritchie D.
Published: February 2018

A case of parathyroid adenoma in a growing girl is described in which radiographs showed bands of increased density in the metaphyses in addition to the usual signs of osteitis fibrosa cystica. The literature is reviewed and the appearances are discussed.
A CASE OF OSTEOPATHIA STRIATA
Authors: Bloor D. U.
Published: February 2018

A case of osteopathia striata in a girl aged three years is described. Similar cases are reviewed.
AN EXPERIMENTAL STUDY OF MUSCLE GROWTH IN THE RABBIT
Authors: Crawford G. N. C.
Published: February 2018

1. In young rabbits the muscle belly of the tibialis anterior was marked at intervals, either on its surface with indian ink, or in its substance by wires. The intervals between ink marks were measured directly, and those between wires by radiography. After four to seven months the measurements were repeated and the amount and site of longitudinal growth determined. The experiments showed that it occurred fairly evenly throughout the length of the muscle belly.

2. By transfer of the tibialis anterior in front of the crural ligament in young rabbits its course was reduced and the extent of contraction necessary to dorsiflex the foot was increased. The rabbits were killed when fully grown and the lengths of the tendons and muscle bellies of the tibialis anterior of the normal and experimental legs were compared. It was found that in every case the tendon of the experimental muscle was shortened and its belly lengthened in comparison with the normal. It is suggested that the increased length of the muscle belly was determined by the increased distance which it had to contract in order to dorsiflex the foot.
RANGE OF MOVEMENT OF THE GREAT TOE IN MEN
Authors: Joseph J.
Published: February 2018

1. The range of variation in the movements at the metatarso-phalangeal and interphalangeal joints of the big toe in fifty males has been investigated by means of lateral radiographs.

2. In the "neutral" position the proximal phalanx is dorsiflexed on the metatarsal and the distal phalanx dorsiflexed on the proximal. Sometimes the distal phalanx is plantar flexed on the proximal but this is not associated with any obvious abnormality of function.

3. There is a wide variation between individuals in the amount of movement found at these joints.

4. At the metatarso-phalangeal joint dorsiflexion is much more free than plantar flexion. The opposite is the case at the interphalangeal joint.

5. There is no significant difference between the right and left sides. Only in plantar flexion at both joints are there significant reductions in the range of movement in older age groups. These reductions are not functionally important.

6. There is an inverse relationship between active and passive dorsiflexion: the greater the range of active dorsiflexion, the less is the range of additional passive dorsiflexion.

7. In lateral radiographs the head of the metatarsal is always rounded.
THE NATURE OF THE BONE CHANGES ASSOCIATED WITH NERVE INJURIES AND DISUSE
Authors: Gillespie J. A.
Published: February 2018

1. Paralysis caused by anterior nerve root section, or by peripheral nerve section, leads to marked changes in the bones and muscles of the affected limb in experimental animals. Vascular changes are not the cause of the bone atrophy in a paralysed limb.

2. The altered properties of the bones of a paralysed limb are due almost entirely to a loss in the quantity of bone; bone quality is only slightly altered.

3. The bone changes that follow paralysis are due to the secondary loss of muscular activity. No evidence could be obtained that nerves exert any specific, trophic influence on bone.
BONE ANOMALIES OF THE TARSUS IN RELATION TO "PERONEAL SPASTIC FLAT FOOT"
Authors: Jack E. A.
Published: February 2018

1. Twenty-three cases of tarsal anomalyâtalo-calcaneal bridge or calcaneo-navicular barâoccurring among thirty cases of "peroneal spastic flat foot" have been studied.

2. The correlation between the clinical features and the mechanical defect is discussed.
CALCIFICATION OF INTERVERTEBRAL DISCS IN CHILDREN
Authors: Walker C. S.
Published: February 2018

1. A case of calcification in the intervertebral discs of a child is described.

2. The difference in the condition as it affects children and adults is discussed.

3. The etiology is considered but no definite conclusion is suggested.
TRAUMATIC DISLOCATION OF THE HIP IN CHILDHOOD
Authors: Mason Mark L.
Published: February 2018

1. The literature of dislocation of the hip in childhood from 1922 to 1954 is reviewed. A total of eighty-eight cases have been recorded.

2. A further case, in a child of one year and eleven months, is described.

3. Nine of the children whose cases have been recorded developed Perthes' disease of the hip after the dislocation, an incidence of 10 per cent. A similar incidence of avascular necrosis of the femoral head has been reported after dislocation of the hip in adults.
BRIDGING OF BONE DEFECTS IN THE FOREARM WITH ILIAC GRAFT COMBINED WITH INTRAMEDULLARY NAILING
Authors: Spira E.
Published: February 2018

1. A technique for bridging bone defects in the forearm with massive iliac graft and medullary nailing is described.

2. The results of fifteen operations are reviewed.
WEDGE ARTHRODESIS OF THE WRIST
Authors: Evans David L.
Published: February 2018

1. A simple and effective method of wrist arthrodesis is described. Originally designed for the correction of flexion deformity of the wrist, it is useful also as a routine method of wrist fusion.

2. The results in nineteen cases are reviewed.
THE FATE OF RADIOPAQUE MEDIA INJECTED INTO THE CANCELLOUS BONE OF THE EXTREMITIES
Authors: Harrison R. G. , Gossman H. H.
Published: February 2018

Radiopaque solutions and suspensions introduced into cancellous bone in the extremities of the cadaver are rapidly removed into the venous system through regional superficial or deep veins. The experiments described in this communication confirm the simplicity of methods of introduction of fluids into cancellous bone and justify further observations on their clinical application for the technique of phiebography.
TUBERCULOSIS OF THE GREATER TROCHANTER
Authors: McNeur J. C. , Pritchard A. E.
Published: February 2018

1. Thirty-eight cases of tuberculosis of the greater trochanter have been reviewed.

2. Classification into bursal and osseous infections is discussed, and reasons have been given for our belief that either lesion may be the primary one.

3. An attempt has been made to assess available methods of treatment. In general, conservative measures are recommended for primary lesions, and surgery for recurrences. We have the impression that chemotherapy is of definite value.

4. The incidence of spread of tuberculosis to the hip joint is discussed. In this connection, reasons have been given for condemning excision of the trochanter.
THE VASCULAR PATTERN AS AN AID TO THE DIAGNOSIS OF BONE TUMOURS
Authors: Begg A. C.
Published: February 2018

1. Direct injection of contrast material into bone indicates its extreme vascularity, particularly near an epiphysis, and emphasises the extraordinary capacity of the minute periosteal vessels. The nutrient artery of a long bone appears to play little part in its nourishment and may be regarded as a vestigeal structure.

2. The vascular pattern of bone tumours may be investigated by injection of the appropriate artery, and sometimes, if a haemangioma is suspected, by direct injection into the lesion.

3. The examination is easily and quickly carried out by direct arterial puncture under local anaesthesia and injection of 35 per cent diodone. A tourniquet applied distally at the appropriate level is often helpful.

4. A study of the vascular pattern of suspected bone tumours has provided useful information in a positive and negative way, assisting both the diagnosis and the planning of treatment. The pathological diagnosis of some tumours, notably osteosarcomas and haemangiomas, may be made with such assurance that possible dissemination of the tumour by biopsy may be avoided.
FRACTURES OF THE TIBIAL CONDYLES
Authors: Slee Gerald C.
Published: February 2018

1. Sixty fractures of the tibial condyles have been reviewed. Fifty were treated by conservative measures and ten by operative reduction. The fractures are classified and the etiology, age incidence, mechanism of injury, methods of treatment, and results are discussed.

2. The indications for operative reduction are described.

3. The combined split and compression types of fracture give the least satisfactory results.

4. Age is no contra-indication to immobilisation in the treatment of these fractures.

5. Emphasis is laid upon the necessity for immobilisation in the treatment of the associated ligamentous injuries.

6. It is considered that the results justify the policy of treatment described.
METHODS OF MEASUREMENT OF MUSCLE AND JOINT FUNCTION
Authors: Salter Nancy
Published: February 2018

1. The importance of accurate methods of measuring the strength of muscles and the amplitude of joint movements in man, both in clinical fields and as criteria of normal function, is discussed.

2. The advantages and disadvantages of subjective and objective methods are reviewed.

3. The main types of apparatus used for the assessment of muscle strength in both normal and clinical conditions are described. A dynamometer of the strain-gauge type is recommended.

4. Methods of measuring the amplitude of movements in man are also described. The protractor type arthrometer is thought to be the most suitable for routine clinical work, but for research purposes a radiographic method may be preferable.

5. The following factors, which must be considered if the measurements taken are to be of greatest use, are discussed: posture, test procedure, standards for comparison, nomenclature and normal variability.
FURTHER EXPERIENCES ON THE PATHOLOGICAL INFLUENCE OF A DEVELOPMENTAL NARROWNESS OF THE BONY LUMBAR VERTEBRAL CANAL
Authors: Verbiest H.
Published: February 2018

1. A measuring instrument is described which enables the surgeon to determine the anteroposterior diameter of the vertebral canal during operation.

2. Developmental narrowness of the lumbar vertebral canal is shown to exist and to be caused by an abnormally short antero-posterior diameter.

3. In patients with a narrow, although not abnormally narrow, lumbar vertebral canal, slight deformities such as posterior spur formation or small disc protrusions may produce particular symptoms, which are interesting from a clinical as well as from a medico-legal point of view.
TRANSPLANTATION OF EPIPHYSIAL CARTILAGE
Authors: Ring P. A.
Published: February 2018

1. An experimental technique for the transplantation of epiphysial cartilage in the rabbit is described.

2. Autogenous transposition of the distal epiphysial cartilage of the ulna was followed by normal growth in five of eighteen animals.

3. Homogenous transplantation was unsuccessful in all the animals studied.

4. Homogenous grafting gives rise to an immunity reaction confined to the reserve Zone of the cartilage.

5. It is suggested that the difference between the fate of homogenous grafts of epiphysial and non-epiphysial cartilage lies in the vascularity of the former.
FATIGUE INFRACTION OF THE MIDDLE OF THE TIBIA IN BALLET DANCERS
Authors: Burrows H. Jackson
Published: February 2018

1. A defect of the middle of one tibial crest is described in young healthy ballet dancers.

2. The clinical and radiological characteristics have been studied in four cases, and the histological appearances in two.

3. The defect is concluded to be an incomplete fatigue fractureâa fatigue infraction.

4. A fifth, uncertain, case has been added tentatively, as presenting a possible serious complication, namely acute fracture from muscle action.

5. The diagnosis, treatment and prognosis are mentioned, with emphasis on the importance of adequate clinical and radiological examination in cases of obscure mid-tibial pain, tenderness or swelling.
TREATMENT OF OSTEOARTHRITIS OF THE HIP BY OSTEOTOMY
Authors: Campbell J. P. , Jackson J. P.
Published: February 2018

Conclusions based on forty-six osteotomies show this to be a sound pain-relieving operation for osteoarthritis of the hip. The field of operation has been widened and some of the disadvantages have been avoided by nail and plate fixation. Early results from this method are similar to those from osteotomy and immobilisation in plaster, and it seems likely that the relief of pain will be just as enduring.
CONGENITAL DISCOID MEDIAL SEMILUNAR CARTILAGE
Authors: Murdoch George
Published: February 2018

1. The occurrence of congenital discoid medial cartilages in two patients is reported: in one the abnormality was bilateral. The three specimens are described and illustrated.

2. The literature on the subject is reviewed and the specimens discussed and classified.
PRIMARY RUPTURE OF BRACHIAL ARTERY AND MEDIAN NERVE IN SUPRACONDYLAR FRACTURE OF THE HUMERUS
Authors: Smyth E. H.J.
Published: February 2018

1. A case, believed to be the fifth on record, of supracondylar fracture with rupture of the brachial artery is described.

2. The relative immunity of the median nerve in these injuries is discussed, with brief reference to a recent case of complete rupture. Only a single previous report of this complication could be found.

3. It is suggested that these injuries are less uncommon than the number reported would indicate.

4. The anatomy of severe displacement is discussed, with special reference to the role of the brachialis.

5. The danger of closed reduction when the relationship of the upper fragment to the neurovascular bundle is in doubt is stressed.

6. The indications for open reduction are given.
ELECTROLYSIS AND STAINLESS STEELS IN BONE
Authors: Wright J. K. , Axon H. J.
Published: February 2018

1. The factors producing electrolytic corrosion of stainless steels are reviewed, and it is shown how several factors operating together can accentuate corrosion in certain positions in the plated fracture.

2. These factors can be minimised by good metallurgy and good engineering on the part of the manufacturers.

3. When and if materials become metallurgically satisfactory, or a truly inert substitute for metal is discovered, it will be possible to assess the true contribution of infection, faulty operative technique and mechanical factors to the failures of internal fixation. Such a critical assessment of these probably more important factors is at present bedevilled by uncertainty as to the purely physical condition of the materials as supplied to the surgeon.
STRESS FRACTURES OF THE FIBULA
Authors: Devas M. B. , Sweetnam R.
Published: February 2018

1. An account is given of fifty stress fractures of the fibula which occurred in athletes.

2. The characteristic symptoms, signs and radiological appearances are described, with details of treatment and prognosis.

3. The mechanism of the injury has been suggested on clinical grounds and supported by experimental methods.
PARAPLEGIA DUE TO HYDATID DISEASE
Authors: Mills T. J.
Published: February 2018

1. Cases of hydatid disease causing paraplegia since 1860 in Great Britain have been briefly reviewed and three recent cases have been added.

2. The types have been classified, the clinical pictures outlined and the treatment discussed.
THE ARTERIAL SUPPLY TO THE ADULT CERVICAL VERTEBRAL BODIES
Authors: Harris R. S. , Jones D. M.
Published: February 2018

1. The spinal branches of the vertebral artery were injected with a suspension of barium sulphate and the blood supply of the vertebral bodies of the lower four or five cervical vertebrae investigated radiologically.

2. Beneath the posterior longitudinal ligament there is a free dorsal arterial plexus from which a large branch arises to enter the back of the vertebral body. This vessel terminates abruptly at the centre of the body where numerous, much smaller, branches radiate towards the upper and lower surfaces.

3. The possible significance of the form of the intravertebral arteries is considered in relation to embolic lesion in vertebral bodies.
THE BLOOD SUPPLY OF DEVELOPING LONG BONES WITH SPECIAL REFERENCE TO THE METAPHYSES
Authors: Lewis O. J.
Published: February 2018

1. Periosteal bone is supplied by periosteal vessels and endochondral bone by the nutrient artery.

2. In the earliest stages of development the metaphysis is supplied by vessels derived only from the nutrient artery. Later, metaphysial arteries derived from the periosteum take over the supply of its peripheral part, the extent of their area of supply progressively increasing.

3. In injected specimens the blood vessels approaching the epiphysial cartilaginous plate end in saccular dilations. Histological sections show these dilations to be blood-filled cartilage lacunae, with no endothelial lining and into which open the blood vessels approaching the epiphysial plate.
THE PROSTHETIC MANAGEMENT OF CONGENITAL DEFORMITIES OF THE EXTREMITIES
Authors: McKenzie D. S.
Published: February 2018

1. Congenital defects of the extremities are described. Although the detailed anatomy is infinitely variable, a broad classification in relation to prosthetic management has been suggested.

2. Most patients with these deformities can be fitted with a prosthesis without major surgical intervention. With this they will have at least as good function as they would have after amputation. A plea is made for a conservative attitude in this respect. It is suggested that recourse to amputation should be confined to cases in which prosthetic equipment falls short of functional and cosmetic requirements, and that, when possible, it should be deferred until the child is old enough to share in the decision.

3. The prostheses applicable to the various types of deformity are briefly described.

4. The application of similar techniques to cases of acquired shortening is mentioned.

5. The incorporation of certain features of artificial arms in flail arm splints is discussed.
OSTEOCHONDRITIS DISSECANS IN ASSOCIATION WITH DWARFISM
Authors: White John
Published: February 2018

1. Three patients suffering from osteochondritis dissecans in several joints, and all below average height, are described.

2. There was evidence of a constitutional upset in each case.

3. It is suggested that there was an underlying endocrine imbalance at puberty.
SUBLUXATION OF THE INFERIOR RADIO-ULNAR JOINT COMPLICATING FRACTURE OF THE RADIAL HEAD
Authors: McDougall A. , White J.
Published: February 2018

1. Dislocation or sublaxation of the inferior radio-ulnar joint in association with fractures of the head of radius is discussed.

2. The incidence of the complication is greater than is generally supposed, and figures are given to support this finding.

3. The subluxation is not always associated with symptoms, and the degree of displacement may not be sufficient to be recognised clinically.

4. The anatomy and mechanism of the displacement have been investigated experimentally, and the results of the experiments are described.
FRACTURE-DISLOCATION OF HIP WITH DISPLACEMENT OF BONE FRAGMENT INTO ACETABULUM DURING CLOSED REDUCTION
Authors: Jeffery C. C.
Published: February 2018

A case of posterior fracture-dislocation of the hip complicated by displacement of a segment of the acetabular rim into the joint at the time of closed reduction is reported.

In treatment, it is stressed that the posterior approach to the hip should be used to minimise further damage to the soft tissues about the joint.
INTRAVASCULAR OSTEOCLASTS
Authors: Sladden R. A.
Published: February 2018

1. In five out of eleven cases of osteoclastoma it was found that osteoclasts were present inside clearly defined blood vessels either within the tumours or in the tissues immediately surrounding the tumours. In two further cases it was found that osteoclasts protruded into the vessels although they were not lying free within the vessels.

2. The possible modes of entry of these cells into the blood stream are discussed. Although accidental dissemination of osteoclasts into damaged blood vessels could not be excluded, it was felt that the process was equally likely to be related to some inherent property of the osteoclasts. From further observations it is suggested that osteoclasts are capable of local destruction of the connective tissues of the vessel walls, probably by enzyme action. Such an action might be analogous to the processes by which, in the opinion of many, osteoclasts bring about the resorption of bone.

3. There did not seem to be any relationship between the finding of intravascular osteoclasts and the malignancy of the tumour, assessing the latter either on histological or clinical grounds. The finding of intravascular osteoclasts does not therefore appear to be of any prognostic significance.
THE MOE PLATE IN INTERTROCHANTERIC FRACTURES OF THE FEMUR
Authors: Kennedy J. C. , McFarlane R. M. , McLachlin A. D.
Published: February 2018

1. The Moe plate has been used in 256 of 270 consecutive intertrochanteric fractures of the femur. There was an operative mortality of l8Â·8 per cent and an overall mortality of 20Â·7 per cent in a group averaging 75Â·2 years of age.

2. The method proved satisfactory, giving secure fixation and also approximation of the fragments by the lag action of the three large screws driven into the head. There was only one case of non-union.

3. In the survivors anatomical and functional results have been satisfactory in about 70 per cent, with half of these showing full functional recovery and the other half requiring only occasional use of a stick or crutch.

4. There are a few intertrochanteric fractures of the femur too comminuted for any form of internal fixation. Traction should be used in this group.

5. A varus deformity developed in about one half of the cases. This is consistent with a good functional result.

6. The main difficulty in these aged people has been survival. The problems have been discussed with suggestions that may perhaps reduce in part a mortality that seems inherent in this injury and at this age.
REDUCTION OF SMITH'S FRACTURE
Authors: Thomas F. Brian
Published: February 2018

A classification of Smith's fractures into three types is proposed. It is suggested that the majority of these fractures are caused by a pronation injury. The reduction of Smith's fractures by supination is described and the importance of the supinated position during splintage is stressed.
ARTHRODESIS OF THE HIP WITH A LAG-SCREW
Authors: McKee G. K.
Published: February 2018

A method of intra-articular arthrodesis of the hip is described in which fixation is obtained with a lag-screw. Two main advantages are claimed: first, that it is a compression arthrodesis and gives early bony fusion; and second, that it gives adequate internal fixation in most cases so that the disadvantages of a plaster hip spica are avoided, and the patient may walk with crutches two or three weeks after the operation.

The results were satisfactory in forty-seven of the first fifty cases in which this method of arthrodesis was employed. There were two post-operative deaths and one failure to secure fusion in a case of massive necrosis of the femoral head.
MULTIFOCAL OSTEOGENIC SARCOMA
Authors: Price C. H. G. , Truscotf D. E.
Published: February 2018

1. The detailed findings are presented of a woman aged fifty who had widely distributed ossifying skeletal tumours, the structure and form of which have been shown to be low-grade osteoblastic osteogenic sarcoma. The patient was treated with heavy doses of P32, to which is attributed some clinical improvement, but which induced a fatal aplastic anaemia.

2. The study of the several tumours, together with the history, the radiographs and the post-mortem findings, suggests that the lesions are multifocal skeletal primary tumours rather than numerous osseous metastases secondary to a solitary new growth in any one bone.

3. The focal neoplastic lesion is discussed in the light of personal experience of other osteogenic sarcomata of low grade but of solitary origin, and of the multifocal form of bone sarcoma which may complicate Paget's osteitis deformans.
LOCAL GIGANTISM
Authors: Charters A. D.
Published: February 2018

1. A case of local gigantism is described, with enlargement of the left thumb, the left ring finger, the right little finger, and the right second and third toes.

2. No other record can be found in the literature of an association of local gigantism of fingers of both hands with a similar condition of the toes of one foot, though there is no theoretical reason why macrodactyly should not affect the digits in any combination.

3. Theories regarding the etiology are discussed.
FEMORAL GROWTH AFTER OCCLUSION OF THE PRINCIPAL NUTRIENT CANAL IN DAY-OLD RABBITS
Authors: Brookes M.
Published: February 2018

1. The principal nutrient canal of the femur in day-old rabbits was occluded and subsequent femoral growth observed.

2. An initial shortening is followed by equalisation and a final absolute shortening of the order of 3 per cent in occluded femora as compared with controls.

3. It is emphasised that the medullary arterial system, fed by principal nutrient, metaphysial and epiphysial arteries, is the mechanism for the delivery of arterial blood to long bones, and that the arteries of bone extremities are of overwhelming importance in the nutrition of the long bone as a whole.
ARTHROPLASTY OF THE HIP
Authors: Denham R. A. , Alexander W. Law
Published: February 2018

1. Two hundred and eleven cases of arthroplasty of the hip have been studied in an attempt to establish the causes of success and failure by comparing the excellent, good and bad results.

2. The findings suggest that the result of an arthroplasty depends largely upon four factors: the surgical approach to the hip joint, the acetabular roof, the interposition substance, and the early post-operative complications.

3. Some important points in the technique of operation and in the post-operative management are described.
THE DIRECT APPROACH TO CONGENITAL DISLOCATION OF THE HIP
Authors: Somerville E. W. , Scott J. C.
Published: February 2018

1. A method of treatment of the congenitally dislocated hip is described.

2. The rationale of the treatment is considered.

3. The subsequent development of the hip generally, and of its individual components, is described.

4. Comparison between the results of other methods of treatment and of this method is not attempted for reasons stated.

5. The advantages of a shortened period of splintage are discussed.

6. The state of fifty completely dislocated hips treated consecutively is described at the end of a follow-up period of from three to seven and a half years.
CHONDROBLASTOMA (CODMAN'S TUMOUR) OF THE THORACIC SPINE
Authors: Buraczewski Janusz , Lysakowska Janina , Rudowski Witold
Published: February 2018

1. A left-sided, paravertebral, hour-glass tumour causing destruction of the neural arches of the third and fourth thoracic vertebrae with evidence of spinal cord compression, is described. The tumour presented the typical histological appearance of a chondroblastoma.

2. The intraspinal part of the tumour was excised and the mediastinal part curetted. Post-operative radiotherapy was given. The patient was symptomless two years after operation.

3. No example of Codman's tumour with similar features and in such a situation has been described before in the literature. Pathological, clinical and radiological aspects of chondroblastomata are briefly discussed and some remarks concerning their treatment are added.
EXCISION OF THE COCCYX FOR COCCYDYNIA
Authors: Pyper J. B.
Published: February 2018

1. Twenty-eight patients subjected to excision of the coccyx for coccygeal pain during the last ten years have been reviewed.

2. No constant means of selection appears to have been used in recommending these patients for operation, and, in retrospect, no factor in the history or examination emerges as reliable for making such selection in the future.

3. Operation may be recommended as likely to provide a cure in about 45 per cent and to give worthwhile relief in another 45 per cent of cases.

4. When conservative treatment has succeeded, operation will not, of course, be required, but failure of conservative treatment is not an essential pre-requisite in recommending operation.

5. If more care were taken to eliminate the markedly psychoneurotic patients the worthwhile results of operation could probably be increased even above 90 per cent.

6. Excision of the coccyx is certainly a useful operation and should not be discarded.
VASCULAR CHANGES AFTER INTERFERENCE WITH THE BLOOD FLOW OF THE FEMORAL HEAD OF THE RABBIT
Authors: Lemoine AndreÌ
Published: February 2018

1. By the surgical division of the main capsular artery supplying the upper femoral epiphysis of the rabbit it is possible to cause changes which resemble those occurring in human osteochondritis.

2. The phase of anaemia (ischaemia and hypovascularisation) lasts in the rabbit less than fifteen days. The whole process lasts approximately ninety days, and only for one-sixth of this period does the femoral head suffer from a reduction in its blood supply.

3. After the fifteenth day until the end of the process the condition changes to one of hypervascularisation, which lasts six times longer than that of ischaemia or relative anaemia.

4. By the ninetieth day the whole process has lost its activity and only some permanent deformities remain. The vascular pattern is from then on the normal in the rabbit.

5. The "osteochondritic" changes cannot be elicited in the distal femoral epiphysis. The apparent reason is the presence of anastomoses between the main artery and other epiphysial vessels.

6. There seems to be reasonable experimental evidence, by implication, in favour of the vascular theory of osteochondritis of the upper femoral epiphysis in children.
OSTEOARTHRITIS OF THE HIP
Authors: Little K. , Pimm Lionel H. , Trueta J.
Published: February 2018

1. A study of normal and osteoarthritic hyaline cartilage has been made with the electron microscope and x-ray diffraction.

2. Normal cartilage consists of a three-dimensional network of collagen fibrils with no preferred orientation, surrounded by a matrix containing polysaccharide.

3. In the osteoarthritic joint the collagen fibrils show definite orientation and a decreased proportion of ground substance. X-ray diffraction confirms this and shows the orientation to be at right angles to the surface of the femoral head.

4. Tensional forces across the joint may explain why osteoarthritic changes first appear in the non-weight-bearing area of the joint.
DISABILITIES AFTER TIBIAL SHAFT FRACTURES
Authors: Ellis H.
Published: February 2018

1. A study of the late results of 343 soundly united tibial shaft fractures was carried out. Limitation of ankle and/or foot movement occurred in twenty-one patients (6 per cent) and was found to be the most important cause of disability. Knee stiffness (2Â·3 per cent of cases) and shortening of up to three-quarters of an inch (5Â·5 per cent of cases) caused little functional impairment.

2. Stiffness of the foot and ankle was correlated with the severity of injury, occurring in 1 per cent of minor, 5 per cent of moderate and 22 per cent of major injuries.

3. One-third of the patients with limitation of foot and ankle movement had clinical evidence of ischaemic contracture.

4. It is argued that, in the absence of direct injury to the joint, persistent joint stiffness is caused by replacement fibrosis of soft tissues. This may result either from direct tissue injury or from associated vascular damage.
OSTEOPETROSIS WITH SYNDACTYLY
Authors: Truswell A. S.
Published: February 2018

A minority of cases of osteopetrosis show in addition syndactyly and distal phalangeal anomalies. The seven cases that have been reported with this combination have had an unusual degree of density and thickening of the skull vault, face and mandible, and of the shafts of the metacarpals, metatarsals, proximal phalanges and clavicles. It is submitted that these features constitute a distinct morphological variety of osteopetrosis.
TIBIALIS ANTERIOR TRANSFER IN CONGENITAL CLUB FOOT
Authors: Singer Martin , Fripp A. T.
Published: February 2018

1. The results of seventy-six transfers of the tibialis anterior tendon to the outer side of the foot to prevent relapse of congenital club foot are reviewed.

2. There were relapses in fifty-two of the seventy-six feet on which the operation had been performed.

3. The equinus component of the deformity is the dominant feature in all the relapses.

4. A test for occult equinus is described.

5. The factors contributing to the high relapse rate are discussed.
RECURRENT SPRAIN OF THE ANKLE JOINT WITH DIASTASIS
Authors: Mullins J. F. P. , Sallis J. G.
Published: February 2018

1. Partial diastasis of the tibio-fibular syndesmosis is believed to be common, but it is often overlooked as a cause of recurrent sprains of the ankle.

2. The treatment of recurrent sprains of the ankle by stabilising the inferior tibio-fibular joint with a lag screw is described. The method has been used in seventy-five patients aged between sixteen and sixty-five years. The longest follow-up has been six years.
THE INFLUENCE OF CORTISONE AND A.C.T.H. ON BONE SUBJECTED TO MECHANICAL STRESS (TOOTH MOVEMENT)
Authors: Storey E.
Published: February 2018

1. When cortisone is administered to rabbits there is early rapid resorption of bone and a partial inhibition of new bone formation. After a few days the effect becomes less obvious, so that, if observations are made at later stages, the results may be ascribed then to simple inhibition of bone growth.

2. The effect of mechanical stress has been studied in the jaw. When tooth movement is induced mechanically there is, in ordinary circumstances, a resorption of bone on the side to which the tooth is moving (the "pressure" side) and bone formation on the opposite side (the "tension" side). After administration of cortisone there is increased resorption on the "pressure" side and there is greater resorption of connective tissues here. On the "tension" side there is resorption and inhibition of bone formation.

3. In the areas of stress, when cortisone is administered, collagen fibres are no longer in apposition, being separated by spaces presumably filled with altered ground substance; this kind of change may be responsible for many of the observed phenomena.

4. A.C.T.H. does not produce a demonstrable resorptive effect on bone or connective tissue until it has been administered for periods longer than is required for cortisone (three weeks); even then the change is not pronounced.

5. In the guinea pig there is slight delay in bone formation with large doses of both cortisone and A.C.T.H., but no significant bone resorption occurs.
A STUDY OF THE END-RESULTS OF COMPRESSION ARTHRODESIS OF THE KNEE
Authors: Charnley John , Lowe H. G.
Published: February 2018

1. An analysis of 171 cases of compression arthrodesis in the knee is presented.

2. A total success rate of 98Â·8 per cent was revealed.

3. The average time between operation and walking free of splintage was nine weeks.

4. When the compression was removed, after an average period of four weeks, 88Â·2 per cent of the knees already showed clinical union.
CORRECTION OF THE PRONATED FOOT
Authors: Rose G. K.
Published: February 2018

1. The mechanical qualities of the peritalar joint, the calcaneo-contact joint, and their interreaction with the hip joint in the standing weight-bearing foot are considered.

2. The most efficient ways of correcting the pronated foot have been indicated.
LONG SURVIVAL AFTER AMPUTATION FOR PAGET'S SARCOMA OF BONE
Authors: Stevens Jack , Lennox Bernard
Published: February 2018

A patient with Paget's sarcoma of the femur, alive and well seven years after amputation, is reported. Long survival in two previously reported cases is also mentioned.
THE MECHANICAL PROBLEM OF THE ARTIFICIAL HIP
Authors: Smyth E. H. J.
Published: February 2018

1. The structure and blood supply of the femoral head and neck, the mechanics of weight bearing, and the known effects of an inert foreign body are considered in relation to arthroplasty.

2. Some artificial hips are reviewed from the biomechanical standpoint.

3. From the information now available it is inferred that mechanical soundness and clinical success are not only co-related but interdependent; and that the mechanical problem of design offers most scope for further development at the present stage of our knowledge.

4. To this end six propositions are submitted.

5. A theoretical replacement arthroplasty, confined to the head and neck, in which breakdown of the component forces suggests that reciprocal use of both tensional and compressive loads might occur as in the natural femur, is described.
STRUCTURAL CHANGES IN BONE ASSOCIATED WITH METALLIC IMPLANTS
Authors: Hickman J. , Clarke E. G. C. , Jennings A. R.
Published: February 2018

1. Radiological and histological observations of the tissue changes resulting from the implantation of various metals in the long bones of dogs are recorded.

2. Of the metals employed, tantalum, Vitallium, alloys "C" and "S" and F.M.B. steel were inert; silver and mild steel were reactive; F.S.T. steel occupied an intermediate position.

3. A correlation has been demonstrated between the anodic back E.M.F., the weight loss due to corrosion and the histological changes produced.
OSTEOID OSTEOMA OF VERTEBRAE
Authors: Mustard W. T. , DuVal F. W.
Published: February 2018

1. Two cases of osteoid osteoma of the vertebrae are presented.

2. The unusual clinical histories and findings are reported in detail.
CONGENITAL SHORT FEMUR
Authors: Ring P. A.
Published: February 2018

1. Nineteen patients with congenital shortening of the femur without associated coxa vara have been examined and discussed.

2. The diagnosis is made on finding a short, bulky thigh, held in lateral rotation. The radiographs commonly show no abnormality apart from shortening, but delay in ossification of the head of the femur, with lateral bowing and cortical sclerosis of the shaft, are occasionally present. The overall shortening of the limb seldom exceeds three inches.

3. The place of various surgical procedures to control limb length is briefly discussed.
LUMBO-SACRAL INTER-BODY SPINAL FUSION
Authors: Dommisse G. F.
Published: February 2018

This review shows that inter-body spinal fusion can be achieved in a satisfying percentage of cases, and the assertion that there is an intrinsic factor peculiar to the vertebral bodies which prevents such a fusion cannot be supported. The operation has a limited but definite place in the field of spinal surgery, and should be reserved for those patients with spinal instability associated with intractable and persistent backache. Spondylolisthesis is the indication par excellence. A new operative technique, which has been developed during ten years, has become standardised. The trans-sacral approach provides a better and safer exposure than those described before. In the event of failure of inter-body fusion, it is suggested that further attempts at grafting should be restricted to one of the posterior methods which have a 75 per cent chance of producing successful bony fusion.

Clinical photographs are reproduced in Figures 16 to 18 to show that patients suffering from a painful spondylolisthesis may be restored to normal activity by this operation.
CHONDROLYSIS IN ARTHRITIS
Authors: Lack Charles H.
Published: February 2018

Plasmin, a proteolytic enzyme derived from the blood, may be activated in synovial fluid both by trauma to synovial tissue and cartilage, and by kinases produced by streptococci and staphylococci. Plasmin normally removes fibrin, but, when in excess, attacks the protein of cartilage matrix. Conversely, excess inhibitor favours the persistence of fibrin and subsequent fibrosis. The relationship of excess protease to the chondrolysis of suppurative arthritis and of excess inhibitor to pannus formation and fibrous ankylosis in tuberculous and rheumatoid arthritis are discussed.
SEVERE ACCIDENTAL FLAYING
Authors: London P. S. , Clarke Ruscoe
Published: February 2018

1. The methods of treating flayed limbs are enumerated, with mention of the reasons against conserving the injured skin.

2. The reasons for conserving the injured skin are presented and they are backed by the results in the patients described.

3. The factors that may influence the survival of injured skin are discussed, and the indications for, and methods of, conserving injured skin are described.
THE THREE TYPES OF ACUTE HAEMATOGENOUS OSTEOMYELITIS
Authors: Trueta J.
Published: February 2018

1. The three age types of acute haematogenous osteomyelitis are conditioned in their respective clinical features by the differing nature of their vascular bone pattern.

2. In the infant the condition causes severe and often permanent epiphysial damage and joint infection, a large involucrum but only transient damage to the shaft and metaphysis.

3. In the child the condition is responsible for extensive cortical damage with involucrum formation, but, except for some stimulation of growth, permanent damage to the growth cartilage and to joints is exceptional. Chronicity of the disease is rare if treatment has been effective.

4. In the adult acute osteomyelitis of the long bones is rare. It causes very frequent joint infection; the cortex is absorbed instead of sequestrating. The whole of the bone is invaded and frequently leaves chronic infection in the bone marrow.

5. The vascular characteristics of the bones in each age group and their relation to the onset of infection are described.

6. Some general directives for management based on these facts are suggested.
PELVIC OSTEOTOMY IN THE TREATMENT OF ECTOPIA VESICAE
Authors: Lloyd-Roberts G. C. , Williams D. I. , Braddock G. T. F.
Published: February 2018

1. We have described an operation the aim of which is to reduce the gap at the pubic symphysis which accompanies ectopia vesicae.

2. The operation. as it is now performed, simplifies subsequent bladder closure and repair of the associated divarication of the recti.
AVASCULAR NECROSIS COMPLICATING UNDISPLACED FRACTURES OF THE NECK OF FEMUR 1N CHILDREN
Authors: Durbin F. C.
Published: February 2018

1. Three cases are reported of avascular necrosis of the head of the femur after undisplaced fractures of the neck of the femur in childhood.

2. It is suggested that the diaphysial vessels play a more important part in the supply of the epiphysis than has previously been recognised.

3. The prognosis for any fracture of the neck of the femur in a child given at the time of the injury should be guarded.