bluuebunny/crossref_metadata_2025 huggingface dataset:
ANTIBIOTICS IN ACUTE OSTEOMYELITIS IN CHILDREN
Authors: Blockey N. J. , McAllister T. A.
Published: February 2018

1. Continued follow-up of the 113 children with acute osteomyelitis previously reported and a study of a further thirty-eight proven cases has not changed our opinion that the correct management is rest and effective antibiotics. Operation should be undertaken only if pus is detectable clinically.

2. Bacteriological evidence shows that the flora causing this disease are less sensitive to benzylpenicillin than ten years ago and that a proportion are also likely to become resistant to methicillin and cloxacillin.

3. The most effective antibiotic combination used was fusidic acid and erythromycin. This lowered the failure rate to 10·5 per cent in thirty-eight proven cases. Two of the four failures were in haemophilus infections. No staphylococcal infection of a long bone became chronic, and all lesions were healed within three months of onset.

4. The duration of treatment (twenty-one days) and the method of splintage (removable plaster slabs) remained the same as in the previous series.

5. Careful watch must be kept on the incidence of haemophilus infections. If it rises, increasing the erythromycin or adding ampicillin may be necessary.

6. Use of the newer aqueous suspension of fusidic acid may lower the incidence of troublesome vomiting (12 per cent in this series).

7. Only 7 per cent of staphylococcus aureus infections in this hospital, and 17 per cent of such infections in our thirty-eight cases were sensitive to benzylpenicillin. It is thought that this drug has outlived its usefulness in osteomyelitis.

8. It is recommended that, on diagnosis, fusidic acid aqueous suspension 5 millilitres should be given three times a day to children aged one to five, and 10 millilitres twice a day for children aged six to twelve, with erythromycin stearate 30 milligrams per kilogram of body weight each day in divided doses.
SYNOVIAL RUPTURE OF THE KNEE JOINT
Authors: Solomon L. , Berman L.
Published: February 2018

1. Twenty-two cases of synovial rupture of the knee have been studied. This condition may complicate any chronic synovitis of the knee in which a tense intra-articular effusion is subjected to increased tension during flexion and extension of the joint.

2. Two types of rupture have been seen; a herniation of the synovial membrane into the popliteal fossa and down the leg, and an acute synovial tear with extravasation of joint contents between the muscle planes of the calf.

3. The diagnosis of this condition, the differentiation of the types of rupture and their treatment are discussed.

4. The acute rupture usually responds to simple bed-rest; the large synovial herniations often need removal and repair of the posterior capsule.
PROGRESSIVE AND RESOLVING INFANTILE IDIOPATHIC SCOLIOSIS
Authors: Ferreira J. H. , de Janeiro Rio , James J. I. P.
Published: February 2018

1. Resolving infantile scoliosis is transient and unimportant; progressive infantile idiopathic scoliosis can be catastrophic.

2. To be able to differentiate the two at an early stage is a considerable advance. This is important for many reasons, but particularly for parents who are anxious for the future of an infant with a small curve which looks so innocent but which can be so malignant.

3. With the new observations reported by Mehta on the difference of the angles between the apical vertebra and its two ribs, and on the radiological relationship of these rib heads to the vertebral body, the prognosis is now almost wholly reliable.

4. Our former clinical impression that all cases with compensatory curves are progressive has now been verified.

5. At last an early distinction between progressive and resolving scoliosis can be made with confidence.
CAPSULAR COMPLIANCE AND PRESSURE-VOLUME RELATIONSHIPS IN NORMAL AND ARTHRITIC KNEES
Authors: Myers D. B. , Palmer D. G.
Published: February 2018

1. Joint compliance estimations were made on the knee joints of fourteen patients with rheumatoid arthritis, three patients with osteoarthritis and three healthy volunteers.

2. Diminishing values for capsular compliance were found in the normal volunteers, the patients under the age of thirty-five years with rheumatoid arthritis, the patients with osteoarthritis and the patients over the age of forty years with rheumatoid arthritis respectively.

3. In the young adult normal volunteers the average compliance was 8·1 cubic centimetres per millimetre of mercury at an intra-articular pressure of 5 millimetres of mercury and 0·7 cubic centimetre per millimetre of mercury at 50 millimetres of mercury. In the older patients with rheumatoid disease the average compliance was 2·1 cubic centimetres per millimetre of mercury at 5 millimetres of mercury and 0·4 cubic centimetre per millimetre of mercury at 50 millimetres of mercury.

4. Both the effects of ageing and the effects of disease appeared to be responsible for the low capsular compliance observed in patients over the age of forty years with rheumatoid arthritis, but duration of disease did not seem to be a contributing factor.
TOTAL DISLOCATION OF THE ILIUM
Authors: MacKinnon W. B. , Lansdown E. L.
Published: February 2018

A case of total dislocation of the ilium after disruption through the tri-radiate cartilage in a girl of thirteen years is described. No previous description of this injury has been found.
DOUBLE HEMIARTHROPLASTY OF THE KNEE IN RHEUMATOID ARTHRITIS
Authors: Hastings David E. , Hewitson W. A.
Published: February 2018

1. Of fifty consecutive double hemiarthroplasties of the knee for rheumatoid arthritis using Maclntosh prostheses, forty-six were available for detailed assessment in thirty-six patients after one to six years.

2. Two early deaths were related to the operation but two late deaths were not. Three knees required revision, one of them twice.

3. The late results were 87 per cent good and 13 per cent fair. No patients followed up were the same as previously or worse. Every patient stated that he would have the operation performed again.

4. In our experience this operation in carefully selected patients produces satisfactory results. It is essential that great care is given to the operative technique.
THE ELLIS PLATE OPERATION FOR SMITH'S FRACTURE
Authors: Fuller David J.
Published: February 2018

1. Thirty-one patients treated with the Ellis plate for Smith's fracture have been examined and the results of the operation are presented.

2. The Type 1 fractures can usually be treated equally well by plaster or by internal fixation. The only compelling indication for open reduction and fixation with the Ellis plate is persistent anterior angulation at the fracture site despite the external splintage.

3. The Type 2 fracture should be treated by open reduction and fixation with the Ellis plate.

4. The Ellis plate is not indicated for the routine treatment of Type 3 fractures.
RESECTION OSTEOSYNTHESIS AND BOYD AMPUTATION FOR CONGENITAL PSEUDARTHROSIS OF THE TIBIA
Authors: Edvardsen Per
Published: February 2018

1. A case of congenital bowing of the tibia is described in which pseudarthrosis developed and recurred after nine operations performed by the age of ten years.

2. Union was finally secured by a procedure based on deep impaction of the trimmed upper fragment into the reamed-out lower fragment. This was followed by a Boyd type of partial amputation of the foot with calcaneo-tibial arthrodesis.

3. The end-bearing stump four years later is entirely satisfactory and the simple prosthesis gives equality of leg lengths.
BALL AND SOCKET ANKLE JOINT IN METATARSUS ADDUCTUS VARUS
Authors: Lloyd-Roberts G. C. , Clark R. C.
Published: February 2018

1. Three children with metatarsus adductus varus have been found to have ball and socket ankle joints.

2. The effect of this finding on treatment is discussed.
THE SNAPPING SCAPULA AND SUBSCAPULAR EXOSTOSES
Authors: Parsons T. A.
Published: February 2018

1. Five cases are reported in which snapping of the scapula was caused by subscapular exostosis. In the four cases in which the exostosis was excised, symptoms were relieved without loss of scapular movement.

2. Antero-posterior views of the scapula do not always show the exostosis, and oblique views are recommended.

3. Winging of the scapula may be caused by a subscapular mass, with a neurologically intact subscapularis muscle.

4. Apart from subscapular exostoses, snapping of the scapula may be caused by exostoses or abnormal angles on the ribs, by Luschka's tubercle, or by an abnormal forward curve of the superior angle of the scapula.
THE QUANTITATIVE COLOUR TELEVISION IMAGE ANALYSER
Authors: Dickson R. A. , Paice F. , Calnan J. S.
Published: February 2018

1. A new piece of equipment, the quantitative colour television image analyser, has been introduced as providing a superior method for measuring bone density.

2. This method produces not only a numerical result but also a pattern of density distribution in the form of a seven colour contour map.

3. The changes in twenty rheumatoid hands at an interval of one year have been measured. The metacarpals and proximal phalanges always lose bone, but the metacarpo-phalangeal joint may gain in density if the disease process is far advanced. Some areas can lose 50 per cent of bone in one year.
ATLANTO-AXIAL SUBLUXATION IN RHEUMATOID ARTHRITIS
Authors: Rana N. A. , Hancock D. O. , Taylor A. R. , Hill A. G. S.
Published: February 2018

1. This paper presents the neurological findings in forty-one patients with rheumatoid arthritis complicated by atlanto-axial subluxation.

2. A method of radiological measurement of the subluxation is described. The extent of neurological involvement was found not to correspond with the degree of subluxation.

3. Fusion of the atlanto-axial complex or of the occipito-atlanto-axial complex is indicated only in patients with progressive neurological signs and in those suffering from acute neurological episodes.

4. Difficulty in obtaining fusion with cancellous bone grafts alone was encountered and we recommend wiring of the laminae C.1 to C.2 in addition.
RADIOGRAPHIC ESTIMATION OF VERTEBRAL ROTATION IN SCOLIOSIS
Authors: Mehta M. H.
Published: February 2018

1. The radiographic appearance of normal thoracic and lumbar vertebrae at 15-degree intervals of rotation is described. Each image can be identified by its characteristic features.

2. The appearance on antero-posterior radiographs of apical vertebrae in scoliosis closely resembles the normal at each phase of rotation, on the basis of which an image-matching method is proposed for estimating rotation in scoliosis.

3. The method gives only approximate values of rotation but has the advantage of being able to monitor rotation through 90 degrees.
COLLES'S FRACTURE
Authors: Pool Christopher
Published: February 2018

1. A prospective study of 239 Colles's fractures was made.

2. This indicates that all displaced Colles's fractures should be reduced.

3. After reduction a below-elbow plaster should be used.

4. An above-elbow plaster has no advantages and may have some disadvantages.
THE SURGICAL MANAGEMENT OF CONGENITAL VERTICAL TALUS
Authors: Colton Christopher L.
Published: February 2018

1. Congenital vertical talus is described and the criteria for diagnosis are emphasised. The need for its distinction from other forms of convex pes valgus is stressed.

2. The operative technique of Stone for Lloyd-Roberts (1963) is detailed and the results of seven such operations are examined.

3. Departure from the technique in any respect has resulted in an unsatisfactory outcome, whereas stringent observation of the operative details has resulted in uniformly good results in four patients.

4. Certain aspects of diagnosis, differential diagnosis, etiology, pathology and surgical management are discussed, together with a review of some of the relevant literature.
THE INFLUENCE OF CORTISONE AND IMPLANTATION SITE ON BONE AND CARTILAGE INDUCTION IN VARIOUS ANIMALS
Authors: Wlodarski K. , Hancox N. M. , Brooks Brenda
Published: February 2018

1. Decalcified lyophilised rat bone matrix prepared by Urist's method acts as an inductor of cartilage and bone when implanted into animals of other species, namely mice, rabbits and gerbils. Induction in rabbits and gerbils was very much weaker than in the mouse.

2. The site of implantation affected the outcome; intramuscular implants induced cartilage and bone more strongly and regularly than subcutaneous or intraperitoneal implants.

3. Rabbit transitional epithelium, growing in cortisone-treated gerbils, caused bone induction, but in general, results with this species suggest that it responds poorly to bone-inducing stimuli.

4. Cortisone, used as an immunosuppressant, did not inhibit bone and cartilage induction.
OSTEOSCLEROSIS IN MYELOMA
Authors: Brown T. S. , Paterson C. R.
Published: February 2018

1. The case is reported of a woman aged sixty-five with widespread osteosclerosis as a feature of IgA myelomatosis.

2. Improvement was noted after treatment by cyclophosphamide and prednisolone.

3. Only two previously reported cases of myeloma with osteosclerosis of comparable extent have been found, but in forty-seven other cases in the literature some sclerosis has been noted.

4. The finding of sclerotic lesions should not rule out multiple myeloma.
CALCANEO-FIBULAR ABUTMENT FOLLOWING CRUSH FRACTURE OF THE CALCANEUS
Authors: St C. John F.
Published: February 2018

1. In a severe crush fracture of the calcaneus part of the lateral cortex may be displaced to lie under the tip of the lateral malleolus. This may cause local pain and tenderness, either by direct bony abutment or by compression of the peroneal tendons.

2. Such pain is usually relieved by excision of the tip of the lateral malleolus, a minor procedure.

3. Four of the five patients reported were completely relieved of lateral pain, and the fifth has only slight residual discomfort.

4. It is important to be aware of this lesion and not to advise subtalar or triple fusion when simple excision of the tip of the fibula would suffice.
THE CONSERVATIVE SURGICAL TREATMENT OF IDIOPATHIC ASEPTIC NECROSIS OF THE FEMORAL HEAD
Authors: Kerboul M. , Thomine J. , Postel M. , D'Aubigné R. Merle
Published: February 2018

1. The surgical treatment of idiopathic aseptic necrosis of the femoral head has been reviewed in the light of experience gained from 240 hips operated upon.

2. When pain is not severe and the necrosis of bone as seen in serial radiographs is not rapidly progressive, simple observation and palliative medical treatment are indicated.

3. When pain disables the patient and collapse of the head is progressive, operation is indicated. If radiographs show necrosis limited to the anterior part of the head and sparing an arc of at least 20 degrees of the lateral part, either an osteotomy bringing the shaft into adduction and flexion or an "adjusted cup" arthroplasty is indicated, with a preference for the latter because it gives better results in a shorter time.

4. If at arthrotomy the necrosis appears to involve the posterior slope of the head, prosthetic replacement, preferably total, should be undertaken.
EVALUATION OF THE GURD TEST FOR FAT EMBOLISM
Authors: Nolte W. J. , Olofsson T. , Scherstén T. , Lewis D. H.
Published: February 2018

1. Blood from forty-one healthy volunteers, seventy-one patients with fractures but without symptoms of fat embolism and seven patients with clinical evidence of fat embolism was examined microscopically for fat droplets and chemically for triglycerides.

2. Fat droplets, after Millipore filtration of the blood, were seen evenly distributed in all three groups.

3. There was no significant difference in triglyceride concentration between serum and filtrate in the three groups.

4. The results do not support the thesis that the Gurd test is a reliable aid in the diagnosis of fat embolism.
RHEUMATOID ARTHRITIS OF THE ELBOW: THE RESULTS OF SYNOVECTOMY
Authors: Porter B. B. , Richardson C. , Vainio K.
Published: February 2018

1. One hundred and twenty-three patients with rheumatoid arthritis who had synovectomy and excision of the head of the radius performed on 154 elbows have been reviewed one to six years after operation.

2. The severity of the disease process at the time of operation was graded radiologically and an attempt made to relate this to the results.

3. Overall, the clinical results were most satisfactory; more than 70 per cent of the patients were pleased with the outcome. When radiographic deterioration of the joint was taken into account, however, only 54 per cent achieved a "satisfactory" result.

4. Clearance of the synovium through combined medial and lateral incisions gave better results than a lateral approach alone.

5. When the disease was far advanced by the time of operation any good results were likely to be short-lived.

6. The indications for synovectomy of the rheumatoid elbow are discussed in the light of these findings.
SUPRA-MALLEOLAR WEDGE OSTEOTOMY OF THE TIBIA IN CHILDREN WITH MYELOMENINGOCELE
Authors: Sharrard W. J. W. , Webb J.
Published: February 2018

1 . The indications, technique and results of supra-malleolar wedge osteotomy of the tibia in the management of valgus or varus deformity of the ankle in children with myelomeningocele are described.

2. This operation should not be performed until as much correction as possible has been obtained by soft-tissue release and muscle balance has been restored by tendon transfer.

3. In sixteen feet satisfactory correction was obtained and maintained in fourteen, one of which had required revision for over-correction.

4. A closing-wedge osteotomy is recommended ; the two failures occurred after opening-wedge osteotomies.

5. In the fourteen feet with satisfactory correction the complications were negligible, deformity has not recurred and epiphysial growth has been well sustained.
RESULTS OF EARLY AND DELAYED INTERNAL FIXATION FOR TIBIAL SHAFF FRACTURES
Authors: Smith J. E. M.
Published: February 2018

1. The results of internal fixation are described in 470 tibial shaft fractures.

2. The immediate internal fixation of compound fractures was followed by so high an incidence of serious complications that the use of this method is not recommended. The immediate internal fixation of fresh closed fractures was also followed by many complications.

3. Delayed rigid internal fixation proved satisfactory for difficult fractures in which an acceptable reduction could not be obtained by closed means ; skeletal traction was of value in such fractures until the skin was soundly healed.

4. Delayed internal fixation reduced both the healing time and the complications.
THE TREATMENT OF UNSTABLE FRACTURE-DISLOCATIONS OF THE THORACO-LUMBAR SPINE ACCOMPANIED BY PARAPLEGIA
Authors: Lewis J. , McKibbin B.
Published: February 2018

1. The results of treatment have been compared in two unselected series of patients with unstable fractures of the thoraco-lumbar spine accompanied by paraplegia.

2. One group had been treated by conservative or " postural" methods while the others had been subjected to open reduction and internal fixation with double plates.

3. No difference in the amount of neurological recovery could be detected between the two groups but while a number of conservatively treated patients had significant residual spinal deformity and subsequently developed serious pain, this did not occur in any of the patients treated by plating.

4. It is concluded that open reduction and internal fixation are indicated in displaced fractures in the interests of long-term spinal function.
METAL SENSITIVITY AS A CAUSE OF BONE NECROSIS AND LOOSENING OF THE PROSTHESIS IN TOTAL JOINT REPLACEMENT
Authors: Evans E. Mervyn , Freeman M. A. R. , Miller A. J. , Vernon-Roberts B.
Published: February 2018

1. Evidence is presented which suggests that after total joint replacement bone necrosis and consequent loosening of the prosthesis may be due to the development of sensitivity to the metals used.

2. Nine patients, from a total of fourteen with loose prostheses, were found to be metal sensitive by skin-patch testing. In twenty-four patients with intact prostheses no sensitivity was demonstrated.

3. In material from the joints of sensitive patients the metal content was raised.

4. Examination of this material showed necrosis of bone and soft tissue following obliterative changes in the vascular supply.

5. Similar reactions were found following the injection of cobalt into a sensitive patient.

6. The release of metal around a prosthesis is greatest where metal rubs against itself.

7. We conclude that prostheses in which metal articulates with polyethylene should be preferred; that any patient in whom loosening or fragmentation occurs should be patch tested; and that if sensitivity is found the implant should be removed.
AVASCULAR NECROSIS OF THE CAPITAL EPIPHYSIS FOLLOWING OSTEOMYELITIS OF THE PROXIMAL FEMORAL METAPHYSIS
Authors: Kemp H. B. S. , Lloyd-Roberts G. C.
Published: February 2018

1. Attention is drawn to the danger of avascular necrosis developing in the capital femoral epiphysis as a complication of osteomyelitis in the intertrochanteric region.

2. This necrosis is commonly aseptic. It is believed to be caused by compression or thrombosis of the epiphysial vessels.

3. The situation will be aggravated if infection spreads to involve the joint.

4. We believe that prompt decompression of both the joint and the bone is indicated in order to reduce the incidence and severity of these complications.
ACRYLIC LUNATE PROSTHESES
Authors: Barber H. M. , Goodfellow J. W.
Published: February 2018

1. Fourteen patients whose Kienböck's disease was treated by prosthetic replacement, and who have had an acrylic lunate prosthesis in place for periods of eight to twenty years, have been reviewed.

2. In most patients pain, weakness and limitation of movement are less than they were before operation. Four wrists are completely painless and the other ten have only occasional slight pain. The average range of antero-posterior movement is 100 degrees.

3. Radiological signs of osteoarthritis are either absent or slight in ten wrists: this is considered to be due to the success of the prosthesis in maintaining the carpal architecture, even after prolonged heavy use.
THE MEDIAL TIBIAL SYNDROME
Authors: Puranen J.
Published: February 2018

1. Exercise ischaemia in athletes with chronic pain over the postero-medial border of the tibia is described.

2. Fasciotomy of the compartment of the deep flexor muscles as a treatment of "shin splints" is recommended.

3. In eleven patients the symptoms were completely relieved and the athletes were able to start effective training within four weeks.
RECURRING DIGITAL FIBROMA OF INFANCY
Authors: Bloem J. J. , Vuzevski V. D. , Huffstadt A. J. C.
Published: February 2018

1. Three typical cases of recurring digital fibroma of infancy are reported, with a follow-up of three to four years. In each case excision of the tumours during the first year of life was followed by recurrence and then by some degree of slow spontaneous resolution, in one case complete.

2. A strictly conservative approach is recommended for three reasons : the difficulty of complete excision, the tendency to spontaneous regression and the facts that no case of metastasis and no case of persistence into adult life have yet been reported.

3. Cytoplasmic inclusion bodies could not be demonstrated in the biopsy material from these cases, nor any virus.
TWENTY YEARS OF BONE AND JOINT TUBERCULOSIS IN BRADFORD
Authors: Nicholson Richard A.
Published: February 2018

The immigrant Asian population of Bradford has a relatively high incidence of bone and joint tuberculosis, which now accounts for most of this disease in the city. One hundred and seventy-six cases of skeletal tuberculosis are reviewed and indigenous and Asian disease compared. The disease in Asians is more acute with greater systemic disturbance. The abscess is often warm, larger and quicker to develop and there is more likely to be multiple site involvement. Tuberculosis is particularly seen in the knee and cervical spine in the Asian as compared with the hip and lumbar region in the indigenous population. The course of the disease is shorter and there are fewer recurrences in the Asian patient.
POPLITEAL CYSTS IN CHILDREN
Authors: Dinham J. M.
Published: February 2018

The natural history of 120 popliteal cysts in children has been reviewed. Of seventy untreated cysts fifty-one disappeared spontaneously during a mean period of one year and eight months. Of fifty cysts submitted to operation, twenty-one recurred in a mean period of seven months. Three children with recurrences had more than one further operation. Most popliteal cysts in children disappear spontaneously, and operation without very good reason is unjustified.
HANGMAN'S FRACTURE
Authors: Williams T. G.
Published: February 2018

Of four hangman's fractures of the axis, three occurred in road accidents and were stable, undisplaced and free of neurological signs, with full recovery after six to twelve weeks in a cervical collar. The fourth fracture occurred in a fall with profound tefraparesis from haemorrhage into the spinal cord, and the patient died a week later. There are two types of hangman's fracture: that of the axis pedicle, which results from more common than usually supposed because of the extension and compression of the cervical column, is slight symptoms it causes.
AN INVESTIGATION OF THE CENTRES OF PRESSURE UNDER THE FOOT WHILE WALKING
Authors: Grundy Michael , Tosh P. A. , McLeish R. D. , Smidt L.
Published: February 2018

The forces under the foot while walking have been measured using a high sensitivity force-plate of the strip-suspended type combined with simultaneous filming of the sole of the foot. The recording of data and the calculation and plotting of results were much simplified by computer aid. Normal and abnormal feet, both barefoot and shod, were investigated in sixteen subjects. It was found that in normal barefoot walking the forefoot carried a total load of the order of three times that of the heel. When footwear was worn the function of the forefoot was progressively reduced as the rigidity of the sole of the shoe increased. Painful conditions of the forefoot also produced a large reduction in the proportion of the total load transferred.
COMPLICATIONS OF HALO-PELVIC DISTRACTION FOR SCOLIOSIS
Authors: Ransford A. O. , Manning C. W. S. F.
Published: February 2018

A survey has been undertaken of the various complications of halo-pelvic distraction in 118 patients with scoliosis prior to spinal fusion. In the first sixty-two patients the standard solid distraction rods were employed. The neurological complications included ten cases of cranial nerve lesions and two cases of paraplegia, one of them permanent. Springs were then incorporated in the distraction rods so as to allow direct readings ofthe distraction forces, and a total force of 18 kilograms was not exceeded in the last fifty-six patients. No further serious neurological complications occurred, but the amount of correction achieved in the adolescent and juvenile idiopathic types of scoliosis was reduced.
SURGICAL PROPHYLAXIS OF SUBLUXATION AND DISLOCATION OF THE HIP IN CEREBRAL PALSY
Authors: Sharrard W. J. W. , Allen J. M. H. , Heaney S. H.
Published: February 2018

The clinical and radiological state of the hips of a group of children with cerebral palsy treated without operation is compared with that in a group treated by operation to correct adduction and flexion deformity and to obtain balanced action in the hip muscles. In the first group, 11 per cent of hips were dislocated, 28 per cent subluxated, 46 per cent dysplastic and 15 per cent normal. In the second group no hip was dislocated, 13 per cent were subluxated, 35 per cent dysplastic and 52 per cent normal. Surgical intervention is indicated clinically for a range of abduction diminishing to less than 45 degrees and–on radiological criteria–for early dysplastic changes, especially a break in Shenton's line, irrespective of the patient's age, severity of involvement or neurological maturity. Prevention of subluxation or dislocation improves function and diminishes the liability to develop a painful hip in adolescence or early adult life.
ACETABULOPLASTY IN THE TREATMENT OF CONGENITAL DISLOCATION OF THE HIP
Authors: Trevor D. , Johns D. L. , Fixsen J. A.
Published: February 2018

The results in 102 acetabuloplasties have been assessed in eighty-six patients, with a minimum follow-up of five years. Clinical and radiological assessment was carried out according to a score system very similar to that used in previous studies, and the results were expressed as excellent, good, fair and poor according to the score obtained. Any hip requiring further stabifising procedures was automatically grouped as a failure. Subtrochanteric femoral osteotomy was used when femoral anteversion was excessive. The results revealed that 73 per cent of the hips were satisfactory (excellent or good) overall, but that a steady deterioration was evident when the five-and fifteen-year groups were compared. Few of the hips were regarded as normal on radiological grounds. Homologous bone bank rib was found to be the most satisfactory graft material. Coxa magna was the most common abnormality that was consistent with a good or excellent result. Avascular necrosis of the femoral head was found in only six hips; it was more commonly present in patients subjected to previous operation. Concentric reduction of the femoral head is essential if acetabuloplasty is to maintain stability of the hip.
THE PATHOLOGY OF THE DEGENERATE MENISCUS LESION
Authors: Noble Jonathan , Hamblen David L.
Published: February 2018

The incidence of horizontal cleavage lesions of the menisci was studied in 100 random necropsy examinations. Sixty per cent of subjects had at least one such tear, the incidence being 29 per cent out of the 400 menisci. Eighty-five per cent of the subjects showed changes of osteoarthritis in the patello-femoral or tibio-femoral joint compartments. The coincidence of horizontal cleavage lesion and osteoarthritis was frequent. Horizontal cleavage lesions were commoner in medial or larger menisci and in males. Eighteen per cent of the menisci were calcified and this was twice as common in those menisci with a degenerate tear. Because the horizontal cleavage lesion was so common in the older knee, it must usually remain unrecognised clinically with other factors causing symptoms of night pain and tenderness.
MASSIVE OSTEOLYSIS OF THE HUMERUS WITH SPONTANEOUS RECOVERY
Authors: Campbell J. , Almond H. G. A. , Johnson R.
Published: February 2018

An elderly woman presented with a pathological fracture of the right humerus. Progressive dissolution of the shaft of this bone took place over six months. No cause could be established and the patient refused biopsy. With only simple splintage for treatment the humeral shaft gradually reformed and re-ossified over a period of two years. The patient has been under review for four and a half years and no further pathology has come to light. The cause of the osteolysis remains obscure.
A TWENTY-ONE-YEAR REVIEW OF A CASE OF CONGENITAL INDIFFERENCE TO PAIN
Authors: Drummond R. P. , Rose G. K.
Published: February 2018

A boy aged three with indifference to pain was followed up until his death from amyloid disease some twenty-one years later. A full necropsy was done and the neuropathology suggested a sensory neuropathy.
CONTACT PRESSURES IN THE LOADED HUMAN CADAVER HIP
Authors: Day W. H. , Swanson S. A. V. , Freeman M. A. R.
Published: February 2018

The purpose of the work described was to find the average pressure on each of several areas of the acetabular cartilage of the cadaver hip under physiological loads. By obtaining load-deflection curves for one chosen area of cartilage, firstly with all the cartilage present and then after the successive removal of other areas, the fractions of the original load carried by the several areas were found, and hence the average pressures on those areas. Seventeen hips (age range twenty. two to eighty-seven years) were examined. Local pressures varied from zero to 3.4 times the average pressure in each hip. The highest pressures in the series (about 4 to 5 megaNewtons per square metre) were on areas of thin fibrocartilage which were identified at the zenith of certain acetabula. The results are too few to establish whether or not the pressure distribution was age-related. The higher pressures found are within the range which in other experiments has led to fatigue failure of femoral head cartilage, and it is suggested that hips in which such pressures exist under loads of three times body weight may be predisposed to osteoarthritis.
INTRAOSSEOUS HYPERTENSION AND PAIN IN THE KNEE
Authors: Arnoldi Carl C. , Lemperg Rudolf K. , Linderholm Hêkan , Arnoldi C. A. , Lemperg Rudolf K. , Linderholm Hêkan
Published: February 2018

The intraosseous pressure in the femur and tibia near the knee and in the internal saphenous vein at knee level was measured in fifty-three patients with suspected knee lesions. There were four groups: with and without degenerative osteoarthritis and with and without aching rest pain of the knee region. Low intraosseous pressures were found in patients with neither osteoarthritis nor rest pain, and in half the patients with osteoarthritis but without rest pain. Low pressures were found in the tibia, but very high intraosseous pressures were found in the femur in most patients with osteoarthritis and rest pain. Patients with no osteoarthritis but with rest pain mostly had high pressures in both the tibia and the femur.
SUPERFICIAL RADIAL NEUROPATHY
Authors: Braidwood A. S.
Published: February 2018

Isolated neuropathy of the cutaneous branch of the radial nerve is a rarely recognised condition. Five cases were described in 1932 by Wartenberg, who suggested the name cheiralgia paraesthetica. The condition has also been described as Wartenberg's disease. Twelve cases of isolated neuropathy of the cutaneous branch of the radial nerve are described, the literature is reviewed and the clinical picture outlined. In six of the cases the condition subsided without treatment, in two there was a good response to local injection of hydrocortisone, and in four cases a satisfactory result followed resection of the nerve. The course and distribution of the superficial branch of the radial nerve are described. The need to avoid the nerve during operations around the wrist is stressed.
THE MANAGEMENT OF INFANTS WITH SCOLIOSIS
Authors: James J. I. P.
Published: February 2018

This is a study of children who first attended as infants with either progressive infantile idiopathic scoliosis or congenital scoliosis. All had a pattern of scoliosis in which early and damaging deterioration is inevitable. The infants were treated from before the age of three, initially by plaster casts and then a Milwaukee brace, followed at about the age of ten by correction and fusion. The cases were then observed to the end of growth or near that point. In the main study there were twelve cases, six of progressive infantile idiopathic scoliosis and six of congenital scoliosis, which were followed through this long period. Only one of the twelve had a curve worse at the end of growth compared with the initial radiograph as an infant; this one curve had increased only 16 degrees in almost as many years. Although small, the series does show that it is nearly always possible to control even the most serious scoliosis in an infant, if it is tackled early and unremittingly. There are supportive studies of children who have partially completed this regime, and interim results in a newer group of children with spina bifida and scoliosis.
THOMPSON PROSTHESIS FOR FRACTURED NECK OF FEMUR
Authors: Chan R. N.-W. , Hoskinson J.
Published: February 2018

The records of 243 patients with Thompson prostheses for displaced femoral neck fractures have been studied.

One hundred and seven prostheses were inserted through an anterior approach and 136 by a posterior approach. The short-term results and complications in these otherwise comparable groups are discussed. The infection rate of 18·5 per cent in the group operated upon by the posterior approach was thrice that after operations by the anterior route (6·5 per cent infected). Drained wounds had significantly less infection (6·3 per cent) compared with the undrained group (28 per cent infected). Other factors influencing the infection rate are discussed. The anterior approach offered greater stability. Of the twenty dislocations in the series, nineteen followed operations by the posterior approach.

The mortality rate six weeks after operation was 6·5 per cent after the anterior approach and 20·6 per cent after the posterior approach. Statistical analysis significantly favours the anterior approach.
THE NEUROVASCULAR ISLAND FLAP FOR DEFECTIVE SENSIBILITY OF THE THUMB
Authors: Krag C. , Rasmussen K. Bang
Published: February 2018

In six patients with defective sensibility of the thumb the transfer of a neurovascular island flap was performed according to Littler's technique. This review one to eleven years later was mainly to determine if reorientation of the cortical representation of stimuli had developed and if tactile gnosis had persisted. The pick-up test was carried through by the three patients with a lesion of the dominant hand. All six patients referred pin-prick in the flap to the donor finger; all had absent two-point discrimination corresponding to the flap, although it had been present within normal limits a few months after operation; and all had better touch, pain and temperature sensibility in the flap than in the surrounding recipient area. All six reported functional improvement. For the best results an intelligent patient is required who has a lesion of the dominant hand and is prepared to use or exercise it regularly.
Infection of intervertebral discs after operation
Authors: El-Gindi S , Aref S , Salama M , Andrew J
Published: February 2018

Infection of the intervertebral space is a rare complication of operation on the disc (Ford and Key 1955). It occurred in five cases in a series of 650 operations for lumbar disc protrusion done by two of the authors of this paper--an incidence of 0-8%. Symptoms began between seven and twelve days after operation. After initial relief of the original sciatic pain, the patients developed severe back pain and muscle cramps in the legs. Straight-leg raising became much more limited than before operation. The erythrocyte sedimentation rate was raised in all cases. The diagnosis was confirmed by rescreening the Myodil, when an indentation was seen opposite the intervertebral space from which the disc had been excised. Early removal of infected material from the disc space resulted in complete relief of pain and cure of the infection.
Treatment of scoliosis by posterior fusion, Harrington instrumentation and early walking
Authors: Piggott H
Published: February 2018

One hundred and three patients with scoliosis treated by posterior fusion and Harrington instrumentation are reviewed. The fusion technique described does not require added bone. Walking in a localiser plaster is encouraged as soon as the wound is healed, usually two weeks after operation. The results compare satisfactorily with others published. It is concluded that added bone is not necessary unless neural arch defects are present, and that early walking is advantageous and without risk to the correction.
The management of thoracic and thoraco-lumbar injuries of the spine with neurological involvement
Authors: Burke DC , Murray DD
Published: February 2018

The results of treatment of injuries of the thoracic and thoraco-lumbar spine with neurological involvement have been reviewed in a retrospective study of 115 patients, of whom eighty-nine received conservative and twenty-six surgical treatment. Operation was reserved, in general, for patients with irreducible dislocations and incomplete neurological lesions, open reduction and internal fixation being the commonest procedure. Only three patients required a delayed spinal fusion for suspected instability after a period of conservative treatment. On the other hand, ten patients, eight of whom had been treated surgically, were left with severe chronic spinal pain. Of the patients treated conservatively, 35% showed significant neurological improvement compared to 38% of those treated surgically, but the latter group contained a much higher proportion of incomplete lesions with a far better prognosis. It is concluded that the place for early operation might be still further restricted.
Local excision of cyst of lateral meniscus of knee without recurrence
Authors: Flynn M , Kelly JP
Published: February 2018

Twenty-two patients with cysts of the lateral meniscus have been treated by operation. A modified operative procedure is described whereby the meniscus is inspected for a concomitant tear. A tear of the meniscus was found in ten patients and these were treated by meniscectomy. The remaining twelve cases were treated by excision of the cyst only. The rehabilitation period was considerably less in these patients. Recurrence of the cyst did not occur. The rationale for local excision is based on the similarity between the cyst of a meniscus and a simple ganglion, and also on the desirability of preserving the meniscus.
Skeletal immaturity in Perthes' disease
Authors: Harrison MH , Turner MH , Jacobs P
Published: February 2018

Skeletal age was estimated by examination of radiographs of the carpus in 182 children suffering from Perthes' disease after the reliability of the Greulich and Pyle Atlas had been checked for a control group of British children. A striking tendency to delayed skeletal maturation was shown in the children with Perthes' disease. This trait was also found in ninety-three unaffected siblings of the patients. The velocity of skeletal ageing as the disease progressed was estimated. In some patients the carpal skeleton failed to mature at all for periods of up to three years and the term "skeletal standstill" is applied to this phenomenon. The significance of these findings is discussed and it is suggested that the maturation defect may have aetiological significance.
Factors in the adherence of flexor tendon after repair: an experimental study in the rabbit
Authors: Matthews P , Richards H
Published: February 2018

The effects of splintage, suture and excision of the tendon sheath on the healing of incompletely transected flexor tendons in the rabbit have been evaluated separately and in various combinations. When all procedures were done together, repair was accompanied by dense adhesion formation with little evidence of any healing activity by the tendon cells. The experiments indicated that the adhesions were the result not of any one single factor studied but of all three contributing in varying degrees. Suturing produced the most adhesions but synovial sheath excision and immobilisation also contributed. It is suggested that these factors are also responsible for the adhesions which occur after flexor tendon repair in clinical practice.
Tenodesis of flexor hallucis longus for paralytic clawing of the hallux in childhood
Authors: Sharrard WJ , Smith TW
Published: February 2018

Paralytic clawing of the hallux may occur in children with congenital disorders of the neuraxis. Tenodesis of flexor hallucis longus allows correction of this deformity in early childhood. Seventeen of these procedures have been reviewed and good results were obtained in fifteen.
The control of pain after Keller's operation by the instillation of local anaesthetic before closure. A prospective controlled trial
Authors: Dinley J , Dickson RA
Published: February 2018

With the aim of controlling pain after Keller's operation, a solution of a long-acting local anaesthetic was instilled into the field before closure in a series of thirty patients. In a controlled prospective trial this simple technique by itself proved to be significantly better than either foot block at the ankle or the usual analgesics and was free from local or systemic complications.
Quantitative histology of the human growth plate
Authors: Kember NF , Sissons HA
Published: February 2018

This paper describes a study in the human femur of the relationship between cell division in growth cartilage and overall bone growth. Growth rates for the distal femur from birth to eighteen years were determined from serial radiographs available from the Harpenden Growth Study; An average of 1-4 cm/year was found for the ages of five to eight years. The development of the growth plate is illustrated in a series of photomicrographs of femur sections. These sections were also used for quantitative histology; The length of the proliferation zone was estimated from cell counts to be twenty-four cells per column. On the basis of this value and the measured growth rate, an approximate mean cycle time of twenty days was found for the proliferating cells of the human growth plate. Since the corresponding cycle time is two days for rodent growth plates, which also have a different structure, it is unwise to extrapolate the findings in this tissue from mouse to man.
The aetiology of congenital angulation of tubular bones with constriction of the medullary canal, and its relationship to congenital pseudarthrosis
Authors: Newell RL , Durbin FC
Published: February 2018

It is suggested that there is a group of cases of congenital angulation of tubular bones in which the lesion is a defect of ossification of the primary cartilaginous anlage and in which neurofibromatosis is not implicated. It appears that in this group the prognosis with regard to the resolution of deformity and the prevention of pseudarthrosis with conservative treatment or relatively simple surgical procedures is better than that in the neurofibromatous type.
Spondylolytic fractures
Authors: Cyron BM , Hutton WC , Troup JD
Published: February 2018

A method is described whereby fractures of the neural arch similar to those in spondylolysis are produced experimentally. The forces, bending moments and displacements required to initiate the fractures are given; The mechanical aspects in the aetiology of spondylolysis are explained by a simplified two-dimensional force analysis.
Fibrosarcoma of bone. A demographic, clinical and histopathological study of all cases recorded in the Swedish cancer registry from 1958 to 1968
Authors: Larsson SE , Lorentzon R , Boquist L
Published: February 2018

The clinical records, radiographs and histopathological material of all forty-one patients recorded as suffering from fibrosarcoma of bone in the Swedish Cancer Registry for the years 1958 to 1968 have been analysed; in addition, four cases were found on histological review of a series of osteosarcomas. From this re-examination, twenty-four patients with genuine fibrosarcoma of bone were identified; twenty-two had primary neoplasms and two secondary. No sex or geographical differences were found. The tumours showed a prevalence for patients in the adult and older age groups. Half of the tumours arose from femoral or tibial metaphysial bone adjacent to a knee joint. All the tumours were of the medullary type. Almost one-third presented with a pathological fracture, and soft-tissue extension had occurred in all but three tumours. In contrast to previous reports, these tumours were more malignant than osteosarcomas and showed a five-year survival rate of only 4-2 per cent. In accessible sites, ablative surgery was used as the primary treatment, Fibrosarcoma of bone is a distinctive lesion and should be distinguished carefully from periosteal and soft-tissue fibrosarcomas because of differences in prognosis and treatment.