bluuebunny/crossref_metadata_2025 huggingface dataset:
OSTEOGENESIS IN THE OSTEOARTHRITIC FEMORAL HEAD
Authors: Jeffery A. K.
Published: February 2018

1. Osteogenesis in the osteoarthritic femoral head has been examined with radioactive 32P and tetracycline bone markers.

2. In advanced osteoarthritis considerable osteogenic activity was observed, particularly in osteophytes, around cysts and in some areas of bone sclerosis.

3. Two forms of osteogenesis were seen: a form of enchondral ossification, and apposition of new bone to existing bone trabeculae.

4. The findings support previous studies suggesting that rapid turnover of bone tissues occurs in advanced osteoarthritis.
HERNIATED INTERVERTEBRAL LUMBAR DISC IN THE TEENAGER
Authors: Bulos S.
Published: February 2018

1. Of 456 patients with features of herniated intervertebral disc eight were under twenty years of age.

2. Differences in the pattern of clinical presentation of the herniated disc syndrome in adults and in adolescents are discussed.

3. Whereas in the adult conservative treatment is usually successful, this is not so in the adolescent, in whom the symptoms and signs tend to persist for many months.

4. It is suggested that in the adolescent conservative treatment should not be prolonged despite the absence of neurological deficit; operation should be undertaken early after confirmation of the diagnosis by myelography.
SILICONE ARTHROPLASTY OF THE TRAPEZIO-METACARPAL JOINT
Authors: Kessler Isidor
Published: February 2018

1. A review of seventeen patients who underwent silicone arthroplasty of the trapezio-metacarpal joint by prosthetic replacement of the base of the first metacarpal is reported.

2. Eighteen operations were performed and observed for periods varying from two to five years.

3. The technique of operation and the criteria for the assessment of results are discussed.
KÜNTSCHER INTRAMEDULLARY REAMING AND NAIL FIXATION FOR NON-UNION OF FRACTURE OF THE FEMUR AND THE TIBIA
Authors: Christensen Niels Olaf
Published: February 2018

1. The Küntscher method of intramedullary reaming and nail fixation was applied to thirty-five cases of non-union of the lower extremity, twenty femurs and fifteen tibias. A bone graft was generally not used.

2. Most of the patients were allowed to bear weight and to exercise the joints within a few days of the operation. Additional measures such as pre-operative surgery for infection or distraction of shortening were used in some cases.

3. The pseudarthrosis healed in all cases, even when infection was present. The nails were generally not removed until after healing had occurred.

4. It is concluded that the Küntscher method gives remarkably rapid consolidation and restoration of function even in difficult cases of non-union of shaft fracture, particularly of the femur.
TREATMENT OF DEFECTS OF THE ULNA IN CHILDREN BY ESTABLISHING CROSS-UNION WITH THE RADIUS
Authors: Lloyd-Roberts G. C.
Published: February 2018

1. Attention is drawn to the progressive disability caused by irreparable defects of the ulna in growing children.

2. Cross-union between the radius and the ulna resolves some of these problems and contributes greater stability and power to the hand.
THE VASCULAR ANATOMY WITHIN NORMAL TENDONS, DIVIDED TENDONS, FREE TENDON GRAFTS AND PEDICLE TENDON GRAFTS IN RABBITS
Authors: Chaplin D. M.
Published: February 2018

1. The normal vascular anatomy of flexor tendons and extensor tendons in the hind limb of the rabbit is outlined. A marked difference between a tendon in a sheath and a tendon with a paratenon is shown, the latter having a much better blood supply.

2. The vascular reaction in flexor tendon divided within a sheath is shown.

3. The revascularisation of free grafts is illustrated and the differences between tendon with sheath and tendon with paratenon are detailed.

4. Experiments are reported to show that the microcirculation within a "vascular" tendon can support a pedicle graft in the rabbit. Such pedicle grafts are shown to be inferior to free grafts of "avascular" tendon, but the vascularity within the pedicle tendon graft may be modified by "blocking" the surface with silastic tubing.

5. The implications of this work on tendon grafting are discussed, together with a review of additional experimental work in related fields.
UPWARD TRANSLOCATION OF THE DENS IN RHEUMATOID ARTHRITIS
Authors: Rana N. A. , Hancock D. O. , Taylor A. R. , Hill A. G. S.
Published: February 2018

1. A diagnosis of upward translocation of the dens was made in eight patients with chronic rheumatoid arthritis selected from a group of patients who had radiographic studies of the cervical spine and from whom a number of patients with atlanto-axial subluxation were also identified.

2. Two of the patients presented with an acute neurological syndrome of serious import and required a stabilisation operation. Though this is an uncommon complication of rheumatoid arthritis it seems that urgent neurological syndromes are likely to be more common than in atlanto-axial subluxation.
ATLANTO-AXIAL ARTHRODESIS
Authors: McGraw R. W. , Rusch R. M.
Published: February 2018

1. This report defines the indications, and describes in detail a technique for atlanto-axial arthrodesis. Open reduction, with wire fixation and bone grafting, achieves the objective of immediate stabilisation of an unstable C. 1-2 articulation.

2. The method is illustrated by fifteen consecutive patients who had atlanto-axial arthrodesis. fourteen of whom had excellent results.

3. When the indications are correct, atlanto-axial arthrodesis by the method described is a safe and effective procedure having an excellent success rate.
THE RESULTS OF LAMINECTOMY FOR COMPRESSION OF THE CORD OR CAUDA EQUINA BY EXTRADURAL MALIGNANT TUMOUR
Authors: Hall A. J. , Mackay N. N. S.
Published: February 2018

1. One hundred and sixty cases of incomplete or complete paraplegia due to extradural malignant tumour have been reviewed. Between 1959 and 1969 laminectomy for decompression of the cord was performed in 154 of these cases as an urgent measure and the results in 129 cases with full records have been assessed.

2. Immediate laminectomy, a palliative procedure, gave worthwhile improvement in 35 percent of cases of incomplete paraplegia; such patients could walk and had satisfactory control of bladder function at least six months after operation.

3. There were no satisfactory results when the paraplegia was complete.

4. The relief of pain following decompression may be gratifying, even if the patient does not improve sufficiently to fulfil the criteria of a satisfactory result.

5. The results emphasise the importance of early diagnosis, myelography and decompression if a patient with incomplete paralysis is to be offered any chance of relief.
LUMBAR SPINAL STENOSIS
Authors: Nelson M. A.
Published: February 2018

1. Nine patients with radiological evidence of narrowing of the lumbar spinal canal, proved at operation, are reviewed.

2. They presented with either a claudicant or a sciatic clinical picture.

3. A classification into primary or secondary spinal stenosis is described. The primary type may be due to a reduction in either the sagittal, coronal or both diameters of the spinal canal.

4. Secondary narrowing of the canal may be superimposed upon a primary anatomical abnormality or may cause narrowing in a previously normal canal.

5. The symptoms are thought to be caused by a further reduction in the size of an already narrow canal, producing traction on the nerve tissue, which is then unable to move freely.
OBSERVATIONS ON THE VENOUS DRAINAGE OF THE HUMAN VERTEBRAL BODY
Authors: Crock H. V. , Yoshizawa H. , Kame S. K.
Published: February 2018

1. Because of the importance of nutrition of the intervertebral disc in relation to its disorders, a detailed study has been made of the neighbouring vasculature of the vertebral body.

2. This has been made possible by an injection technique involving prevention of leakage by freezing with liquid nitrogen.

3. By this method capillary beds are found in the vertebral end-plate cartilage in the adult. A very fine subchondral post-capillary venous network has been demonstrated draining by short vertical tributaries to a much coarser horizontal collecting vein system connecting with the familiar basivertebral system.

4. This arrangement may be of special importance in the nutrition of the intervertebral disc.
CONGENITAL DIPLOPODIA WITH HYPOPLASIA OR APLASIA OF THE TIBIA
Authors: Karchinov K.
Published: February 2018

1. The syndrome here described in six Bulgarian subjects is characterised by partial duplication of the foot or diplopodia, combined with either hyperplasia or aplasia of the tibia. The accessory elements are located along the medial border of the "normal" foot and consist of two or three toes with related metatarsal and tarsal bones. The fibula is not directly involved.

2. No evidence of familial inheritance was found in these cases.

3. Various reconstructive measures and the place of amputation of the whole foot are discussed in the course of the six case reports.
PYOGENIC INFECTIONS OCCURRING PRIMARILY IN INTERVERTEBRAL DISCS
Authors: Kemp H. B. S. , Jackson J. W. , Jeremiah J. D. , Hall A. J.
Published: February 2018

1. Pyogenic infection of the intervertebral disc in fifteen patients is described.

2. The importance of certain radiological signs in establishing the diagnosis is discussed.

3. Delayed diagnosis is believed to be responsible for the high incidence of paraplegia in this condition.

4. The place of operation in the management of this lesion is considered.
THE STRUCTURE OF THE PARS INTERARTICULARIS OF THE LOWER LUMBAR VERTEBRAE AND ITS RELATION TO THE ETIOLOGY OF SPONDYLOLYSIS
Authors: Krenz J. , Troup J. D. G.
Published: February 2018

1. An anatomical study of the bony structure of the pars interarticularis of the fourth and fifth lumbar vertebrae has been made in specimens from seven cadavers aged seventeen to sixty-seven.

2. Layers of cortical bone have been described antero-laterally and postero-medially which are thickest in the narrowest region of the pars.

3. In one specimen from a seventeen-year-old male, a healing fracture was found in the antero-lateral layer of cortical bone in the right neural arch of the fourth lumbar vertebra.

4. The stresses to which the pars is subject consist primarily of shear forces applied to the articular processes. The significance of these stresses to the etiology of spondylolysis is discussed.
THE OXYGEN INTAKE AND ENERGY COST OF WALKING BEFORE AND AFTER UNILATERAL HIP REPLACEMENT, WITH SOME OBSERVATIONS ON THE USE OF CRUTCHES
Authors: Pugh L. G. C. E.
Published: February 2018

1. The relation of oxygen intake and walking speed has been investigated in a sixty-two-year-old patient before and after unilateral hip replacement for osteoarthritis.

2. Before operation walking speed was reduced to three to five kilometres per hour and stride length to 73 centimetres. Oxygen intake was 0·9-l·2 litres per minute and net energy cost 49 kilocalories per kilometre.

3. Nine months after operation the patient could walk at up to 8 kilometres per hour with a stride of 115 centimetres, oxygen intake of 2·4 litres per minute and net energy cost of 34 kilocalories per kilometre. Most of this improvement took place within three months of operation.

4. The oxygen intake of walking at ordinary speeds after full recovery was comparable with that of control subjects aged twenty-seven to twenty-nine years. In very fast walking, however, the oxygen intake was higher than that of the controls, whose oxygen intake was 1·95 litres per minute at 8 kilometres per hour.

5. The use of a stick or crutches did not reduce the oxygen intake in slow walking. However, crutches enabled the subject to walk at over 8 kilometres per hour with oxygen intake of 2·4 litres per minute (85 per cent of maximum oxygen intake).
CONDYLO-CEPHALIC NAIL FIXATION FOR TROCHANTERIC FRACTURES OF THE FEMUR
Authors: Collado F. , Vila J. , Beltrán J. E.
Published: February 2018

1. An initial series of 100 consecutive cases of trochanteric fracture treated by the Küntscher technique of condylo-cephalic nailing with the aid of an image intensifier has been reviewed.

2. The advantages of this simple method over internal fixation by open reduction and insertion of some kind of nail and plate are discussed.
SYNOVECTOMY OF THE KNEE-JOINT IN RHEUMATOID ARTHRITIS
Authors: Graham James , Checketts Roger G.
Published: February 2018

1. The results of synovectomy of the knee in eighty-five patients with rheumatoid arthritis are presented.

2. When reviewed between five and nine years after operation 55 per cent of 122 knees still had improvement in pain.

3. Only 31 per cent of knees lost movement.

4. Recurrence of symptoms in nearly all cases was related to the recurrence of active rheumatoid synovitis.

5. Recurrence of symptoms was a little less likely when the generalised disease improved, when the Rose-Waaler test was negative, when only one knee was involved and when the operation had been carried out within three years of the onset of disease in that knee.
RECURRENT BENIGN OSTEOBLASTOMA OF THE SECOND THORACIC VERTEBRA
Authors: Gertzbein S. D. , Cruickshank B. , Hoffman H. , Taylor G. A. , Cooper P. W.
Published: February 2018

1. A case is reported of a benign osteoblastoma of the body of the second thoracic vertebra causing paraplegia in a woman aged twenty-six.

2. The tumour was resected, apparently entirely, through a costo-transversectomy approach, and the paraplegia resolved almost completely.

3. Five and a half years later symptoms recurred, due to a recurrence in the form of a large, partly calcified tumour in the left upper thorax which was resected in toto via a transpleural approach.

4. The considerable histological differences between the original tumour and the recurrence are discussed.
PULMONARY METASTASES FROM CHONDROBLASTOMA OF THE TIBIA
Authors: Riddell R. J. , Bromberger N. A. , Louis C. J.
Published: February 2018

1. A case of chondroblastoma occurring in the upper tibial epiphysis of the right leg of a girl aged fourteen is reported.

2. Because the tumour recurred the leg was amputated.

3. Pulmonary metastases appeared two years after amputation.
THE BLOOD SUPPLY OF THE SPINAL CORD
Authors: Dommisse G. F.
Published: February 2018

1. A high incidence of paraplegia following operations for the correction of severe scoliosis in adults led to an investigation of the normal blood supply of the human spinal cord.

2. This entailed three methods of study: micro-dissection of the vessels of the spinal cord in thirty-five cadavers; radiological measurements of the spinal canal in fifty healthy subjects; and a study of the macerated spinal column in six adult cadavers.

3. The blood supply of the spinal cord is shown to be least rich, and the spinal canal narrowest, from the T.4 to approximately the T.9 vertebral level. This is named the critical vascular zone of the spinal cord, the zone in which interference with the circulation is most likely to result in paraplegia.
PYROPHOSPHATE ARTHROPATHY: A CLINICAL STUDY OF FIFTY CASES
Authors: Bjelle Anders , Sundén Göran
Published: February 2018

1. A systematic collection of the clinical findings in fifty patients with pyrophosphate synovitis,among some 300 patients with obscure disorder of the knee, has been made over a period of eighteen months. The numbers of men and women were equal, the mean age being seventy years (range thirty-seven to ninety), and the mean age at the onset of symptoms fifty-nine years.

2. A difference in the clinical picture between the sexes was found. In men an acute synovitis predominated, in women chronic joint complaints.

3. A high incidence of accompanying disease was found, but none had a significant relationship to the arthropathy, although the high frequency (20 per cent) of synovitis following an acute severe illness of some other kind was striking.

4. No specific radiological sign except for calcifications in articular cartilage and menisci was found in these patients, and no relationship to osteoarthrosis could be established.

5. The great variability of symptoms and the surprisingly high incidence attracts attention to pyrophosphate synovitis as a cause of joint symptoms, especially in elderly patients.
A STUDY OF THE DEVELOPMENT OF CYTOTOXIC ANTIBODIES PRODUCED IN RECIPIENTS OF XENOGRAFTS (HETEROGRAFTS) OF ILIAC BONE
Authors: Elves M. W. , Salama R.
Published: February 2018

1. The humoral immune response of rats against sheep iliac bone grafts has been examined.

2. Fresh, marrow-containing grafts elicited a brisk and sustained antibody response. Attempts to wash out the marrow were not uniformly successful in removing cellular antigens from the grafts.

3. Decalcifying and freezing bone grafts at —20 degrees Celsius do not impair immunogenicity to any significant extent. Immunogenicity was found to be reduced in grafts subjected to freeze-drying.

4. Deproteinised Oswestry bone grafts and Kiel grafts gave rise to antibody production in a few recipients, and in the case of the former this response did not occur until after six or seven weeks from grafting.

5. The highest degree of osteogenesis in composite bone xenograft-autografts was found by Salama and colleagues (1973) to occur in Oswestry bone grafts. It is suggested that osteogenesis in xenografts may be impaired by an immune response.
STUDIES ON SLICES AND ISOLATED CELLS FROM FRESH OSTEOARTHRITIC HUMAN BONE
Authors: Bard D. R. , Dickens M. J. , Edwards J. , Smith Audrey U.
Published: February 2018

1. The use of the Metals Research Macrotome for cutting 100 μ thick sections of fresh, unfixed specimens of arthritic human femoral heads and normal goat condyles is described.

2. A technique for isolating living cells from these slices by decalcification followed by enzymic digestion is reported.

3. The microscopic appearances of the fresh slices, the decalcified slices and the isolated cells as seen by incident or transmitted fluorescent lighting, by phase-contrast microscopy, by scanning electron microscopy and by histological and cytological techniques are illustrated.

4. These techniques might be applicable to the examination of biopsy specimens of pathological bone or to basic research on bone cells.
OSTEOCHONDRITIS DISSECANS FOLLOWING CONGENITAL DISLOCATION OF THE HIP
Authors: Weissman S. L.
Published: February 2018

1. A case of osteochondritis dissecans of the hip in a young girl who at the age of one and a half years underwent open reduction of congenital dislocation of the hip, is reported.

2. The possible relationship between this condition and the osteochondritic changes which followed the reduction is discussed.
THE INHERITANCE OF TARSAL COALITION AND ITS RELATIONSHIP TO SPASTIC FLAT FOOT
Authors: Leonard M. A.
Published: February 2018

1. A clinical and radiological survey has been made of the families of thirty-one patients with peroneal spastic flat foot and tarsal coalition (twenty-seven calcaneo-navicular, four talo-calcaneal).

2. Thirty-nine per cent of ninety-eight first degree relatives were found to have some type of tarsal coalition.

3. A surprise finding was that not one of the first degree relatives had ever had symptoms referred to the tarsus.

4. No case of "ball and socket" ankle joint or of carpal coalition was found in this series.
ACETABULAR DEVELOPMENT IN CONGENITAL DISLOCATION OF THE HIP
Authors: Harris Nigel H. , Lloyd-Roberts G. C. , Gallien R.
Published: February 2018

This investigation examined the validity of the hypothesis that the acetabulum in congenital dislocation of the hip will develop satisfactorily provided accurate congruous and concentric reduction is obtained as early as possible, and is maintained throughout growth.

Seventy-two patients with eighty-five hips were studied. The children were more than one year old on admission and over ten years at the time of review. Acetabular development was assessed radiologically by measurement of the acetabular angle. Angles of less than 21 degrees were regarded as normal, and more than 21 degrees as indicating some failure of development. Satisfactory acetabular development occurred in 80 per cent (angles 24 degrees or below), and was unsatisfactory in 20 per cent (angles above 24 degrees).

If three errors in management, namely failure to obtain congruity, failure to maintain congruity and ischaemic necrosis secondary to manipulative reductions, are excluded from the analysis, it is found that 95 per cent of acetabula develop satisfactorily. The outcome is largely independent of the age on admission up to four years old, and of bilateral involvement. It is concluded that acetabuloplasty should not be necessary if the patient is admitted under the age of four or congruity is obtained in the functional position under four and a half years.
METATARSAL OSTEOTOMY FOR METATARSALGIA
Authors: Helal B.
Published: February 2018

An oblique osteotomy in the distal half of the metatarsal shaft is described for the treatment of metatarsalgia due to prolapse of one or more of the middle three metatarsal heads. Thirty-eight patients who have had this operation have been followed up for a period of from two to five years. The operation is simple, recovery is rapid and symptoms have been well relieved.
HYPOXAEMIA AFTER FRACTURES
Authors: Tachakra S. S. , Sevitt S.
Published: February 2018

Serial arterial blood-gas analyses showed a phase of primary hypoxaemia in thirty-two out of fifty fracture patients (64 per cent) without head, chest or abdominal injury. The incidence was greater in those with shaft fractures of the femur or tibia or both, than in those with fractured hips, and was related to the severity of injury and the nature of the accident. Most affected subjects were already hypoxaemic on admission to hospital: the arterial PO2 commonly fell to between 60 and 70 millimetres of mercury, and the episode generally lasted a few days. The hypoxaemia was generally subclinical but four patients developed mild clinical fat embolism. Early hypoxaemia was not found in six patients admitted with only soft-tissue injuries. One or more subsequent attacks of subclinical hypoxaemia, each lasting a few days, occurred in half of those previously affected. Most episodes followed fracture operation or manipulation. Pulmonary thromboembolism seemed responsible in two patients, but it could be excluded in others given oral anticoagulant prophylaxis from soon after admission. Pulmonary fat embolism is the most likely explanation of the primary episodes and could account for most of the subsequent periods of hypoxaemia.
LUMBO-SACRAL FUSION WITH SPRING FIXATION
Authors: Attenborough C. G. , Reynolds M. T.
Published: February 2018

A method of posterior lumbo-sacral fusion is described in which springs are used to fix the grafts and to maintain immobilisation. Fifty patients with lumbar disc degeneration or spondylolisthesis have been reviewed. The results have been assessed clinically by grading the symptoms before and after operation. Stay in hospital has been short and return to work rapid. There has been a high proportion of good results.
OSTEOPHYTES AND THE OSTEOARTHRITIC FEMORAL HEAD
Authors: Jeffery A. K.
Published: February 2018

The study describes the topography, morphology and growth of osteophytes in forty femoral heads removed from patients presenting with advanced osteoarthritis of the hip. In addition to standard histological techniques, radiography of serial bone slices and in vivo bone labelling with tetracycline and 32P were used. The pattern of major osteophyte formation appeared to be influenced by the direction, degree and rate of displacement of the femoral head in relation to the acetabulum; four principal patterns of growth were noted. Osteophytes form part of extensive osteogenic processes that involve bone structure in the osteoarthritic joint.
OSTEOSARCOMA IN CHILDREN
Authors: Price C. H. G. , Zhuber K. , Salzer-Kuntschik M. , Salzer M. , Willert H. G. , Immenkamp M. , Groh P. , Matêjovský Z. , Keyl W.
Published: February 2018

A study is presented of the aetiology and results of treatment in a group of 125 proven osteosarcomas present in children under fifteen years of age. These cases have been collected from the records of one English and six European treatment centres. There is a slight male preponderance, but the striking aetiological feature is the very high proportion of tumours of the long bones of the limbs (96 per cent).

The two and a half and five year disease-free survival rates were respectively 15 and 12 per cent, with a further 9 per cent still living, but under observation for less than two and a half years. Evidence of metastasis after two and a half years is very unusual, but no child with a tumour of an axial or girdle bone lived this length of time.

Although the differences in the results of the different methods of treatment employed are not statistically valid, the largest number of long survivors had been treated by early amputation, which method also provided the lowest rate of local tumour recurrences. Reasons are discussed which indicate that prompt ablation is the treatment of choice, perhaps with certain advantages in the light of recent advances in adjuvant treatment. The past situation in connection with childhood osteosarcoma certainly provides strong support for immediate carefully designed clinical trials of the new adjuvant methods cited.
THE IMPACT OF ARTHROSCOPY ON THE MANAGEMENT OF DISORDERS OF THE KNEE
Authors: Dandy D. J. , Jackson R. W.
Published: February 2018

A study has been made of 800 consecutive arthroscopic examinations of the knee with special emphasis on the changes in management that resulted. Of 614 knees that would have been operated upon if arthroscopy had not been available, open operation was avoided in 32 per cent, a different operation was done or planned in 27 per cent, and there was no important change in the remaining 41 per cent. Of 186 knees that would have been treated conservatively if arthroscopy had not been available, the examination resulted in some immediate benefit to 30 per cent of the patients. There were no wound infections after arthroscopy alone, and the known incidence of incorrect interpretation was 1.4 per cent.
FALSE ANEURYSM OF FEMORAL ARTERY FROM CANCELLOUS EXOSTOSIS OF FEMUR
Authors: Cassie G. F. , Dawson A. S. , Sheville E.
Published: February 2018

A boy aged fourteen trapped and tore at its origin a branch of the terminal part of the superficial femoral artery over a cancellous exostosis during extension of the knee from the position of full flexion. Three months later an expanding false aneurysm necessitated arteriography, after which suture of the tear gave a successful result.
AN UNUSUAL REACTION IN MUSCLE IN ASSOCIATION WITH A VITALLIUM PLATE: A REPORT OF POSSIBLE METAL HYPERSENSITIVITY
Authors: Halpin D. S.
Published: February 2018

A case is reported in which fractures of the radius and ulna were fixed with Vitallium plates and screws. Seven years later a painful swelling appeared over the extensor aspect of the forearm. After eight years sarcoma was suspected and a pale tumour infiltrating muscle was found at operation. However, the histology excluded neoplasia and showed massive fibrosis and patchy necrosis of muscle, with chronic inflammatory changes peripherally. After the removal of the metal the swelling disappeared. A sinus down to the ulna followed operation and was not cured two years later. At this stage standard patch testing showed skin sensitivity to cobalt. Metal sensitivity is proposed as the cause of this extraordinary reaction in muscle.
RADIAL NERVE ENCLOSED IN THE CALLUS OF A SUPRACONDYLAR FRACTURE
Authors: Symeonides Pan P. , Paschaloglou C. , Pagalides T.
Published: February 2018

At operation for the correction of cubitus varus by removal of a wedge based laterally, the radial nerve fortunately was first explored and found to run through a transverse bony tunnel at the posterior level of a supracondylar fracture sustained eight years previously. After elevation of the bony tunnel and nerve en bloc the osteotomy was completed; neurapraxia of the radial nerve soon recovered. With hindsight, the entrance and exit foramina of the tunnel could be clearly seen in the antero-posterior radiograph taken before the operation.
Madelung's disease of the wrist and dyschondrosteosis
Authors: Golding JS , Blackburne JS
Published: February 2018

Twenty-six index patients with primary Madelung's deformity of the wrist were examined, as were sixty-five of their relatives. Standard radiographs were taken and measured to determine whether mesomelic dwarfism, a feature of dyschondrosteosis, was present. No case of mesomelia was found. No evidence of Madelung's deformity was found in the relatives of the index patients, who were all female. It is concluded that primary Madelung's deformity of the wrist is not an expressions of dyschondrosteosis, that it is not inherited, and that it does not occur in the male. One index patient with dyschondrosteosis was examined. Eight of her relatives were similarly affected, and three of these were male. It is suggested that previously recorded male cases of Madelung's deformity of the wrist were expressions of dyschondrosteosis or of secondary deformity.
Fracture-dislocations of the sacrum. Report of three cases
Authors: Bucknill TM , Blackburne JS
Published: February 2018

The pattern of fracture-dislocation of the upper part of the sacrum is demonstrated in three patients. The fracture line followed the segmental form of the sacrum and was usually caused by a posterior force against the pelvis which had been locked by hip flexion and knee extension. Fractures of the lumbar transverse processes also occurred, presumably from avulsion by the quadratus lumborum muscle. The damage to the sacral plexus found in all three cases recovered after several months. Radiographs of the injury are difficult to obtain in severely injured patients but oblique views of the sacrum help to determine the extent of the forward dislocation.
The clinical manifestations and pathomechanics of contracture of the extensor mechanism of the knee
Authors: Bose K , Chong KC
Published: February 2018

Experience with thirty-eight Asian children and adolescents who presented with either stiffness of the knee, genu recurvatum, habitual dislocation of the patella or congenital lateral dislocation of the patella showed that all those disorders were manifestations of contracture of the extensor mechanism, which fell into two groups according to the components involved. In Group I the main components affected were in the midline of the limb, namely rectus femoris and vastus intermedius; these patients presented with varying degrees of stiffness of the knee, or worse, with genu recurvatum. In Group II the main components involved were lateral to the midline of the limb, namely vastus lateralis and the ilio-tibial band; these patients presented with habitual dislocation of the patella, or worse, congenital lateral dislocation of the patella. In both groups untreated patients developed secondary adaptive changes such as subluxation of the tibia or marked genu valgum which made operative procedures more formidable and less effective. Release of the contracture should therefore be performed as early as possible.
The hip in myelomeningocele. Management directed towards a minimum number of operations and a minimum period of immobilisation
Authors: Menelaus MB
Published: February 2018

The hip problems in 116 children with myelomeningocele are discussed. The management described stresses the importance of selection of the type of operation; major surgery is appropriate only for those children who benefit significantly, and this generally means only those with strong quadriceps muscles on both sides. Some children with acetabular dysplasia gain immediate stability if acetabuloplasty is combined with other hip operations. Children who lack strong quadriceps muscles are best served by simpler procedures, such as tendon excision, designed to rid them of fixed deformity and to prevent recurrent deformity. The operations described are performed whenever possible under one anaesthetic and are combined with any other limb operation that may be necessary. It is suggested that the aim in management is not the treatment of paralytic dislocation of the hip but the correction of fixed deformity so that the child can stand with a stable posture. Subluxation and dislocation are treated incidentally to procedures designed to prevent or correct fixed deformity.
Subtalar arthrodesis by cancellous grafts and metallic internal fixation
Authors: Dennyson WG , Fulford GE
Published: February 2018

A technique of subtalar arthrodesis by means of metallic internal stabilisation and autogenous cancellous bone grafting is described. Of forty-eight feet with mobile pes planus treated by this method forty-five gained union after an average of seven and a half weeks in a below-knee weight-bearing plaster, and forty-three had satisfactory correction of the deformity.
Spread of gold injected into the joints of healthy rabbits
Authors: Stein H , Yarom R , Robin GC , Peters PD , Hall TA , Makin M
Published: February 2018

This study shows that after intra-articular injection, aurothiomalate and colloidal gold of small (200 A) particle size were rapidly absorbed from joints while the larger, 300 A, particle size colloidal radioactive gold could not be found outside them. Larger particle size suspensions seem therefore more likely to remain localised in the joint and its lining synovium after intra-articular injection, the systemic absorption from the joint cavity diminishing with increasing particle size. It was also found that the intra-articular injection of small amounts of aurothiomalate, of colloidal gold and of colloidal radioactive gold produces identical degenerative lesions in the lining cells of the proximal convoluted tubules of the kidneys. These lesions were always found, although gold particles were demonstrated only in sampled kidney tissues of the animals injected with the soluble gold preparation whereas no gold could be detected in the tissues of animals injected with colloidal non-radioactive or radioactive gold. Electron microscopic evidence is presented to suggest the possibility that the mitochondria are the "target" organelles of the gold-induced cellular damage. Mitochondrial damage was demonstrated in liver and spleen in addition to the already described kidney damage. The correlation between structure and function of the mitochondrial changes is not clear, and ionic shifts may be both a cause and a result of damage.
Chemonucleolysis
Authors: McCulloch JA
Published: February 2018

A prospective study of 480 patients who underwent enzymatic dissolution of the nucleus pulposus with chymopapain is reported. Seventy per cent of patients with the clincial criteria for a disc herniation had a favourable response to chemonucleolysis. The commonest cause of failure was persistent back pain. In patients with sequestered discs or lateral recess stenosis surgical intervention was not made more difficult by chemonucleolysis. Those with a previous operation, spinal stenosis or psychogenic components to the disability had very poor results. Complications were few and easily managed.
The late repair of torn cruciate ligaments using menisci
Authors: Tillberg B
Published: February 2018

An operation using either the medial or the lateral meniscus to effect the late repair of torn cruciate ligaments is described. Forty-three patients under fifty years of age who were unable to return to their work because of severe joint laxity have been treated in this way and reviewed after one to thirty years. Sagittal stability was measured by a special apparatus, and a comparison was made between normal knees and affected knees before and after operation. The review of forty-five knees showed normal stability in thirty-one, slight instability in twelve and no improvement in two. Forty-one patients had returned to their former work: twenty-two complained of instability when tired; all had pain-free joints. The use of a meniscus for the reconstruction of either cruciate ligament is considered to be simple, safe and effective.
Acute osteomyelitis in children
Authors: Mollan RA , Piggot J
Published: February 2018

A number of problems in the treatment of acute osteomyelitis have remained unresolved in recent years. The clinical experience of ninety-three patients with proven acute haematogenous osteomyelitis is presented to help resolve these problems. Analysis of the clinical features, the operative, bacteriological and haematological findings is made and discussed in detail. Eighteen patients had continuing bone infection and recommendations are made as to how diagnosis and management might have been improved. Surgery is considered to be an essential part of the diagnostic and therapeutic management of this disease. A combination of cloxacillin and fusidic acid is recommended at the antibiotic treatment.
Osteochondritis dissecans patellae
Authors: Edwards DH , Bentley G
Published: February 2018

Six cases of osteochondritis dissecans patellae have been studied in five patients in an attempt to clarify the aetiology and prognosis. Assessment of the results of treatment was performed using a standard protocol. The thirty-four previous case reports in the literature are reviewed. In four of the five patients symptoms began after flexing the knee under load and three showed patellar subluxation on tangential radiographs. Thus, repetitive shearing stress on the patellar surface is thought to be an important aetiological factor. The indication for operation is a loose osteochondral fragment either wholly or partly detached from the articular surface of the patella. Vertical excision of the affected area of articular cartilage with drilling of the underlying bone gave two "good" and two "excellent" results. Healing of the drilled area and maintenance of the cartilage space was seen in radiographs of all four cases so treated. This simple method of treatment, which probably causes filling of the defect in the surface by fibrocartilage, is recommended.
Irradiation lesions of the growth plate in rabbits
Authors: Arguelles F , Gomar F , Garcia A , Esquerdo J
Published: February 2018

The effects of gamma irradiation on the growth plate have been studied in nineteen rabbits with a 1,000 rads/skin dose. The rabbits were killed after one to ninety days. The growth plates were studied by microscopic examination, thymidine-H3 autoradiography, and fluorescence with radiographic measurement. Changes were already detected after twenty-four hours at the cell mitosis level, which showed the sensitiveness of the chondrocyte itself. The lesions were clearly seen with the optical microscope after seven days, and they were most advanced between the fourteenth and twenty-first day after irradiation. Regeneration of the cartilage began in the fourth week and the histological appearance became normal after seventy days. Fluorescence with tetracycline showed a temporary retardation of growth, with consequent shortening of the affected limb.
Spondylolisthesis of the cervical spine. Report of a case
Authors: Sheikholeslamzadeh S , Aalami-Harandi B , Fateh H
Published: February 2018

Spondylolisthesis of the fourth cervical vertebra is reported in a thirty-four-year-old woman. Only one other case at this level has been found in the literature, but others have been recorded of the sixth cervical vertebra.
Chondrosarcoma of the bones of the hand
Authors: Roberts PH , Price CH
Published: February 2018

Nineteen chondrosarcomas are reported arising in proximal phalanges or metacarpal bones of the hand mainly in elderly patients, predominantly women. The usual clinical presentation was of a progressively painful large tumour, often arising in a dormant lesion near the metacarpo-phalangeal joint. Radiologically most showed some bone expansion with a poorly defined area of destruction and a considerable soft-tissue swelling. Histologically, malignancy was usually obvious, but confusion might arise from the inclusion of bland areas of chondromatous tissue that probably represented the original lesion. Four tumours, initially curetted and grafted, recurred locally and necessitated amputation of the digit or ray. Amputation was the primary treatment for fourteen other tumours and was curative except in one patient who eventually needed amputation through the forearm for a large second recurrence. One tumour was satisfactorily controlled by excision of the affected phalanx. None of these nineteen tumours is known to have metastasised. Correct treatment implies a carefully considered balance between conservation of function and complete removal of all tumour tissue.
Polytenosynovitis caused by Toxoplasma gondii
Authors: Vass M , Kullmann L , Csoka R , Magyar E
Published: February 2018

Two cases are reported of polytenosynovitis involving the wrists and ankles and caused by toxoplasmosis, together with the investigations that led to the diagnosis. Medical and surgical treatment of the first patient and medical treatment only of the second patient gave satisfactory results.
Total prosthetic replacement of a humerus for chronic osteomyelitis with a pathological fracture. Report of a case
Authors: Yoshimoto S , Kaneso H , Tatematsu M
Published: February 2018

A case is reported four years after successful total replacement of the left humerus for chronic osteomyelitis of six years' duration, with an axillary sinus that had persisted despite repeated operations and more distally a pathological fracture that had failed to united after bone grafting. The disability was such that the patient had requested amputation, but he returned to his previous work as a driver six months after the total replacement and there has been no recurrence of infection.
Aetiology of osteochondritis dissecans. Failure to establish a familial background
Authors: Petrie PW
Published: February 2018

In a family study in which thirty-four patients with osteochondritis dissecans and eighty-six of their first-degree relatives were examined clinically and radiologically, only one relative was found to have osteochondritis dissecans. No association with other forms of osteochondritis, endocrinological abnormalities or dwarfism was found.
Anterior dislocation of the radial head in children: aetiology, natural history and management
Authors: Lloyd-Roberts GC , Bucknill TM
Published: February 2018

The results of operation for traumatic anterior dislocation of the head of the radius in eight children have been reviewed. We are satisfied on the basis of the results obtained and the outcome in one untreated patient that operative reduction is fully justified, provided that the annular ligament is reconstructed and internal fixation employed. We have not seen unilateral congenital dislocation and doubt its existence. Secondary subluxation of the distal radio-ulnar joint has been noted in an untreated patient.
The treatment of flexion contracture of the knee in myelomeningocele
Authors: Abraham E , Verinder DG , Sharrard WJ
Published: February 2018

A follow-up study, on average four years after operation, of seventy-six cildren with myelomeningocele who had surgical treatment for flexion contracture of the knee, is reported. After a single operation sixty-eight knees (55 per cent) had a contracture of less than 20 degrees, which was the main criterion of success. About half of the cases of transplantation of the hamstrings to the femur, division or elongation of the hamstrings, or supracondylar osteotomy had successful results. Transfer of the hamstring tendons to the patella was successful in nine of twelve instances, so giving the lowest rate of failure. Forty-five patients were active walkers at follow-up as compared to eighteen before operation. However, only one of the eleven patients over twelve years of age with a motor level above T.12 was an active walker at review. Several conclusions are drawn. A flexion contracture of the hip greater than 30 degress should be corrected before operation of the knee. Supracondylar osteotomy as a primary procedure should only be used to correct flexion contracture of the knee secondary to malunited fractures. Faradic stimulation is useful in the evaluation of muslce function before operation. An intelligence quotient below 65 and weakness of the arms are relative contraindications for correction of the deformity of the knee.
Joint surface incongruity and its maintenance: an experimental study
Authors: Goodfellow J , Mitsou A
Published: February 2018

The paper reports an experimental investigation into the mechanisms whereby the joints of living animals maintain their precise contours. The normal patter of joint incongruity in the rabbit's hip having first been established, three groups of experimental animals underwent operative procedures designed to reduce the joint pressure to a level unrealistic in normal life. In one group the hip was dislocated by manipulation; in a second group the muscles around the hip joint were divided; and in a third group the hind limb was disarticulated through the knee. When the animals were killed at intervals of a few weeks after the operations the experimental hip joint showed increased congruity in all cases. It is concluded that in immature animals there is a mechanism in joints to control the modelling of their shapes towards an ideal incongruity, and that that mechanisms is pressure sensitive.
Analytical radiography of club feet
Authors: Simons GW
Published: February 2018

A radiographic method is described for making the diagnosis of talo-navicular subluxation before ossification of the navicular bone occurs. Seven basic combinations of deformities are thought to occur in the club foot. Radiography before operation enables the surgeon to determine which of these combinations exists in a particular foot, and radiography during operation enables him to determine wheter or not all the existing deformities have been corrected, and therefore whether or not the operation must be extended.
The aetiology of Perthes' disease. Genetic, epidemiological and growth factors in 310 Edinburgh and Glasgow patients
Authors: Wynne-Davies R , Gormley J
Published: February 2018

The aims of this survey were to establish the familial incidence of Perthes' disease, to note any associated developmental anomalies and to collect information on preceding trauma or synovitis, on the pregnancy and birth, and on various sociological factors. Height and weight measurements were obtained for 217 patients, and comparisons made with those of their parents, unaffected sibs and (local) controls. Results showed an extremely low frequency of Perthes' disease among relatives, with no obvious pattern of inheritance. As genetic factors were not apparent, environmental and sociological causes were sought. The disease occurred particularly in children who were third-born or later in the family, and had older than average parents. Many came from low-income families and one in ten had been a breech birth, shown other malposition or had had a version late in pregnancy. Many children were already undersized at the time of developing Perthes' disease and remained short than average throughout life. Neither their parents nor sibs were shorter than normal, indicating that the patients' short stature was not familial. The child who is going to develop Perthes' disease is already constitutionally and socially at a disadvantage, and during the perinatal period and the first few years of life is perhaps more susceptible to trauma than is a normal child.
Snapping elbow due to dislocation of the medial head of the triceps. A report of two cases
Authors: Dreyfuss U , Kessler I
Published: February 2018

Two cases of unusual snapping at the elbow are described. In both, the medial head of the triceps was found to be separated from the main muscle belly. During flexion of the elbow, the medial head dislocated over the medial epicondyle, producing a characteristic snapping phenomenon. Both cases were of long standing and had been asymptomatic for years. The first clinical symptoms were those of an ulnar neuropathy. In order to restore the normal position of the medial head of the triceps, its tendon was detached from the olecranon, passed under the central tendon and interlaced to it. The ulnar nerve was left in the epicondylar groove in one case and transposed anteriorly in the other. At the end of the procedure flexion of the elbow was unobstructed and the snapping phenomenon had disappeared.