bluuebunny/crossref_metadata_2025 huggingface dataset:
RADIOLOGICAL SIGN OF RECURRENT DISLOCATION OF THE PATELLA
Authors: McDougall A. , Brown J. Douglas
Published: February 2018

1. Attention is drawn to the importance of taking tangential radiographs of the patella in all cases of injury to the knee, especially when there is difficulty in distinguishing between recurrent dislocation of the patella and tear of a meniscus.

2. New bone formation along the medial side of the patella confirms a diagnosis of recurrent dislocation.

3. The importance of Coleman's original observations is stressed.
PAGET'S SARCOMA OF BONE
Authors: Price C. H. G. , Goldie W.
Published: February 2018

1. An analytical study of eighty histologically proven cases of Paget's sarcoma confirms and elaborates existing knowledge of the etiology of this tumour. The frequency with which this tumour occurs in certain parts of England may be seen by comparison with the numbers of osteosarcoma and fibrosarcoma cases registered at Bristol and Leeds. An overall incidence figure for Paget's sarcoma of 0·l6 and 0·18 per 100,000 population per annum has been calculated for the Bristol and Leeds areas respectively. The similarity of the age incidence curves of Paget's disease and Paget's sarcoma are shown and discussed in the light of demographic information.

2. Histologically, most Paget's sarcomata resemble recognised tumour types as seen in otherwise normal bones, the most frequent forms being osteosarcoma and fibrosarcoma. The type of tumour arising in an osteitic bone is uninfluenced by age, sex or site of origin. Thirty-eight per cent of the cases were complicated by fracture, which occurred with slightly greater frequency in fibrosarcoma and with advancing age. A causal connection between sarcoma and fracture is supported but not vice versa.

3. Survival statisticsfor this series are compared with Bristol records for osteosarcoma and fibrosarcoma (without Paget's disease), the mean survival of seventy-four patients being 11·1 months from the date of the initial symptoms of malignancy. Four long-term survivors are reported, the five-year and ten-year survival rates being respectively 5 per cent and 3·1 per cent. The effects of age, site, sex, fracture and treatment upon survival are tabulated and discussed.
METAPHYSIAL DYSOSTOSIS
Authors: de Haas W. H. D. , de Boer W. , Griffioen Francisca
Published: February 2018

1. The patient, who at the age of ten and a half years was described by Jánsen as the first recorded case of metaphysial dysostosis, has been re-examined at the age of forty-four and the clinical, pathological and radiological findings at various ages have been compared. Measurements have been compared with those obtaining in normal individuals.

2. The striking feature is the development of normal bony structure associated with marked deformity and dwarfing. Joint surfaces have remained intact.

3. There is some deafness, which is partly caused by sclerosis of the petrous temporal bone.
CLOSED OR OPEN INTRAMEDULLARY NAILING OF FEMORAL SHAFT FRACTURES?
Authors: Rokkanen P. , Slätis P. , Vankka E.
Published: February 2018

1. A series of 154 patients with 156 femoral shaft fractures treated during a three and a half year period is reviewed. Fifty-four fractures were treated by closed intramedullary nailing, sixty-four by open intramedullary nailing and thirty-eight by conservative methods.

2. All the patients had fresh fractures of a similar degree of severity. Seventy-eight per cent of the fractures were sustained in traffic accidents, and 21 per cent were compound.

3. The technique of closed intramedullary nailing is described in detail. The importance of a complete and faultless armamentarium and a high-quality image intensifier is emphasised.

4. All fractures united within twelve months after the accident.

5. The functional results were assessed upon the basis of walking ability and return to work. Nailed fractures did better than conservatively treated ones, and closed nailing was slightly superior to open nailing. At twelve months after the injury all patients treated by closed nailing walked without a stick, compared with 96 per cent of the cases treated by open nailing and 81 per cent of the conservatively treated patients. The same trend was noted regarding return to work.

6. The benefit of intramedullary nailing was partly dependent on the severity of the fracture and the age of the patient. The most gratifying results of nailing were obtained in patients over thirty-five years of age with severe fractures.

7. Osteitis occurred in one case treated by closed nailing, and low grade wound infections in five cases, representing an overall infection rate of 3·8 per cent.

8. Seventy-four per cent of the patients were examined one to four years after the fracture. There was less angular deformity and more rotational deformity in the nailed than in the conservatively treated fractures. The tip of the nail gave slight discomfort in the trochanteric area in one patient in three. Residual joint stiffness was infrequent in the nailed cases as compared to the conservatively treated ones.

9. The indications for closed intramedullary nailing of femoral shaft fractures are outlined.
A REVIEW OF SMITH'S FRACTURES
Authors: Woodyard J. E.
Published: February 2018

1. Forty-four cases of Smith's type fractures are reviewed and emphasis laid upon the significance of the different fracture types.

2. Treatment is reviewed and recommendations made for future management.
INJURIES OF THE TIBIO-FIBULAR LIGAMENTS
Authors: Monk C. J. E.
Published: February 2018

1. Attention is drawn to lesions of the inferior tibio-fibular ligaments. Two main types are described: the anterior type and the total type.

2. The clinical and radiological characteristics are described.

3. The value of strain-view radiography is stressed.

4. A plan of treatment is suggested.
ORTHOPAEDIC ASPECTS OF THE EHLERS. DANLOS SYNDROME
Authors: Beighton P. , Horan F.
Published: February 2018

1. The orthopaedic features of 100 patients with the Ehlers-Danlos syndrome are described.

2. The significance of these findings is discussed and comment is made of their relationship to the other stigmata of the syndrome.
THE TREATMENT OF CHRONIC OSTEOMYELITIS BY SAUCERISATION AND SECONDARY SKIN GRAFTING
Authors: Evans E. Mervyn , Davies D. M.
Published: February 2018

1. In chronic osteomyelitis grafting a cavity with split skin is a reliable method of treatment. The skin cover so obtained is durable.

2. The method may be used with good prospects of success even when the cavity is large and there is extensive disease of bone.

3. Operation is indicated for the relief of pain, to close a sinus or sinuses, to obtain healing of an ulcer or to prevent recurrent episodes of acute infection.

4. The technique of operation employed in eleven cases is described and illustrative case reports are given.
POST-OPERATIVE ANEURYSM OF THE DESCENDING GENICULAR ARTERY PRESENTING AS A PULSATING HAEMARTHROSIS OF THE KNEE
Authors: Rifaat M. A. , Massoud A. F. , Shafie M. B.
Published: February 2018

1. A case of traumatic aneurysm of the descending genicular artery complicating elective operation on the knee joint is reported.

2. The aneurysm was mainly intra-articular, presenting as a pulsating haemarthrosis soon after operation.

3. The pathogenesis, symptomatology, diagnosis and management are briefly discussed.
BONE STRUCTURE IN OSTEOMALACIA, WITH SPECIAL REFERENCE TO ULTRASTRUCTURE
Authors: Bonucci Ermanno , Denys-Matrajt Haydée , Tun-Chot Sirinn , Hioco Denis J.
Published: February 2018

1. Four cases of osteomalacia secondary to vitamin D deficiency have been investigated histologically and with the electron microscope.

2. Three main types of cells were found along the osteoid tissue. Cells of Group 1 are like normal osteoblasts, except that their cytoplasm has an ordered granular endoplasmic reticulum, without enlarged cysternae. Moreover, it contains isolated rosettes of glycogen. Cells of Group 2 are like young progenitor cells. There are almost no rough cysternae in the cytoplasm. This contains clusters of glycogen, isolated ribosomes and many mitochondria. Cells of Group 3 are structurally like "resting" flat osteoblasts in normal bone.

3. The paper discusses how the presence of the three groups may be related to vitamin D deficiency or secondary hyperparathyroidism.

4. Malacic osteoid tissue consists of apparently normal collagen fibrils. Both optical and electron microscopy show that this tissue can calcify. But calcification stops at an early stage, or proceeds much more slowly than normal. So large areas ofosteoid tissue are left uncalcified.

5. Calcium salts are laid down either as needle-shaped crystals exactly like those in normal bone, or else abnormally. Where abnormal they either appear in a finely granular, almost amorphous form, or else acquire a characteristic star-like crystalline structure.

6. Where calcification takes place bundles of laterally aggregated collagen fibrils are found.
SURFACE ULTRASTRUCTURE OF MATURE ADULT HUMAN ARTICULAR CARTILAGE
Authors: Liverpool G. Meaciiim , Roy S.
Published: February 2018

1. The surface of mature adult human articular cartilage from the knee has been studied by electron microscopy in eleven patients ranging in age from thirty-seven to eighty-three years. The ultrastructural appearance varies from person to person and often from area to area in the same specimen. These variations range from an intact surface to one showing overt fibrillation visible with the light microscope.

2. In areas where the articular surface appears intact the underlying superficial matrix consists of closely packed collagen fibres with only a small amount of interfibrillary ground substance. The collagen fibres show a predominantly tangential orientation in this region of the cartilage. Osmophilic lipidic bodies are sometimes seen in the matrix very close to the joint surface.

3. The appearances under the electron microscope are altered in what is interpreted as an early ultrastructural change in the development of cartilage fibrillation. In the affected areas the collagen fibres show abnormally wide separation by an excessive amount of interfibrillary matrix. Collagen fibres become directly exposed to the joint cavity, and the surface can also show accumulations of finely granular material and sometimes tuft-like projections containing collagen fibres and fine fibrils. At a slightly later stage shallow clefts and steeply sloping curves are apparent at the surface. It is suggested that these various alterations precede the development of overt fibrillation visible under the light microscope.

4. Electron micrographs occasionally show small "blisters" at the articular surface. Electron microscopy has not given evidence of shedding of cells into the joint cavity from non-fibrillated areas of adult human articular cartilage. Cells can, however, sometimes become exposed at the surface in fibrillated areas.
HAEMOPHILIC CYSTS
Authors: Steel W. M. , Duthie R. B. , O'Connor B. T.
Published: February 2018

1. Haemophilic cysts are a rare but serious complication of bleeding ilito the musculo-skeletal system. Five cases are reported.

2. The cysts may arise from bleeding into muscle, under periosteum, or into bone.

3. In early cases conservative treatment by immobilisation and replacement therapy should produce resolution.

4. When alarming increase in size or progressive neurovascular compression occurs, excision of the cyst or amputation should be carried out to prevent the dangerous consequences of rupture, sinus formation or chronic infection.
PSEUDOMALIGNANT OSSEOUS TUMOUR OF SOFT TISSUE
Authors: Angervall L. , Stener B. , Stener I. , Åhrén C.
Published: February 2018

1. Five cases of pseudomalignant osseous tumour of soft tissue are reported.

2. Clinical and histological observations suggest that this lesion is a reactive condition initiated by an infection.

3. Tomography is helpful in demonstrating the characteristic peripheral ossification around non-ossified central regions of the lesion.
CHANGES IN THE CARTILAGE OF THE POSTERIOR INTERVERTEBRAL JOINTS AFFER ANTERIOR FUSION
Authors: Baker W. De c. , Thomas T. Glyn , Kirkaldy-Willis W. H.
Published: February 2018

1. This paper describes the macroscopic and microscopic changes that are seen in posterior intervertebral joints after anterior vertebral fusion.

2. We now have a reasonably clear view of the types of change seen under these circumstances. The type varies from case to case and in different parts of the same specimen. So far we have no clear idea of the sequence or the pattern that leads from the normal to complete fibrosis or osseous ankylosis.

3. Further experimental work is needed in order to build up a clear concept of the sequence of events and of their relative importance. To do this it will be necessary to immobilise joints for longer than before.
ENGINEERING CONSIDERATIONS IN THE INTERNAL FIXATION OF FRACTURES OF THE TIBIAL SHAFT
Authors: Laurence M. , Freeman M. A. R. , Swanson S. A. V.
Published: February 2018

1. The probable greatest bending moment applied to a plated or nailed fracture of the tibia during restricted weight-bearing is estimated to be, in men, up to about 79 Newton metres (58 poundsforce feet). The maximum twisting moment is estimated to be about 29 Newton metres (22 poundsforce feet).

2. Twenty-two human tibiae were loaded in three-point bending and broke at bending moments of from 57·9 to 294 Newton metres (42·7 to 216 poundsforce feet) if they had not previously been drilled; tibiae which had holes made through both cortices with a c. 3-millimetre (⅛-inch) drill broke at from 32·4 to 144 Newton metres (23·8 to 106 poundsforce feet). Tibiae loaded in torsion broke at twisting moments of from 27·5 to 892 Newton metres (20·2 to 65·8 poundsforce feet) when not drilled, 23·6 to 77·5 Newton metres (l7·3 to 57·1 poundsforce feet) when drilled.

3. When bent so as to open the fracture site, the 14-centimetre Stamm was the strongest of all the single plates tested (reaching its elastic limit at a bending moment of 17·6 Newton metres (13 poundsforce feet) and 5 degrees total angulation at 22·6 Newton metres (16·6 poundsforce feet)), while the Venable was the weakest (elastic limit 4·9 Newton metres (3·6 poundsforce feet) and 5 degrees at 7·9 Newton metres (5·8 poundsforce feet)). A 13-millimetre Küntscher nail reached its elastic limit at 42·2 Newton metres (31·1 poundsforce feet) and 5 degrees total angulation at 49 Newton metres (36 poundsforce feet).

4. In torsion the 15-centimetre Hicks was the strongest ofthe plates (elastic limit 27·5 Newton metres (20·2 poundsforce feet) and 5 degrees rotation at 16·7 Newton metres (l2·3 poundsforce feet)).

5. Küntscher nails in bones provided no dependable strength in torsion.

6. In both bending and torsion, a preparation of one Venable plate on each of the two anterior surfaces was stronger than any single plate, and was as strong as the weaker drilled tibiae.

7. The three currently available metallic materials (stainless steel, cobalt-chrome and titanium) have static mechanical properties so similar that the choice between them can be made on other grounds.

8. The highest load applied to a screw during bending tests was about half that needed to pull a screw out of even a thin-walled tibia.

9. Screws beyond four for one plate are mechanically redundant at the moment of implantation but may be necessary as an insurance against subsequent deterioration in strength.

10. Countersinks in plates are a source of significant weakness, and should preferably be as shallow as possible.

11. An unoccupied screw hole in the centre of a plate is a source of serious weakness.

12. Only the strongest implants tested were strong enough to withstand the bending or twisting moments to be expected in restricted weight-bearing. In two-plate preparations a danger is introduced by the fact that these moments are similar to those required to Ireak a drilled tibia.
THE ETIOLOGY OF TRANSIENT SYNOVITIS OF THE HIP IN CHILDHOOD
Authors: Hardinge Kevin
Published: February 2018

A careful study of children with transient synovitis of the hip has failed to establish any connection with infection by staphylococci or streptococci, with allergy, with viral infection and with trauma.
NECROSIS OF ARTICULAR CARTILAGE AFTER SLIPPING OF THE CAPITAL FEMORAL EPIPHYSIS
Authors: Lowe H. G.
Published: February 2018

1. Six cases of necrosis of articular cartilage complicating slipping of the upper femoral epiphysis are reviewed: histological examination in one case showed death of the superficial two-thirds of the articular cartilage, with survival of a layer of basal chondrocytes. In all six cases, after severe initial reduction of joint space as seen radiographically, there was gradual return of joint space, suggesting some regeneration of articular cartilage. The prognosis after cartilage necrosis is therefore not always so bad as has been supposed.

2. Various hypotheses concerning the cause of cartilage necrosis complicating slipped epiphysis are reviewed. The precise cause remains unknown, but there is substantial evidence against its being a consequence of ischaemia of the femoral head.
THE BLOOD SUPPLY OF THE TALUS
Authors: Mulfinger G. L. , Trueta J.
Published: February 2018

1. The intraosseous and extraosseous circulation of the talus was examined in thirty necropsy specimens.

2. The blood supply to the talus is quite diffuse and arises from the three major arteries of the lower leg.

3. The common patterns of circulation, as well as the variations, have been documented.
EPIPHYSIAL CHONDROBLASTOMA OF BONE
Authors: Schajowicz Fritz , Gallardo Hector
Published: February 2018

1. A clinical, radiological and pathological study of sixty-nine cases of epiphysial chondroblastoma has been made.

2. The nature of the tumour is discussed and its clinical and radiographic features are described. A special type is described, for which the name "cystic chondroblastoma" is suggested.

3. The results of treatment are described and the generally benign behaviourof the lesion is noted.

4. The occurrence of malignant change is noted and discussed.
MYOSITIS OSSIFICANS CIRCUMSCRIPTA
Authors: Paterson Dennis C.
Published: February 2018

1. Four cases of myositis ossificans circumscripta are presented.

2. It remains an obscure condition but there are characteristic clinical, radiological and microscopical features.

3. While the majority of cases arise as a direct result of injury, these four cases suggest that this is not always so ; the diagnosis from osteosarcoma, bone or joint infection may then be difficult.

4. Noble's classification (1924) of myositis ossificans is adequate and should be accepted. Confusion would be avoided if cases such as those presented here were included in the classification suggested.
ARTHROGRAPHY OF THE ANKLE
Authors: Mehrez M. , Geneidy S. El
Published: February 2018

1. The appearance of arthrographs of healthy and of injured ankles are described on the basis of experimental and clinical studies.

2. Arthrographic appearances have been correlated with findings at operation.

3. Arthrography is a valuable method of investigation for the accurate diagnosis of injuries about the ankle.
THE REACTION OF BONE TO SELF-CURING ACRYLIC CEMENT
Authors: Charnley John
Published: February 2018

1. A general picture of the histological state of the bone-cement junction, up to seven years after implantation, is presented as a result of the study of twenty-three human specimens.

2. The transmission of load from cement to bone occurs at isolated points through the medium of newly formed fibrocartilage.

3. It is clear that this fibrocartilage has been produced in response to mechanical pressure on fibrous tissue which has undergone compression between cement and underlying bone.

4. Direct contact exists between the surface of the cement and the newly formed fibrocartilage at these sites of load transmission.

5. Load-bearing fibrocartilage frequently shows areas of ossification extending into it from the underlying bone.

6. Where soft tissues in contact with cement are too thick or too delicate for load transmission a thin layer of giant-cell cytoplasm coats the cement surface.

7. No collections of giant cells to form granulomatous or caseating areas have been seen.

8. Fat storage, indicating the absence of chemical irritation, can occur within ten microns of the cement surface.
DIRECT REPAIR OF THE DEFECT IN SPONDYLOLISTHESIS
Authors: Buck J. E.
Published: February 2018

A method of repairing the defect in spondylolisthesis by internal fixation with screws and bone grafting is described. Sixteen patients have been operated upon with only one failure. In two cases the spine was re-explored for incidental complications and the defect was found to have fused solidly.
FUNDAMENTAL PRIORITIES IN POLLICISATION
Authors: White W. F.
Published: February 2018

1. A small series of fourteen pollicisations has been studied.

2. The keyword, so far as the operation is concerned, has been simplicity.

3. It has been appreciated that a transposed finger can never become a thumb, and it may not be wise to strive too har1d by means of transplants to emulate the perfection of the normal thumb, especially if this is done at the expense of one of the fundamental priorities.

4. Nevertheless, if sensibility, good position and proximal stability are achieved, pollicisation can provide a useful addition to hand function and a reasonably satisfactory appearance.
OSTEOTOMY FOR UNREDUCED CONGENITAL DISLOCATION OF THE HIP IN ADULTS
Authors: Henderson R. S.
Published: February 2018

1. In unreduced congenital dislocation of the hip in adults, causing severe symptoms, it seems that there is a place for a calculated abduction type of femoral osteotomy, which should "defunction" a painful false joint. Care should be taken to avoid excessive angulation, which may lead to painful symptoms from contact of the osteotomy apex to the area of the true acetabulum. Genu valgum and lateral rotation deformity are complications, as is failure of union at the osteotomy site.

2. A series of eleven hips in seven patients is reported, in which such an abduction type of osteotomy has been done. Six of these hips have been highly satisfactory. Three have required subsequent operations to correct deformity. Only one has ended up with arthrodesis. In three, results have been only fair. The use of a reversed nail-plate to secure internal fixation is described.
THIEMANN'S DISEASE
Authors: Cullen J. C.
Published: February 2018

Two brothers with osteochondrosis of the phalangeal epiphyses in the hand (Thiemann's disease) are described and the condition discussed.
EXERCISE ISCHAEMIA IN THE FASCIAL COMPARTMENT OF SOLEUS
Authors: Kirby N. G.
Published: February 2018

1. A bilateral case of chronic intermittent ischaemia of the soleus muscle within its fascial compartment is described in a dental surgeon aged twenty-seven.

2. Symptoms were promptly relieved by decompression.

3. The mechanism of the condition is compared with that of the anterior tibial syndrome.
ANOMALOUS MUSCLE BELLY OF THE FLEXOR DIGITORUM SUPERFICIALIS
Authors: Vichare N. A.
Published: February 2018

1. An anomalous muscle belly of flexor digitorum superficialis (sublimis) presenting as an aching swelling and simulating a ganglion is reported.

2. It is suggested that this could be an atavastic muscle belly of flexor digitorum superficialis.
IMMATURE JOINT CARTILAGE AND THE HOMOGRAFT REACTION
Authors: McKibbin B.
Published: February 2018

1. Grafts of joint cartilage from immature lambs were used to repair articular cartilage defects in other lambs and in adult sheep.

2. Stability of these grafts in a functional state was found in most for periods up to fourteen months. Although a limited homograft reaction occurred this did not lead to destruction of the cartilage, even though parts of it were well vascularised.

3. The results suggest that the process of endochondral ossification is associated with the liberation of antigenic material leading to sensitisation of the host. Destruction ofthe cartilage is prevented by an inhibitory action which the matrix appears to exert on the destructive elements themselves and which is itself dependent on the vitality of the chondrocytes.

4. The avascularity of cartilage is not a sufficient explanation for its privileged position in relation to the homograft reaction.
THE NATURAL HISTORY OF PERTHES' DISEASE
Authors: Catterall A.
Published: February 2018

1. Eighty-nine cases of Perthes' disease are reviewed.

2. The prognosis varies with the amount of the epiphysis involved.

3. It is possible to assess the amount of epiphysial involvement by a study of the early radiographs. Cases were allocated to four groups on this basis.

4. It is confirmed that both sex and age at the time of diagnosis influence the final prognosis. The reasons for this are discussed.

5. The concept of "the head at risk" is suggested and radiological signs described to diagnose such cases.

6. It is hoped that the classification suggested may in future act as a basis for comparisons of treatment.
THE ABDUCTION WEIGHT-BEARING TREATMENT IN LEGG-PERTHES' DISEASE
Authors: Petrie J. Gordon , Bitenc Igor
Published: February 2018

1. The duration of Legg-Perthes' disease seems somewhat shortened by abduction weightbearing plaster treatnlent. The average age of onset of our sixty patients at the start of this treatment was seven years nine months. The patients were treated in abduction plasters for an average of nineteen months.

2. The contour of the femoral head in relation to the acetabulum is better preserved than after our previous methods of treatment. We have evaluated our cases by the method of Mose, by the epiphysial index of Eyre-Brook and the epiphysial quotient of Sjovall, and by the centre/edge angle of Wiberg.

3. There was no undue influence on the growing epiphysis and no evidence of ligamentous strain.

4. With this type of protected weight-bearing, the patients were kept active when both hips were affected.

5. No patient with unilateral disease showed Legg-Perthes' changes on the opposite side while under treatment or at follow-up.

6. The children were able to be at home and to attend school.
OSTEOGENESIS IMPERFECTA
Authors: King John D. , Bobechko Walter P.
Published: February 2018

1. Osteogenesis imperfecta is characterised by osseous fragility. Patients with the "congenita" form have multiple fractures before birth; those with the "tarda" form have osteoporosis, and develop multiple fractures and milder deformities of long bones at varying times after birth.

2. The frequency of blue sclera, dentinogenesis imperfecta, bruising, ligamentous laxity, and deafness are recorded in sixty patients seen at the Hospital for Sick Children, Toronto, from 1949 to 1969. The major orthopaedic deformities of long bones were antero-lateral bowing of femur and anterior bowing (sabre shin) of tibia.

3. The incidence of scoliosis (40 per cent) is high in osteogenesis imperfecta. Two patients, one in Toronto and one in Seattle, have had Harrington instrumentation and fusion for this.

4. Fractures were commonest in the femur and tibia and few in the cervical spine and femoral neck. There were four cases of disturbing hyperplastic callus formation.

5. Twenty-one patients were operated on for long bone deformities and recurrent fractures by the Sofield technique. Despite extensive subperiosteal dissection non-union is rare (four cases). Fourteen of twenty-one patients so treated are able to walk, with or without assistance. Surgical intervention to both correct and prevent deformities is justified.

6. Patients with osteogenesis imperfecta compensated for their disability by reasonable academic achievement and by choosing a sedentary occupation.
THE PLACE OF CLOSED MANIPULATION IN THE MANAGEMENT OF FLEXION-ROTATION DISLOCATIONS OF THE CERVICAL SPINE
Authors: Burke David C. , Berryman Douglas
Published: February 2018

1. The pathology and pathogenesis of dislocations and fracture-dislocations of the cervical spine has been reviewed.

2. A method of treatment using skeletal traction and manipulation under relaxant general anaesthesia is described. Results of treatment are given for all patients admitted to the Centre with flexion-rotation dislocations of the cervical spine complicated by neurological lesions, between November 1961 and December 1968.

3. After reviewing the literature and considering the results obtained in seventy-six cases, we advocate a policy of conservative management with gentle manipulation of the cervical spine in selected cases, reduction being maintained thereafter by skeletal traction. We reserve operation for the few cases that demonstrate late instability or for those rarer cases in which manipulation fails and the patient has either an incomplete neurological lesion or a double skeletal injury.

4. The low incidence of late instability after adequate conservative treatment is stressed, and the danger of overdistraction of the cervical spine by heavy traction in patients with severe ligamentous damage is emphasised.
HALO PELVIC TRACTION
Authors: O'Brien John P. , Yau Arthur C. M. C. , Smith Taylor K. , Hodgson Arthur R.
Published: February 2018

Halo pelvic traction, a method of correcting the deformed spine, is discussed and experience with treatment of our first twenty-five patients presented.
CONGENITAL SPLIT FOOT (LOBSTER CLAW) AND TRIPHALANGEAL THUMB
Authors: Phillips R. S.
Published: February 2018

1. The pedigree of a family in which lobster claw foot and triphalangeal thumb occurred together is presented. The affected members of two generations are described. The clinical appearances and radiological abnormalities are described in detail. Results of surgical treatment of the forefoot cleft are presented.

2. Lobster clawing of the foot is discussed with particular reference to associated hand and finger abnormalities. Triphalangeal thumb is discussed. The current and probably acceptable theory of the etiology of duplication is expanded. A hypothesis is formulated of excessive activity at the pre-and post-axial borders of the distal limb bud, followed by variable resorption, to explain not only the cause of lobster claw foot but also its occurrence in association with triphalangeal thumb.
PAPAIN-INDUCED DEGENERATIVE ARTHRITIS OF THE HIP IN RABBITS
Authors: Bentley George
Published: February 2018

1. Degenerative arthritis has been produced consistently in adult rabbits by the injection of the proteolytic plant enzyme papain into the hip joint. Arthritic changes were recognisable radiographically after six weeks.

2. A progression of changes occurred, from loss of acid mucopolysaccharide staining in the matrix, fibrillation, fissuring and erosion of articular cartilage with death of chondrocytes in the weight-bearing areas, to secondary bony changes of subchondral sclerosis, occasional cysts and osteophyte formation.

3. Synovial inflammation occurred with accumulation of cartilage and bone debris in the inferior capsule and later capsular thickening.

4. It is suggested that this arthritis is sufficiently similar to human osteoarthritis to be useful as a model for further studies of the pathogenesis of the disease and the effects of different methods of treatment.
DESTRUCTIVE JOINT CHANGES FOLLOWING KIDNEY TRANSPLANTATION
Authors: Aichroth Paul , Branfoot A. C. , Huskisson E. C. , Loughridge Lavinia W.
Published: February 2018

1. Destructive changes in a knee joint, eventually requiring arthrodesis, are reported in a patient who had undergone renal transplantation.

2. The underlying pathology was avascular necrosis with separation of large osteochondral fragments.

3. The pathogenesis is discussed.
THE LONG-TERM EFFECTS OF WIDE LAMINECTOMY FOR LUMBAR DISC EXCISION
Authors: Jackson R. K.
Published: February 2018

1. The results of wide laminectomy of the fifth lumbar vertebra and disc excision in 132 patients are reviewed and compared with some published results of the interlaminar operation.

2. There was no significant difference in either the immediate or the long-term results of the two operations suggesting that post-operative morbidity was not related to operative technique.

3. The incidence of post-operative back pain was found to increase with age at operation, duration of pre-operative symptoms and length of follow-up, and supported the impression that backache is predominantly a feature of the underlying degenerative process rather than the incidental operation.

4. The significance of recurrent disc lesions is discussed. Recurrence usually occurred at the previously cleared disc space and was thought to indicate incomplete degeneration of the disc at the time of the original operation.

5. The place of fusion combined with disc excision is discussed. No reliable indications for coincident fusion were found in this series.

6. The value of radiography is discussed. Plain radiographs were essential before operation to exclude other causes of backache and sciatica; otherwise they were of little value. Motion radiographs were no more helpful and myelography was used only when the level of the lesion was in doubt.

7. The risk of an acute cauda equina lesion following manipulation of a prolapsed lumbar disc is noted and the danger of manipulation, unless facilities for emergency surgery are available, is stressed.
ANTERIOR TRANSPERITONEAL LUMBAR FUSION
Authors: Freebody D. , Bendall R. , Taylor R. D.
Published: February 2018

1. Anterior transperitoneal lumbar fusion is a successful method of stabilising painful mechanical derangements which have not responded to the usual conservative measures.

2. The operation in this series was done mainly for backache; it should not be contemplated if there is definite evidence of nerve root compression, because sequestrated disc material cannot be removed from the spinal canal from the anterior route.

3. Careful technique has resulted in few complications attributable to the operation.

4. This method is sometimes thought to be inapplicable in cases of spondylolisthesis with a displacement of more than one-third. However, in this series we have seen the block type of graft used with a good measure of clinical and radiological success.

5. There is no doubt that for those patients who have had previous unsuccessful laminectomies or posterior fusions anterior interbody fusion offers an excellent prospect of recovery.
THE TREATMENT OF METATARSALGIA WITH HALLUX VALGUS
Authors: Raymakers R. , Waugh W.
Published: February 2018

1. Arthrodesis of the first metatarso-phalangeal joint combined with excision of those lesser metatarsal heads with fixed subluxation and painful callosities is an excellent treatment for painful hallux valgus with metatarsalgia.

2. A series of thirty feet in twenty-five patients is reported in which this combined operation was done.
"PSEUDORHEUMATOID" NODULES IN CHILDREN
Authors: Pournaras John , Gibson A. A. M.
Published: February 2018

1. Thirteen cases of "pseudorheumatoid" nodules are presented. Eight of these have been observed for three months to eleven years.

2. Histologically the nodules were identical to those that may be associated with rheumatoid arthritis or rheumatic fever.

3. No evidence of systemic disease was found.

4. The etiology is not clear but the prognosis is good.
ARTHROGRAPHY IN RECENT INJURIES OF THE LIGAMENTS OF THE ANKLE
Authors: Fordyce A. J. W. , Horn C. V.
Published: February 2018

1. A series of patients with recent ligamentous injuries of the ankle is presented. Stress radiography and arthrography were carried out in all cases, with surgical exploration where indicated. The findings are correlated.

2. Both stress radiography and arthrography are unreliable in the diagnosis of injuries to the "lateral ligament" of the ankle.

3. Arthrography may be useful in the demonstration of injury of the inferior tibio-fibular joint and of the medial ligament.
UNUSUAL COMPLICATIONS OF SKULL CALIPER TRACTION
Authors: Weisl H.
Published: February 2018

1. The insertion of skull calipers is not generally known to be associated with any morbidity or mortality.

2. In the past six years the details of three fatal complications have been collected: there was one case each of cerebral abscess, subdural abscess and extradural abscess.

3. Brief notes of eleven other similar cases, five of cerebral abscess and six of osteomyelitis of the skull, have been supplied by colleagues.

4. The implications of these findings are discussed.
A POST-NATAL SURVEY FOR CONGENITAL DISPLACEMENT OF THE HIP
Authors: Wilkinson J. A.
Published: February 2018

1. There is an increasing prevalence in the evidence of prenatal extended knee postures in the legs of newborn, from normal births to breech deliveries and to babies with hip displacements. The extended knee postures are also commoner in female births.

2. Babies with reducible hip displacements appear to be born more often in summer as the result of winter conceptions. Spontaneous recovery is very high, with or without splintage.

3. Irreducible hip displacement does not respond to splintage during the first six months of life. Even with adductor tenotomy, there is a great risk of acetabular and femoral epiphysial damage. This is thought to be due to incarceration of the limbus, present at birth.
TOTAL REPLACEMENT ARTHROPLASTY OF THE ELBOW FOR RHEUMATOID ARTHRITIS
Authors: Dee Roger
Published: February 2018

1. A chrome-cobalt hinged prosthesis has been specially designed for total replacement of elbow joints disorganised by rheumatoid arthritis, and has been used in twelve patients over the last two years.

2. The technique of insertion includes fixation of the two main portions in the humerus and in the ulna by acrylic cement before they are joined by an axis pin.

3. Ten of the twelve patients obtained 90 degrees or more of painless movement and good muscle control of the artificial joint.

4. The results to date suggest that the prosthesis and surgical technique have a wider application than for rheumatoid arthritis.
THE RIB-VERTEBRA ANGLE IN THE EARLY DIAGNOSIS BETWEEN RESOLVING AND PROGRESSIVE INFANTILE SCOLIOSIS
Authors: Mehta M. H.
Published: February 2018

1. A study of serial radiographs of 138 children with infantile scoliosis starting under the age of two years has resulted in a method of early differentiation between resolving and progressive curves.

2. The method involves careful measurement of the rib-vertebra angles at the apex of the curve and observation of the relationship of the head of the rib to the body of the vertebra as seen in antero-posterior radiographs.

3. The influence of the infantile growth spurt upon progressive curves is examined and the importance of early diagnosis and treatment is stressed.
THE USE OF THE HEMIARTHROPLASTY PROSTHESIS FOR ADVANCED OSTEOARTHRITIS AND RHEUMATOID ARTHRITIS OF THE KNEE
Authors: MacIntosh D. L. , Hunter G. A.
Published: February 2018

1. Hemiarthroplasty is a method of dealing with painful deformities of advanced osteoarthritis and rheumatoid arthritis of the knee.

2. The indications and contra-indications for this procedure are discussed. Careful selection of patients is essential.

3. The technique of operation and management after operation are described.

4. The results of such a procedure, as done by one surgeon, are given. Good results have been obtained in 80 per cent of the osteoarthritic knees and in 69 per cent of the rheumatoid knees.

5. The complications, place of associated operations and value of revision procedures are discussed.
EQUINUS DEFORMITY IN CEREBRAL PALSY
Authors: Sharrard W. J. W. , Bernstein S.
Published: February 2018

1. Correction of equinus deformity in cerebral palsy either by elongation of the tendo calcaneus or by gastrocnemius recession gives satisfactory results without splintage or bracing after operation.

2. Gastrocnemius recession is the operation of choice in paraplegic spastic cerebral palsy, and wherever possible in tetraplegic cerebral palsy. In hemiplegia the whole of the triceps surae is usually involved, and elongation of the tendo calcaneus is almost always needed.

3. Correction at operation should aim to result in a mild degree of equinus deformity at the end of the growth period in hemiplegic spastic cerebral palsy. Over-enthusiastic gastrocnemius recession can lead to excessive weakness of the calf in some patients.
RADIOISOTOPE KNEE JOINT SCANS IN HAEMOPHILIA AND CHRISTMAS DISEASE
Authors: Forbes Charles D. , Greig William R. , Prentice Colin R. M. , McNicol George P.
Published: February 2018

1. in thirty-five patients, twenty-eight with classical haemophilia and seven with Christmas disease, arthropathy of the knee of various grades has been investigated by radioisotope scanning after intravenous injection of technetium, 99mTc.

2. The abnormality of the colour scan particularly matches the clinical severity in acute haemarthrosis.

3. In patients with no clinically apparent joint disease the scan may be of value in the early detection of involvement.

4. The possible value of articular scanning in the selection of patients for treatment and in the assessment of the short and long term results is discussed.
THE SIGNIFICANCE OF THE SUBSCAPULARIS MUSCLE IN THE PATHOGENESIS OF RECURRENT ANTERIOR DISLOCATION OF THE SHOULDER
Authors: Symeonides Pan. P.
Published: February 2018

1. The pathogenesis of recurrent anterior dislocation of the shoulder has been studied at operation and by experiments on cadavers.

2. Lesions of the subscapularis muscle leading to lengthening and laxity have been demonstrated.

3. This lengthening is the prime factor in producing instability of the shoulder; capsular and bony defects are no more than subsidiary causes.

4. Good results have been obtained by a procedure based on this theory of etiology.
INTRA-ARTICULAR GANGLION OF THE KNEE
Authors: Muckle David S. , Monahan Patrick
Published: February 2018

Two cases of ganglion arising in the alar folds of the infrapatellar fat pad are reported. Both patients had symptoms of internal derangement of the knee, sufficient to justify operation.
BILATERAL CONGENITAL CONTRACTURE OF THE ILIO-TIBIAL TRACT
Authors: Mehta M. H.
Published: February 2018

1. A case is described of bilateral congenital contracture of the ilio-tibial bands in a healthy girl of ten months.

2. With the hips extended each lower limb was held in about 25 degrees of fixed abduction.

3. Division of the ilio-tibial bands abolished the abduction contractures.
ENZYMES IN FIBROBLASTIC LESIONS
Authors: Jeffree Grace M.
Published: February 2018

1. Histochemical staining and correlated biochemical estimations of five hydrolytic enzymes were done on eighteen benign and twenty malignant fibroblastic lesions of bone and soft tissue.

2. Alkaline phosphatase activity was moderate in a fibroma and very high in fibrous dysplasia. In a typical fibrosarcoma the fibroblasts showed no enzyme activity and estimations were low. Exceptions indicated an osteogenic potential in the tumour.

3. ß-glucuronidase, leucine aminopeptidase, and to a less extent non-specific esterase, were more active in malignant than in benign lesions, and the highest activities were found in sarcomata arising in Paget's disease of bone.

4. Acid phosphatase showed no correlation with malignancy and was generally unremarkable except for high activity in osteoclasts, but was raised in two sarcomata that occurred after irradiation of giant-cell tumours.

5. A non-osteogenic fibroma and a fibrous cortical defect, though poorly represented in this series, are not uncommon; they sometimes lead to pathological fracture, but sarcoma is very rare in such lesions. They tend to show more alkaline phosphatase than fibrosarcoma but not the very high activity of fibrous dysplasia, which is related to its osteogenic potential.

6. Fibrous dysplasia most often presents in the five to fifteen age group but seldom leads to malignancy, though this may occur, usually as osteosarcoma, which has a similar high content of alkaline phosphatase. Fibrosarcoma is typically negative or very weak in this enzyme: the exceptional cases with high activity were tumours which were in part osteosarcoma. Generally the demonstration of high alkaline phosphatase activity in a fibroblastic lesion of bone, in the absence of trauma or inflammation, suggests the diagnosis of fibrous dysplasia.
LATE FRACTURE OF THE ACETABULUM AFFER TOTAL HIP REPLACEMENT
Authors: Miller A. J.
Published: February 2018

1. Nine cases of stress fracture of the pelvis after total hip replacement are reported, five after Ring replacement and four after a McKee. In none of the cases did the fractures unite.

2. In three cases infection was probably an important cause of the fracture. In six cases there was no infection. Only one presented a history of injury.

3. The combination of the various factors that might have caused the stress fractures is discussed.
ILIO-FEMORAL VENOUS THROMBOSIS AFTER OPERATIONS ON THE HIP
Authors: Darke S. G.
Published: February 2018

1. In a prospective controlled trial in patients undergoing hip operations, six out of thirty-three patients receiving prophylactic Dextran 70, and five out of thirty-three patients receiving only dextrose, were shown by ascending phlebography to have ilio-femoral thrombosis. Oedema was the only consistent clinical finding.

2. This study does not therefore support the conclusion of other reports that Dextran 70 is of value in preventing ilio-femoral thrombosis after operations on the hip joint.

3. It is suggested that patients needing operation on the hip joint are especially prone to major vein thrombosis and it may be that higher dosage of Dextran 70 is indicated.

4. This controlled investigation of sixty-six patients, now submitted as a preliminary report, is continuing.
THE EFFECT OF INJECTION OF HYDROCORTISONE INTO RABBIT CALCANEAL TENDONS
Authors: Balasubramaniam P. , Prathap K.
Published: February 2018

This experiment demonstrates that infiltration of hydrocortisone into rabbit calcaneal tendons has a direct effect on the tendon, producing necrosis of collagen at the site of injection. The repair of the lesion so produced is incomplete even after eight weeks, and is often complicated by dystrophic calcification. Similar morphological changes may account for spontaneous rupture of tendons in patients receiving steroid infiltration.
POST-RADIATION SARCOMA IN ANKYLOSING SPONDYLITIS
Authors: Edgar M. A. , Robinson M. P.
Published: February 2018

1. Five cases of fibrosarcoma arising after radiotherapy in cases of ankylosing spondylitis are reported.

2. The relationship of the tumours to irradiation is discussed.

3. Objective neurological signs arising in the lower limbs of patients with ankylosing spondylitis after a latent period following radiotherapy may indicate an underlying sarcoma.
THE INFLUENCE OF CORTICOSTEROIDS ON NORMAL AND PAPAIN-TREATED ARTICULAR CARTILAGE IN THE RABBIT
Authors: Shaw N. E. , Lacey Eve
Published: February 2018

1. Because of the controversy over the clinical effects of corticosteroids on joint tissues a series of experiments on the knee joints of rabbits was undertaken.

2. The articular cartilage of the distal femoral epiphyses of normalcontrols has been compared with that of rabbits treated daily either with cortisone or with methyl prednisolone systemically or by intra-articular injections.

3. The changes caused by intravenous papain and their subsequent recovery have been described, and the adverse effect of corticosteroids on recovery has been assessed.

4. The biological mechanisms involved are discussed, and as a result caution is urged in the administration of corticosteroids in the presence of progressive degenerative joint disease.
SACRAL EXTRADURAL CYSTS
Authors: Crellin R. Q. , Jones E. R.
Published: February 2018

1. Seven cases of sacral extradural cyst are reported.

2. The etiology and clinical features are discussed and the literature reviewed.

3. The differential diagnosis is discussed; certain features, useful in making the diagnosis of sacral extradural cysts, are recorded.

4. When a cyst causes symptoms excision brings relief. Because some cysts are symptomless, it is important to exclude an accompanying prolapsed intervertebral disc.