bluuebunny/crossref_metadata_2025 huggingface dataset:
DISLOCATION OF THE SHOULDER COMPLICATED BY RUPTURE OF THE AXILLARY VESSELS
Authors: Kirker James R.
Published: February 2018

1. A case is reported of traumatic dislocation of the shoulder joint complicated by rupture of the axillary artery and vein and complete brachial plexus palsy. Whether the rupture occurred at the time of injury or during reduction is not known.

2. Despite a delay of five weeks before operative treatment was undertaken the usefulness of the arm was preserved.

3. After rupture of the axillary artery at this level an adequate collateral circulation is rapidly established in a healthy young adult.

4. The case illustrates the importance of careful examination of the peripheral nervous and vascular systems before and after reduction of a dislocated shoulder.
SPONTANEOUS FRACTURES OF BOTH FIRST RIBS
Authors: Jenkins S. Aubrey
Published: February 2018

1. A case of spontaneous fracture of a first rib is described.

2. Its evolution from a previously intact rib through the stage of a "linear" crack to pseudarthrosis has been traced.

3. An older pseudarthrosis was present on the opposite side.

4. Alderson's observation is confirmedâthat the breach in the rib is acquired. There is no need to suppose a developmental anomaly of ossification, even in a bilateral case.
TECHNIQUE AND RESULTS WITH THE ACRYLIC FEMORAL HEAD PROSTHESIS
Authors: Robert  , Judet Jean
Published: February 2018

At the end of this short study we have to sum up our views about the use of the acrylic prosthesis for arthroplasty of the hip. Some fatalities and a proportion of bad or poor results make this operation one to be undertaken only by surgeons well trained in the surgery of the hip and only on patients who really need it. However, the tolerance of the tissues to acrylic resin and the fixation of the stem in the neck of the femur promise to be lasting. We know that a much longer time is necessary to confirm these general statements, which proceed from an experience of only five years and the study of six hundred cases.
THE ROLE OF THE FIRST RIB IN THE SCALENUS ANTERIOR SYNDROME
Authors: Williams A. F.
Published: February 2018

1. Dissections have been made of the cervico-brachial region.

2. The possible causes of the scalenus anterior syndrome are discussed and an attempt is made to relate them to the anatomical findings.

3. It is suggested that a more suitable description is the "first rib syndrome," and that the most logical treatment is to remove part of the offending first rib.
RICKETS AND OSTEOMALACIA FROM RENAL TUBULE DEFECTS
Authors: Dent C. E.
Published: February 2018

1. Cases of rickets and osteomalacia caused by kidney tubule defects have been classified into six sub-groups according to the various disturbances of tubule function concerned.

2. The manifestations, treatment and prognosis appropriate to the sub-groups have been considered.

3. The name "tubular rickets" (or osteomalacia) is suggested for these cases of mainly tubule dysfunction in contrast to "glomerular rickets" (or osteomalacia) which might be used to distinguish cases in which defect in the glomeruli overshadows and precedes that in the tubules.
CHANGES IN THE HEAD OF THE FEMUR IN CHILDREN SUFFERING FROM GAUCHER'S DISEASE
Authors: Todd R. McL. , Keidan S. E.
Published: February 2018

1. Two children suffering from Gaucher's disease, who developed changes in the femoral head typical of Perthes' disease, are reported. Similar changes have been recorded in the literature in seventeen children under the age of fifteen years.

2. The possible factors giving rise to the bone changes are discussed and it is considered that they result from aseptic necrosis. Splenectomy does not appear to hasten the development of bone changes in this disease.

3. In one of the patients, the blood Wassermann reaction was positive, but syphilis was not thought to play any part in the production of the bone changes.
THE EFFECT OF DENERVATION ON THE REGENERATION OF SKELETAL MUSCLE AFTER INJURY
Authors: Saunders J. H. , Sissons H. A.
Published: February 2018

1 . The repair of a simple crush injury was studied in rats, in both normally innervated and completely denervated muscle. In each case the histological findings at periods from two hours to thirty-two weeks are described.

2. The denervated muscle showed active and effective repair.

3. A comparison with the findings in normally innervated muscle establishes that the cellular processes of repair do not depend on connections with the central nervous system.
THE EFFECT OF CORTISONE ON THE REGENERATION OF SKELETAL MUSCLE AFTER INJURY
Authors: Sissons H. A. , Hadfield G. J.
Published: February 2018

The effect of cortisone on the repair of simple muscle injury was studied in rabbits. The histological findings in the crushed muscle are described for a period up to twenty-one days after injury.

Cortisone defers the onset of muscle regeneration, and retards its progress, but it does not change the course of the repair process or alter its eventual outcome under the conditions of the experiment.

This apparent refractoriness of repair of muscle, as compared with that of other connective tissues, is discussed.
THE PLACE OF EXTERNAL IRRADIATION IN THE TREATMENT OF OSTEOGENIC SARCOMA
Authors: Tudway R. C.
Published: February 2018

The foregoing suggestions may be summarised in the following recommendations for the treatment of osteogenic sarcoma.

1. Deep x-ray therapy in high dosage, followed by local resection, should be given serious trial especially: 1) in the upper limb; 2) in the group with atypical clinical or radiographic signs, or histology resembling that of inflammatory lesions; 3) with Grade I histology; and 4) in the young.

2. Deep x-ray therapy followed at once by amputation should be used for osteogenic sarcoma if : 1) local resection would leave a lower limb more unstable than an artificial leg ; or 2) if response to x-rays is poor.

3. Deep x-ray therapy alone should be used: 1) if the patient is unsuitable for, or refuses, any operation ; and 2) palliatively, if metastases are present or the tumour is too advanced, or the patient is not fit for radical treatment.

4. Amputation alone should be used palliatively, for pain or fungation, when x-ray therapy has failed to relieve, or is not readily obtainable.

5. Biopsy and histological grading must be performed in every case. A histological diagnosis is most important. Coley (1949) and MacDonald and Budd (1943) support this view.

6. The records of every possible case should be sent to and discussed by a group with special experience of these tumours.
A RECONSIDERATION OF CUP ARTHROPLASTY OF THE HIP
Authors: Adams J. Crawford
Published: February 2018

1. The unreliable results of the conventional cup arthroplasty are attributed to mechanical imperfections in the reconstructed joint.

2. If its reliability can be improved, there will remain a place for cup arthroplasty, which, in relatively young and active patients, offers advantages over prosthetic replacement arthroplasty.

3. A technique of concentric cup arthroplasty is described. The new joint is shaped with precision to exact dimensions and lined with a cup designed to ensure stability, concentric movement and a uniform clearance between the moving parts.

4. The results so far are encouraging and justify continued clinical trial.
SYNOVECTOMY AND CURETTAGE IN THE TREATMENT OF TUBERCULOSIS OF JOINTS
Authors: Wilkinson M. C.
Published: February 2018

1. Experience in the treatment of tuberculous disease of the spine, hip and knee by combined constitutional, antibiotic and operative measures is described.

2. In patients with tuberculosis of the spine, especially in the thoracic region and when perispinal abscess formation is a prominent feature, the treatment helps to ensure stable ankylosis in the type of case in which it otherwise might not occur.

3. In children with tuberculosis of the hip and in adults and children with tuberculosis of the knee it is usually possible to save the joint and to restore function, provided the joint has not been destroyed before treatment is begun.
CALCIFYING ENCHONDROMA OF LONG BONES
Authors: Laurence W. , Franklin E. L.
Published: February 2018

1. Five cases of calcified enchondroma are described. In all except one the condition was symptomless and was discovered accidentally.

2. The radiographic features are described and the differential diagnosis is discussed.

3. It is emphasised that when the diagnosis is in doubt biopsy should be undertaken.
POPLITEAL ANEURYSM AFTER LATERAL MENISCECTOMY
Authors: Hooper R. S. , Spring W. Emmet
Published: February 2018

1. A case of traumatic aneurysm in the popliteal fossa after a lateral meniscectomy is described.

2. Relevant factors in the surgical anatomy of the inferior genicular artery are discussed.

3. The value and limitations of angiography of the popliteal artery are considered.

4. Treatment is governed by the degree of involvement of the popliteal artery. In the case described cure of the aneurysm was obtained by endo-aneurysmorrhaphy.
PRIMARY FUSION OF THE POSTERIOR SUBTALAR JOINT IN THE TREATMENT OF FRACTURES OF THE CALCANEUM
Authors: Dick Ian Lawson
Published: February 2018

1 . A small series of fractures of the calcaneum with distortion of the subtalar joint has been reviewed.

2. All were treated by subtalar fusion, in most as part of the primary treatment.

3. In all patients the subtalar joint fused by bone without post-operative plaster immobilisation.

4. Plaster immobilisation is not only unnecessary, it is undesirable.

5. Heavy work, including work on ladders and scaffolding, can be undertaken after subtalar fusion.
THE BLOOD SUPPLY OF THE FEMORAL SHAFT
Authors: Laing P. Gowans
Published: February 2018

1. Previous investigations into the blood supply of the femoral shaft are reviewed.

2. Details of the blood supply of the shaft of the femur in seventeen children under one year of age, and in ten adults, are given.

3. These findings are discussed with special reference to the fate of the femoral shaft after fracture or operation.
EARLY TREATMENT OF PARAPLEGIA FROM FRACTURES OF THE THORACO-LUMBAR SPINE
Authors: Holdsworth F. W. , Hardy Alan
Published: February 2018

1. Paraplegia from fracture-dislocation at the thoraco-lumbar junction is a mixed cord and root injury. The root damage can be distinguished from cord damage by neurological examination and by comparison of the neurological level with the fracture level.

2. Even though the cord injury is complete, as it usually is, the roots often escape or recover.

3. Fracture-dislocations can be divided into stable and unstable types. Because of the possibility of root recovery care must be taken to prevent further damage to the roots by manipulation of the spine or during treatment. For this reason unstable fracture-dislocations are fixed internally by plates.

4. Internal fixation also assists in the nursing of the patient. The nursing technique and the care of the bladder are described.
TUBERCULOSIS OF THE ELBOW
Authors: Wilson J. N.
Published: February 2018

1. Thirty-one cases of tuberculosis of the elbow have been reviewed and the general characters of the disease described.

2. The condition is classified into four types distinguishable radiologically.

3. Treatment is predominantly conservative. Operation is sometimes indicated for extra-articular lesions. Arthrodesis is advisable in selected cases but it is not essential for healing.

4. Of twenty patients observed for five years or more, seventeen returned to work, seven required permanent splintage and five had residual pain or sinuses.

5. It is suggested that the best position for fixation of the elbow is 30 degrees below the right angle.
CONGENITAL KYPHOSIS
Authors: Bingold A. C.
Published: February 2018

1. Three cases of congenital kyphosis at or near the thoraco-lumbar junction are reported.

2. The features of the deformity are discussed.
THE BONE CYSTS OF OSTEOARTHRITIS
Authors: Landells J. W.
Published: February 2018

1. The bone cysts of osteoarthritis are found in relation to defects in the watertight layer between the joint space and the cancellous bone; these defects are sometimes obvious openings, but more often they are openings closed by fibrous tissue, fibrocartilage or new bone. The small cysts lie close to the surface. Their rounded outlines suggest the agency of fluid pressure in their formation, and the fluid and cells found in the cysts are compatible with origin in the joint space and articular cartilage.

2. The hypothesis is advanced that the cysts are formed by the intrusion of synovial fluid under pressure into the substance of the bone, and the sclerosis around by displacement of the trabeculae and their reinforcement by new bone.

3. The objections to the hypothesis that the cysts represent a primary degeneration in the bone are discussed.
RECOVERY IN PARTLY PARALYSED MUSCLES
Authors: Morris D. D. B.
Published: February 2018

1 . The extensor digitorum longus of the rabbit was partly denervated by section of one of its two nerve branches and examined histologically for evidence of sprouting of new fibres.

2. Sections from material fixed two and three days after operation showed terminal bundles in which varying numbers of axons and motor end-plates have degenerated. This supports the concept that the motor unit is not confined to single groups of neighbouring muscle fibres, but innervates fibres scattered throughout the muscle.

3. New fine fibres branching from intact intramuscular axons to reinnervate denervated muscle fibres were observed as early as four days after operation.

4. Such new fibres were most numerous in the early weeks after operation and their numbers then declined. Two months after operation no small fibres or simple end-plates were seen.

5. No new fibres were seen in areas of the muscle containing only denervated nerve fibres. The new fibres were formed only under the stimulus of proximity to the degenerating ones.

6. The relationship of these findings to the mechanism of recovery of human muscle affected by poliomyelitis is discussed.
FRACTURES COMPLICATING ELECTRO-CONVULSIVE THERAPY AND CHRONIC EPILEPSY
Authors: Kelly J. P.
Published: February 2018

1. A study of 2,200 patients receiving electro-convulsive therapy showed that fifty-three sustained fractures or dislocationsâan incidence of 2Â·4 per cent. Of the fifty-three injuries, twenty-one occurred in the spine, fifteen in the neck of femur, fifteen in the upper end of humerus, one in the coracoid process; one dislocated jaw required anaesthesia for its reduction (other cases of transient dislocation of the jaw are excluded).

2. The incidence, site, and type of spinal fractures are recorded, and the relation of the fracture to the first convulsion is noted. No late changes were found in the spines of patients examined two years or more after treatment. A neutral position of the spine during the convulsion is believed to diminish the risk of fracture.

3. Fracture of the neck of the femur is a serious injury in these patients. In one case the injury was bilateral.

4. The fifteen cases of fracture-dislocation of the upper humerus are analysed. They included two cases of posterior dislocation of the humeral head; the possible mechanism of this is explained and a method of prevention suggested.

5. Fifty-three patients with chronic epilepsy with psychosis were examined. Four cases of fractured spine were discovered. The site of fracture was different from that of fractures caused by convulsive therapy and a reason for this is suggested. The type and mechanism of the fracture are similar in the two groups.
DEGENERATIVE RHEUMATOID CHANGES
Authors: Kersley G. D. , Barber H. S. , Cregan J. C. F. , Gibson H. J.
Published: February 2018

1. Three cases of a degenerative type of rheumatoid arthritis, with large cystic cavities filled with pus-like material, are described. They may arise from bursae or breaking-down nodules.

2. Four cases in which necrosis and subluxation complicated rheumatoid disease of the cervical column are recorded.

3. The pathogenesis of necrotic and cystic areas in rheumatoid arthritis is discussed.
STRUCTURAL CHANGES IN THE LUMBAR INTERVERTEBRAL DISCS
Authors: Harris R. I. , Macnab Ian
Published: February 2018

One of the interesting aspects of spinal pathology having an important bearing on the treatment of backache is that the spine acts as an integrated whole and that damage sustained by one part frequently injures other structures in the spinal column. Thus disc degeneration may be associated with an extrusion of nuclear material; it may initiate degenerative changes in the posterior joints; it may predispose to tears of the posterior spinal ligaments; or it may give rise eventually to all of these lesions, any one of which may produce backache with or without sciatica. The sciatica may be referred pain or may be produced by nerve root pressure. Nerve root pressure in such instances is commonly due to an extrusion of nuclear material, but it may also be due to pressure on the nerve root within the foramen by a "squashed" disc or by a subluxated posterior joint.

Radiographs are of great value in the diagnosis of disc degeneration and they are of greater value in the assessment of the secondary effects that have taken place. With the use of bending films evidence of early degenerative changes may be obtained, tears of the supraspinous ligament can be detected, and abnormal movements of the posterior joints can be seen. Careful study of the antero-posterior and lateral projections will reveal evidence of subluxation of the posterior joints, chip fractures and degenerative arthritis in the zygapophysial articulations, and will clearly demonstrate overriding of the facets.

The investigation of subjective phenomena, such as backache, is fraught with many difficulties and it must be preceded by an investigation of the anatomy of the part and the anatomical variations, the normal and abnormal physiology and the pathological lesions that occur. Many of these changes of course may have no clinical significance, but it is only when armed with the knowledge of what may occur that we can tackle the problem of low back pain on a logical basis.
OSTEOGENIC FIBROMA OF BONE
Authors: Golding J. S. R. , St Andrew  , Sissons H. A.
Published: February 2018

Two cases of benign osteoblastic tumours of the spine, occurring in young patients, and presenting as expanding osteolytic lesions with some central calcification and ossification, are described. It is suggested that they represent a condition allied to, but usefully separated from, osteoid osteoma of bone. The name osteogenic fibroma of bone, proposed by Lichtenstein for this type of case, is accepted.
METAPHYSIAL DYSOSTOSIS
Authors: Cameron J. A. P. , Young W. B. , Sissons H. A.
Published: February 2018

1. Details of clinical, radiological, biochemical and histological investigations of a case of metaphysial dysostosis are presented.

2. The patient was a boy of seven years, and showed widespread lesions (involving long bones of limbs, small bones of hands and feet, pelvis, clavicles, and ribs) characterised by retardation of growth and ossification with masses of partly calcified tissue in the metaphyses.

3. No radiological, clinical or histological evidence of renal osteodystrophy was found in the case described.

4. Metaphysial dysostosis is discussed in relation to other chondrodystrophies.
FATIGUE FRACTURES OF THE LOWER TIBIA
Authors: Singer Martin , Maudsley Roy H.
Published: February 2018

1. Five patients with seven fatigue fractures of the lower third of the tibia are described; two had bilateral fractures. There is a striking similarity in the site and appearance of these fractures.

2. All occurred in middle-aged or elderly people without a history of unusual activity or illness.

3. The fractures are so nearly identical as to constitute an entity which, as far as we are aware, has not been described before.
TUBERCULOSIS OF THE SUBDELTOID BURSA
Authors: Pimm Lionel H.
Published: February 2018

1. The previous literature in English on tuberculosis of the subdeltoid bursa is reviewed.

2. Two further cases are reported.

3. Emphasis is placed on the neglect of the condition in standard text-books and the need for bearing the diagnosis in mind.

4. Treatment by radical excision, a period of immobilisation and full supportive antibiotic therapy are recommended.
MUSCLE RECOVERY IN POLIOMYELITIS
Authors: Sharrard W. J. W.
Published: February 2018

1. The results of a three-year study of recovery in 3,033 lower limb muscles and 1,905 upper limb muscles in 142 patients are presented.

2. The rate of recovery of partly paralysed muscles is the same in all muscles and muscle groups in the lower or upper limb. Clinical differences in the ability of individual muscles to recover depend upon the proportions of their number that remain permanently paralysed.

3. The rate of recovery is slowest in adults and most rapid in young children.

4. The amount of further recovery to be expected in a muscle can be predicted from a knowledge of its grade at any time after one month from the onset of the paralysis. Fourteen-fifteenths of the total amount of recovery takes place by the beginning of the twelfth month; with rare exceptions individual muscle recovery is complete after twenty-four months.

5. Ninety per cent of muscles that are still completely paralysed after six months remain permanently paralysed.

6. The prognosis of a completely paralysed muscle is related to the level of paralysis in muscles supplied by the same spinal segments.

7. Deterioration in power in a muscle is uncommon and, when it occurs, is associated with the presence of the strong opposing force of antagonist muscles or of gravity.

8. The application of these findings to the management of cases of paralytic acute anterior poliomyelitis is discussed.
THE USE OF MYO-ELECTRIC CURRENTS IN THE OPERATION OF PROSTHESES
Authors: Battye C. K. , Nightingale A. , Whillis J.
Published: February 2018

Obviously these and other problems need much research, but the preliminary work already done is promising enough to indicate that a useful and dependable prosthesis could be developed to operate by the use of changes of muscle potential, and that such apparatus could be made light enough for practical use at the work-bench and in the home.
THE DISTRIBUTION OF THE PERMANENT PARALYSIS IN THE LOWER LIMB IN POLIOMYELITIS
Authors: Sharrard W. J. W.
Published: February 2018

1. The distribution of the permanent paresis and paralysis in the muscles of 203 lower limbs affected by poliomyelitis is analysed and related to the destruction of motor nerve cells in the grey matter of the lumbo-sacral cord.

2. The tibialis anterior and tibialis posterior and the long muscles of the toes are more often paralysed than paretic; these muscles are innervated by short motor cell columns. Muscles such as the hip flexors and hip adductors that are more often paretic than paralysed are innervated by long cell columns.

3. Muscles innervated by the upper lumbar spinal segments are more frequently affected than those innervated by the sarcal segments. This agrees with the segmental incidence of motor cell destruction found in poliomyelitic spinal cords.

4. Each muscle or muscle group is associated in paralysis with other specific muscles. For instance, the long toe extensors with the peronei and the calf muscles (triceps surae) with the biceps femoris. Associated muscles are innervated by adjacent motor cell columns. The probability of recovery in a paralysed muscle can be determined by reference to the degree of involvement in its associated muscles.

5. The distribution of the paralysis in an individual lower limb is determined by the site and size of foci of motor cell destruction. The cell loss in certain common patterns of paralysis is described.

6. The practical application of these findings is discussed.
EXPERIENCES WITH EXPERIMENTAL PLASTER BANDAGES CONTAINING RESIN
Authors: Arden C. P. , Ward F. G.
Published: February 2018

A short experience with melamine resin plaster-of-Paris bandages is described. The bandages make a lighter splint with a saving of material and time, and the splint is more durable.
THE HISTOCHEMISTRY OF THE PREOSSEOUS STAGE OF BONE REPAIR STUDIED BY AUTORADIOGRAPHY
Authors: Duthie Robert B. , Barker Audrey N.
Published: February 2018

1. The utilisation of radioactive sulphur in vivo has been demonstrated both macroscopically and microscopically during the preosseous stage of bone repair.

2. The labelled mucopolysaccharide complex, chondroitin sulphuric acid, has been studied during the formation of the medullary and periosteal blastemata in the healing of a fracture.

3. The appearance and possible significance of mast cells adjacent to a fracture, and resulting from the stimulus of trauma, are discussed.

4. Cortisone has been seen to affect the formation of the periosteal cartilaginous blastema and subsequent process of endochondral ossification, with liberation of increased amounts of chondroitin sulphuric acid which was calcified rather than ossified.
THE HAND IN SURGERY
Authors: Capener Norman
Published: February 2018

We surgeons are privileged in having a profession which also encompasses a craft; by it we should have understanding of the problems of craftsmanship in modern life. Ultimately it is at the core of human happiness. Craftsmanship is based upon creative ability, good design, the almost loving conflict of man and material, and the consequent unification of both in completion. Craftsmanship is only possible as a manifestation of individuality. Integrity and invulnerability are its outcome.

May it not be that in the atomic age (if there is one outside of destruction) there may be a return to the craftsman's life of the eighteenth century; not of necessity for the maintenance of economic life, because that will be done for him by the machine, but rather for the maintenance of health?
TENDON GRAFTS FOR FLEXOR TENDON INJURIES IN THE FINGERS AND THUMB
Authors: Pulvertaft R. Guy
Published: February 2018

1. A series of 149 consecutive cases of flexor tendon grafting in the fingers and thumb is reviewed and the results are analysed. A description of the technique which has evolved from this experience is given.

2. Replacement of a divided flexor digitorum profundus in the presence of an intact sublimis tendon restored a useful range of movement in 80 per cent of cases.

3. Replacement of both flexor digitorum profundus and sublimis gave good results in 70 to 80 per cent of cases.

4. Replacement of a divided flexor pollicis longus tendon gave good results in 85 per cent of cases.

5. The particular tendon used for the graft did not materially influence the result, but there are special indications for the use of the different tendons.

6. The choice of splintage or of early movement after operation does not appear to have a significant bearing upon the result.

7. The most important factor in determining the result is probably a precise and gentle surgical technique and complete haemostasis. Minor differences in method are of little importance. The failures in this series were due more to faulty performance of the operation than to any other single factor.
ANEURYSMAL BONE CYST
Authors: Taylor F. W.
Published: February 2018

1. Three cases of aneurysmal bone cyst are recorded. It is suggested that the condition is a type of cavernous haemangioma and the term haemangiomatous bone cyst is preferred.

2. A survey of the published cases suggests that in its early stages the lesion is amenable to local surgery, which is the treatment of choice, but for inaccessible lesions deep x-ray therapy may be effective.
THE OSTEOPOROSIS OF CUSHING'S SYNDROME
Authors: Sissons H. A.
Published: February 2018

1. The bone changes in four autopsied cases of Cushing's syndrome are described. The changes take the form of osteoporosis, which is most marked in the spine and the ribs.

2. The osteoporosis results from impaired osteoblastic bone formation in the presence of a normal degree of osteoclastic bone resorption.

3. Histological abnormalities of fracture callus in Cushing's syndrome indicate interference with the proliferation of osteoblasts and cartilage cells and with the formation of new tissue by these cells.

4. The bone changes in Cushing's syndrome are comparable with those produced in experimental animals by the administration of A.C.T.H. or cortisone.
PSEUDOCOXALGIA
Authors: Ratliff A. H. C.
Published: February 2018

A review of fifty cases of idiopathic pseudocoxalgia (Legg-CalveÌ-Perthes disease) followed into adult life for periods of eleven to thirty years (average seventeen years) after diagnosis shows:

1. In the whole series rather more than one-third of the patients developed hips which were normal or nearly normal.

2. An equal number had hips which could only have been considered "fair."

3. About one quarter had hips which gave pain and which showed marked loss of movement and gross degenerative changes radiologically.

Judged from the point of view of symptoms, the results were better than the foregoing would suggest. Three-quarters of the patients were fully active and free from pain but only two-fifths had hips which were radiologically good. It is possible that such apparently good results are unlikely to be permanent, and I hope, therefore, to continue this follow-up for another ten or fifteen years. It can, however, be concluded at this stage that an immediate good result is likely to be maintained at least until the age of twenty-five years, even though half of such patients will have radiologically abnormal hips.

There is a characteristic pattern of deformation of the femoral head and neck in the adult resulting from this condition in childhood, based on the degree of flattening of the head and shortening of the neck.

The end-results are better in adequately treated cases.

Two cases are reported in which osteochondritis dissecans developed as a late complication.
VASCULAR COMPLICATIONS OF SHOULDER INJURIES
Authors: Henson G. F.
Published: February 2018

1. Two cases of arterial damage complicating shoulder injuries are reported.

2. The treatment is described and the importance of early diagnosis is stressed.

3. Operation was indicated in both cases by developing ischaemia in spite of conservative measures.
POSTERIOR DISLOCATION OF BOTH SHOULDERS
Authors: Arden G. P.
Published: February 2018

1. A case of posterior dislocation of both shoulders, in a patient believed to be epileptic, is described.

2. The difficulties of early diagnosis are discussed.
TENDON TRANSPLANTATION IN THE PREVENTION OF FOOT DEFORMITIES AFTER POLIOMYELITIS IN CHILDREN
Authors: Mortens J. , Pilcher M. F.
Published: February 2018

A carefully planned operation may be expected to check increasing deformity without doing harm, and to make subsequent bony stabilisation easier. In favourable cases it may be possible to restore muscle balance and stability, making further surgery unnecessary. A longer follow-up is necessary to determine to what extent this ideal can be achieved.
LIPOMATOSIS OF SKELETAL MUSCLE IN MAFFUCCI'S SYNDROME
Authors: Cameron A. H. , McMillan D. H.
Published: February 2018

A boy aged eleven with a solitary chondroma of the right tibia, and angiomata of the skeletal muscle, subcutaneous tissues, and periarticular tissues of the same limb, is considered to be a case of Maffucci's syndrome (dyschondroplasia with angiomata), although there was not the severe deformity encountered in the previously reported cases. There was a secondary atrophy and adiposity of skeletal muscle, and this was attributed to anoxic effects produced by the angiomata.
BANKART'S OPERATION FOR RECURRENT DISLOCATION OF THE SHOULDER
Authors: Dickson J. W. , Devas M. B.
Published: February 2018

1. Fifty cases of recurrent dislocation of the shoulder are reported, operated upon by Bankart and his colleagues from 1925 to 1954.

2. This is the first detailed survey of his patients, some of whom we were unable to trace.

3. It has been confirmed that the operation is successful, and that a full range of movement can be regained after operation, though not in every case.

4. Two cases treated unsuccessfully are described and discussed.
SOME OBSERVATIONS ON CONGENITAL DISLOCATION OF THE HEAD OF THE RADIUS
Authors: Caravias D. E.
Published: February 2018

1. Radiological criteria in the diagnosis of congenital dislocation of the head of the radius are suggested.

2. Some of the radiographic features described as characteristic of congenital dislocation of the head of the radius may be found also in post-traumatic dislocation of the radial head.
PREPARATION OF THE AMPUTEE AND STUMP FOR LIMB FITFING
Authors: Langdale-Kelham R. D. , Cooksey F. S.
Published: February 2018

One of the most important factors in the rehabilitation of the amputee is the preparation of the patient and stump for limb fitting and training. The different procedures for the upper and lower extremities are described. Emphasis is laid on the importance of early reassurance and rehabilitation whenever possible. Patients unavoidably immobilised for long periods require general physical reconditioning before limb fitting and training can be undertaken. Special care is needed to avoid the upper limb amputee's becoming dependent on the surviving hand and using the artificial limb only for its cosmetic effect.
TREATMENT OF OSTEOCHONDRITIS DISSECANS
Authors: Smillie I. S.
Published: February 2018

1. The record is presented of an attempt to treat osteochondritis dissecans on idealistic lines.

2. The operative technique to be adopted in the various circumstances likely to be encountered in the knee joint is described. Two cases affecting the talus are recorded.

3. The radiological appearance has become virtually normal in twenty-seven cases (the remaining four are recent); healing has been observed directly in seven cases in which a second operation to remove the means of internal fixation was necessary; and the patients' complaints have been eliminated, but the long term results of treatment are unknown.

4. Suggestions are made for possible developments in the technique of operation.
DYSPLASIA EPIPHYSIALIS PUNCTATA
Authors: Karlen A. G. , Cameron J. A.P.
Published: February 2018

1. A case of dysplasia epiphysialis punctata is described, with some histological observations.

2. Both parents were syphilitic.

3. The etiology is not yet fully determined. Some suggestions are put forward for further investigation.
THE TORN ACETABULAR LABRUM
Authors: Paterson Ian
Published: February 2018

Complete reduction of a dislocated hip may be blocked by a partial separation of the acetabular rim. The diagnosis is radiological and is easily missed. Treatment is by open operation and resection of the partly detached fibrocartilaginous rim.
MOVEMENTS OF THE LUMBAR SPINAL COLUMN
Authors: Allbrook David
Published: February 2018

1. Previous studies of the movements of the lumbar spine are criticised in the light of new observations from radiograph tracings. It is shown that, contrary to recent teaching, the lumbar spine is a very mobile part of the vertebral column.

2. The movement of the lumbar spine is analysed. It is shown that the lower vertebrae have the most movement, and that the range gradually becomes less in the upper lumbar spine.

3. This movement may be roughly correlated with the incidence of spurs arising from the anterior margin of the vertebral bodies.

4. These spurs are shown to arise in the anterior longitudinal ligament; they are probably caused by intermittent pressure from the intervertebral disc lying behind the ligament.
ANTERIOR DISLOCATION OF THE HEAD OF THE RADIUS ASSOCIATED WITH UNDISPLACED FRACTURE OF THE OLECRANON IN CHILDREN
Authors: Hume A. C.
Published: February 2018

1. Three cases of anterior dislocation of the head of the radius associated with an undisplaced fracture of the olecranon are described.

2. A combination of pronation of the forearm and hyperextension of the elbow is suggested as a possible mechanism.
REPORT OF THE TREATMENT OF EXPERIMENTAL FAT EMBOLISM WITH HEPARIN
Authors: Gardner A. M. N. , Harrison M. H. M.
Published: February 2018

1. Reports of the lipaemia-clearing effect of heparin suggested that this drug might be of therapeutic value in fat embolism.

2. In an experimental trial with rats, heparin was found both to accelerate death and to increase the number of deaths after fat embolism.

3. It is accordingly concluded that a clinical trial of heparin in human fat embolism would not be warranted.
THE REACTIONS OF INJURED HUMAN ARTICULAR CARTILAGE
Authors: Landells J. W.
Published: February 2018

1. The lines of fracture confirm the suggestions of earlier authors on the lines of strength in cartilage, with the additional feature of a transverse plane of weakness at the apex of the calcified zone.

2. The normal nutrition of cartilage is synovial, and access of a free blood supply is followed by destruction of hyaline articular cartilage.

3. Minor traumatic events in the articular lamella are common, particularly in osteoarthritic joints; the results of these on the cartilage are like the changes of osteoarthritis.

4. The removal of uncalcified cartilage can be described in two stages of a physico-chemical kind; the removal of calcified cartilage is a single cellular process.

5. There is evidence that the carbohydrate moiety of cartilage is present in two separable phases, one fixed to collagen, the other free.

6. The repair mechanisms after fracture are those available to restore the damage of osteoarthritis, and reasons can be shown why in fact they are ineffective.
THE RESULTS OF TREATMENT OF SLIPPED FEMORAL EPLPHYSIS
Authors: Hall J. E.
Published: February 2018

1. One hundred and seventy-three hips in 138 patients have been examined and studied in reference to the type of treatment received.

2. Shepherd's method of assessing the results of arthroplasty operations has been adapted to this series.

3. Satisfactory results were found in 77Â·9 per cent of all patients.

4. The value of straight longitudinal traction is questioned. Medial rotation appears to be an essential step in the reduction of the deformity.

5. Manipulation was found to be a relatively safe and effective method of reducing the deformity in patients seen soon after an acute episode, and should be reserved for them.

6. Complications were common after nailing operations, and included subtrochanteric fracture in three cases.

7. Avascular necrosis was the commonest cause of a poor result. The two types of avascular necrosis are discussed.

8. Avascular necrosis was found in 37 per cent of cases in which a manipulation was followed by a nailing operation.

9. Avascular necrosis was not found in any case in which a manipulation was combined with the use of Moore's pins, but such cases were kept under observation for a shorter time.

10. Avascular necrosis was found in 38Â·1 per cent of cases of cervical osteotomy.
THE RELIEF OF TRAUMATIC ARTERIAL SPASM IN THREATENED VOLKMANN'S ISCHAEMIC CONTRACTURE
Authors: Benjamin A.
Published: February 2018

1. Three cases of traumatic arterial spasm are reported.

2. In each case there was increased tension in a neighbouring myofascial compartment.

3. The cause of this tension was oedema, possibly supplemented in one case by haematoma.

4. Release of tension by splitting the sheath was followed by relaxation of the artery.

5. It is suggested that tension in a fascial compartment may provide the stimulus that maintains arterial spasm and that the consequent ischaemia aggravates the oedema, so that a vicious circle is established.

6. It is further suggested that if spasm persists in spite of the usual measures, including exploration of the artery, the distal myofascial compartment should be decompressed. Division of the deep fascia of the cubital or the popliteal fossa is not enough.

7. Such persistent arterial spasm is uncommon, and further observations are needed to define the significance of increased tension in a distal myofascial compartment.
DISLOCATION OF THE SHOULDER COMPLICATED BY COMPLETE RUPTURE OF THE AXILLARY ARTERY
Authors: Stener Bertil
Published: February 2018

A case of complete rupture of the axillary artery in a man aged eighty-seven is described. The injury occurred in connection with an antero-inferior dislocation of the shoulder. It is not known whether the rupture was caused by the dislocation itself or by the reduction. A successful suture of the artery was performed. A review of the literature is given, and earlier attempts to suture the artery in cases of this type are noted. The indications for this operation are discussed.
OLIGODACTYLY
Authors: Jones Meredith Vaughan
Published: February 2018

The skeletal and arterial changes in a somewhat unusual case oligodactyly are described.
THE SPEED OF HEALING AFTER FRACTURE OF THE TIBIAL SHAFT
Authors: Ellis H.
Published: February 2018

1 . A series of 343 tibial shaft fractures proceeding to sound union in adults, and 192 fractures in children, was studied. Groups of fractures differing from each other only in the one particular variable under consideration were compared.

2. The severity of the injury (as assessed by the degree of displacement, of comminution and of compound wounding) was found to be an important determinant of speed of fracture union and of incidence of delayed and non-union. A simple classification of severity of injury is described.

3. Distraction delayed healing. Traction which avoided distraction had no effect on the rate of union of fractures of moderate severity compared with cases of similar severity of injury treated by immobilisation only. Major fractures subjected to traction did take longer to unite on the average, but there was no increase in the incidence of delayed or non-union.
NEUROBLASTOMA IN ORTHOPAEDIC PRACTICE
Authors: Busfield P. I.
Published: February 2018

1. Neuroblastoma is a disease that may concern the orthopaedic surgeon closely.

2. Six such cases are reported.

3. Early diagnosis may be difficult, but can be achieved if the condition is suspected and an adequate investigation is carried out on suspicion alone.

4. The prognosis in these patients is still poor, but might be improved by a vigorous combination of surgery, irradiation and chemotherapy. The recent advance in treatment with vitamin B 12 may improve the prognosis substantially.
THE RESULTS OF PARTIAL AND TOTAL EXCISION OF THE PATELLA
Authors: Duthie H. L. , Hutchinson J. R.
Published: February 2018

1. Seventy-seven operations on the patella have been reviewed.

2. There is no evidence that arthritic changes in the femoral condyles are an inevitable sequel of complete excision of the patella.

3. There is a direct relationship between the severity of symptoms after complete excision of the patella and the extent of ossification in the quadriceps tendon.

4. Patello-femoral arthritis after partial excision of the patella may be due to faulty realignment of the patellar ligament and consequent tilting of the patellar remnant towards the femoral condyles.
AN UNUSUAL MALFORMATION OF THE RADIUS AND ULNA
Authors: Harrison R. G. , Wardle E. N.
Published: February 2018

An anomaly is reported in a girl aged eight years in which an outgrowth from the left radius articulated with a hollow in an eminence on the corresponding ulna. The histological findings are described and the significance of this unusual malformation is discussed.
CONGENITAL DISCOID CARTILAGE
Authors: Ross James A. , Tough Ian C. K. , English T. A.
Published: February 2018

1. A case of discoid medial cartilage is describeâthe fifth so far recordedâand comparison is made with the previous cases in the literature.

2. The origin of the anomaly, its incidence and clinical features are discussed.

3. The view is expressed that discoid cartilage is a congenital lesion due to abnormal development, fibrocartilage being laid down in mesenchyme which normally disappears in the formation of the joint. It is not the effect of arrest of a normal process or persistence of a normal foetal state. The only time at which a cartilage may be said to be disc-shaped is in the earliest weeks of embryonic life, when the disc or plaque of undifferentiated mesenchyme is present between the developing bones. The central part of this mass disappears early, and the fibrocartilage develops in its peripheral portion. In a ten-weeks'-old embryo (37 millimetres) the cartilages were shown to have a crescentic shape like that of the adult cartilage.
TUBERCULOSIS OF THE FEMORAL NECK AND GREATER TROCHANTER
Authors: Ahern R. T.
Published: February 2018

The results obtained from combined chemotherapy and radical surgery in eighteen patients with trochanteric tuberculosis have been satisfactory so far, although the period of observation is still short. The results compare very favourably with those of all other methods of treatment.
FAMILIAL OSTEOARTHROPATHY OF THE FINGERS
Authors: Allison A. C. , Blumberg B. S.
Published: February 2018

1. Two unrelated families with a genetically determined arthritis-like syndrome of the joints of the hand and wrist are described.

2. The condition begins before puberty, is relatively painless and is not functionally disabling. The condition resembles that described by Thiemann and appears to fall into the group of avascular necrosis.

3. The appearance of the abnormality is controlled by a single autosomal gene which manifests itself in nearly all persons who are heterozygous for it. Two of the offspring of a marriage between affected persons showed much greater involvement than their siblings.

This suggests that they may represent the effect of the abnormal gene in double dose. If this is so, the type of inheritance cannot strictly be regarded as "dominant," since the abnormal homozygote is different from the heterozygote.
THE MANAGEMENT OF PATHOLOGICAL FRACTURE OF THE MAJOR LONG BONES FROM METASTATIC CANCER
Authors: Bremner R. A. , Jelliffe A. M.
Published: February 2018

1. Problems of management of a pathological fracture of a major long bone through a metastatic cancer deposit are outlined. The relatively short life expectancy of these patients is stressed.

2. The results of treatment of thirty-six consecutive fractures of this type by internal fixation and radiotherapy, and of similar treatment used "prophylactically" on seven occasions, are reviewed.

3. Four-fifths of the patients with lower limb fractures became ambulant with crutches and were able to return home.

4. "Prophylactic" internal fixation and radiotherapy appear to be helpful in selected cases.

5. The theoretical dangers and difficulties of the technique are discussed. They are easily surmountable and have probably been over-emphasised in the past.

6. It is concluded that this is the best method at present available for dealing with this difficult problem.
POSTERO-LATERAL DISLOCATION OF THE KNEE WITH CAPSULAR INTERPOSITION
Authors: Quinlan A. G. , Sharrard W. J. W.
Published: February 2018

1. Five cases of postero-lateral dislocation of the knee with capsular interposition are described.

2. The mechanism of the injury is considered in the light of the case histories and the findings at operation.

3. The constant clinical findings associated with this injury are described.

4. Open reduction is recommended: with early operation the prognosis for function and stability is good.
TREATMENT OF PERTROCHANTERIC AND BASAL FRACTURES OF THE FEMUR BY IMMEDIATE FIXATION WITH A TWO-PIECE NAIL AND PLATE
Authors: Bremner R. A. , Graham W. D.
Published: February 2018

1. The results of treatment of 100 consecutive patients with pertrochanteric and basal fractures of the femur treated by early operative fixation with a McKee two-piece nail and plate are reviewed.

2. Technical failures are analysed and discussed.

3. The pattern of mortality is discussed and contrasted with that in a comparable series of patients treated conservatively.

4. It is concluded that early operative fixation is the method of choice in the management of these fractures, and that the McKee pin and plate is a satisfactory and reliable device for securing internal fixation.