bluuebunny/crossref_metadata_2025 huggingface dataset:
DELAYED TRAUMATIC TETRAPLEGIA
Authors: Scott P. J.
Published: February 2018

1. The theories that have been advanced to explain the occurrence of traumatic tetraplegia in patients without evidence of vertebral column injury are reviewed.

2. Traumatic tetraplegia of delayed onset is described in a middle-aged man with ankylosing spondylitis. There was no injury of the vertebral column.

3. The reasons are given for suggesting that the tetraplegia was caused by injury to the arterial supply of the cord.
THE TREATMENT OF FRACTURE-SEPARATION OF THE CAPITULAR EPIPHYSIS
Authors: Crabbe W. A.
Published: February 2018

1. Seventeen children with fracture-separations of the capitular epiphysis are reviewed.

2. Soft-tissue suture was used in eleven and metallic fixation in six children.

3. There was one bad result because of faulty technique but all the other children obtained good results.

4. Soft-tissue suture was found to be a simple procedure with none of the complications of wire fixation.
RECURRENT DISLOCATION OF THE PATELLA DUE TO ABNORMAL ATTACHMENT OF THE ILIO-TIBIAL TRACT
Authors: Jeffreys T. E.
Published: February 2018

1. Three cases of recurrent dislocation of the patella due to abnormal attachment of the ilio-tibial tract are described.

2. The nature of the abnormality and surgical management are discussed.
CYST FORMATION IN OSTEOARTHRITIS
Authors: Ondrouch A. S.
Published: February 2018

1. The cause of cyst formation lies in the major overloading of certain regions caused by the unevenness of the articular surface produced by the arthritic process.

2. Photoelasticity investigations disclose an overburdening of the bone beneath the surface of the joint, which in turn markedly resembles the shapes of actual cysts.

3. The results of this investigation fit organically into the logical sequence of processes in accordance with our theory.

4. This theory is further borne out by the successful formation of cyst phenomena in healthy joints by overloading (Trias 1961).

5. Our theory has no immediate practical bearing on the treatment of arthritic cysts. However, it uncovers certain interesting aspects of the behaviour of bone tissues under mechanical overloading above the limits of biological, though below those of mechanical bearing capacity. Conclusions arising therefrom might in many respects be useful in research into the physiology of bone.
AGE CHANGES IN THE ORGANIC FRACTION OF BONE
Authors: Smith J. W.
Published: February 2018

1. The relative concentrations of organic material in adjacent microscopic regions of bone have been studied by three methods, and the results suggest that this concentration varies considerably.

2. The variations in the organic concentration in bone have been correlated with the age of the bone and its inorganic concentration.

3. It is suggested that the progressive calcification of bone as its age increases, occurs, to some extent, at the expense of the organic fraction of the tissue.
OSTEOPOROSIS IN PATIENTS WITH FEMORAL NECK FRACTURES
Authors: Stevens Jack , Abrami George
Published: February 2018

1. It is now more than three years since a group of ninety-one patients with transcervical fracture of the neck of the femur were examined for osteoporosis at the time of injury using a histological or a radiographic technique, or a combination of both methods.

2. After patients with basal fractures were excluded, ninety fractures in eighty-eight patients were available for review and sixty-six (74 per cent) were adequately followed up.

3. In this series the fate of the fracture did not appear to be influenced by the presence or absence of osteoporosis, or by the degree of osteoporosis.

4. The incidence of osteoporosis increased with advancing age, but this increased incidence did not appear to be responsible for the greater proportion of failures after the age of sixty-five.

5. In this series of patients examination for osteoporosis was made by methods which were believed to be the best available at the time. The possibility that these are not absolutely reliable cannot be ruled out.
TRANSPLANTATION OF THE GREATER TROCHANTER IN ARTHROPLASTY OF THE HIP
Authors: Charnley John , Ferreira A. De S.D.
Published: February 2018

1 . The results of transplanting the greater trochanter in 225 "low-friction" arthroplasties of the hip have been examined.

2. Non-union occurred in an average of 7 per cent of cases.

3. When non-union occurred the results still showed improvement.

4. Four different methods of fixation were used, of which that using two wires, crossed in the horizontal and coronal planes, never failed to secure union.

5. Transplantation of the greater trochanter to the best position is only possible if the neck of the femur is shortened or if the centre of motion of the arthroplasty is displaced medially by deepening the acetabulum, or by a combination of both.

6. In the best position the transplanted trochanter considerably improved active abduction against gravity.
OSTEOCHONDRITIS IN CONGENITAL DISLOCATION AND SUBLUXATION OF THE HIP
Authors: Dooley B. J.
Published: February 2018

In this review of 106 cases it appears that immobilisation of a contracted, dislocated or subluxated hip in an extreme position in plaster as the initial treatment caused vascular damage to the femoral epiphysis in approximately 50 per cent of cases. Preliminary frame

reduction in the dislocated hips slowly stretches the soft tissues and allows adaptation of the vessels to the position required for reduction. Open reduction would seem to reduce the incidence of osteochondritic changes. When a hip is immobilised in plaster the extreme of any position, particularly with regard to rotation, should be avoided.
DUPUYTREN'S CONTRACTURE IN THE FOOT
Authors: Stoyle T. F.
Published: February 2018

1 . A case of plantar Dupuytren's disease in a woman aged twenty-three is described.

2. A review of the literature has shown that the histology and rapid recurrence have led to an erroneous diagnosis of fibrosarcoma and treatment by amputation on several occasions.
DELTA PHALANX
Authors: Jones G. Blundell
Published: February 2018

1. Delta phalanx is a rare congenital abnormality not to be confused with other forms of angular deformity of the phalanges.

2. The deformity needs radical treatment by repeated surgery because there is no tendency to spontaneous correction and growth of the phalanx is prevented by the epiphysial deformity.
BONE PRODUCTION IN NON-OSTEOGENIC FIBROMA
Authors: Morton K. S.
Published: February 2018

1 . Six patients have been presented in whom an established diagnosis of non-osteogenic fibroma of bone was made. Metaplastic bone was identified within the tumour tissues.

2. Three other patients are reported in whom the diagnosis appeared to be, on radiological and histological grounds, either fibrous dysplasia or non-osteogenic fibroma.

3. This evidence has convinced the author that the two lesions are frequently not distinctive and that they are, in fact, closely related. Because the natural history of the two conditions, especially in their simple or monostotic form, is also the same, there is good reason to consider them as varying histological manifestations of the same pathogenetic process.
UNREDUCED POSTERIOR DISLOCATION OF THE SHOULDER TREATED BY OPEN REDUCTION AND TRANSPOSITION OF THE SUBSCAPULARIS TENDON
Authors: Oyston J. K.
Published: February 2018

1 . A case of posterior dislocation of the shoulder treated by open reduction and obliteration of the defect in the head of the humerus by implantation of the subscapularis tendon is reported.

2. It is suggested that this method is indicated in cases in which there is a deep V-shaped depression on the anterior aspect of the humeral head.
HYDATID DISEASE OF BONE IN AUSTRALASIA
Authors: Alldred A. J. , Nisbet N. W.
Published: February 2018

1 . The incidence of hydatid disease in bone is discussed and the relevant literature reviewed.

2. The parasitology and methods of control are described.

3. The pathology of hydatid disease affecting bone is described.

4. An analysis of fifty-three cases is made showing that the disease commonly occurs in the spine, the long bones, the ribs and scapula, and the pelvis and hip. The treatment and prognosis of each group is discussed.

5. Three cases of hydatid disease of bone occurring in animals are described.
THE RESULTS OF OSTEOTOMY FOR EARLY PRIMARY OSTEOARTHRITIS OF THE HIP
Authors: Harris N. H. , Kirwan E.
Published: February 2018

1. The clinical and radiological results of seventy-one osteotomies for primary osteoarthritis of the hip performed with internal fixation have been examined two to eight years after operation. Advanced cases where osteotomy would have been purely a salvage procedure were excluded.

2. The hips were divided into two groups: one in a relatively early and the other in a later intermediate stage of the disease. The two criteria for inclusion in the "early" group were a) fiexion movement of 90 degrees or more, either with the patient conscious or completely relaxed under anaesthesia, and b) no collapse of bone seen in the radiograph.

3. The clinical results show that early osteotomy seldom fails to give relief of pain, which is closely correlated with improved function and a favourable assessment of the operation by the patient. A good range of flexion, not less than 70 degrees and frequently 90 degrees, is retained when the criteria mentioned above obtain.

4. The radiological assessment was based upon examination of the joint space, the cystic appearances and the degree of collapse of bone, if any, as seen in serial films. There was convincing evidence of regression indicating arrest of the arthritic process in 70 per cent of the "early" cases.

5. Regression after osteotomy appears to be a well-defined process which is more commonly observed and more complete when the osteotomy is performed sooner rather than at a later stage of the disease. With few exceptions a good radiological result is associated with a good clinical result.

6. Some of the possible causes of failure are discussed. Osteotomy is more likely to fail if delayed till stiffness is severe and collapse of bone has begun. Large cysts, rapid advance of the disease, and a valgus osteotomy in the presence of lateral subluxation may also prejudice the results.

7. This review offers good support for Nissen's suggestion that in primary osteoarthritis of the hip osteotomy should be performed early, while the joint is still mobile and capable of repair, in order to retain good function.

8. Relief from pain is not the only consideration in deciding when to operate; the prospects of arresting the disease and of stimulating a healing reaction in the disordered cancellous bone and articular cartilage by early osteotomy should always be kept in mind.

9. In many respects the findings of this review are complementary to those of Postel and Vaillant (1962) who reported excellent results from varus osteotomy of Pauwels' type in a series of cases of subluxation of the hip with pain but without frank secondary osteoarthritic change.
INFERIOR TIBIO-FIBULAR DIASTASIS TREATED BY CROSS SCREWING
Authors: Smith M. G. H.
Published: February 2018

Dr J. Robert Close has been good enough to point out a misquotation from his article, "Some Applications of the Functional Anatomy of the Ankle Joint"(Journal of Bone and Joint Surgery, 1956, 38-A, 761) in a later contribution by Mr M. G. H. Smith entitled "Inferior Tibio-fibular Diastasis Treated by Cross-screwing (Journal of Bone and Joint Surgery, 1963, 45-B, 737). Dr Close, in referring to tibio-fibular diastasis and deltoid ligament rupture with low fractures of the fibula, wrote (p. 780), "Treating diastasis therefore frequently means treatment for the deltoid lesion. When one realises that a certain amount of spreading apart of the malleoli and a certain amount of rotation of the fibula about the tibia are anatomical requirements for normal ankle motion the necessity for later removal of such internal fixation becomes obvious. Screws thus placed have been known to break during normal walking after the fractures have healed." In his paper Mr M. G. H. Smith, making mention of tibio-fibular movement, wrote, "This small range of movement of the fibula at the inferior tibio-fibular joint caused Close (1956) to recommend that screws placed across the joint to maintain reduction of diastasis be removed before weight bearing and movement were commenced. He stated that screws had broken when left in position." Further abbreviation by editorial staff led to the statement actually printed p. (737): "Close (1956) recommended the removal of screws that had been placed across the joint to maintain reduction of diastasis before movement was allowed, because the screws broke when left in position." The inadvertent change in sense unfortunately escaped attention, and we very much regret that Mr Close was thus misquoted.
TRANSARTICULAR NAILING FOR FRACTURES OF THE FEMORAL NECK
Authors: Jarry Leo
Published: February 2018

1. A technique of transarticular nailing for subcapital and transcervical fractures of the neck of the femur is described.

2. Forty-four operations have been done, and twenty-one patients have been under observation for periods of from one to six years. In one of these pseudarthrosis has developed; in two others there has been delayed union.

3. The method gives sound fixation by a "squeezing effect" on the proximal fragment, which is enhanced by the locking of the adjacent articulation.

4. It is presented as an alternative to prosthetic replacement for treatment of femoral neck fracture in the aged. The nail damages the articular surface of the acetabulum but not the femoral head.

5. The importance of care after operation is stressed.

6. The advantages of the method, the role of circulatory changes in the femoral head and the mechanics of transarticular fixation are discussed.
MONARTHRITIS
Authors: Pitkeathly D. A. , Griffiths H. E. D. , Catto M.
Published: February 2018

1. Forty-five patients with monarthritis of at least six months duration have been reviewed. Arthrotomy and synovial biopsy were carried out in every case. The period of follow-up varied from two to eight years from the time of biopsy. A re-examination of the biopsy material was made at the time of clinical assessment.

2. Twelve patients (27 per cent) were diagnosed as having definite or probable rheumatoid arthritis. Four patients (9 per cent) had psoriatic arthropathy and six (13 per cent) had a persistent monarthritis of undetermined type. A further four patients (9 per cent) had polyarthritis of undetermined type, ten (22 per cent) were diagnosed as having osteoarthritis and seven (16 per cent) were completely normal (self-limiting joint disease).

3. There was a moderately good relationship between biopsy findings suggestive of rheumatoid arthritis and the eventual clinical outcome.

4. Monarthritis of the wrist was followed in every case by the development of significant disease, either rheumatoid arthritis or psoriatic arthropathy.

5. Rheumatoid arthritis may remain monarticular for many years.

6. It is concluded that thorough investigation of patients with monarthritis is of considerable help in diagnosis and prognosis.
FATTY INFILTRATION OF THE MEDIAN NERVE
Authors: Yeoman P. M.
Published: February 2018

1. Three cases of fatty infiltration of the median nerve are reported.

2. One patient had symptoms of median nerve compression.

3. The intimate association of fibro-fatty tissue within the nerve precludes enucleation of the swelling.
FLEXOR ACCESSOREUS LONGUS
Authors: Grogono B. J. S. , Jowsey J.
Published: February 2018

1. An unusual muscle anomaly found during an operation for a severe club foot is recorded.

2. This muscle fitted the description of the flexor accessoreus longus and may add support to the phylogenetic theories of development of the long flexor muscles suggested by Wood Jones.
CHANGES IN SERUM CALCIUM AND PHOSPHORUS DURING STILBOESTROL TREATMENT OF OSTEOPOROSIS
Authors: Parfitt A. M.
Published: February 2018

1. The changes in serum calcium and phosphorus which occurred in forty-one patients with post-menopausal osteoporosis during treatment with stilboestrol were examined.

2. There was a fall of approximately 15 per cent in mean serum phosphorus and of approximately 3 per cent in mean serum calcium.

3. The fall in serum calcium is considered to furnish some evidence against the theory that the primary action of stilboestrol is a reduction in calcium excretion.
A BIOMECHANICAL ANALYSIS OF THE USE OF CEMENT TO ANCHOR THE FEMORAL HEAD PROSTHESIS
Authors: Charnley John
Published: February 2018

It has been shown by mechanical analysis that by using cement to bond the stem of a femoral head prosthesis to bone two advantages are obtained when the conditions are compared with conventional methods.

1. "Fretting" between the implant and the living bone is eliminated. This source of persistent relative movement is probably the most important starting point for the progressive loosening of weight-bearing implants.

2. When cement is used the bond with the bone is exposed to stresses which are of an order three hundred times less than the shear strength of bone. The conventional prostheses expose the bond to compressive stresses which are near to the failure limits of the compressive strength of bone, especially in elderly patients with atrophic cortical bone in the femoral neck.
THE BIO-ELECTRICALLY CONTROLLED PROSTHESIS
Authors: Popov B.
Published: February 2018

1. A bio-electrically controlled limb for forearm amputees is described.

2. The technique of its use and its advantages are listed.
A SYSTEM OF POWERED PROSTHESES FOR SEVERE BILATERAL UPPER LIMB DEFICIENCY
Authors: Simpson D. C. , Lamb D. W.
Published: February 2018

1. A description of the planning for the application of a powered prosthesis to a child with bilateral upper limb deficiency is given.

2. Details of twenty such children are recorded.
THE UNIVERSITY OF CAPE TOWN LEG
Authors: Allen C. E. Lewer
Published: February 2018

1. The University of Cape Town leg is described.

2. A brief discussion of the principles of a powered lower limb prosthesis is given.
FUTURE DEVELOPMENTS IN EXTERNALLY POWERED ORTHOTIC AND PROSTHETIC DEVICES
Authors: Nickel Vernon L. , Waring Worden
Published: February 2018

Future devices will be more reliable, although more versatile and complex. They will require less attention and maintenance, but more skill when maintenance or repair is necessary. They will require less training of the patient before he can use them successfully and will be more immediately responsive to his wishes, giving smooth, integrated movements, varying with the intensity and direction of his effort.
MULTIPLE OSTEOSARCOMATA
Authors: Davidson J. W. , Chacha P. B. , James W.
Published: February 2018

Although an osteosarcoma appears to be a solitary lesion clinically, as in this instance, only routine radiographic skeletal survey in such cases will detect multiple osseous involvement. Ross (1964) reported that in ninety-eight cases of osteosarcoma arising in apparently normal bone, fifteen showed metastases to other bones, a much higher incidence than previously recorded. It is also possible that multicentric osteosarcomata, although undoubtedly rare, may be discovered more often if a radiological survey is done. In many large series of osteosarcomata no mention of a skeletal survey has been made, and, while this is routine in some centres, it is not yet general practice.
THE DISTRIBUTION AND ANASTOMOSES OF ARTERIES SUPPLYING THE HEAD AND NECK OF THE FEMUR
Authors: Sevitt S. , Thompson R. G.
Published: February 2018

1. At necropsy the arterial distribution within the head and neck of the femur was investigated by arteriographic injection in fifty-seven uninjured hips of mostly elderly subjects.

2. Before injection all vessels to the head except for one or more particular groups were divided.

3. The superior retinacular arteries were found to be the most important arterial supply to the head. Through the widely distributed branches of their lateral epiphysial vessels (superior capital) they supplied the superior, medial, central and usually the lateral parts of the head: through anastomoses they could also supply the anterior and posterior segments, the subfovea and the inferior sector, which receive separate contributions. Sometimes the inferior or the lateral connections were defective.

4. The arteries in the ligamentum teres were either absent or unimportant for the head in most subjects. Either the vessels in the ligament never reached the head or they supplied only a limited subfoveal zone. In only one out of sixteen specimens was the whole head injected through the vessels of the ligamentum teres.

5. The inferior retinacular arteries were found to be of subsidiary importance and generally supplied a variable infero-lateral part of the head, particularly posteriorly. In a small number there was an anastomotic supply to other parts of the head, but only in two out of sixteen specimens was nearly all the head injected through these vessels.

6. The regular anastomotic supply from the superior retinacular arteries to the subfovea and to the inferior part of the head was in curious contrast to the infrequent anastomotic filling of the lateral epiphysial arteries from the inferior retinacular or ligamentum teres arteries.

7. Vessels within the femoral neck sometimes supplied the lateral part of the head but never the medial three-quarters.

8. The neck of the femur received important branches from the superior retinacular arteries but only in a small number (15 per cent) was part of it entirely dependent on this supply.
ACTINOMYCOSIS OF A METACARPAL BONE
Authors: Mendelsohn B. G.
Published: February 2018

1. A case of actinomycosis of the metacarpal bone of the right little finger from a punch injury is described.

2. The infection lasted five months and responded to prolonged courses of antibiotics and iodine preparations and drainage of recurrent abscesses.
A HISTOLOGICAL STUDY OF AVASCULAR NECROSIS OF THE FEMORAL HEAD AFTER TRANSCERVICAL FRACTURE
Authors: Catto Mary
Published: February 2018

1. Loss of osteocytes in the bone trabeculae of the femoral heads of "normal" elderly patients was patchy and distinguishable from that resulting from avascular necrosis after fracture.

2. Changes in the haemopoietic marrow were the earliest and most sensitive indicators of ischaemia, loss of osteocytes rarely being complete until three or four weeks after fracture.

3. In 109 femoral heads removed more than sixteen days after fracture the viability could be determined by histological means. All of these had suffered some damage to the vascular supply but in a number the head remained alive apart from the region of the fracture line. These heads were nourished by the blood vessels of the ligamentum teres and sometimes by retinacular arteries, usually of the inferior group.

4. Some femoral heads became completely necrotic following fracture, others were only partly affected. A variable amount of the subfoveal region commonly remained alive and it was from this site that revascularisation spread into the head. The upper segment of the femoral head least often remained alive and its subchondral region was usually the last to revascularise.

5. In a group of unselected femoral heads a third remained alive following fracture and two-thirds were partly or completely necrotic.

6. Femoral heads which were partly necrotic appeared capable of uniting and completely revascularising, there being invasion of the necrotic bone by vessels from across the fracture line and from the ligamentum teres. This contrasted with the completely necrotic femoral heads described elsewhere in this issue which united but in the absence of proliferation of ligamenturn teres vessels failed to revascularise completely and developed late segmental collapse.

7. Avascular necrosis did not appear to be the sole cause of non-union.

8. Necrotic bone showed no alteration in radiological density. Reossifying bone in areas of revascularisation sometimes caused an absolute increase of radiodensity especially when associated with halted revascularisation. This increase of radiological opacity was the result of deposition of new on dead bone with broadening of the trabeculae. Marrow calcification was minimal.

9. Obliterative sclerosis of venules in the ligamentum teres was found in "normal" patients even in infancy. No thrombosis was seen in the ligaments following fracture but where the femoral heads were completely necrotic and not revascularised the ligaments were often also necrotic.

10. There appeared to be no increase in degenerative changes in the articular cartilage of the femoral heads following fracture compared with fifty elderly controls. Some loss of chondrocytes in the deep zone of the weight-bearing area was found in about a quarter of the femoral heads. In only one head was the cartilage almost completely acellular. An almost normal depth and a smooth contour of the articular cartilage were retained.
TRAUMATIC ISCHAEMIA OF THE CALF
Authors: Monk C. J. E.
Published: February 2018

1. A patient with complete ischaemia of the muscles of the calf and anterior compartment of the leg is described.

2. In diagnosis, tenseness of the calf, equinus and pain on attempted dorsiflexion of the ankle are most important.

3. Peripheral pulses may be present and do not contra-indicate decompression by operation to prevent ischaemia.
OSTEOCHONDRITIS DISSECANS AND COXA PLANA
Authors: Stillman B. C.
Published: February 2018

Both osteochondritis dissecans and coxa plana are diseases with identical pathological changes, namely avascular necrosis. Although the etiology is not known in either case, it seems likely that when the etiological factors are fully determined they will prove to be applicable to either condition. The relative importance of each etiological factor in the multiple pathogenesis of these two conditions is almost certainly different in each disease process, and probably in each individual case. Present day concepts suggest that there is an underlying constitutional disturbance, which is associated with other factors (of which trauma is almost universally accepted as being one; perhaps the only one), to predispose the individual to these conditions.

It is hoped that further studies along these lines will not only help to provide a better understanding of the two conditions mentioned above, but will also be of value in the appreciation of the pathogenesis and etiology of a large number of disturbances including such varied conditions as dysplasia epiphysialis multiplex congenita, cretinoid dysgenesis of the capital femoral epiphysis, adolescent coxa vara, transient synovitis of the hip, and the recently discussed (Merle d'Aubigné 1964) idiopathic avascular necrosis of the femoral head in adults.

That there is an etiological relationship between osteochondritis dissecans and coxa plana seems clear, but much more work is required before we will have at hand the patho-physiological evidence that will permit an accurate correlation of these two conditions.
PHLEBOGRAPHY IN OSTEOARTHRITIS OF THE HIP
Authors: Phillips R. S.
Published: February 2018

1. Phlebography has been done on seven hips showing no radiological evidence of osteoarthritis. The findings largely confirm the work of previous authors.

2. Thirty-seven osteoarthritic hips have been examined in the same way. As the degenerative process worsens radiologically so the pattern of venous drainage deviates further from the so-called normal.

3. An attempt is made to explain the phlebographic findings in the light of known facts of the pathology of the disease.
CAUDA EQUINA AND SPINAL CORD COMPRESSION IN PAGET'S DISEASE
Authors: Klenerman L.
Published: February 2018

1. Three patients with backache and spinal cord or cauda equina compression due to Paget's disease of the vertebrae are reported; all three were relieved by laminectomy.

2. One case is of particular interest because it is only the second one reported where compression was due to a single affected vertebra.
SKIN ARTHROPLASTY AS A POSSIBLE MEANS OF MOBILISING A TUBERCULOUS HIP
Authors: Karlen A. G. , Gunn D. R.
Published: February 2018

1. In seventeen cases of tuberculosis of the hip in children with severe destruction of the joint arthroplasty was done using full thickness skin from the abdominal wall as the interposing material.

2. The results, after a follow-up on the average of three years, show that one-third of the cases are very satisfactory, one-third are fair and one-third show no movement.
PSEUDOMALIGNANT OSSEOUS TUMOUR OF SOFT TISSUE
Authors: Jeffreys T. E. , Stiles P. J.
Published: February 2018

1. A case of pseudomalignant osseous tumour of soft tissue is reported.

2. The relationship between this condition and myositis ossificans is discussed and the importance of differentiating it from osteosarcoma is stressed.
A CONTRIBUTION TO THE DIFFERENTIAL DIAGNOSIS OF HURLER'S DISEASE AND FORMS OF MORQUIO'S SYNDROME
Authors: Bitter T. , Muir Helen , Mittwoch Ursula , Scott J. D.
Published: February 2018

1. Mucopolysaccharides were analysed in the urine of thirteen patients with Morquio's syndrome aged between three and fifty-nine years and of fourteen controls of comparable ages.

2. There were no significant qualitative or quantitative differences between patients and controls.

3. The clinical and radiological findings suggested that these patients did not have the "Morquio-Ullrich" form of the disease, which appears on retrospective assessment of case reports to be more uniform and less diffuse than the Morquio-Brailsford form which may include a number of possibly unrelated diseases.

4. Keratosulphate has so far been demonstrated in the urine only of patients with the "Morquio-Ullrich" form of the disease, although the mucopolysaccharide excretion has been investigated in only a few patients with the Morquio-Brailsford form. The normal mucopolysaccharide excretion of the present series of patients suggests that a normal mucopolysaccharide excretion distinguishes the Morquio-Brailsford from the Morquio-Ullrich form, the latter having a number of features overlapping with Hurler's disease, where large amounts of mucopolysaccharide other than keratosulphate are excreted.

5. Both qualitative and quantitative analysis of urinary mucopolysaccharide are thus necessary to distinguish between Hurler's disease, the Morquio-Ullrich form and the Morquio-Brailsford's form of Morquio's syndrome.
THE TREATMENT OF CONGENITAL CLUB FOOT
Authors: Blockey N. J. , Smith M. G. H.
Published: February 2018

1. The results of treatment of 186 club feet have been reviewed.

2. Early strong repeated manipulation and splintage produced correction in all, but only sixty-five out of 186 remained acceptable at three years. The other 121 relapsed.

3. Relapse occurred in the first year in eight, between twelve and eighteen months in twenty-five, between eighteen and twenty-four months in twenty-three, and between twenty-four and thirty-six months in sixty-five.

4. Relapse was slightly commoner when treatment began after the first month of life.

5. Relapse was treated either by manipulation and plaster or by soft-tissue correction, leaving fifty-two out of 121 acceptable at three years and sixty-nine which were not acceptable (this includes those in plaster after soft-tissue correction, necessitated by relapse around the ages of two and a half and three and is thus adversely loaded).

6. The three year results in 186 feet were studied: 63 per cent were acceptable and 37 per cent were not. Five year results in eighty-seven feet were studied: 87·4 per cent were acceptable and 12·6 per cent were not.

7. Soft-tissue correction is described. It produced 89 per cent acceptable feet but 11 per cent relapses in 280 operations.
NON-TRAUMATIC PROGRESSIVE PARALYSIS OF THE POSTERIOR INTEROSSEOUS NERVE
Authors: Mulholland R. C.
Published: February 2018

1. A case of spontaneous posterior interosseous paresis is reported. It is suggested that the cause was replacement fibrosis secondary to local ischaemic damage from unremembered minor trauma.

2. In a patient with a posterior interosseous nerve paresis examination may reveal a space-occupying lesion near the elbow along the course of the nerve thus compressing it. Recovery may be expected after its removal. Consequently the nerve should be explored before resort to tendon transfers.
NON-UNION OF OBLIQUE DISPLACEMENT INTERTROCHANTERIC OSTEOTOMY FOR OSTEOARTHRITIS OF THE HIP
Authors: Scott P. J.
Published: February 2018

1. The rate of non-union of 100 intertrochanteric osteotomies of the McMurray type, with internal fixation, is reported. One in five was not united one year after operation. The criteria of union are discussed.

2. The patient's disability in twelve ununited osteotomies has been assessed, and related to the mobility of the osteotomy.

3. The factors which prejudice union have been analysed. The principal cause of non-union appeared to be the varus angulation strain on a varus osteotomy displaced medially more than half the diameter of the bone. Obliquity inwards and upwards of the osteotomy was a contributory factor. The types of internal fixation used, the use of external splintage and the period of protected weight bearing with crutches did not appear to be related to the rate of union.

4. It is concluded that marked inward displacement of the osteotomy, combined with either obliquity of the osteotomy or a varus position, prejudices union; that the use of this technique is unfounded in principle and not supported empirically; and that displacement should be eschewed to avoid this complication of intertrochanteric osteotomy in the treatment of osteoarthritis of the hip.
SYNOVIAL CHONDROMATOSIS
Authors: Jeffreys T. E.
Published: February 2018

1. Nineteen patients with articular synovial chondromatosis are reviewed.

2. The etiology, diagnosis and management of the condition are discussed.

3. It is concluded that extensive synovectomy is not justified; simple removal of loose bodies is the treatment of choice.
ARTHROPLASTY OF THE FOREFOOT
Authors: Kates Alexander , Kessel Lipmann , Kay April
Published: February 2018

1. The technique and results of arthroplasty of the metatarso-phalangeal joints for the grossly deformed forefoot are described.

2. The early results are very encouraging.

3. Attention is drawn to some of the complicating problems in rheumatoid arthritis, particularly the hazard of arteritis.
THE FEATURES OF FRACTURE HEALING IN CATS AFTER IMMEDIATE AND DELAYED OPEN REDUCTION
Authors: Emery M. A. , Murakami H.
Published: February 2018

1. Clinical studies in humans have indicated that a delay of one to three weeks in the open reduction of a fracture decreases the incidence of delayed union and non-union.

2. Studies in cats indicate that a delay of two weeks before open reduction causes a different repair mechanism from that following immediate operation.

3. Repair after delayed operation is characterised by increased periosteal new bone formation and more rapid endochondral bone formation. After immediate operation periosteal new bone is slow to develop; much more fibrous tissue and cartilage develop, followed by slow endochondral bone formation.
TREATMENT OF POTT'S PARAPLEGIA BY OPERATION
Authors: Goel M. K.
Published: February 2018

Early decompression in Pott's paraplegia gives encouraging results. It produces speedy recovery from paraplegia and ensures rapid healing of the lesion. Lateral extrapleural decompression without fusion for lesions of thoracic vertebrae is safe and satisfactory. It gives adequate exposure of the anterior and posterior parts of the vertebral bodies and of the theca, without endangering the stability of the spine. Age, sex and site of the lesion have no influence on the prognosis, whereas paraplegia of longer duration, paraplegia in flexion, and paraplegia presenting as a spinal cord tumour carry a bad prognosis. In early lesions there is reconstitution of vertebral bodies whereas in advanced lesions there is consolidation or bony fusion.
THE BOUTONNIèRE DEFORMITY
Authors: Souter W. A.
Published: February 2018

1. A series of 106 central slip injuries has been reviewed.

2. Although the boutonnière deformity in many cases may be no more than a cosmetic defect, this survey has shown that in some instances it can constitute a slowly progressive lesion, with considerable disability and gross deformity of a digit.

3. Conservative treatment seems to be superior to operation, at least in those patients seen within six weeks of injury. Treatment by splintage alone yielded in this series a 75 per cent success rate, whereas operation showed only 50 per cent success.

4. When a sizeable fragment of bone has been avulsed from the middle phalanx, suture of the fragment in position is indicated and gives remarkably satisfactory results.

5. Injuries with soft-tissue loss over the proximal interphalangeal joint may yield successful results after suture or plastic repair of the tendon, and wound closure by split-skin grafts or local rotation flaps.

6. Poor results tend to occur in cases complicated by phalangeal fracture or by multiple hand injuries, and it may be advisable to defer the repair of the central slip until recovery from the other injuries has been completed.

7. With gross disruption of the proximal interphalangeal joint primary arthrodesis is probably indicated.
PARALYTIC DEFORMITY IN THE LOWER LIMB
Authors: Sharrard W. J. W.
Published: February 2018

1. The nature of paralytic deformity arising in poliomyelitis, cerebral palsy and spina bifida is considered and three types of deformity–acute contracture, postural contracture and deformity from muscle imbalance are described.

2. The place of physiotherapy, splintage and surgery in the management of these varieties of paralytic deformity is discussed and the overall results of treatment are reviewed.
INCREASED EPIPHYSIAL DENSITY IN BONE SARCOMA
Authors: Wood H. L.-C.
Published: February 2018

1. Two cases are described in which increased density of the lower femoral epiphysis was due to sarcoma.

2. In one of these, multiple sarcomata were present.
MASSIVE OSTEOLYSIS OF THE HUMERUS TREATED BY RESECTION AND PROSTHETIC REPLACEMENT
Authors: Poirier H.
Published: February 2018

1. A case of massive osteolysis of the right humerus is described. Diseased bone was resected leaving only the lower part of the humerus. The resected bone was replaced by a titanium prosthesis.

2. The diagnosis, etiology, prognosis and treatment of the condition are briefly discussed.
THE ACTION OF THE ILIOPSOAS MUSCLE IN THE NEWBORN
Authors: McKibbin B.
Published: February 2018

1. Dissections of the newborn child revealed that the psoas muscle is a lateral rotator of the hip in all positions but that this secondary action is much stronger when the limb is abducted.

2. It has also been shown that the iliacus portion of the muscle can contribute towards the completion of abduction movement.

3. An attempt has been made to reconcile these facts with the accepted concept of the action of the muscle in the adult.

4. The clinical significance is discussed.
CONGENITAL LATERAL DISLOCATION OF THE PATELLA
Authors: Green J. P. , Waugh W.
Published: February 2018

1. Four cases of congenital lateral dislocation of the patella are described.

2. The significance of the associated flexion contracture is emphasised.

3. Early diagnosis and operative realignment of the extensor mechanism is considered to be important because it should avoid the secondary growth changes which can produce serious disability.
THE EFFECT OF EXPERIMENTAL EPIPHYSIODESIS ON GROWTH IN LENGTH OF THE RABBIT'S TIBIA
Authors: Hall-Craggs E. C. B.
Published: February 2018

1. Experimental epiphysiodesis was performed on either the upper or lower epiphysial cartilage of one tibia of young rabbits, the other tibia serving as a control.

2. Subsequent growth was observed at each epiphysis by radiography.

3. After both operations the normal deceleration of growth rate of the uninjured epiphysis on the experimental side was reduced and this epiphysis made a greater contribution than its control to the final length of the bone.

4. Serial sections of the injured epiphysis revealed that the arrest of growth was due to the formation of a narrow bony bridge between the epiphysial and metaphysial bone.

5. The additional growth of the uninjured epiphysis appeared to have a direct relationship to the deficiency of growth at the epiphysis that had been injured by operation.

6. The results may indicate the existence of a local system of growth control.
EFFECT OF ENVIRONMENTAL FACTORS ON THE REPAIR OF BONE IN VITRO
Authors: Prasad G. C. , Reynolds J. J.
Published: February 2018

1. The use of a protein-free synthetic medium has provided a new technical approach to the study of fracture healing in vitro.

2. The tibiae of fourteen-day embryonic chicks were cut in half in the middle of the shaft, the fragments were placed in apposition and the explants grown in vitro for up to sixteen days. The process of bone repair was studied by means of histology and biochemical estimations.

3. The rate of growth in length of fractured bones was greater in an atmosphere containing 50 per cent of oxygen than in one with 20 per cent oxygen, thus emphasising the importance of an adequate oxygen supply for the regeneration of osteogenic cells.

4. The effect of varying the concentration of glucose in the medium was investigated. Two milligrams of glucose per millilitre was the most favourable for healing; higher levels caused fibroblastic changes in the cartilage cells and inhibited the proliferation of osteogenic cells at the fracture site.

5. Histological examination showed that many of the phenomena that occur in the repair of fractures in vivo can be reproduced in vitro in synthetic medium. Similar results were obtained whether the fracture was made in whole bones or in isolated shafts from which the cartilaginous ends had been removed; the latter are more favourable for biochemical study.
THE MANAGEMENT OF DEFORMITY AND PARALYSIS OF THE FOOT IN MYELOMENINGOCELE
Authors: Sharrard W. J. W. , Grosfield I.
Published: February 2018

1. Deformities of the foot in children with myelomeningocele are described and classified. The results of a policy of operative correction of deformity in 148 patients all of whom had had at least one operation on the foot between 1947 and 1965 are described.

2. In 241 feet in which there were deformities 433 operations were performed, including tenotomies, soft-tissue divisions, tendon transfers and bony procedures. At the time of review successful correction of deformity had been obtained in 81 per cent with a plantigrade foot that could bear weight safely, and with a distribution of muscle activity that required minimal external support and presented the least liability to recurrent deformity.

3. The management of individual deformities is described and the causes of failure are analysed and discussed.
INTRA-ARTICULAR DISLOCATION OF THE PATELLA
Authors: Feneley R. C. L.
Published: February 2018

A case of intra-articular dislocation of the patella is reported. Its special interest lies in the apparent simplicity of both injury and reduction.
FRACTURE HEALING IN COMPRESSION OSTEOSYNTHESIS IN THE DOG
Authors: Olerud Sven , Danckwardt-Lillieström Göran
Published: February 2018

1. The healing of the radius and tibia in dogs after compression plating of osteotomies made by a Gigli saw was studied.

2. The methods used were indian ink microangiography and terramycin labelling. The Spalteholz technique and azane colouring were used.

3. Revascularisaton of the fracture region took place both from newly formed vessels in the Haversian systems and from periosteal and endosteal vessels.

4. The fracture gap was filled at an early stage by a vascular network. Under stable conditions direct angiogenic bone formation took place around this network.

5. Rebuilding of the cortical bone in the fracture region occurred by osteoclastic activity. Groups of osteoclasts made cavities in the necrotic bone and were immediately followed by loops of vessels; behind and around the loop new bone was formed. Another form of bone absorption consisted of bundles of vessels which eroded necrotic cortical bone without new bone formation.

6. The new bone was initially oriented along the fracture gap but, by conversion into secondary osteones, it became progressively oriented longitudinally in the direction of the original bone.

7. Under stable conditions some periosteal and endosteal callus formation occurred though it was of slight importance. It regressed very soon and was seldom seen in the radiographs.
THE SIGNIFICANCE OF THE FINE STRUCTURE OF ARTICULAR CARTILAGE
Authors: Bullough Peter , Goodfellow John
Published: February 2018

The collagen framework of articular cartilage is disposed, as in other connective tissues, to resist tension forces within the material. In this paper the fine structure of articular cartilage, as demonstrated by polarised light microscopy and electron microscopy, is related to the gross anatomy and to the naked eye changes of chondromalacia and fibrillation.
ANTERIOR CERVICAL DISCECTOMY AND FUSION
Authors: Simmons Edward H. , Bhalla S. K. , Butt W. P.
Published: February 2018

1. A series of 154 patients who underwent anterior cervical discectomy and fusion has been studied. A detailed analysis of the first eighty-four patients who have been observed for periods of from one to eight and a half years is described. In sixty-eight patients the fusion was done with a keystone type of graft, in seventeen by a dowel (Cloward) graft.

2. Despite a preponderance of multiple level fusions in the keystone series, clinically better results (80·8 per cent excellent or good) were found in this group than in the dowel group (64·8 per cent excellent or good).

3. A biomechanical study has indicated the keystone graft to be more stable than a dowel graft under flexion and extension strains as well as lateral bending strain. The graft is more stable the closer it is to the line of "zero velocity."

4. The three cases of non-union all occurred in the dowel group. The high incidence of fusion with the keystone technique is considered to be related to the type of graft, its method of seating, its depth of penetration, its larger surface area and the fact that raw cancellous bone of the adjacent vertebral bodies is in contact with the graft above and below.
DISLOCATION AND DEFORMITY OF THE HIP IN CHILDREN WITH SPINA BIFIDA CYSTICA
Authors: Menelaus M. B.
Published: February 2018

1. Paralytic dislocation of the hip in spina bifida generally requires reduction and iliopsoas transfer. The muscle transfer ensures that the hip remains reduced, lessens the need for calipers and prevents progressive flexion deformity. In addition, varus and rotation osteotomy of the femur and innominate osteotomy are sometimes required. Varus and rotation osteotomy alone is indicated if the psoas is not strong enough for transfer. The age for reduction of dislocated hips and muscle transfer has been reduced to eight months as experience and confidence has been gained.

2. Flexion deformity is best prevented by early iliopsoas transfer. An anterior release operation is occasionally indicated when there is flexion deformity and a weak psoas muscle. This procedure, alone or supplemented by extension osteotomy, may be necessary to correct severe flexion deformity in children seen late.

3. Lateral rotation deformity of the hip may be caused by unbalanced iliopsoas action or the unbalanced action, or contracture, of the short lateral rotator muscles. If the deformity is sufficient to make the gait bizarre, or if it is difficult to fit a caliper, then soft-tissue operations as described are of value.

4. Abduction deformity can be corrected by division of the unopposed or contracted abductors.
PYCNODYSOSTOSIS
Authors: Emami-Ahari Z. , Zarabi M. , Javid B.
Published: February 2018

1. A patient is described, the thirty-fourth reported, who shows all the skeletal changes of pycnodysostosis with the exception of the oral findings.

2. It is suggested that the pseudarthroses of the tibiae in our patient cannot be taken as evidence against normal union because of the possibility of inadequate management of the fractures.

3. We consider that the use of strong intramedullary nails in the treatment of long bone fractures in these cases is advisable.